Articles Posted in Pharmacy Error

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In a highly unusual case, a nurse charged with reckless homicide after a medication error killed a patient pleaded not guilty in a state courtroom packed with other nurses who came in scrubs to show their support for the accused nurse defendant. The medication error occurred when the nurse injected the patient with a paralytic medication instead of the sedative Versed. This case is unusual because most of the cases involving medication errors are resolved in the civil action through a Plaintiff bringing a civil lawsuit for damages caused by the error. Some errors are negligence, some are gross negligence, and in this particular case, the allegation is that it is criminal. Obviously, that begs the question: what is a medication error. Many publications have focused on this and there are some accepted definitions.

Medication errors can occur at many stages of the medical care, including writing the wrong prescription or giving the wrong medication when the prescription is correct. They can also occur in many different settings, such as at a doctor’s office, urgent care facility, ER, hospital, or pharmacy. Still other prescription errors occur in the patient’s home when the home health aids give the wrong medication. A prescription is a written order, which includes detailed instructions of what medicine should be given to whom, in what formulation and dosage, by what route, when, how frequently, and for how long. A prescription error can be thought of as a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription. The prescription should include, at a minimum, the identity of the patient, the drug being prescribed, the dose, and the route, timing, frequency and duration of administration.

Adapting the definition of a medication error, a prescribing fault can be defined as a failure in the prescribing process that leads to, or has the potential to lead to, harm to the patient. A previous definition, stated that ‘a clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is an unintentional significant (i) reduction in the probability of treatment being timely and effective; or (ii) increase in the risk of harm when compared with generally accepted practice’. However, this rules out prescribing faults that do not result in harm, and ignores the fact that it is desirable to detect and examine all errors, whether ‘clinically meaningful’ or significant, since an error indicates a weakness in the system, which might on a future occasion lead to an error of clinical relevance.

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Katz Wright & Fleming LLC, LLC is a personal injury law firm that has handled many pharmacy negligence cases in the Atlanta area and throughout Georgia. The number of pharmacy error cases in the United States keeps increasing as more and more pressure is placed upon pharmacists at the big box employers such as CVS, RiteAid, Walgreens and Walmart. For example, pharmacists are often discouraged from taking bathroom or lunch breaks during their shifts because rule and regulations which require the pharmacy to close if there is not a pharmacists on site and working. Examples of actionable malpractice include, but are not limited to:

The patient’s doctor ordering medication to raise blood pressure the blood pressure of single mom to treat the patient after a stroke and the pharmacy dispensing medication which actually raised her blood pressure causing post-stroke complications.

A middle-aged man who was prescribed medication to treat skin lesions. The pharmacy filled the prescription with the wrong medication which caused boils to form on most of the skin on his body, including his genitals.

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Medical malpractice cases often turn on medical expert testimony. Both sides in the lawsuit must hire experts to render opinions about liability (i.e., was there malpractice) and damages (i.e, did the malpractice result in the injuries and damages that the plaintiff is complaining of in the lawsuit). Many times, a client is allergic to an antibiotic or other drug, and despite the client listing this in the medical intake sheet when treatment begins at the doctor or dentist’s office, they are prescribed the anti-biotic which they are allergic to. Often the results can be catastrophic enough to support a dental malpractice or medical malpractice case because the signs and symptoms caused by the negligently prescribed drug, coupled with the illness or injury the patient was being treated for join forces to wreak havoc on the patient in very short order. Defense experts in Infectious Diseases, General Medicine and Pharmacology are often retained to testify in medical malpractice trials  in an attempt to insulate the negligent prescribers from liability. For instance, the signs and symptoms when a patient is prescribed a strong antibiotic that he or she is allergic to that specific drug are: severe allergic reactions which can last for weeks or even months, including red man’s syndrome, DRESS syndrome (Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a distinct, severe, idiosyncratic reaction to a drug characterized by a prolonged latency period. It is followed by a variety of clinical manifestations, usually fever, rash, lymphadenopathy, eosinophilia, and a wide range of mild-to-severe systemic presentations), skin exfoliation, rashes on many parts of the body, whole body edema, including the trunk, torso, arms, hands, legs, face, and head., difficulty breathing and anxiety caused by the medication reactions.

Since these cases really do deal with clear liability, i.e.,  doctor who prescribes a drug to someone who is allergic to the drug and the patient has listed the allergy in his or her chart is negligent and not even a hired defense expert will risk opining otherwise, the role of the defense expert in these cases is to obfuscate the link between the malpractice (i.e., prescribing and administering a drug that someone is allergic to) and the signs and symptoms that are related above. Obviously the plaintiff’s expert, if it is true, will link the malpractice with the injuries that the plaintiff is complaining of in the lawsuit.

Attorney Robert J. Fleming has been handling wrongful death cases, automobile accident cases, personal injury cases, dental malpractice and medical malpractice lawsuits for individuals and families who have been harmed, injured or died as a result of the carelessness or negligence of another for more than 20 years in and around Atlanta, Georgia and its surrounding areas, including Alpharetta, Austell, Avondale Estates, Chamblee, College Park, Conyers, Duluth, Decatur, Doraville, Hapeville, Johns Creek, Jonesboro, Lawrenceville, Norcross, Peachtree City, Riverdale, Roswell, Sandy Springs, Stone Mountain, and Smyrna. If you have been seriously injured and would like quality legal representation, contact Robert J. Fleming directly on (404) 525-5150 or contact us online.

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Medication errors in Georgia have been exploding in the last few years. One of the reasons, is that pharmacies, hospitals, doctors offices, and other medical providers are overworked and understaffed. The difficulties they face are compounded by the number of prescriptions that are filled each day. Many of these prescriptions are for drugs that, if mis-filled can cause dangerous side effects, including but not limited to permanent disability, blindness and even death.

Many of these prescription error cases could and should have been avoided by proper protocols in place at the pharmacy. Many pharmacists do not double-check the work of pharmacy technicians to ensure that the prescriptions are filled correctly with the correct medication, correct dosage, correct instructions and so on and so forth. Due to the potentially lethal consequences of a prescription errors, there is no excuse for filling a prescription with the wrong medication or with the wrong dose with the wrong instructions are for the wrong patient or any of the other plethora of prescription areas that we see on a regular basis.

Patients who receive these medications should be vigilant in making sure that number one number one medication that you received from the pharmacy is supposed to be yours, that it is in fact the drug that it says it is on the packaging both on the paper packaging that the pill bottle is in and also on the pill bottle itself, and that the dosages are correct as you know them to be as prescribed by your doctor. While many people might question why they have to be so vigilant, the answer is that if you take the drug as a result of a prescription error, you run the risk of seriously harming your health. And, while you do have the ability to seek compensation for the injuries caused by taking the wrong drug or in the wrong doses because of the prescription error, this would be of little relief if the drug causes a permanent disability or death. In fact, most prescription areas are harmless and did not result in debilitating injuries. However the prescription errors that do result in harm are often catastrophic and life-changing. Prescription errors often result in serious injuries such as brain damage, loss of vision which many times is permanent, heart problems, blood pressure issues, severe allergic reactions which manifest themselves many times with permanent injuries to your skin, eyes and other organs of the body.

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CVS, Walmart and Rite Aid account for the vast majority of prescriptions filled in the U.S. Not surprisingly, these pharmacies are involved in the majority of prescription errors as well. Doctors are writing and dictating prescriptions in fast-paced and hectic environments such as in hospitals, dental offices, emergency room, urgent care centers, medical clinics, dental clinics and doctors’ offices. Once these prescriptions are sent to the pharmacy to be filled, the pharmacist , in order to comply with the standard of care for pharmacists, must check to make sure that the prescription itself is accurate. Then, once it is filled, the pharmacist must ensure that the prescription, as filled, is accurate and correct. Finally, the pharmacist must make sure that the properly prescribed prescription should be dispensed to the patient or whether there is an alert or other reason why it should not be dispensed. In a busy retail environment (such as at CVS, Walmart, Rite Aid, Target, Publix, Kroger, etc.) this is not always done and prescription errors occur. The reason that this compliance with the standard of care for pharmacists is so critical is that a mis-filled prescription, or a medication filled in the wrong dosage, or a medication filled with the correct dosage but with the wrong instructions, can potentially lead to serious injury and sometimes can even be fatal.

Failure to adhere to the standard of care amounts to negligence, or pharmacy malpractice. In order to prevail in a court of law, the Plaintiff in these types of cases must prove: (1) that there was a duty flowing from the pharmacist-patient relationship to comply with the standard of care and properly fill the prescription; (2) that this duty was breached when the pharmacist did not dispense the correct prescription; (3) that the breach of the standard of care caused the injuries that the Plaintiff is complaining of; and (4) that the damages that the Plaintiff is complaining about were a direct and proximate result of the malpractice. In most cases, the duty element of the case is clear, as the Plaintiff was a patient/customer of the pharmacist and received her prescription from the pharmacy. The more difficult issues presented when you file a lawsuit for pharmacy malpractice are in proving what the applicable standard of care was and that the pharmacist breached this duty. Similarly, the Plaintiff still must prove that the malpractice caused her injuries and in exactly which ways Plaintiff has suffered. Damages usually include past medical and hospital bills, past pain and suffering, future medical and hospital bills, past loss of earnings and future loss of earnings or a decreased ability to work and labor in the future due to the Plaintiff taking the wrong medication after the prescription error.

Prescription errors result in over 7,000 deaths every year. If you suspect that you, or a loved one, have been the victim of prescription error, feel free to contact Attorney Robert J. Fleming for a confidential and free case evaluation. Mr. Fleming can be reached directly by phone on (404) 923-7497.

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A jury has awarded $2.5M to an autistic boy’s family. The lengthy trial included evidence of Janssen Pharmaceutical’s alleged plan to obscure evidence for years that the drug was linked to the growth of female breast tissue in adolescent boys.The jury based its decision, at least in part, in its finding that the drug company failed to warn the boy’s parents and physicians of the risks associated with the drug.

This is a key verdict that will play a vital role in the valuation of the thousands of Risperdal cases that have been filed in recent years. Of course, each case is different based on the facts, but this is an important benchmark for valuation. However, the two most troubling side-effects that are the subject of lawsuits and which are reportedly associated with Risperdal are:

Breast Development in Boys

Gynecomastia is enlargement or development of breast tissue in males.  It is more common and particularly disturbing in children and adolescents.  The development of gynecomastia is usually a permanent change that will require surgical removal by a reconstructive surgeon.  Gynecomastia has been attributed to Risperdal’s stimulation of prolactin, a hormone common in women who are pregnant or nursing.  Adolescents or boys who develop breast tissue suffer not only physical changes but also severe emotional trauma.

Lactation in Girls

Lactation in girls who are not of child-bearing age and of women who are not pregnant or nursing has been seen with Risperdal use.  Girls may develop breast tissue prematurely and the development will be permanent.  No long-term damage is seen other than premature development and resulting emotional trauma.

Other less common side-effects reportedly associated with Risperdal are:

  • Movement Disorders such as akathesia (restlessness), akinesia (inability to move or hesitational movement), Tardive Dyskinesia (abnormal movement of face, shoulders, arms and legs), Parkinson’s like tremors, Torticolis (stiffening of the tongue, which may cause difficulty breathing).

All of the movement disorders may be permanent even after the medication has been discontinued.  Many patients also require additional medication to control the symptoms.

  • Diabetes

Risperdal has been allegedly associated with an increased risk of development or worsening of diabetes.  The exact relationship is unknown.

  • Death in the Elderly

Risperdal has been allegedly associated with mortality in elderly dementia patients.  The FDA required a Black Box warning regarding use of Risperdal in the elderly. Patients who have died from Risperdal use had an actual cause of death of adverse events such as cardiac failure, pneumonia and cerebrovascular events (stroke).

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The recent children’s drug settlement exemplifies the risk associated with giving any medications to children. As an Atlanta medication error attorney, I am frequently contacted by parents who have filled prescriptions for their children at local pharmacies, only to realize after giving the medication to their kids that they were either dispensed the wrong medication or given the correct medication but in the wrong dosage.

Many pharmacy errors which result in hospitalization are caused by lack of technician training, lack of sufficient quality control that ensures that the prescription that is dispensed is actually what was ordered by the doctor and a simple lack of attentiveness on the part of the pharmacy team involved in filling the prescription. Unfortunately, parents are seldom in a position to catch the pharmacy error and the result can often lead to serious injury to the child and hospitalization.

Among the largest pharmacies in the United States are Walgreens, CVS, Rite Aid, Walmart, Kroger, Safeway, Target, Publix, Costco, and Sam’s Club. Many of these chains compete on price. This puts tremendous pressures on their pharmacists and technicians to fill more prescriptions in the same amount of time and for the same pay. This often can lead to errors. Errors, theoretically, should be detected in many cases by the quality control systems in place. These would include protocols that the workers in the pharmacy are supposed to follow to uncover prescription errors before the medication is dispensed to the patient, and computer-related programs which are designed to catch errors such as drug interactions or allergies that are not detected by the pharmacist or pharmacy technicians. I say, “in theory” because many of the protocols and computer aides are ignored by the over-worked employees, which effectively renders them useless.

On the opposite end of the spectrum, we find errors being made in smaller pharmacies that are not part of a chain, which go undetected allowing the wrong medication to be dispensed because these smaller pharmacies do not utilize any of the protocols or computer aides that the larger pharmacies have in place (but often fail to use). Either way, the prescription errors are not detected.
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When doctors use electronic prescription systems to deliver prescriptions, patients are not only more likely to follow through with the medication course, but also less likely to suffer injuries from filling errors. In fact, new research indicates that the use of electronic prescriptions improves patient adherence to medication programs, thereby contributing to better patient outcomes, and reducing health-care costs by lowering the number of prescription errors.

The researchers went through more than 40 million prescriptions. They found that patient adherence to medication programs is much higher when doctors use electronic prescription tools to hand out prescriptions. The adherence rate was about 10% higher when doctors used electronic prescription systems.

There is a simple enough reason for this. Patients, who get electronic prescriptions are less likely to lose their prescription, or abandon the prescription. Additionally, patients are much more likely to stick to a medication program, when medications are cost-effective. Electronic prescription systems allow a doctor to check the prices of medications before prescribing them. Additionally, electronic prescription systems give a doctor access to other important data like the patient’s insurance status and medication history. This helps the physician make cost-effective prescription decisions for the patient.
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A large number of birth control pills produced in India to be distributed in the Atlanta and other parts of the US have been recalled because of a packaging mistake that could render the pills useless. Health authorities in the US said Monday that Glenmark Generics, Inc. USA recalled seven lots of generic norgestimate and ethinyl estradiol tablets. The pills were sent to wholesale and retail pharmacies across the US between September of 2011 and December of 2011.

This packaging error has disrupted the daily regimen required for the oral contraceptive to work. It’s not known how many packets are affected by the mistake. Some of the pills were as much as 180 degrees out of their usual place thus causing the lot number and expiration date to be seen only on the outer pouch. The pills need to remain in sequential order to maintain the daily regimen.

Doctors are advising women who take these pills to immediately start using a non-hormonal form of birth control. Woman are also advised to inform their healthcare provider immediately and take a pregnancy test if the experience any pregnancy symptoms.

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Safety, dependability, and ease of use are what most women look for in a contraceptive. However, numerous lawsuits have been filed against NuvaRing and other drug companies claiming that some forms of birth control are not as safe as women think they are.

Some lawsuits have been filed claiming that women have been seriously injured after using NuvaRing birth control. While other lawsuits have been filed claiming that young women have died after using the contraceptive. Other lawsuits claim that consumers were not amply cautioned about the increased danger linked with the birth control.

NuvaRing has a mixture of Desogestrel and ethinyl estradiol. A study by the US Food and Drug Administration (FDA) found that the chance of having a cardiovascular episode was greater when woman used a contraceptive that contained 30 – 40 microgram of ehinyl estradiol, which NuvaRing has. Hormones in NuvaRing can also cause a user’s blood to clot easier. Blood clots that form in the legs can travel to the lungs and block vessel carrying blood to the lungs. Some are extremely critical of third and fourth generation forms of birth control because they believe that second generation forms of birth control are safer and just as effective. And they stress that Desogestrel is linked to a greater risk of venous thromboembolism, which can be fatal.

The FDA has begun listening to the fears and concerns over certain forms of birth control. At an advisory committee meeting this past December, the FDA listened to the testimony of parents of a 24-year-old woman who died. The parents believe their daughter developed a pulmonary embolism from using NuvaRing.
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