New Jersey Injury Lawyer & Attorney : Law Offices of Scott D. Grossman : Serving Monmouth County, Bergen County

USA Today has an interesting report on how pharmacy boards across many states have a majority of their board members made up of employees of major chain pharmacies, ensuring that any oversight of pharmacies or reduction of filling errors is limited at best.

The concept of having pharmacy chain employees on state pharmacy boards supposedly ensures that these boards have the expertise of seasoned professionals to draw from. While that may be true, it also ensures that the boards are staffed with a number of members who act to protect the interests of the pharmacies they work for. It reduces the concept of an "independent" state board regulating and overseeing the functioning of thousands of pharmacies in a state, to a farce.

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Pharmacies and physicians in Ohio are test driving an electronic prescription system that marks a move from old, handwritten paper prescription to paperless prescription procedures, promising among other things, the reduction of errors.

Physicians in some counties already have the e-prescription system installed, and have been using it with success. There has been a lot of positive feedback about the system that allow doctors to maintain records of patients, and then send their prescriptions to the pharmacy to be filled and ready by the time the patient gets there. The program is part of a nationwide promotion of the system by the federal government including a Medicare bonus incentive for doctors who prescribe through the system, that's expected to kick off in 2009.

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New Hampshire's Pharmacy Board has a neat way of protecting their pharmacists from pharmacy error lawsuits – if an error doesn't result in any disciplinary action, they simply don’t record the incident.

As this report reveals, because of this protective system, citizens have no way of telling how many errors a particular pharmacy or pharmacist has scored on their tally. The State Board of Pharmacy only releases records to the public in case there is any disciplinary action taken against the pharmacist in question, for his error. The Board admits it takes this step to protect the pharmacies and pharmacists. The pharmacies may be safe and protected. But who, we wonder, is responsible for protecting citizens? When records are available for public review only in the event of a disciplinary action, then it becomes hard for people to know exactly how many pharmacies have been diligent in following regulations and maintaining safe dispensing practices, and how many have been casually sweeping pharmacy errors under the Board's carpet. 

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More than 2 years after her death, the parents of a two-year-old girl have succeeded in their personal crusade - the passing of an Ohio bill that would help reduce the kind of pharmacy errors that were responsible for her death.  Emily Jerry died in March of 2006 after a hospital pharmacy technician compounded a chemotherapy drug, with a saline solution that had up to 26 times more salt than was needed for the treatment.

Emily had been diagnosed with an abdominal tumor, and had had been undergoing chemotherapy at the Rainbow Babies and Children's Hospital in Cleveland. The cancer was almost gone, and her parents were looking forward to taking her home. A trip to Disneyland to celebrate the disappearance of the tumor had been planned, and all that was needed to say goodbye to the hospital was one last round of chemotherapy. Instead, Emily woke up after the treatment in severe pain and vomiting violently. She died three days later. It was later that the pharmacy technician's horrible pharmacy error came to light.  

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The New Jersey Senate Health, Human Services and Senior Citizens Committee has unanimously passed an identical version of "The Pharmacy Quality Improvement and Error Prevention Act" A-1025. The new bill is identical to the one I discussed in April of last year, with almost the same provisions and the same language.

This bill titled "The Pharmacy Quality Improvement and Error Prevention Act S-409" has been introduced by Senator Jeff Van Drew, and claims to seek to establish strong measures to prevent pharmacy errors across New Jersey. These measures include the creation of a Medication Error Prevention Task Force consisting of 24 members, that would be responsible for providing guidelines for the improvement of pharmacy quality control standards, and to reduce the number of errors that occur at New Jersey pharmacies.   The bill also require pharmacies in the state to monitor and review any pharmacy errors that may occur, and also mandates the State Board of Pharmacy to release regular alerts about prescriptions drugs that have similar sounding names, so that the frequency of errors is reduced. Pharmacists are required to report any medication errors occurring on their watch to the Board of Pharmacy.

So far, so good. 

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Earlier this year, I had discussed a bill introduced in the New Jersey legislature, called innocuously enough “The Pharmacy Quality Improvement and Error Prevention Act." On the surface of it, the Bill, which was passed unanimously in the Assembly in March 2006, addressed common concerns about the increasing instances of pharmacy errors, and the need for more measures to prevent these errors, and hold pharmacies accountable for the results of any prescription mistakes on their watch. The Bill also included immunity for pharmacists from any civil liability that may arise from prescription mistakes they made. In all the brouhaha over the Bill, its sponsors conveniently failed to highlight this significant point.

Now, an identical bill “The Pharmacy Quality Improvement and Error Prevention Act A-1803" has been introduced in the Assembly by Assemblywoman Valerie Huttle. She has been busy promoting her legislation, hailing it as an effective measure to prevent the number of injuries that occur because of prescription mistakes in New Jersey.  

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It's everyone's biggest nightmare – popping a couple of pills for an ordinary ailment, and discovering later in your hospital emergency room, that the problem could be traced to pharmacy error at your local store. Now, a troubling report by WCNC points to an incentive scheme at North Carolina's biggest chain pharmacy as the cause of a growing number of errors at the franchise.

The company in question is CVS, which has the highest number of stores – 285 of them - in the state out of all the nationwide chains. According to the report, the distinction with other chains doesn't quite end there. CVS also has the highest number of citations from  the North Carolina Pharmacy Board for prescription errors. In fact, the Board has repeatedly cited the chain for creating a work environment in which employees are likely to make mistakes.

 

Regular customers who get their prescriptions filled at CVS are noticing the difference in service, the report says. Staff members often seem to be in a hurry to rush through prescriptions. It's not simply a desire to squeeze more out of their workday that's behind this high speed work environment. As the report points out, the company has incentive systems in place that reward employees based on the volume of prescriptions they fill. In fact, CVS pharmacists routinely receive updates on the amount of extra cash they stand to make depending on how quickly they can fill bottles with pills.

 

The extent to which CVS has been able to continue this practice unchecked, is shocking. Consider these statistics – the Board of Pharmacy stipulates 150 as the number of prescriptions that can safely be filled by a pharmacist in a single day. At CVS, some former employees have gone on record to claim that on a busy day, it's not unusual for pharmacists to fill as many as 500 prescriptions.  

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Earlier this week a story on ksl.com, a Utah television station, reported that an eighteen-year-old honor student received a potentially lethal dose of oxycodone for strep throat and has been in a coma since April 30. The teen, Jessie Scott of Draper, Utah, was given a teaspoon of concentrated oxycodone hydrochloride for pain due to strep throat, when the actual prescription called for a five-milligram dose. The Wal-Mart pharmacy that filled the prescription, was supposed to dilute the concentrated medication before dispensing it to Jessie, but it failed to do so. Jessie received 20 times’ the prescribed dosage due to Wal-Mart’s negligence. As of a result of the pharmacy’s horrific error, a few hours after taking the lethal dose, Jessie Smith’s organs began to fail, he was placed on a ventilator, and one of his lungs collapsed.

Our thoughts and prayers are with Jessie Scott and his family.

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Pharmacy error, mistake, negligence… whatever you want to call it, is becoming a national epidemic. How many more babies and young people have to get injured or die before something is done to address it? Last week, yet another report filed in Texas of newborns receiving an adult dosage of Heparin, the blood thinning medication, leading to terrible tragedy, only this time, the babies did not survive. Unlike the overdose that occurred involving actor Dennis Quaid’s newborn twins, the Texas overdose was not due to a labeling error, rather, it was apparently due to a mixing error by a hospital’s pharmacy. That hospital was Christus Spohn Hospital South in Corpus Christi, Texas. According to a recent AP article, on July 4, 2008, 17 newborns received 100 times the appropriate dosage of the drug. Of the 17, two died, three were released, and the remaining 12 are in the hospital’s NICU.

Kiii.com, a television station in Texas, further reported that the premature twins, a boy and a girl born to Eric and Erica Garcia, were transferred to Christus Spohn after birth  and allegedly died from the Heparin overdose. While the hospital is not admitting responsibility for the twins’ death since they were born four weeks early, they are investigating the matter. It is of note that two of the staff pharmacy employees have taken temporary leave.

Our hearts go out to the Garcia family during this difficult time.

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You have read on this blog my ongoing reporting and analysis of the epidemic of pharmacy errors and the threat to the public that it poses. Well here is a variation on the theme.  Today it was announced on NJ.com, that retail pharmacy chain Rite Aid settled a lawsuit with New Jersey for $475,000 for selling expired over-the-counter medications along with expired infant formulas and baby food. According to the article, 42 Rite Aid stores were found selling expired items throughout New Jersey. If the chain, which also includes Eckerd stores, fails to comply with the terms of the settlement over the next year, it faces an additional $175,000 in penalties.

 Once again, I implore the public to be extra vigilant when shopping at these pharmacies. It is bad enough that we are forced to defend ourselves against prescription errors at the hands of pharmacists and their technicians; now simply going to the shelves for Tylenol or a can of Similac has become a potential health threat to us as well.

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As a pharmacy error attorney, I have witnessed first hand many cases where children and adults are given the wrong medication due to medications have similar names and sizes so they are easily confused by pharmacy staff. In addition, children taken to adult hospitals suffer injuries or fatalities because these hospitals carry mostly adult size doses of medication so when a child is treated, their medication is often confused with the appropriate adult size.

According to an article from the American Medical News, a shocking 11% of child patients have adverse drug events during hospital stays. Most of the results came from children staying in adult hospitals and given adult sized doses instead of the pediatric size. Dr. Sharek, chief clinical patient safety officer at Lucile Packard Children's Hospital in Palo Alto, Calif. said “We are so used to writing pediatric, weight-based doses and when children are being cared for at adult hospitals staffed by adult-based nurses and adult-based pharmacists, that's a type of error that could theoretically occur a lot more frequently." The American Medical News goes on to say “The Joint Commission, which accredits and certifies more than 15,000 U.S. health care organizations and programs, said in its sentinel event alert that children are at greater risk for adverse drug events. That's because most medications are formulated and packaged for adults, and most hospitals and emergency departments are geared toward caring for adults.” The Joint Commission is further investigating these problems and suggests that hospitals identify and administer pediatric medications. Frank Federico, RPh, said "Medication should be delivered to the nursing unit or available in ready-to-administer fashion. That way, there is less that nurses have to do and less chance for error.”

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A large chain pharmacy commits another mistake by mislabeling a three month old's prescription with the wrong dosage.  I used the word mistake here because it is a well known way to describe pharmacy errors but the truth is that the words "pharmacy mistake" sound way too innocuous for these situations. 

This time, in a  recent article on FoxNews.com, the victim was a baby with a sinus infection. The parents filled a doctor's prescription for Histacol DM syrup at a Palm Coast, Florida Walgreen's store. The dosage of the medication was to be a quarter of a milliliter. The prescription was erroneously filled by a Walgreen's pharmacy, who wrote the  dosage at a quarter teaspoon, six times the prescribed amount of medication.  Upon taking the first dosage, the baby became unresponsive and was rushed to the hospital, where doctors were able to stabilize the child. In a typical move,  Walgreen's offered $2,000 to make this bad story disappear, which the family refused.

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The medical journal Pediatrics has released a study that shows that hospitalized children are at a high risk of being overdosed, given the wrong medication or have an adverse reaction. In fact, the study revealed that one out of every 15 hospitalized children has fallen victim to medication errors. It is a heartbreaking, terribly frightening new study. Read FoxNews.com's article about the study.

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There was an article on USAToday.com which excerpted an interview with a young pharmacist (who incidentally is now enrolled in law school), about pharmacy errors. It was a pretty interesting article, as it gave another view as to who is ultimately responsible for prescriptions that are filled and dispensed to the drug-consuming public. The pharmacist, Eli Phillips, Jr., a second generation pharmacist (his dad is a pharmacist too), was quoted as saying "Ultimately, the pharmacist is responsible for every prescription that leaves, whether it is correct or incorrect. It's all on the pharmacist. The technicians are there only as a means of support."

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I found this article on courant.com about a report recently released by standard-setting organization for the pharmaceutical and dietary supplement industry, U.S. Pharmacopeiahas, or USP, which found that there are at least 3000 pairs of drugs with similar names, which is contributing to the high incidence of pharmacy dispensing mistakes. Here are a few examples:

-Zestril (high blood pressure) and  Zetia (cholesterol)

-Lamactil (epilepsy) and Lamisil (fungal infections)

-Celebrex (arthritis) and Celexa (antidepressant)

-Zantac (reflux) and Xanax (anxiety)

Scary, right? The article offers some helpful tips to protect yourself from a mix-up with potentially deadly consequences:

-Don't have your prescription telephoned in

-Make sure the script is printed in English (as opposed to Latin code or illegible scribble)

-Keep a copy of your prescription

-Double check the pills and the label BEFORE you leave the pharmacy

 

 

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A recent article on Science Daily.com reported on a study which revealed that  pharmacists who work at pharmacies with drive-thru service windows feel that the drive-thru causes distractions that may lead to delays and dispensing errors. 

 

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I’m sure everyone is aware of the horror that actor Dennis Quaid and his wife Kimberly Buffington have suffered through in recent months. The couple welcomed twins in late November who were accidentally given 10,000 units of heparin instead of the usual 10 units of heparin while in the hospital (Cedar-Sinai Medical Center, Los Angeles). The babies, thankfully are recovering, but the Quaids have filed a lawsuit against the maker of the drug. The lawsuit centers around Baxter Healthcare Corporation’s failure to clearly label its 10 unit and 10,000 unit vials of heparin and failing to recall the product after three other babies died due to such a mistake. Apparently, both the small and large doses of the drug have similarly colored labels.

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KLTV-7 out of Tyler-Longview, Texas reported today that a Walgreen pharmacy filled a prescription for the antibiotic Augmentin four times the prescribed dosage for a five-month old baby. When the baby's mother gave her daughter the first dosage, the baby was vomiting and was lethargic. The label on the prescription said that the baby was to get two teaspoons twice a day of the antibiotic. The baby's doctor prescribed 1/2 teaspoon twice a day. When the pharmacist was confronted with the error, his response was that they were really busy the night the prescription was filled and "accidents happen." Unbelievable. While the baby will be okay, it's yet another lesson to the prescription consuming public how vigilant we all must be when it comes to our health.

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A report out of Columbus, Georgia late last week revealed that a woman went to her local CVS Pharmacy to fill a Vicadin prescription for her son who sprained his ankle. The prescription was for twenty pills, but the pharmacist put 90 pills in the bottle. Horrified, and afraid of what could happen if someone got his hands on these excess pills, she called the pharmacy to report it. At that time she was told to either bring them back or throw them out, and when she told the pharmacist that she might not be able to get back to the store that night, she was told to, “Do what you want with them. Keep them. It doesn’t matter.” This did not sit well with the worried mother who then contacted the Georgia Narcotics Agency, who advised that she return the excess pills to the CVS, and when she went to do just that, the pharmacist refused to take them back. What an incredulous error in light of the fact pain killer prescriptions are to be checked by three different pharmacy staffers, including the pharmacist.

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When I read this story, I was horrified by what happened to a newly pregnant St. Louis woman who went to Walgreens to fill a prescription for prenatal vitamins and was instead given a potent chemotherapy drug that killed her unborn child. The woman and her husband filed a lawsuit seeking some form of justice against the powerful pharmacy chain, alleging that Walgreens failed to properly supervise pharmacy personnel who dispensed the medicine, failed to verify the prescription with her physician, and failed to follow appropriate protocol.

The couple alleges in their complaint that she began to feel ill and began vomiting about a month into her pregnancy and assumed it was morning sickness, all the while taking what she thought were the prenatal vitamins.  About a month later, she miscarried her baby. It is alleged that her unborn child was killed due to the ingesting of the potent chemotherapy drug.  After her miscarriage, she continued to take the chemotherapy drugs (still thinking they were prenatal vitamins) because she believed that the vitamins would prepare her for a subsequent pregnancy. It wasn't until she telephoned Walgreens for a refill that the pharmacist realized the mistake.  Please read the full article.  I implore you to write in about your own personal stories pertaining to pharmacy mistakes and errors and your opinions about what has happened to this couple.

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Late last week, a friend of mine called the office to tell me about a co-worker who fell victim to the ever-increasing incidence of pharmacy error. The co-worker, let’s call her “Janet,” hadn’t been feeling well and visited her physician, who diagnosed a common infection and prescribed a course of antibiotics. Janet filled the prescription at her local chain pharmacy located in Western Monmouth County. Within a day or two after starting the medication, Janet was feeling increasingly sicker, and at one point, thought she was having a stroke, as one side of her body lost all sensation. Janet’s husband rushed her to the emergency room; at first, the ER doctors thought she was suffering from a rare allergic reaction to the antibiotic, but soon learned that the pharmacy filled the prescription with the incorrect dosage, double the dosage originally prescribed by the doctor! Continue Reading...

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HealthDay News cited a recent study in that found that many of the harmful errors in chemotherapy for pediatric cancer patients are caused by dispensing or administration mistakes rather than by prescribing errors. According to the study, 85 percent of the drug errors were not detected until the child received the medication, and about 16 percent required an escalation of care as a result of the errors.

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A Portland, Oregon pharmacy erroneously made a drug 10 times more potent than intended, killing three people who received it at an Oregon clinic in April 2007. A recent article in the  Northwest Florida Daily News  reported that ApotheCure Inc., a drug compounding pharmacy company in Texas, admitted that an employee made a weighing error in the creation of the drug colchicine. The improperly weighed drug was then sent to the Center for Integrative Medicine in Portland, where three people received injections of the defective batch to treat back pain and subsequently died between the end of March and beginning of April from toxic levels of the drug. The Food and Drug Administration is investigating this matter.


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A recent post on The Blotter, an ABC News Blog, reported yet another incident of pharmacy negligence in the wake of the report on "20/20" last month. This time, a seven year old  Modesto, California boy was given an adult high blood pressure medication by a Walgreen's pharmacy, instead of the medication he needed for a mental health condition. The boy ended up in the hospital and the boy's mother was urged to report the incident. Not knowing where to turn, she called ABC News. The drug the boy was given, Toprol XL, is usually administered to adults with high blood pressure. The drug the boy was supposed to take was Tegretol-XR.  Both drugs sound very similar and are apparently often confused, to the point that in 2005, the FDA issued a warning about the potential for confusing these two medications. In the case of the seven year old, Walgreen's released a statement to ABC News, whereby it shifted some of the blame to the boy's doctor for hand writing the prescription which was ultimately misread by the pharmacy.

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Citizens of New Jersey, would it shock you to learn that in response to concerns about a dangerous increase in pharmacy-related prescription errors, your state legislature has introduced a bill, which if enacted into law, would preclude all forms of recourse should your pharmacist’s mistake cause you or your loved ones to suffer serious physical injuries. Well it’s hard to believe, but amazingly true: pharmacists would receive total immunity from civil liability for any errors committed resulting in serious harm as long as the error was reported to the New Jersey Board of Pharmacy. Even more astonishing is the likely effect the legislation will have on the large national and regional pharmacy chains- complete insulation from liability for the negligent acts of their pharmacist employees. Continue Reading...

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Tonight's 20/20 program (see "Tragic Mistakes") sheds light on what can only be called a silent epidemic of the occurrence of pharmacy errors across the nation. The segment featured the tragic story of a young mother who gave her four-month old daughter who was born prematurely what she thought was an anti-seizure medication. What she actually gave the infant was an adult dose of a diabetes medication, which left her daughter permanently disabled, unable to talk, walk or feed herself. Walgreen's, the national pharmacy chain, was responsible for the dispensing error, this act of negligence that caused irreparable harm.

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Late last year, a jury delivered a verdict ordering Eckerd Corporation to pay Ms. Tiffany Phillips $7.7 million for a pharmacy error which resulted in the loss of the young woman's new kidney. CVS, also a named defendant in the action, reached a confidential settlement with Phillips for an undisclosed amount.
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Let's say you go to your internist this past winter complaining of a sinus infection. Your trusted doctor prescribes you a brand new antibiotic, not the usual one you've tolerated well and taken in the past. Why did he prescribe this new drug as opposed to the old standby? Is it because your doctor believes this new drug is the state of the art in fighting sinus infections... or is something else motivating him?

The pharmaceutical industry's influence on doctors' prescribing practices looms largely in the background in today's medical practice. It's more than lunches or free pens from the perky sales rep dispensing free samples with the office manager. Way more.

 

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Pharmacy errors can occur when a pharmacist i) dispenses the incorrect medication, ii) dispenses the incorrect dosage of the correct medication, iii) dispenses the correct medication with incorrect instructions, or iv) when the pharmacist fails to take into account known drug allergies or dangerous drug interactions with other medications being taken by a patient.

Serious injuries and even death can result from the negligence of pharmacists. People who have fallen victim to pharmacy negligence may become unable to work, may require long term care, may become disabled, and may experience a serious decline in quality of life. Should you or someone you love experience a serious personal injury resulting from the negligence of your pharmacy, contact The Law Offices of Scott D. Grossman, LLC for a free and confidential consultation at (732) 625-9494 or toll free (888) 899-9494.

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A sad but unfortunately all too increasingly common story of how devastating pharmacists' errors can be. Please read this article and empower yourself when you need a prescription filled.

Read the entire article on consumeraffairs.com.

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New research conducted by the University of California, San Diego concluded that in the first few days of every month, the incidence of fatalities due to pharmacy negligence rises by as much as 25 percent. The study was published in Pharmacotherapy, the journal of the American College of Clinical Pharmacy.

Read a synopsis of the study on ScienceBlog.com. 

 

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