Articles Posted in Fatal Pharmacy Errors

It is estimated that Maryland medication errors are responsible for up to a third of all preventable deaths in the state. Thus, encouraging safer prescription practices is a paramount concern among lawmakers. According to a recent news report, there is currently ongoing debate on whether imposing criminal sanctions against medical professionals who were found to be negligent would decrease the total number of errors.

Earlier this year, we covered a tragic case involving the death of a hospital patient after he was administered the wrong medication by an attending nurse. The nurse is alleged to have disregarded hospital protocol and overlooked several errors, ultimately resulting in the patient’s death. Although the state health department decided not to revoke the nurse’s license, the local prosecuting authority recently filed reckless homicide charges against her, claiming that her conduct was criminal. If convicted, the nurse could face years in prison.

The local prosecuting authority’s decision to pursue criminal charges against the nurse has triggered a discussion regarding the possible effects that imposing criminal liability against negligent nurses or pharmacists could have on Maryland pharmacy error rates. On the one hand, patient advocates argue that more accountability would increase the amount of care that nurses and pharmacists would provide to each patient. Because the leading cause of pharmacy errors is distraction or inattention, in theory, this would decrease the number of pharmacy errors.

Pharmacists and nurses have a very important job that must be taken seriously at all times. However, medical professionals are human, and it is not uncommon for a nurse or pharmacist who is comfortable doing their job to begin to engage in multi-tasking. While the ability to multi-task is seen as a good thing in some contexts, when the safety of a patient is on the line, pharmacists should keep the focus of their attention only on the task at hand. As studies have repeatedly shown, a Maryland pharmacist who multi-tasks while filling a patient’s prescription increases the risk of a Maryland pharmacy error.

Back in 2017, a woman died after she was given a lethal dose of the paralyzing agent vecuronium instead of Versed, which the doctors intended to provide her with. According to a recent news report, prosecutors released additional documentation in the 2017 case showing that the nurse made at least ten errors in the moments leading up to the time when she gave the patient the lethal dose.

Evidently, a nurse administered the lethal dose of vecuronium to the patient, who stopped breathing a short time after the medication entered her bloodstream. At the time, the nurse admitted to being involved in an unrelated conversation with a colleague when she reached for the medicine. The nurse grabbed the wrong medication and apparently failed to notice the boldface type on the packaging stating WARNING: PARALYZING AGENT.

Recently, the Institute for Safe Medication Practices (ISMP) issued a report asking that Maryland pharmacists, as well as pharmacists across the country, take additional precautions in the wake of a fatal 2017 pharmacy error. The ISMP is a nonprofit organization dedicated to reducing the number of pharmacy errors across the United States. In furtherance of that goal, the ISMP operates a voluntary error-reporting system. The ISMP then uses this data to work with pharmaceutical companies to eliminate the root causes of common errors such as similarly named drugs, confusing packaging, and dangerous device design.

The Error

According to the ISMP report, a patient was admitted into the ICU with a headache and vision loss. An MRI was conducted, and it was determined that the patient had a hematoma of the brain. The patient was transferred, and a full-body scan was ordered. While the radiologist was explaining the procedure to the patient, the patient indicated she had claustrophobia. The radiologist requested the patient be given a dose of Versed to help with her claustrophobia.

Evidently, the patient’s primary nurse requested that a radiology nurse provide the patient with the medication. The radiology nurse declined, stating that the patient would need to be monitored after administration of the drug. The primary nurse indicated she would send another nurse to the radiology department to monitor the patient after she was given the medication.

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Medication errors are estimated to affect over 7 million people per year. While many of these errors do not result in patient hospitalization or even patient injury, the fact is that medication errors are a very real threat and patients should double-check all prescriptions for errors before taking any medication. If you have questions about possible errors with your medication, contact a Maryland pharmacy error attorney.

Most medication errors are the result of a pharmacist – either in a retail seating or in a hospital – improperly filling a patient’s prescription. However, there are other less common types of errors that patients should be aware of. For example, each year many mistakes are the result of a pharmacist’s incorrect advice.

Pharmacists’ primary role is to safely fill all prescriptions and counsel patients on their medications. However, pharmacists are also there to answer a patient’s questions regarding over-the-counter medications. Such questions are commonly based on an over-the-counter medication’s potential interactions with prescribed medication that may not have been filled at the pharmacy. Other errors involve incorrect advice regarding medication that is available in varying strengths, some of which may be available over-the-counter.

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The chances are that anyone who has dropped off a prescription or refill request to a retail pharmacy has had to wait a considerable amount of time for the pharmacist to fill the prescription. First, the patient must wait in line to drop off the prescription. Then, the pharmacist often tells a patient to come back in at least 30 minutes – sometimes even longer.

While waiting 30 or 45 minutes for a prescription to be filled isn’t a problem for most patients, the fact that a pharmacy is so busy raises some concerns for pharmacy experts. According to a recent news report discussing the prevalence of errors and what can be done to curb them in the future, it is estimated that there are approximately 100,000 deaths caused by pharmacy errors each year. The leading cause of Maryland pharmacy errors is commonly understood to be an overworked pharmacist.

The article details the startling account of a woman who was provided the wrong medication by her local pharmacy. The woman was prescribed the pain medication Gabapentin. Her physician instructed the woman to take the medication three times a day, taking two pills for each dose.

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Earlier this month, a man in a New Zealand hospital died due to opioid toxicity after he was administered what turned out to be a fatal dose of fentanyl. According to a local news report covering the story, the error was a result of system-wide failures across the spectrum of care providers.

The victim of the error was at the hospital for a routine knee surgery. The hospital had just implemented a new e-prescribing system the month before, whereby physicians could order medication at a patient’s bedside with one touch on a computer screen. The physician overseeing the victim’s care was attending to another patient when he remembered to put in an order for the victim’s medication. The physician input the medication order and then returned his attention to the other patient.

The physician, however, failed to switch the computer screen back to the patient who was with him. Thus, when the physician entered a medication order for fentanyl patches that was intended for the other patient, the order was sent to the victim’s file.

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By some estimates, medical errors are among the top three causes of death in the United States. While the classification of a medical error is broad, including surgical errors and medical malpractice, the classification also includes pharmacy errors. Indeed, there are tens of thousands of pharmacy errors each year, and this number is likely a gross underestimate because nearly all errors that do not result in serious injuries or death go unreported.

When pharmacy errors are reported, authorities take them very seriously. Indeed, a recent article discusses one pharmacist who was found guilty of reckless homicide and imprisoned for six months after an error he made resulted in a young girl’s death. While this is rare, it does happen because the law does not necessarily require intentional conduct to find someone guilty of a homicide.

According to a recent news report, the pharmacist who was responsible for the young girl’s death has tried to turn his life around with the help of a seemingly unlikely friend – the father of the girl who died from the pharmacist’s mistake. In the wake of his daughter’s death, the girl’s father decided that he did not believe the pharmacist intended to cause an error and that he wanted to do what he could to emotionally support the pharmacist while he was in jail. The two men became friends and have since begun to work together to help raise awareness around issues of pharmacy errors.

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When a pharmacist gives a patient the wrong medication, or the incorrect dose of the proper medication, the patient can be put in great danger. The range of medical issues that can result from a Maryland pharmacy error is broad, but the most common problems that arise after a pharmacy error are adverse reactions and overdoses.

Many prescription medications are controlled for the very reason that they interact negatively with a large number of other medications – both prescription and over-the-counter. Other medications are controlled due to the fact that they require a very precise dosage to be effective. If these medications are provided in excess strength, the patient may suffer an overdose that can potentially be fatal.

Of course, pharmacists are responsible to correctly fill patients’ prescriptions. And while pharmacists cannot normally be held criminally liable for their errors, injured patients and their families may be able to pursue a claim for financial compensation from the pharmacist as well as their employer. These pharmacy error lawsuits, however, can be complex due to the scientific issues that arise when attempting to prove that a pharmacist’s error was the cause of the patient’s injuries.

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Last month, a jury in Massachusetts rendered a guilty verdict in a case brought against a pharmacist who had run a pharmacy that was tied to hundreds of cases of meningitis in 20 states. According to a national news source covering the case, the pharmacist was acquitted of murder charges but was convicted on several counts of “racketeering, racketeering conspiracy, mail fraud and introduction of misbranded drugs into interstate commerce with the intent to defraud and mislead.”

Evidently, the pharmacist ran a compounding pharmacy that would create custom-made medications. However, inspections conducted during the investigation revealed that the equipment used to create the medication was not sterilized, and ingredients used in the process had expired. In addition, prosecutors alleged that the pharmacist, as well as several of his employees, actively lied about the condition of the lab.

The medication created in the lab was shipped to 20 states and was tied to 700 cases of meningitis. It is believed that 64 people died due to the unsafe medication that was created in the lab, which was the deadliest meningitis outbreak in U.S. history.

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Earlier this month, a British news source published an article discussing the 2016 death of a man who was provided the incorrect prescription just days before he died. According to the report, the man had been receiving medication for type II diabetes, heart problems, and glaucoma. He had filled the prescriptions in the past with no problem, but in May of last year he was provided another patient’s prescription. Apparently, the packet containing the pills contained another customer’s prescription with his name on seven different labels; however, the victim’s name was printed on the outermost packaging.

An investigation was conducted into the fatal pharmacy error, and it was discovered that the filling technician had opened the interior packet of pills, added additional requested pills, and then sealed the package back up. Apparently, the technician did not notice that the name on the seven labels inside the packaging and the name on the outside packaging did not match. And neither did her supervisor.

After the error occurred, but before it was discovered, the man began complaining of chest pain and having a difficult time breathing. Two days after the error, he passed away. The coroner’s report indicated that the prescription error at least “hastened” the man’s death. However, the prosecuting authority determined that there was insufficient evidence to pursue criminal charges. Since the accident, the branch where the error occurred has stopped assembling medication packets on location.

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