CLEVELAND — The attorney leading the effort to prove pharmacy chains failed in stopping the abuse of opioids in the early 2000s sought to establish that some Walgreens pharmacists did not follow the company’s own policies when there were red flags that prescriptions should not be filled.

Lake and Trumbull counties are suing Walgreens, Walmart, CVS and Giant Eagle in federal court alleging the companies collectively failed to take measures that would have stemmed the spread of legal opioids in homes and illegal opioids on the streets of these two counties. The counties are seeking compensation for the money they are still spending to reduce addictions and take care of those impacted by the drug crisis.

If successful, this landmark case is expected to be replicated by counties and other governmental agencies across the nation.

Using a box filled with Walgreens documents that had all the prescriptions that Walgreens pharmacists failed to fill in Lake and Trumbull counties between 2015 and 2017, plaintiff attorney Mark Lanier of Houston questioned Natasha Polster about whether Walgreens’ compliance documents are filled out at the time when prescriptions are being filled at the pharmacies.

Polster is the vice president of pharmacy quality, compliance and patient safety for the drug store chain.

Lanier noted there were 646 reports turned over by the company for the trial period for the two-county region. Lanier said that represented 4.5 prescriptions not filled because of red flags per year.

The plaintiff’s attorney argued it would be better to look at the detail of the prescription orders that were filled to determine the numbers that should not have been filled, but were anyway.

When filling out prescriptions, pharmacists and pharmacy workers are supposed to check a computer network that identifies the customers, their prescription histories, as well as the physical conditions they appear to be in when the prescriptions are filled.

The records will show, among other things, the types of prescriptions that have been prescribed, the potency of the prescriptions, the frequency they are supposed to be filled, as well as when the prescriptions were filled previously and where the prescriptions were filled.

Providing examples, Lanier sought to show that some pharmacies in the two-county region provided opioids to clients in spite of the pharmacy employees marking one or more items on the forms that should have been red flags preventing the prescription from being filled.

On one example, the person that filled out the form noted the person receiving the prescription appeared to be intoxicated, but the prescription was given anyway.

Other examples were that persons seeking to purchase the prescriptions did so in five to seven days, when the refill frequency was supposed to be 30 days or longer.

Polster emphasized that in spite of the markings on those forms, only the persons filling the prescriptions know what was happening at the time.

“There might have been a mistake in the marking the form,” she said. “They may have known why the prescription needed to be filled in a shorter period of time.”

When questioned why Walgreens would fill the prescriptions of “a known” problem doctor when CVS and Walmart would not, Polster said the company has a policy of filling prescriptions on a case-by-case basis, not doing a blanket ban of filling a particular doctor’s prescriptions.

“If a doctor has all of the proper licenses and we have not been notified by an enforcement agency, we look at them on case-by-case basis,” she said.

The company provides regular review of its pharmacy records and if a store or a particular pharmacist are found to have not followed procedures, Polster noted they may be given counseling, verbal and written reprimands, a final written reprimand and termination.

Lanier questioned if it is common practice for pharmacists from competing stores to talk to one another about problem customers.

“Yes,” she responded. “It is not a requirement.”

Lanier noted Walmart has continuous education available for chronic pain management.