Prescription for Minoxidil Misfilled with Methotrexate

And other malpractice news
August 2015, Vol 3, No 8 - Malpractice News

In This Article

Prescription for Minoxidil Misfilled with Methotrexate

The Case
The plaintiff, age 24, had undergone a failed kidney transplant and was on dialysis and immunosuppressive therapy. The plaintiff was also hypertensive. In March 2011, the plaintiff picked up his routine medications from Penny Wise Drug. The plaintiff’s prescription for minoxidil 2.5 mg was misfilled with methotrexate 2.5 mg.

The plaintiff began to experience throat pain the following day. After a week, the plaintiff went to the emergency department with a sore throat, left cheek swelling, and pain rated as 7 out of 10. The plaintiff’s oropharynx had a white coating of the buccal mucosa and posterior oropharynx consistent with thrush, and an abscess in the left cheek. The plaintiff was discharged with medication and was instructed to follow-up with the nephrologist.

Four days later, the plaintiff was scheduled for his routine dialysis. The plaintiff was evaluated at St Luke’s because of mouth lesions and worsening clinical condition related to recent antibiotic therapy. The plaintiff was then admitted to St Luke’s, where it was confirmed that there had been a prescription misfill.

The plaintiff had ingested the methotrexate for 10 days. He suffered kidney injury from nephrotoxicity, and required intravenous (IV) administration of antibiotics. The plaintiff also suffered the loss of all of his hair. In addition, the plaintiff required 17 packed red blood cell or platelet transfusions, as well as placement of a central IV catheter to facilitate the IV administration of his medications.

The Verdict
A confidential settlement was reached.

Eric P. Rangel v. Penny Wise Drug Stores, Inc. Canyon County, ID, District Court, Case No. 13-2166.

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Failure to Properly Diagnose and Treat a Child with H1N1 Flu

The Case
The plaintiff’s child, age 8, became ill in August 2009. The child was diagnosed as having the H1N1 strain of flu, and there was an influenza pandemic in the New Orleans area. Two days later, the child was seen by pediatrician Louis Bevrotte, who misdiagnosed the child and prescribed antibiotics. The child was taken to the emergency department of Children’s Hospital the next day, and seen by the on-call pediatrician, Neel Shah. Dr Shah diagnosed flu, but did not prescribe Tamiflu or any other anti-viral medication. The child’s condition continued to worsen, and she was seen 3 days later by her long-time pediatrician, Floyd Buras. Dr Buras did not prescribe any anti-viral medications. Dr Buras saw the child again 3 days after that and sent her to Children’s Hospital; anti-viral medications were started the next day. The child did not respond and was admitted to the intensive care unit. The girl died 13 days after she initially became ill.

The plaintiff alleged negligence in the failure to make a proper, timely diagnosis, and in failing to prescribe anti-viral medications. The plaintiff claimed that the girl was at “high risk” for complications from flu because of a history of pulmonary conditions. The defendants denied any negligence and also claimed that use of anti-viral medication would not have changed the outcome.

The Verdict
An $8 million verdict was returned for the plaintiff against Bevrotte and Buras; Shah received a defense verdict; the state caps on recovery reduced the verdict to $500,000.

Butler v. Bevrotte, et al. Orleans (LA) Parish Court, Case No. 11-3534.

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Woman Claims Flu Vaccine Caused Guillain-Barré Syndrome

The Case
The plaintiff, age 56, received a mandatory flu vaccination through her hospital employer in October 2011. About 2 weeks later, the plaintiff began experiencing numbness, tingling, and weakness in her lower legs, which eventually progressed to her arms. She was diagnosed with Guillain-Barré syndrome. The plaintiff was hospitalized, and received intravenous treatment to improve her immune system, which included plasma, red blood cells, and other blood products. The plaintiff required treatment at a rehabilitation facility to regain her strength and relearn how to walk.

The plaintiff now relies on a cane, walker, and wheelchair for ambulation. The plaintiff also required treatment from a neurologist for debilitating pain in her arms and legs. The plaintiff claimed that she will continue to require therapy, medication, and physician visits. She sought compensation through the National Vaccine Injury Compensation Program. The plaintiff presented expert opinion that the flu vaccine caused the Guillain-Barré syndrome, while the government argued that flu vaccines do not cause Guillain-Barré syndrome.

The Verdict
A $1.5 million settlement was reached prior to the trial.

Wendy Lister v. Secretary of Health and Human Services, US Court of Federal Claims, Case No. 13-492V.

Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, Nashville, Tennessee, 800-298-6288.

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Stakeholder Perspective
Ensuring Patient Safety
Chelsey D’Ambrosio, PharmDc
Donald J. Dietz, RPh, MS

Chelsey D’Ambrosio, PharmDc, and Donald J. Dietz, RPh, MS, provide insight on the role of pharmacists in medical malpractice.

It is the responsibility of a pharmacist to preserve patient safety. In these featured cases, there were preventable errors that led to patient harm. Although there may be mistakes made outside of the pharmacy, it is crucial that pharmacists work stringently to recognize and eliminate the potential for errors within their practices. There are several strategies that can be implemented in both community and clinical practices to minimize error and provide the best outcomes for patients.

Community and clinical pharmacists should familiarize themselves with the Institute for Safe Medication Practices’ high-alert medications lists. Although there are different lists for each setting, there are numerous medications present on both lists. Methotrexate is considered a high-alert medication, and properly holds this title as evidenced by the error in this case. Pharmacists can implement safeguards for the medications included on these lists, such as system alerts and mandatory counseling at time of dispensing.

With regard to safe practices for community pharmacists, some strategies include the use of tall man lettering on clearly labeled shelves. In addition, pharmacists can ask staff members to provide a second-check for long or complicated prescription directions. Potential system changes for implementation could include a hard stop for missing patient allergy information, and flags for special populations (eg, pediatric, geriatric, and pregnant patients). Lastly, community pharmacists should repeat telephone orders back to physicians for confirmation.

Clinical pharmacists should be mindful of the aforementioned safety strategies, as well as implement methods more specific to their own practices. Upon re­viewing a profile or receiving an order for a patient weighing more than 100 kg, pharmacists should confirm that kilograms were not mistakenly entered for pounds. Abbreviations such as “U” for units, “MS” for morphine, or “QD” for daily should not be used, because these may be confused with other numbers, letters, or medications. The commonly used “QD” abbreviation may be mistaken as “QID” (ie, 4 times daily). The Institute for Safe Medication Practices recommends writing the word “daily” instead of “QD.” Also, trailing zeros and naked decimal points should never be used.

Anticipating and preventing errors is essential in providing the best care possible for patients. Pharmacists should practice with a cautious mind and maintain open communication with other healthcare professionals to decrease the risk for medication errors.

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Last modified: August 21, 2015
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