State regulators say a San Diego pain clinic physician and a Rancho Santa Fe pharmacist turned a local medical office into an unsafe compounding hub for injectable GLP-1 diabetes and weight-loss drugs. The Medical Board of California is now moving to revoke the doctor’s license, while public records show the pharmacist surrendered his pharmacy credentials last year.
In a June 2026 accusation, the Medical Board of California alleges Dr. Ronald Cohen allowed pharmacist Bernard Gramlich to use Cohen’s Sorrento Valley office to compound semaglutide and tirzepatide, then leave the finished vials at the clinic so staff could administer them to patients, according to the board’s filing. The board says the office lacked a certified cleanroom, did not have required hygiene equipment or written operating procedures, and that some compounded products were handled and labeled in ways that undermined traceability, per the Medical Board of California.
What Investigators Found
Investigators cited a list of quality-control problems: vials that were mislabeled, medications not dispensed in child-resistant containers, and doses with no tracking numbers or expiration dates. Those gaps make it difficult to trace specific lots or investigate any contamination scares. The Times of San Diego reviewed the board’s filing and reported that Cohen allegedly went ahead and administered some of the compounded injections to his own patients despite those deficiencies. The complaint also describes a February 2023 agreement that let Gramlich use space inside Cohen’s clinic for compounding work.
Regulatory History Of The Pharmacist
Gramlich was already on regulators’ radar. In 2023, the California State Board of Pharmacy put him on probation for multiple compounding violations tied to Fairbanks Pharmacy in Rancho Santa Fe, which later closed. Board discipline listings show that Gramlich’s personal pharmacy license was marked as voluntarily surrendered effective July 16, 2025, according to the California State Board of Pharmacy.
Federal Action And The Wider Crackdown
Gram Peptides, the company Gramlich lists online, drew federal attention this spring. On March 31, the U.S. Food and Drug Administration sent a warning letter saying the firm was offering products such as retatrutide and tirzepatide and selling bacteriostatic water for injection that the agency described as unapproved new drugs. The letter warned that injectable products can pose risks of serious harm and gave the company 15 working days to respond.
The move against Gram Peptides is part of a broader federal squeeze on the GLP-1 gray market. In March, the agency publicly warned 30 telehealth companies over illegal marketing of compounded GLP-1 products and signaled it would move quickly against misleading or noncompliant claims.
Legal Implications
The Medical Board’s accusation asks for full revocation of Cohen’s license, a step that would trigger administrative hearings where state lawyers must prove the alleged departures from the standard of care. Medical Board of California filings say Cohen acknowledged that he relied on Gramlich to oversee compounding and that he did not maintain records of what was produced at the clinic.
Gramlich, for his part, surrendered his pharmacy license in 2025 and, according to public reporting and board records, agreed to wait at least three years before seeking reinstatement and to reimburse nearly $60,000 to cover the pharmacy board’s investigation costs.
What Patients Should Know
Patients who received semaglutide or tirzepatide injections at the clinic are urged to hold on to any medication, receipts, or visit records and to talk with their primary care provider before making any abrupt changes to treatment. Stopping these drugs cold turkey can backfire, so any transition to new medication or dosing should be supervised.
For those trying to make sense of the bigger picture around compounded GLP-1 drugs, recent legal analyses of the FDA’s enforcement campaign lay out how the rules are shifting and what that might mean for access, safety, and future crackdowns.
