Articles Posted in Medication Dosing Error

We rely on doctors, including psychiatrists, to keep us healthy. When one prescribes us a medication we trust them and take it. This is particularly true of vulnerable people like nursing home residents and other individuals who have to rely on health care providers for their day-to-day needs. Sometimes health care providers make errors, so we have a medical malpractice system to help right those wrongs. But in some much rarer cases doctors are much more malicious than that, and they actually intentionally act against their patients’ interests for their own financial benefit. These cases can result in doctors losing their licenses or even facing criminal charges.

Suspended Illinois Psychiatrist Pleads Guilty to Criminal Charges

Way back in 2009 the Chicago Tribune and Pro Publica reported that Dr. Michael Reinstein was over prescribing the psychiatric drug clozapine and that it appeared that he was receiving kickbacks for doing so. Previously, in the early 1990s, Reinstein was actually suspended from the Medicaid program after being accused of failing to keep proper records. His Medicaid bills from 1991 showed that he had cared for 70 patients a day on 44 different days and that on 12 days he had seen over 100 patients. If a doctor were to see 100 patients even in a 16 hour shift he or she would have a little less than ten minutes with each patient and that presumes that the doctor would take no breaks to eat, get a glass of water, or use the restroom.
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When you or a loved one is facing what appears to be a terminal illness treatment decisions can be difficult. Not only do you often have to learn a lot to truly give informed consent to the available treatments, but in the case of experimental treatments even more issues arise. The experimental nature of these treatments means that there is no guarantee that they will work and no guarantee that they will not make your situation even worse than it already is, but on the other hand such a treatment may present the only chance there is of recovery.

Some patients are pushed into these treatments and medications without truly understanding the consequences while others who know what they are getting into are denied access to potentially life saving or lengthening treatment. The red tape patients and their doctors have to go through to get access to these treatments can be prohibitive. This conflict is real and difficult to resolve. In light of it, the Food and Drug Administration (FDA) has now announced that it will make access to these treatments easier for patients.

FDA Announces New Policy
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One of the saddest things about many of the personal injuries and wrongful deaths that result from medical malpractice is that so many of these injuries are entirely preventable. Whether its a hospital’s failure to use appropriate safety protocols or a medical worker’s failure to comply with those protocols, far too many people suffer entirely preventable injuries.

Study Discusses Evidence-Based Estimate of Patient Harms Associated with Hospital Care The Journal of Patient Safety published a study by Dr. John T. James, PhD that provides information about preventable hospital injuries. In the study, Dr. James reviewed data from medical records of patients treated in New York Hospitals. The original study was based on data from 1984 but it has now been updated with numbers from studies from 2008 to 2011. The studies used what is called the “Global Trigger Tool” to flag certain evidence in medical records that may point to an adverse event that harms a patient. The review of these records allowed the study’s author to estimate that the true number of preventable patient deaths caused by hospital error is around 400,000 per year. Experts were also able to estimate that serious harm happens somewhere between ten and twenty times as often as lethal harm.
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The Food and Drug Administration (FDA) announced today that it has approved a new prescription drug to treat chronic hepatitis C(genotype 1). The drug is called Harvoni and it is made by Gilead Sciences. It is the first combination pill approved to treat the disease, and is also the first approved treatment for the disease that does not also require the administration of interferon or ribavirin. The drug works by interfering with certain enzymes that the hepatitis C virus requires in order to multiply. The hope is that using this sort of one-pill treatment for the disease will simplify treatment. It is a laudable goal, as simpler treatment regimens could ultimately results in less medical malpractice and better outcomes for patients, assuming that the simpler treatment regimen is safe.

Additional Purported Benefits of the Drug

In addition to being a one-pill solution, Harvoni could also decrease the overall duration of treatment for Hepatitis C, reports The New York Times. For a large number of patients it would also make it possible for them to be treated exclusively with an oral medication for the first time. Finally, it is cheaper than an already existing treatment called Sovaldi, also made by Gilead Sciences. However, that does not mean by an stretch of the imagination that Harvoni will be cheap.
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The Chicago Tribune reports that Illinois officials have suspended a controversial psychiatrist’s license to practice. The doctor, Dr. Michael Reinstein, prescribed a dangerous antipsychotic drug called clozapine to patients in nursing homes and mental health facilities. Dr. Reinstein prescribed to drug to over half of the patients he was treating. The drug is linked to the potentially wrongful deaths of three of Dr. Reinstein’s patients, resulting in the doctor being accused of fraud. As it turns out, the accusations are substantiated.

The Illinois medical board suspended Dr. Reinstein’s license because it found that he received $350,000 in illegal payments from the maker of clozapine while he disregarded both the drug’s life-threatening effects and the fact that there were other safer treatment options for his patients. Clozapine increases the risk of death in elderly patients and can result in inflammation of the heart wall and seizures. It also has substantial side effects that are not fatal but that seriously impact quality of life, including but not limited to extreme constipation, bedwetting, night-time drooling, muscle stiffness, sedation, tremors, and weight gain. Prescribing such dangerous drugs unnecessarily is a serious type of medication error malpractice.
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Prescription drug errors are a serious cause of death and injury in the United States. As we reported earlier this year, Portland’s KATU found that 15,000 people are killed each year by prescription pills in the United States. The Food and Drug Administration (FDA) reports that medication errors kill at least one person every day in the United States, and injury 1.3 million others each year. These drug errors often result in lawsuits over personal injury or even wrongful death.

In a recent article, California Health Report described a different type of prescription drug problem that we don’t often think about that is becoming much more serious as our country becomes more and more diverse. According to the United States Census Bureau, one in five Americans speaks a language other than English at home. However, many pharmacies only provide drug information and instructions in English. And that English, especially the English regarding side effects and drug interactions, can be difficult to understand for even a native English speaker.
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Chicago Healthcare Daily reports the City of Chicago is suing five drug companies. The city claims that the drug companies are pushing consumer use of prescription painkillers which creates opioid addicts and drives up costs for all consumers. The lawsuit over the prescription drugs asserts that, since 2007, the city has paid for almost $9.5 million worth of prescription opioids. These medicines, while necessary to treat some people’s pain, are highly addictive.

The theory behind the lawsuit is that the drug companies have misled the public both about the risks of using these painkillers and about the benefits of taking the medications. This leaves the patients who take the pills unaware of the costs and benefits of the drugs. These addictive drugs are similar to heroin, which leads some who become addicted to the pills to move on to heroin since it can be both cheaper and easier to obtain. Chicago is not the first to make these claims, as two counties in California already filed similar suits.
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Investigative journalists at Portland’s KATU published an in depth report this week on the severity of the pharmacy error problem. They report that 15,000 people are killed each year by prescription pills in the United States. The theory is that due to the danger these pills can pose, those who dispense them should be held to a high standard. But unfortunately, far too many of those charged with the public safety fall short.

Intoxicated Pharmacists

The KATU team examined the records of thousands of pharmacies and pharmacy workers. The results were shocking. They found one pharmacist who was working not just drunk, but with a blood alcohol content more than twice what the legal limit is in most states. They found pharmacists taking the drugs they were supposed to be dispensing. At least one pharmacist was taking amphetamines and replacing them with empty capsules. Any of these intoxicated people could make serious errors in dispensing medication.

Take only as directed. It’s a warning that’s easy to follow. But what happens when physicians transfer a patient’s care to another provider without knowing what medications that patient has already been prescribed? Serious injury and even death can occur when transitions in care leads to uninformed medication orders. To combat these complications, the medical community has been implementing Medical Reconciliation, a process to compare a patient’s medications across caregivers and pharmacies in order to identify duplications, interactions between medications, and whether patients should continue taking current medications.

Medical Reconciliation should be implemented whenever there is a transition in care where new medications are ordered or existing orders are rewritten. A care transition may include changes in setting, service, practitioner, or level of care. For example, a patient’s daily medication may be suspended during a hospital stay, and the need to restart the medication upon discharge may be overlooked. Or a dosage has been mis-transcribed and when a new physician assumed care, the patient was overdosed and seriously injured. Medical Reconciliation attempts to prevent discrepancies like this.

The process of Medical Reconciliation includes

A common form of medical negligence concerns medication errors. Approximately 1.5 million people in the United States are affected by a medication error in some way each year. A medication error can occur at any point in time between when the prescription is made for a certain medication to the administration of the drug to a patient. There can also be errors made by the prescription filling pharmacy. An improper medication can exacerbate a patient’s problem, or could even cause death.

Doctor Prescribes the Incorrect Medication

There are many ways in which a doctor could be liable for negligently causing a medication error when preparing a prescription. For example, the doctor could prescribe the incorrect medication to treat a diagnosed condition, which could cause the condition to get worse. A medication error at this stage in the prescription process could be the result of an improper diagnosis made by the doctor in the first place, a human error could be made by the doctor in transcribing the prescription, or the medication error could be the result if the doctor improperly prescribes a dosage amount that is too small or too large. Dosage errors are the most common medication error that occurs due to the doctor’s negligence. The doctor could also be negligent if he or she prescribes multiple medications but fails to consider the potential for hazardous drug interactions that could occur if the patient were to take the prescribed medications together in combination.

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