Swap-Meet Sales of Medicines Prompt Inquiry

The death of an ailing Northridge boy whose immigrant parents sought medical treatment from a neighbor has prompted authorities to investigate the sale of medicine purchased in Mexico and sold illegally at area swap meets.

State and local authorities say the illegal sale of imported medicines, especially antibiotics, has increased over the last several years in predominantly Latino communities. Antibiotics bought at a San Fernando swap meet and injected by a neighbor were at first suspected of contributing to the June 11 death of 2-year-old Jesse Gonzalez.

Even though the Los Angeles county coroner’s office has determined that Jesse’s death was not caused by black-market drugs, physicians at San Fernando Valley health clinics have seized the opportunity to warn their patients of the dangers of using such medicines. At the same time, law enforcement and health officials say they will step up efforts to stem the illegal sale of medicines.

Language barriers and confusion over state and federal laws prohibiting the sale of such medicines allowed local entrepreneurs relative freedom to conduct their business without interference, police and health officials said.

No Prosecutions

In Los Angeles, no person has been prosecuted for the sale of black-market medicines such as antibiotics, said Deputy City Atty. Susan Frauens, supervisor of the consumer protection unit.

She said an investigation may result in misdemeanor charges of selling and practicing medicine without a license against the swap-meet vendor who sold the couple the antibiotics and the neighbor who injected the boy. The Los Angeles district attorney’s office announced Friday that it would not file any criminal charges against the boy’s parents.

The incident has also prompted consideration of a joint investigation by state and federal officials, said Kenneth Sain, the supervising inspector of the state Board of Pharmacy.

“The basic problem is that these products are unsafe for self-medication,” Sain said. “That is why drugs such as antibiotics are available only with a prescription, because there can be serious side effects.”

Federal law requires that all drugs sold in the United States be approved by the Food and Drug Administration, FDA spokesman Michael Schaffer said. The sale of antibiotics and other drugs manufactured in Mexico, and not approved by the FDA, violates that law as well as federal requirements that products be labeled in English, he said.

“We can’t assure the safety of drugs made outside of this country and not approved for sale,” Schaffer said.

Brisk Business

But many recently arrived and longtime Latino immigrants consider the Mexican-made products superior to their U.S.-made counterparts. Familiar U.S. brands of mouthwash, cough medicine and cold remedies that are made in Mexico and labeled in Spanish are legal for sale in this country and draw a brisk business at swap meets that cater to the Latino customer.

“Medicine from Mexico, they say, is better,” said Angelica Lugo, the mother of the Northridge boy. “We all used the medicine there and stayed healthy.”

Lugo, who moved to the United States six years ago, said she had taken her son to a physician for his persistent cough and cold, but he did not get any better. So she went to a Sun Valley swap meet to find a cure.

“I’ve taken my children to the doctor lots of times,” said the 20-year-old mother of three. “But they make you wait all day, and then they just give you Tylenol and ice water. They don’t pay attention to you if you don’t have much money.”

Her son died 12 hours after a neighbor administered an injection of an antibiotic that the swap-meet vendor had sold her for $4.

The Los Angeles county coroner’s office determined last week that the boy’s death was caused by a lung abscess brought on by bronchial pneumonia. But doctors said the boy might have survived the ailment if his parents had sought medical treatment from a physician, rather than the neighbor, who had no formal medical training.

Lugo, whose job is cleaning floors for a large department store, said she saw nothing wrong with seeking help for her son from someone who was not a doctor. She and her seven brothers and sisters had always been treated by her aunt in the small Mexican village where Lugo had lived.

“Why would I want to kill my own son?” Lugo said. “I wanted to help him.”

Still on Display

Despite the growing interest by law enforcement officials, vendors at two Valley swap meets last week, one in Sun Valley and one in San Fernando, continued to display tables filled with legal remedies, as well as a variety of Mexican-made ointments and tablets containing antibiotics such as penicillin. Labels in Spanish on some of the medicines displayed said sale of the product requires a prescription.

During a recent visit by reporters to the Sun Valley swap meet where Lugo said she purchased injectable antibiotics, a vendor there sold customers black-market medications that she said were effective to treat a variety of illnesses such as colds, sore throats and fever.

The few swap-meet medicine vendors who are willing to talk worry that the boy’s death will draw the attention of authorities to their business. One vendor at the San Fernando swap meet, a 19-year-old San Diego man who declined to give his name for fear of prosecution, said he believes that increased scrutiny by health authorities will make sale of the products very difficult.

“It’s going to get a lot more complicated,” the man said.

So far, the FDA has not decided whether to use its own investigators to check the illegal sale of black-market drugs in Southern California, FDA spokesman Schaffer said. “But usually when a problem gets out of hand, the agency steps in,” he said.

State laws regulate the licensing of businesses that sell prescription drugs, as well as the people allowed to prescribe them. But officials from the state Board of Medical Quality Assurance and the state Board of Pharmacy said the growing use of illegal antibiotics has pointed out weaknesses in laws that are supposed to prevent their sale.

“Sometimes these things fall through the cracks,” said Frank Heckl, a spokesman for the board. “We don’t have jurisdiction unless the person who is selling the drugs is also diagnosing, telling you that if you have this or that symptom, that you should take this.”

Across State Lines

Meanwhile, Pharmacy Board inspector Sain said that his agency is responsible for regulating drugs in the state but that “when they are brought across state lines, it becomes a federal problem.

“But we have been talking about some sort of cooperative effort among the various agencies,” Sain said.

Local police admit that the cases are especially complicated because enforcement requires expertise in both Spanish and medicine. “Another problem is whether or not you are going to classify antibiotics as dangerous drugs,” said Los Angeles Police Detective Carl Whiting.

Medical professionals say they try, unsuccessfully, to discourage many of their Latino patients from using unprescribed antibiotics.

“I’m really frustrated with this problem,” said Shelini Bhargava, a pediatrician at Los Angeles County Public Health Center in San Fernando. “It’s a real danger, and the patients are so naive that they just get taken for a ride.”

But the low cost of imported antibiotics prompts many patients to buy the illegal medicine at swap meets, which also saves the cost of a doctor’s visit, Bhargava said. “They think it’s cheaper to buy penicillin for $10 than see a doctor,” she said.

Bhargava said she tries to explain to patients that the use of antibiotics can be harmful for children under 6 because the drugs can mask the symptoms of an illness that requires a physician’s care.

“The scariest part is that they also give children injections,” Bhargava said. “You can get real bad allergic reactions from these. Also, we don’t know where and how it’s given and whether it’s a sterile needle.”

Risk of Allergic Reactions

Treating an illness with unprescribed antibiotics is more dangerous than using over-the-counter medication because of the risk of severe allergic reactions, said Dr. Raymond Wilson, a pharmacology specialist with the food and drug branch of the state Department of Health Services. The misuse of antibiotics can actually strengthen the infection that it is supposed to cure, he said.

In addition, various infections require specific types of antibiotics, as well as specific doses, Wilson said. “Prescription requirements exist for the safety of the individual, so that people know how much to take and when to take it,” he said.

The greatest danger is that often the antibiotics will temporarily relieve symptoms of an illness even if the disease is still active, said Les Rukasin, associate director of pharmaceutical services at UCLA. “So people never seek proper medical treatment and could end up dying,” he said.

Doctors and health officials worry that the practice of purchasing antibiotics without a prescription, which is not required in Mexico, will be a hard habit for some to break. “Many people are set in their ways and keep doing it after they arrive here,” said Lionel Cohen, a Valley physician who treats many Latino patients.

In Mexico, some people become used to curing their own illnesses without ever seeing a doctor, clinic physician Bhargava said.

“People think that penicillin will cure everything,” Bhargava said. “The only good that can come out of this tragic incident is if people realize that this is not the way to take care of illness.”