Samples of drug batches are checked regularly by a third-party laboratory that looks for bacterial contamination. The pharmacy also uses a bacteria detection process that mixes a substance into drug batches that attracts bacteria. If bacteria infiltrated the drug they will grow quickly and be readily detectable.
Wilson said he believes it is harder to maintain quality assurance at bigger facilities.
"As long as humans are involved you're going to have potential problems," he said. "Hopefully, the system catches those problems before they get out to the patients. A problem occurred and somebody didn't catch it."
Lynn Shumake, the owner of Blue Mountain Apothecary in Columbia, said he believes the compounding industry is well regulated. He said something just went wrong with the New England Compounding case and people are waiting to find out what.
"I think the early respondents will rush out to say pharmacies are not regulated," Shumake said. "We are highly regulated. We are just not regulated by the FDA. I think there is good strong oversight."
The Institute for Safe Medication Practices blames other outbreaks in recent years on the lack of oversight of these facilities.
In 2011, nine people died in Alabama after a bacterial outbreak caused by contamination of a daily nutrition supplement given to hospital patients who can't eat normal food. Earlier this year, Franck's Pharmacy, a compounding facility in Florida, closed after 33 people in seven states contracted a rare fungal eye disease from a contaminated injectable dye used by ophthalmologists during eye surgeries.
Federal officials continue to investigate the New England Compounding case. They expect new cases in coming weeks, but aren't sure of the ultimate impact.
"It will be interesting to see what happens in the next half year or so with this case," said Bentley, the Boston lawyer. "It is unfortunate this kind of tragedy had to occur."
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