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Pharmacist Robert Ray Courtney

By Terry Frieden
CNN Washington Bureau

KANSAS CITY, Missouri (CNN) -- A Kansas City pharmacist accused of diluting chemotherapy drugs was indicted Thursday by a federal grand jury on 20 felony counts carrying penalties of up to 196 years in prison and $5 million in fines.

The U.S. attorney's office announced Robert Ray Courtney, 48, of Kansas City, and the pharmacy he owns, Research Medical Tower Pharmacy, were each charged with eight counts of tampering with consumer products, six counts of adulteration of a drug and six counts of misbranding of a drug.

Prosecutors said Courtney dispensed highly diluted chemotherapy drugs to unsuspecting patients, claiming he misbranded and tainted prescription drugs.

According to the indictment returned Thursday, the tampering counts charged Courtney with "reckless disregard for and extreme indifference to the risk that another person would be placed in danger of death or bodily injury."

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The charges represented a sharp escalation by federal prosecutors, who nine days ago arrested Courtney on a criminal complaint carrying a maximum penalty of five years in prison.

Meanwhile, FDA and FBI agents continued to search records, staffed a hotline and worked in other ways to determine how many patients were affected and in what manner.

"We view this as a very serious public safety issue," Chris Whitney, spokesman for the U.S. attorney's office in Missouri, said last week. "Our No. 1 priority is to identify the patients. We are beginning to go through records now, but it's like looking for needles in haystacks."

Courtney is accused of reducing the potency level of drugs Gemzar and Taxol from about 39 percent to less than 1 percent of the intended strengths prescribed by a doctor, according to an affidavit.

Officials said the investigation began in May when a sales representative for Eli Lilly, maker of Gemzar, noted the pharmacy had purchased only about one-third of the drug it had supposedly provided and billed to patients.

A doctor informed by the salesman decided to send samples he obtained to an independent lab and found the samples highly diluted.

On July 27 the doctor gave the FBI and FDA additional samples prepared by the pharmacy that also were diluted.

Federal investigators working with the physician ordered more chemotherapy prescriptions and found lesser amounts of the drugs than they were represented to contain.

The affidavit cited one prescription for Gemzar that if filled properly would have cost the pharmacy $1,021.25; the amount of Gemzar allegedly detected in the treatment dispensed would have cost only $241.88.

The FBI has established a hotline for patients and doctors, 816 421-8639. Investigators urged physicians who may have dispensed the drugs, or patients who may have received them, to identify themselves.