Meds IV = Advanced Specialty Pharmacy = MedWorksRx = PalliRx

If you need to get caught up on the latest news and developments concerning Meds IV, please read the news article here, and our entries here here here here and here. 9 people have died in Alabama following an nutrition IV solution that was made by compounding pharmacy Meds IV.

Update 1: It's been confirmed that Meds IV doesn't just happen to have the same ownership as Advanced Specialty Pharmacy. Meds IV is actually Advanced Specialty Pharmacy dba Meds IV.


They're one in the same, the only difference is marketing and being able to not have the 9 deaths effect Advanced Specialty Pharmacy's reputation. But it absolutely should.

We're seeing an effort by those behind Meds IV to remove as much information about themselves as they can. And we think the reason they're doing this is because they go by several other names and they don't want people to associate the bad press with other names they're going by. They don't want people to make the connection. But we're going put as much as we can here so it doesn't matter what information they try to remove. This post will be updated as we receive more information.

The bottom line is this:

Meds IV is run by the same people as Advanced Specialty Pharmacy, the same as MedWorksRx, which is the same as PalliRx. Meds IV was only created a year ago. How convenient would it be for them to just close up Meds IV after this incident and continue on without anyone knowing they're still around through their other companies.

Let's start with Advanced Specialty Pharmacy. Advanced Specialty Pharmacy is owned by both William Rogers and Tim Rogers. That can be illustrated here where Tim Rogers is listed as the co-founder and here where William Rogers is listed as the owner, and Tim as manager. Also, Anthony Cingoranelli is a principle owner in Advanced Specialty Pharmacy. On their website, they've recently removed their Birmingham location and now only their FL location is displayed. That location is 102 Oxmoor Rd. Birmingham, AL, which brings us to our next company: PalliRx.

PalliRx was listed on Tim Roger's LinkedIn page as a company he's partnered with. Where's PalliRx located? 102 Oxmoor Rd. Same as Advanced Specialty Pharmacy.



Finally there's MedWorksRx. MedWorksRx is also listed as a partner on Tim Roger's LinkedIn page, and is owned by Edward Anthony Cingoranelli. Here we come full circle as Cingoranelli is the owner of Meds IV, and Tim Rogers is the president.

From al.com:

The hospital system says in its suit that it had attempted to contact the Meds IV to ask it to preserve the evidence, but had not gotten a response. Cingroranelli is identified in the suit as the owner of the company, while Rogers is identified as its president.

We're already seeing efforts to take down all links to Meds IV and wash away the blood from their hands. No doubt they've invested a lot into Advanced Specialty Pharmacy and wouldn't want the deaths from Meds IV to tarnish whatever good name they had before. MedWorksRx and PalliRx are fairly new "entities" and we hope as people begin to make the connection will steer clear of everything relating to Rogers and Cingroranelli. We haven't fully looked into Cingroranelli yet but Rogers's background is mostly wholesale - which means just selling products you bought from someone else with no value added (not actually making anything). It's easy to think you're an expert at pharmaceuticals when you're wheeling and dealing them but compounding and manufacturing are a different story and we get the feeling the people running this operation are completely unqualified.

If you have any information on these companies or Rogers and Cingroranelli, please send us an e-mail at peoplelikingpeople@yahoo.com.

Alabama Deaths: Judge Orders Meds IV To Preserve Evidence

Shelby County Circuit Judge Conwill has just ordered Meds IV to preserve any evidence related to the nutrition IVs linked to the 9 deaths in Alabama. The order came after Baptist Health Systems filed a lawsuit earlier today.

From al.com:

Conwill issued a temporary restraining order that requires parties involved with the company to preserve the evidence after Baptist Health System and Shelby Baptist Medical Center filed a lawsuit Wednesday evening in Shelby Circuit Court.

The hospital system says in its suit that it had attempted to contact the Meds IV to ask it to preserve the evidence, but had not gotten a response. Cingroranelli is identified in the suit as the owner of the company, while Rogers is identified as its president.

Interesting. Kudos to Baptist Health systems for filing this suit. It appears that Meds IV are hiding under their desks. Someone needs to step in and take action on-sight to make sure no evidence is destroyed immediately. Also, we see now that Tim Rogers is the president, and a man named Edward Cingoranelli is the owner. Cingoranelli...we've heard that name before. Ah yes, MedworksRx, the company Tim Rogers listed in his LinkedIn profile as being a partner, is owned by Anthony Cingoranelli. It's starting to look like Meds IV, MedworksRx, and possibly PalliRx are run by all the same people. And then there's the connection to Advanced Specialty Pharmacy, where Tim Rogers is a co-founder with William Rodgers.

Update 1:

Ok, Anthony Cingoranelli and Edward Cingoranelli are the same person. His full name is Edward Anthony Cingoranelli. Mr Cingoranelli is also listed as a principle for Advanced Specialty Pharmacy.

Who is Tim Rogers of Meds IV?

We're going to start looking further into Tim Rogers, the man behind Meds IV, the compounding pharmacy that produced the nutrition IVs that resulted in 9 deaths in Alabama. There isn't much to be found on Meds IV at this point. They were hardly referenced at all online before the incident, there was no address listed on the website (which has since been taken down), and a search for the phone number on their site turned up nothing. We're taking this to mean it's either a fairly new company or they purposefully stayed under the radar. Update: We now learn that Meds IV has only been operating for 1 year. So to look into this more we'll be looking into the President of Meds IV Tim Rogers. As we find out more, we will continue to update this page. If there's not much here at the moment it's because it's still a work in process, stay tuned.

Tim Rogers is listed on the Alabama Society of Health-System Pharmacists board of directors site as the immediate past president of the organization.

What I find it interesting that he's the only one listed on the entire page that isn't a pharmacist or doctor. Go down the line and you see Pharm.D and Ph.D. With Tim Rogers there is no such title and simply mentions "Advanced Specialty Pharmacy, Inc."

Tim Rogers has just taken his LinkedIn profile down. We viewed it earlier today but when we try to go back now it says "We’re sorry, but the profile you requested does not exist." Fortunately we were able to save a copy.



A copy of his profile is below. I want to point out that while this may look like a big resume and list of accomplishments, many are very recent and look like projects he had been trying to start as opposed to established companies. And he's listed companies he is partnered with, not necessarily ones he owns or works for. Meds IV has only been operating for 1 year, MedworksRx (owned by Anthony Cingoranelli, dispensing at Drs. offices) he's been a partner with only 1 year, and PalliRx (a repackager, owned by Micah J Russell) a partner only 2 years. These 3 companies may have been leveraged to work together, for example PalliRx could become a distribution channel for Meds IV. The bulk of his work history is Advanced Specialty Pharmacy where he is an officer (owned by William Rogers), and Cardinal Health, one of the big 3 medical wholesalers.

Tim Rogers's Summary

Starting and operating nuclear pharmacies.
Starting and managing specialty IV compounding pharmacies.
Cardioplegia solutions.
TPN Solutions
Intrathecal Pumps Medications
Pharmaceutical Repackaging

Tim Rogers's Experience

President

Meds IV, Inc

Pharmaceuticals industry

2010 – Present (1 year)

Meds IV, Inc is a pharmaceutical company focused in delivering complex compounded sterile products to hospitals and physician offices including intrathecal pump medication refills and schedule II epidural and PCA products.
TPN/Cardiopelgia/Anesthesia Syringes/Oxytocin

Partner

MedWorksRx

Pharmaceuticals industry

2010 – Present (1 year)

MedWorksRx develops and manages retail pharmacy operations.

Partner

PalliRx, Inc

Privately Held; Pharmaceuticals industry

January 2009 – Present (2 years 3 months)

Pharmaeutical Repackager

Officer

Advanced Specialty Pharmacy

Pharmaceuticals industry

2005 – Present (6 years)

Nuclear Pharmacy Services

Immed-Past-President

Alabama Society of Health Systems Pharmacists

Pharmaceuticals industry

October 2009 – October 2010 (1 year 1 month)

President of the Alabama affiliate of ASHP

RVP

Cardinal Health

Pharmaceuticals industry

1999 – 2004 (5 years)

Lead the South East Region of Nuclear Pharmacy Services division of Cardinal Health.

Tim Rogers's Education

Samford University

BS Pharmacy, Pharmacy

1987 – 1990

Tim Rogers's Additional Information

Groups and Associations:

ASHP, AlSHP, Birmingham Emmaus Community

Honors and Awards:

2007 Birmingham Top 40 under 40

Update 1: We've found a lawsuit back in 2006 that was eventually dismissed. Cardinal Health had been suing Advanced Specialty Pharmacy.

From ereleases.com:

Advanced Specialty Pharmacy, LLC (ASP) today announced that litigation initiated by Cardinal Health 414, Inc. ("Cardinal") against ASP and related parties has been amicably resolved.

The original lawsuit (Case No. 2006-CV-2305) was filed on April 28, 2006, in the United States District Court, Eastern District of Louisiana.

Advanced Specialty’s counter-claim filed in this litigation against Cardinal that asserted violations of various federal and state antitrust laws will also be dismissed as part of the settlement.

Although the terms of settlement are to remain confidential between the parties, Advanced Specialty Pharmacy will continue to serve its nuclear pharmacy customers in all of its existing markets. "ASP envisions rapid future growth in these markets based on our business model of very competitive pricing and a responsiveness to customer needs that large national companies cannot match," stated Tim Rogers, a co-founder of ASP.

We will be looking into the initial claim by Cardinal against Advanced Specialty Pharmacy but take a look at the timing of it: This dismissal is from October 2006, the initial claim probably some time in 2005. Tim Rogers worked at Cardinal until 2004 and co-founded Advanced Specialty Pharmacy in 2005. We're thinking the litigation may have been regarding Tim Rogers violating a non-compete clause he had with Cardinal, especially since his counter suit asserted that Cardinal violated antitrust laws.

Compounding Pharmacy "Meds IV" Connected to 9 Deaths

Nine people have died in Atlanta, GA following an IV treatment. And the 9 deaths (19 outbreaks total) spanned across 6 different hospitals, so it isn't an issue with a particular hospital having a contamination or problem not following procedure. The common denominator? They all received a Nutrition IV from "Meds IV", a compounding pharmacy. It was found that the deaths were caused by a bacteria called Serratia marcescens.

from gbp.org:

The Alabama Department of Public Health said it first learned of the problem on March 16, when two hospitals in the state notified officials of patients with bloodstream infections.

The cases of bacteremia were caused by Serratia marcescens, a germ that produces bright bright red colonies. The bacterium was identified and named in Italy in the early 1800s, after it was found to be turning polenta blood-red.

This event will no doubt raise questions about quality control at compounding pharmacies. Unlike most pharmacies, compounding pharmacies make most of the solutions they dispense themselves. This provides a value for patients that require custom made ointments, oral solutions, and IVs. But it does make it more difficult to ensure the dosage and quality. Instead of mass producing thousands of the same pill on a daily basis as a pharmaceutical manufacturer might do which could be more easily monitored and controlled, compounding pharmacies produce their medications only when a particular patient has a need for it. They're made to order. So one minute a pharmacist is making an oral solution, the next minute the same pharmacist could be producing a completely different inhalant powder.

We tried visiting the website of "Meds IV" but it appears they've recently taken the site down in light of the allegations. We were able to view a cached version before it was removed (click on image to view full size):





Their most important asset is their reputation...well, I guess that's all gone to shit. If customer satisfaction is guaranteed, what does that mean if they kill you? Do they bring you back to life?

We're trying to find more information about Meds IV, they don't appear to be that well known with much of a presence. They don't even list an address on their website and a search for their phone number 205-837-0899 turns up nothing.

Update:

We have found the president of Meds IV, Tim Rogers.



click on image to view full size.

There is next to nothing to be found about Meds IV, besides the latest articles. We're guessing this was a very small operation that was fairly new with not a lot of customers. Perhaps he offered the hospitals a steep discount to get his foot in the door. It could be that there are some legal issues with compounding pharmacies selling to hospitals. It is standard practice for a compounding pharmacy to make medications for a particular patient. But when they start producing it in bulk to resell to hospitals and aren't seeing any patients at all, that could be a problem. Instead of being a pharmacy they're getting into manufacturer territory and need to be treated and regulated as such.

Update 2: Was the Parenteral Nutrition I.V. a hard to find item (HTF)?

If you look at the list of products that were displayed on Meds IV's website, you may or may not notice that many of them are items that are in short supply. Heparin and Promethazine for example have had supply issues for quite some time now. It appears that indeed there were supply issues with the parenteral nutrition I.V., from nutritioncare.org:

Parenteral Nutrition Product Shortages

There is a growing and critical shortage of electrolyte and mineral injections needed for parenteral nutrition. We have heard from many consumer groups, healthcare systems, and clinicians regarding their short supplies or inability to obtain these products. The seriousness of this shortage has the potential to be similar to that of intravenous (IV) multivitamins, which resulted in significant complications and some deaths.

Compounding & The Hard-To-Find Market

People Liking People actually have a little experience in the little known hard to find market of hospital pharmaceuticals/I.V.s. Different medications go in short supply all the time. There's only so much supply to go around, and sometimes there's not enough to meet the demand, whether it's a raw material shortage, a legal issue, or manufacturing problem. Well some medications are absolutely vital and when you have a patient dying on a hospital bed, the hospital will try to do whatever they can to find the medication that they need. And they're also willing to pay a lot more for that medication. This sets the stage for the hard to find market.

The hard to find market consists of many distributors that make their money off these shortage problems. They get wind that a product is going to go short, so they stock up as many as they can at the low price from a variety of suppliers and manufacturers. They may either flip them to another distributor for a quick profit, or wait for the market price to quadruple and sell them to hospitals for much higher. It doesn't always go as planned, so there's a lot of guessing and risk/reward calculating going on.

Well for some medications there simply isn't any product left, even the hard to find distributors don't have any. Hospital pharmacists are calling all the suppliers they can think of and no one is able to get their hands on it. This sets the stage for the compounding pharmacy to enter the hard to find market. When the hospitals have run out, their primary wholesaler has run out, the manufacturer isn't able to produce much more, and the hard to find distributors can't get their hands on any, the compounding pharmacist is the only other option in creating availability, and they then take advantage of this situation and sell their compounded product at ridiculously high profit margins. Something that might cost $4 to make could be sold for $1,000.

It appears to us now that this isn't just your average compounding pharmacy that's just helping out and serving hospitals from time to time. It may be that their whole business revolves around these shortages. Not that that's necessarily an evil business model, but like I said before when you start compounding on a massive scale you go from compounder to manufacturer. And I'm willing to bet that Tim Rogers and whoever else ran Meds IV just wasn't up to the task. Every week they're probably making something new that the week before hadn't even heard of. It's short? Ok let's make it. They don't specialize in a group of particular meds, they switch between what's selling and what's not at the blink of an eye. So if that's truly the model it's no wonder that their quality control wasn't exactly up to par.

Person of the Day: Jeff Stone

Meet Jeff Stone, the County Supervisor of Riverside County in California. Many of you are probably wondering why we should care about him and how is he so likable that he gets his own Person of the Day. Well Jeff Stone isn't just your ordinary county supervisor. He goes above and beyond his call of duty and the way he serves his county is unparalleled. He's one of those admirable people where the more you know about him, the more you feel like he's the older brother you never had. How did this man rise to a position of such great power? He learned from experiences along the way and kept himself humble by the people he surrounded himself with. He's known as County Supervisor today, but what a lot of people don't know is he had a very successful pharmacy career that would become the building blocks to where he is today. Sit back and relax, and just take in a wonderful story about a man living the American Dream.

Jeff Stone grew up in the diverse city of Anaheim where he was introduced to many different cultures and all walks of life. Even as just a wee toddler, he was developing an appreciation for people that would serve as a backbone for the ethics and integrity he has today which act as a moral compass to the very difficult decisions he has to make on a daily basis. He lived a very modest upbringing. He saw that the way to success was an honest living and that was only achieved by hard work.

Jeff's early adulthood would be very rewarding but come with enormous challenges. In 1983 Jeff saw an opportunity. There were thousands of people living in the city of Temecula, yet when people there needed to get their medications they had to drive out for miles to the nearest pharmacy. Jeff opened up his own pharmacy which he named "Temecula Pharmacy" and made a killing in profits. For a while everything was going just fine for Jeff. There were some bumps along the way, which became excellent learning opportunities. Jeff was and still is a student of life and always takes the time to look at every situation as a tool to better himself. The California state Board of Pharmacy were major crybabies and were always looking for every little violation that Jeff Stone did. At one point there 20 accusations lodged against him by the Board of Pharmacy. Fortunately he was able to get 16 of them dismissed by using good persuasion tactics, and most people don't even know about the 4 that actually stuck. Long story short, he admitted to committing four improper business practices. They were probably for very silly things to begin with like not giving patients the right medication. You know how those Pharmacy Boards can be. But Jeff took the challenges head on without fear, because he understands that life is full of challenges and if you don't meet them head on you'll get run over. That's definitely up there with our top 10 admirable traits.

One day a woman named Sharon Di Meglio went to Jeff Stone's pharmacy to get her prescription for 7.5mcg of Liothyronine filled. What happened next created a stir that would be Jeff's second real test as a pharmacist, and most importantly, a human being. Instead of Ms. Di Meglio getting 7.5mcg of her medication from Jeff's pharmacy, what she received instead was a lethal dose that gave her permanent brain damage. When you're in business as a pharmacist, you obviously can't always spend all your time checking the dosages because checking to see how you're money is doing in the stock market takes up a lot of your time. Besides, that's what pharmacy techs are for. Jeff definitely knew the importance of delegating tasks.

So here you have a man of great integrity and character, and he's having the challenge of his life to deal with this potential PR disaster the best he can. What he did next was very genius, and anyone in a tough public relations situation can learn from this: he used to run and hide approach. The media was calling his phone off the hook, both to his personal phone and to his pharmacy. Did he take the bait and answer the calls? Did he confess to giving the patient a lethal dose? Of course not; he'd be an idiot to do that. A lot of money is at stake here - remember he was the owner of the pharmacy and any hit that pharmacy takes is a direct hit to his own pocketbook. At a time of crisis, Jeff did exactly what he needed to do, and he did it with the calmness of a patient sedated with Demerol.

Fast forward to today. Our pharmacy boy is all grown up now and is the Riverside County Supervisor. You're probably starting to understand a little about why this great man is worthy of his own day. We'll leave you with this for now and will get to more of his triumphs and tribulations in the coming days. There's definitely a lot to admire in this great man, and we can learn a lot from his character and determination.