The state of Tennessee took action Tuesday against the top pharmacist at the Massachusetts compounding center in the middle of the recent deadly meningitis outbreak.
Still, the trouble continues for the New England Compounding Center, which is now being investigated by multiple states.
The Tennessee Board of Pharmacy accepted pharmacist Barry Cadden's voluntary surrender of his license and said he is no longer allowed to do business in Tennessee.
Cadden co-owns NECC along with his brother-in-law. In the agreement, Cadden did not admit any wrongdoing.
However, he essentially avoided a hearing that might have exposed damaging truths about the way NECC conducts business. That could have meant trouble with pending lawsuits, which are piling up against the company.
NECC shipped thousands of possibly tainted injections to health facilities in 23 states across the country. Investigators with the Food and Drug Administration discovered fungal spores in supposedly sterile vials obtained at the company's headquarters near Boston.
"I can't think of any precedent in the past that would rise to the significance of this or to the scope of this. This has been a catastrophe," said attorney John Smith.
As part of the agreement, the state board could decide to fine the company, and - separately - Cadden. The law allows the board to assess $1,000 for every violation. So, with 69 confirmed cases, the fine for NECC and its top pharmacist could start at $69,000.
Tennessee continues to report more cases than any other state involved in the outbreak, with 70 cases as of Tuesday. And it also has seen the highest number of deaths involved with the NECC injections at nine.
Nationally, the Centers for Disease Control and Prevention reported 308 cases in 17 states with 23 total deaths as of Tuesday.
The state of Massachusetts revealed a set of glaring problems at the NECC facility, including filthy floor mats and lapses in safety testing.
And it appears the company had multiple chances to prevent the outbreak from ever happening in the first place.
Democratic Massachusetts Gov. Deval Patrick said a preliminary investigation found that the NECC shipped orders from the lots of steroid shots suspected in the meningitis outbreak before its own tests came back confirming the lots were sterile. In some cases, they said, drugs went out up to 11 days before test results came back.
"It's also clear that our own rules here in Massachusetts governing compounding pharmacies have not kept pace with an industry that's changing rapidly," Patrick said. "No one should live in fear that medicine is unsafe. In these times of constantly questioning the role of government, surely we can all agree that protecting the public's safety and health is paramount."
New documents detailed problems an outside firm hired to do an assessment found there years ago.
The state documents, obtained by The Associated Press under a public records request, say investigators in 2006 found inadequate contamination control and no written standard operating procedures for using equipment, among other problems. The problems were corrected that year, and a state inspection in May 2011 as the company prepared to update its facilities found no such issues.
Copyright WSMV 2012 (Meredith Corporation). All rights reserved. The Associated Press contributed to this report.