Negligence in Dispensing Methotrexate

And other medical malpractice news
February 2015, Vol 3, No 2 - Malpractice News

In This Article

Negligence in Dispensing Methotrexate

The Case
The plaintiff, age 62, was administered methotrexate, and maintained that she received an excessive dosage from what her physician had ordered (1 dose/week), and was administered 1 dose daily for 8 days. The plaintiff claimed that her hair fell out, she developed mouth sores, and suffered acute kidney failure. The plaintiff recovered, but claimed that she was at increased of kidney failure in the future. The plaintiff alleged negligence in dispensing the medication.

The defendant claimed that any error was solely the fault of the hospital’s nursing staff in misreading the physician’s order. The defendant argued that he was not required to check a physician’s order each time it refilled to the automated dispensing machine. According to the Trial Reporter of Central and Northern Arizona, a confidential settlement was reached with the hospital prior to trial. A $600,000 verdict was returned at trial with the jury finding the defendant 20% at fault, and the hospital 80% at fault. The plaintiff was to receive $120,000 from the defendant.

The Verdict
Hospital settles for confidential amount prior to $120,000 net verdict against pharmacy

Wilson v. Fuller-Selle, LLC, d/b/a Pharmacare Services, Maricopa County (AZ) Superior Court, Case No. CV 2012-000908.

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Failure to Inform Patient of Risk of Not Taking All of Prescribed Antibiotic

The Case
The plaintiff’s decedent, age 84, went to Palisades Medical Center in January 2010. The decedent was suffering from pulmonary edema, caused by congestive heart failure, was admitted, and placed under the care of internist Hilda Roque-Dieguez. Three days later the decedent was prescribed an antibiotic in response to lower-leg cellulitis. The decedent was also diagnosed with bacteremia and she developed sepsis. The woman died in early March 2010, while hospitalized. Several defendants were initially named in this suit, but the matter went to trial as to Dr Roque-Dieguez only.

The plaintiff claimed that the defendant failed to properly monitor the decedent’s intake of the antibiotic for cellulitis, and failed to fully inform her regarding the risks of not taking the full amount. The decedent missed several doses of the antibiotic, which the plaintiff claimed caused the decedent to develop bacteremia and sepsis, contributing to her death. The plaintiff claimed that an alternative antibiotic should have been prescribed or the decedent should have been fully informed of the risks of not taking the antibiotic prescribed. The plaintiff claimed that the defendant was aware that the decedent was missing doses.

The defendant claimed that she did inform the decedent of the risks of not taking the antibiotic. The defendant also claimed that the woman’s death was due to pre-existing cardiac conditions and that sepsis had not been confirmed. According to a published account a defense verdict was returned.

The Verdict
New Jersey Defense Verdict

Angel Diaz, o/b/o Estate of Emilia Diaz v. Palisades Medical Center Corp, Pauline J. Nualla, RN, and Hilda Roque-Dieguez, MD, Hudson County (NJ) Superior Court, Case No. L-000109-12.

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Improper Prescription of Halobetasol, Multiple Other Prescriptions Blamed for Blisters

The Case
The plaintiff, age 50, went to her long-time primary care physician in August 2010 to seek treatment for fever blisters, as well as to refill her medications. The plaintiff had a history of eczema, fever blisters, and facial acne. She was given refills on prescriptions for Clindamycin 1% lotion for her acne, Halobetasol 0.05% ointment for her eczema, and Zovirax 5% cream and Valcyclovir 500 mg tablets for her fever blisters. The plaintiff had these prescriptions filled the same day. In January and February 2011, the plaintiff suffered a severe breakout of blisters on her face. The plaintiff could not leave home and was too embarrassed to work for 2 weeks. The plaintiff alleged negligence in the prescription of Halobetasol for facial acne and also in prescribing multiple medications at 1 time.

The defendant argued that the Halobetasol was not prescribed for her face, but for the eczema on her elbows. The defendant claimed that the plaintiff had confused her medications, causing her to use the wrong medication on her face. The defendant also claimed that, in December 2010, the plaintiff had received large amounts of prescription steroids to treat a sinus infection from a different physician, arguing that the plaintiff’s breakout could have been caused by the influx of additional steroids into the system.

The Verdict
Texas Defense Verdict

Rosetta Ross v. Yaa Amoah-Honny, MD, Harris County (TX) District Court, Case No. N/A.

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

Stakeholder Perspective
Identifying Opportunities For Improvement
Donald J. Dietz, RPh, MS

Donald J. Dietz, RPh, MS, Provides Insight On The Role Of Pharmacists In Medical Malpractice

Retail pharmacists perform a valuable role in safeguarding the appropriate use of prescription pharmaceuticals. These 3 recent cases are examples where patients were harmed by the inappropriate use of prescription pharmaceuticals. As is often the case, there are multiple external factors involved that led to patient harm that extended well beyond the pharmacist’s role. Our goal is to call attention to situations where pharmacists could intervene and prevent untoward medical events.

In the first case, methotrexate’s multiple dosing regimens lead to dispensing confusion. When preparing a prescription for initial dispensing and the medication has multiple dosing administrations, the pharmacist may want to verify the product, strength, and administration schedule with a prescriber prior to dispensing. Pharmacists should also pay close attention to high-dose alerts and other Drug Utilization Review messages for these products.

The takeaway for pharmacists in the second case is to communicate the importance of how to take a prescription at the initiation of therapy. With an antibiotic, the pharmacist can play an important role by conveying the importance of not missing doses. Pharmacists should also educate patients about what to do when a dose is missed and ensure the patient knows that the medication must be taken until completely finished.

The third case identifies opportunities for pharmacists to counsel patients when multiple prescriptions are issued at the same time. In this situation, the patient was to receive 4 prescription products for 3 different dermatological conditions. In addition, the patient had received a recent corticosteroid prescription from a different prescriber to systemically treat a sinus infection. The learning opportunity here includes ascertaining if the patient is on any other prescription or over-the-counter medications when new therapy is initiated. Furthermore, with multiple dermatological conditions, it would be an excellent opportunity to review with the patient which prescription is used to treat each condition, how and where it is to be applied, and what are signs that the medication is working as prescribed. Conversely, pharmacists should educate patients on what side effects to be aware of during the course of treatment.

It is always easier to retrospectively examine situations and identify opportunities for improvement. The goal here is to help us proactively identify challenging situations you may encounter in your pharmacy or clinic, and realize the importance of taking the extra time to help prevent untoward events.

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