Cologne pharmacies closed after mother and baby die: What you need to know

The closures are for the sake of preventative health prevention as investigations continue, said a spokesman for the North Rhine-Westphalia Ministry of Health on Thursday. 

In addition to Heilig-Geist-Apotheke, where the substance was purchased, authorities are also closing the Contzen-Apotheke and the Apotheke am Bilderstöckchen (the city's main pharmacy).

A 20-strong police murder squad is investigating the deaths of the mother and her baby. Here are some of the key questions.

What happened?

A 28-year-old pregnant woman from Cologne purchased a glucose mixture in the Heilig-Geist-Apotheke in Cologne’s Longerich district for a routine test.

Through the test, commonly taken by pregnant women in Germany, she wanted to rule out gestational diabetes.

But the woman died in the hospital a few hours later. It was not clear how advanced her pregnancy was.

Her baby, who doctors tried to delivery by emergency caesarean section, also died after the surgery. The cause for both deaths was multiple organ failure.

READ ALSO: Mother and baby die after taking medicine from Cologne pharmacy

Why was the test deadly?

Forensic investigators discovered that drug from the Cologne pharmacy contained poison - "a toxic substance which is available in pharmacies but which has absolutely no place in the mixture,” said public prosecutor Ulrich Bremer on Tuesday. 

According to the investigators, the toxic substance was found in a container from which the glucose was transferred into small sachets. 

Was it an accident or a crime?

Prosecutors are still investigating exactly how the toxin got into the container, with the homicide department looking into whether it was a negligent killing - or deliberate act. "Indeed, this cannot be ruled out," said prosecutor Bremer. 

Investigators are now questioning witnesses, tracking supply chains, and investigating pharmacy records and other evidence. 

"We must clarify: Who worked where and when? Who was allowed to work with the substances," said Bremer. 

Are there any other toxic mixtures in circulation?

Investigators can't yet rule this out. The police and city warned against taking glucose from the affected pharmacy. Instead, patients should hand them in at the nearest police station, they said.

The city has also prohibited the pharmacy for the time being from selling products it has produced or bottled itself.

Is it normal for such products to be bottled at the pharmacy?

"This is part of the daily routine of a pharmacy," Stefan Derix, Managing Director of the North Rhine Chamber of Pharmacists, told Focus Online.

The required quantity is filled from a larger container into a smaller one for immediate use, said pharmacist Dagmar Hussmann, who trains young pharmacists at the PTA Academy in Cologne. 

So far, this procedure has not caused any problems. "We are talking about a very trivial pharmaceutical activity here," Derix added. 

In addition, such tasks should only be performed by trained personnel, he said, such as pharmacists or pharmaceutical technical assistants.

What is the purpose of the diabetes test?

Normally women drink the mixture with medical accompaniment, and a few hours later they receive blood samples - this determines whether they have gestational diabetes or not. 

The test is a standard procedure in Germany: it is recommended by doctors and paid for by health insurance companies. It is not associated with any risks for women, according to an information brochure published by Germany’s Joint Federal Committee, an important body in the German health system.

Should pregnant women continue to carry out the test?

There is no reason for a general distrust of self-manufactured drugs, said the Vice President of the Federal Association of German Pharmacists (ABDA), Mathias Arnold, on Tuesday in Düsseldorf.

The investigators also did not see any indications that medicines from other pharmacies are contaminated.