Follow-up review. Drugs and Narcotics Agency

FOLLOW-UP REVIEW
Drugs and Narcotics Agency
November 2003

Russell W. Hinton, State Auditor

Performance Audit Operations Division Department of Audits and Accounts

254 Washington St, S.W. Atlanta, GA 30334

This is a Follow-up Review of the Georgia Drugs and Narcotics Agency. The Department of Audits and Accounts released a Performance Audit on the Agency in September 2000. This Review was conducted to determine the extent to which the Agency has addressed the recommendations presented in the Audit. A copy of the original Audit can be obtained through the contact information on the back of this Review.
Background Information
The Georgia Drugs and Narcotics Agency exists to protect the health, safety, and welfare of the general public by providing an enforcement presence to oversee all laws and regulations pertaining to dangerous drugs and controlled substances. The Agency inspects pharmacies to determine if they are complying with the laws and rules of the State Pharmacy Board; and to identify drug diversion (resulting from theft, forgery or improper prescribing/dispensing). The Agency also investigates complaints regarding pharmacies or pharmacists.

As of March 2003, there were 2,146 retail pharmacies and 941 other prescription drug facilities (such as manufacturers, wholesalers, pharmacies in prisons, etc.). These facilities have to register with, or be licensed by the Pharmacy Board, and can be inspected by the Agency. The Agency has divided the state into 13 territories, with one agent assigned to and responsible for the inspections within each territory. In fiscal year 2003, the Agency expended $1.36 million, of which $1.35 million were state funds.
Synopsis of the Audit Recommendations
The purpose of the Audit was to determine if the Agency was fulfilling its purpose of protecting the health, safety, and welfare of the general public through its inspection and enforcement activities. The audit focused on the Agency's pharmacy inspection activities and drug diversion functions through reviews of Agency records and interviews with Agency personnel and drug enforcement personnel in other states. We found several areas in which action needed to be taken to improve the program's effectiveness and efficiency, including setting more specific goals, monitoring agents' work, updating the procedures manual, obtaining necessary equipment, and inspecting facilities following the Pharmacy Board's laws and rules. The audit also suggested that consideration be given to implementing a drug monitoring program.

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Status of the Audit Recommendations
Recommendation in 2000: The Agency has agreed that more specific goals and objectives should be set to evaluate its overall effectiveness.
Current Status: As reported in 2000, the Agency's Results-Based Budgeting (RBB) goal was for law enforcement authorities, health care professionals, as well as the general public [to] have access to technical expertise and other resources related to dangerous drugs and controlled substances. This goal, however, could not be used to measure the Agency's effectiveness in fulfilling its purpose of preventing drug diversion and ensuring that pharmacies operate in compliance with the laws and rules of the Pharmacy Board. In addition, no data had been collected to evaluate the Agency's effectiveness in achieving the objective (desired result) associated with the goal: that 90% of the law enforcement agencies that use its services rate them as being satisfactory.
The Agency continues to have the same goal and desired result, and therefore, continues to be unable to evaluate its effectiveness in preventing drug diversion and ensuring pharmacies operate in compliance with the laws and rules of the Pharmacy Board. It should be noted that in March 2003, the Agency began sending evaluation forms to law enforcement agencies that the Agency had worked with on investigations to gather data for the only desired result, and as of September had received 31 surveys, all of which rated their technical assistance as satisfactory. Agency staff noted plans to establish a goal of being more accessible; additionally, staff noted that the Agency's effectiveness is measured by its accomplishments each year.
In its response to the Follow-Up, the Agency noted plans to continue sending out random surveys to gauge satisfaction with services, but noted that they rely primarily on the law enforcement agencies to contact them directly if there are problems with the services provided. In addition, the Agency noted that its goal is to educate and investigate drug diversion, and the presence of the Agency is a deterrent to many would-be diverters; however, if someone wants to divert drugs, no one agency is going to be able to prevent them from doing so.
Recommendation in 2000: The Agency should improve its procedures for monitoring its agents' work activities.
Current Status: Agency personnel have indicated that management performs a more detailed review of inspection reports and verifies the inspection data with the pharmacists; however, this review is not documented. Additionally, while staff report that the amount of time spent on inspections and the number of pharmacies inspected is reported, no documentation was provided to indicate this information is reviewed or activities are monitored.
In its response, the Agency stated that there is not enough manpower or time to monitor the agents in the manner suggested. The response noted that the Director and Deputy Director review every inspection report and they believe this to be sufficient.
Recommendation in 2000: As a result of this audit, the Agency has agreed to make updating its procedures manual a priority and require its agents to do a better job of documenting deficiencies identified during their inspections.
Current Status: The Agency has completed an update of the procedures manual. The manual is distributed to all agents, who are informed of policy changes through memos that eventually

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become part of the official manual. The updated manual provides direction to agents on how to document deficiencies. Of 43 inspection reports reviewed, 31 (72%) contained sufficient information to determine the type and degree of deficiency; however, 12 (28%) did not contain enough information to determine if deficiencies were found.
The Agency noted that agents have been advised to indicate as much information as possible when violations or deficiencies are identified.
Recommendation in 2000: The Agency has agreed to continue its efforts to obtain the necessary equipment to improve its overall efficiency and to improve its record-keeping procedures.
Current Status: The Agency reported that it obtained 10 surplus computers; however, the computers were not loaded with software and, due to budget constraints, they have not purchased software therefore rendering the computers useless. A review of budget requests indicated that the Agency requested laptops in fiscal years 2003 and 2004. However, budget constraints have been cited as the reason the request has not been approved. In addition, as was the case during the original audit, only the facility name and the date of the last inspection are recorded in the computer; therefore, detailed inspection and violation data must be located in the hardcopy files.
Agency staff also noted that agency information and an e-mail address are now available on the State's web page, thereby making them more accessible to the public. The director's computer is equipped with Internet access and he receives any e-mail sent through the portal.
Recommendation in 2000: Action is going to be taken by the Agency to clarify its responsibilities for inspecting the different types of facilities subject to the Pharmacy Board's laws and rules.
Current Status: While the Agency has updated its procedures manual to reflect the Pharmacy Board's rules dealing with the frequency of inspections, it is not inspecting facilities with the frequency required by the Pharmacy Board, and cites lack of personnel as the reason. One inspection position is currently vacant and another inspection position has been eliminated.
The report noted that, while the Agency is responsible for inspecting physicians who dispense drugs, it did not have an up-to-date listing of these physicians. In June, 2002, the Agency submitted a written request to the Medical Board for a list of dispensing practitioners; the Medical Board recently provided the list, via the State Board of Pharmacy.
In its response, the Agency noted plans to begin inspecting dispensing physicians in the near future.
Legislative Recommendation in 2000: Consideration should be given to implementing a drug monitoring program as recommended by the Drug Enforcement Administration.
Current Status: To date, legislation providing statutory authority for such a program has not been proposed. Agency personnel have indicated that a Pharmacy Board task force will present proposals for a drug monitoring program to the General Assembly during the 2004 session.

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For additional information, please contact Paul E. Bernard, Director, Performance Audit Operations Division, at 404.657.5220.
Copies of this Follow-up Review and the original Performance Audit of the Georgia Drugs and Narcotics Agency can be obtained by calling the number above
or on our website: http://www.audits.state.ga.us/internet/pao/followup.html

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