|
In a recent post I highlighted the hunger strike of Tampa pharmacist Raj Bhat RPH. He started his hunger strike on July 5, 2010 to protest what he believes are dangerously high quotas required of pharmacists working for online pharmacy company Medco. According to Bhat the quotas required online pharmacists to fill upwards 45 prescriptions per hour, a pace he says leads to life threatening prescription errors.
As a pharmacy malpractice attorney, I have often criticized large pharmacy chains for high quotas that put profits over patient safety. Quotas increase profits because the more prescriptions that are filled, the more money the company makes. Quotas can compromise patient safety however, because when the pharmacists work at too fast a pace to meet unreasonably high quotas, they make mistakes like filling the prescription with the wrong medicine or the wrong dose of medicine.
Bhat's hunger strike is more than simply criticizing quotas. It is an active attempt to end the practice by drawing attention to it. As of January 17, 2011 he had been on his hunger strike for 28 weeks. On that day his blog was updated with a post indicating he suspended the hunger strike to "drink a glass of orange juice". Apparently, his heath has spiraled downward from going without food for so long. His current status is unknown because that was the last time he posted on his blog and there have been know media stories on him in a long time.
I have deep respect for Bhat's desire to make a difference and his willingness to take a moral stand. However, I can't help but wonder if his hunger strike will accomplish nothing more than him quitting or worse yet dying without change. He does not seem to understand that moral conviction and a willingness to put your life on the line is not enough. While true change can occur through such courageous acts, the act alone is never enough. To prevail, the act must be used as a vehicle to bring relentless, continuing, and unending public media attention to the situation. Bhat has failed to grasp this point. His blog is rarely updated and he does not appear to know how to generate ongoing media attention. Hopefully, he will figure this out before it is too late.
I have written many posts on the topic of electronic prescriptions. Up until now, my review of the literature has suggested that it reduces the number of medication errors whether the result of a pharmacy, hospital, doctor, or nurse. However, at least some researchers are now concluding that the practice of using computer software to enter the prescription, order the prescription, and fill the prescription with the proper medicine at the proper dose and frequency can create errors unique to the electronic format.
Lynn Peoples recently wrote on the subject for Anesthesiology News. Her article quotes statistics provided by anesthesia resident and researcher Karen Caputo Nanji M.D. Apparently Dr. Nanji and her colleagues studied pharmacy chains in Florida and other states. Their findings included the fact that 11.6% of the electronic prescriptions had errors. Of those errors 60% were missing information, 15.9% lacked clarity, 15.7% had conflicting information, and 7.6% involved the wrong prescription.
Of course these results are from only one study. However, the researchers did review 3898 electronic prescriptions. The sample size seems large enough to be statistically relevant. If so, it maybe that electronic prescribing does little in the long run to reduce prescription pharmacy errors.
Online pharmacies continue to grow rapidly. The growth is largely based on their claims of cost savings and convenience of doorstep delivery of prescriptions. The industry claims that cost savings are achieved based on the elimination of the brick and mortar store. However, according to an article in the Baltimoresun.com, pharmacists working for Medco Health Systems are claiming that cost savings are also coming from quotas that may lead to medication errors.
A former Medco pharmacist in Tampa Florida is so concerned about the quotas causing mistakes in filling prescriptions that he began a hunger strike. Raj Bhat was a pharmacist in Medco's Tampa mail order pharmacy filling plant until he was fired in 2005. He claims he was fired because of complaints about the company's prescription filling quota of up to 45 prescriptions an hour. The company says they fired him because of poor job performance. Bhat started the hunger strike in early July of 2010 after a trial court dismissed his lawsuit against the company. The lawsuit claimed damages as a result of his firing. Although Bhat has appealed the trial court's decision, the appellate process can be very slow. It may take years before an appellate court ultimately decides whether his lawsuit can move forward.
Apparently, the United Steel Workers Union has taken up the cause because Medco pharmacists have joined their union. The Baltimore Sun articled quoted the Steelworkers Union as saying the company makes high demands on its professionals, requiring them to work at a pace they think is too fast. Pharmacists have complained for years that working at too fast a pace can lead to errors in judgment resulting in filling prescriptions with the wrong medicine or the wrong dose of medicine. For example, Daniel Hussar, a pharmacy professor at the University of the Sciences in Philadelphia says "The large chains push their pharmacists to work 10, 12, 14 hours a day at a pace that is often a blur."
Medco denies it has quotas. Instead, the company says "Our longtime operating policy is that we have performance standards to ensure we maximize the delivery of both quality of care and cost effectiveness." As a Florida pharmacy error lawyer, this statement sounds to me like corporate double speak. After all, any definition of performance standards that revolves around filling prescriptions would have to involve quotas. Especially in light of the number of former employees that have surfaced willing to say the company has quotas.
Unfortunately, the Florida Board of Pharmacy does not believe it has the power to regulate the number of prescriptions a pharmacist fills in any given time period. Their rational is that no specific law states the board can set a specific limit on the number of prescriptions filled. However, it appears the board may be missing the point. They law does give the Board the power to protect the public health. Based the number of pharmacy error injuries that have been blamed on pharmacists moving too fast, it would seem to me that quotas do affect public health.
A pharmacy prescription misfill occurs when the pharmacist fills a prescription with the wrong medicine. Sometimes the misfill can cause personal injury or death. When this occurs, the victim and or the victim's family should consult a personal injury attorney to decide whether it makes sense to file a personal injury lawsuit.
Recently, A Pharmacy misfill attorney brought suit on behalf of Reva Tosh and her husband, Gerald Tosh, against Rite Aid pharmacy in Montgomery, Alabama. According an article published January 27, 2010 in the Montgomery Advertiser Riva Tosh took her prescription for pain medicine to the Rite Aid to be filled. The prescription misfill occurred when the Rite Aid pharmacy filled the prescription with a steroid called dexamethasone, a steroid used in cancer treatment. The medicine was given in a dose seven times the normal dose. Mrs. Josh took it for 28 days before the prescription misfill was discovered.
The main issue at trial was whether Mrs. Josh's Cushing Syndrome, a disorder that caused her to have mental and physical problems was caused by the Rite Aid prescription misfill. The jury apparently believed that it did. The jury awarded Mrs. Josh 2 million dollars for her damages and awarded her husband $500,000.00 for loss of his wife's companionship.
Walgreens recently announced its third quarter results. According to an Associated Press Article published in the New York Times, Walgreens pharmacy sales were up 4.5 percent for the quarter over last year. There was no mention in the article about whether pharmacy errors were also up. That is because there is no National requirement to report them. Only the pharmacies themselves really know the statistics on how many prescriptions are misfilled and how many lead to injuries. Some have suggested the error rate is about 3 percent. However, one thing is clear, prescription mistakes continue to happen.
Alison Young of the Atlanta Constitution recently wrote an enlightening article on the subject. In the article she describes the personal stories of several consumers that recieved the wrong medicine or wrong dose of medicine. She pointed out that CVS, Rite Aid, Kmart and Kroger, the leading pharmacy chains in Georga, have issued statements saying that safety is their top priority and that they all have systems to ensure prescription accuracy.
Most people do not think to check the medicine they have received from a pharmacy. They rely on the fact that pharmacist's are professionals. It never crosses their mind that the pharmacist may have made a mistake. Unfortunately, their is a very real possiblity that the pharmacist has filled your prescription with the wrong medicine or the wrong dose of medicine.
According to the FDA, as many as 1.3 million people are injured as a result of medication errors each year. With statistics like this, it does not make sense to blindly trust that your pharmacist has properly filled your priscription. I have created a video to help the consumer make sure they have received the correct medicine. To view the video click on this pharmacy error prevention link.
The number of pharmacy mistakes continues to rise with the ever increasing number of prescriptions filled in the United States each year. Sometimes pharmacy malpractice occurs because the pharmacy has too few qualified employees for the number of prescriptions it is filling. Other times pharmacy negligence occurs because some pharmacists may not be paying attention to what they are doing. It is hard to know whether any real discipline occurs when a pharmacist makes multiple errors because there are really no mandatory error reporting requirements. However, state Pharmacy Boards do receive voluntary complaints from time to time.
It is good to know that at least in Bridgeport Connecticut, the pharmacy Boards investigate the pharmacy mistake complaints that are made. After complaints from three separate customers, the state Department of Consumer Protection began investigating CVS pharmacist Holland K. Nguyen. As a result, she is now facing disciplinary charges for allegedly making pharmacy prescription errors in improperly filling two dozen customers' prescriptions while working at a CVS pharmacy.
According to The Courant, Nguyen gave some customers the wrong drug, gave others the wrong dose of a drug, and dispensed some drugs with improper instructions. For example, state records indicate she allegedly gave one customer 50 times the prescribed dose of the steroid Prednisone; gave another customer Viagra instead of the medication the customer was supposed to receive; gave another customer the blood-pressure drug Quinapril in a 10 mg dose instead of the 40 mg dose that the prescription called for; and gave another patient an antibiotic with directions to take one tablet four times a day when it should have been taken twice a day. These errors and the others occurred between 2005 and 2008 while she was working at a CVS pharmacy on Boston Avenue in Bridgeport. Ngeyen apparently agreed to surrender her pharmacist license in December of 2008.
The question that has to be asked is whether CVS allowed a pharmacist that had made twelve potentially dangerous errors to continue working without any disciplinary measures. The fact that she was still working at the same CVS when the state finally took action suggests CVS did nothing.
Scott Distasio
pharmacy malpractice attorney
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
888-595-0022
In a previous post about a pharmacist from England that was charged criminally for dispensing the wrong medication, I boldly stated:
"In the United States it is highly unlikely that this type of pharmacy mistake would
lead to such an extreme reaction. Simply put, such negligent conduct does not
warrant criminal charges."
Technically, I was not wrong because I stated it was "highly unlikely". However, such criminal prosecutions do in fact occur in the United States. For example, Eric Cropp, a Hospital Pharmacist, was recently charged criminally for his role in the overdose death of 2 year-old Emily Jerry. According to Cleavland.com, Eric Cropp is about to plead no contest to charges of involuntary manslaughter.
The pharmacy malpractice occurred when a pharmacy technician in the hospital pharmacy improperly mixed a solution with 23% saline instead of 1% saline. According to Cleavland.com, the pharmacy tech actually pointed out to Eric Cropp, the supervising pharmacist, that she thought there was something wrong with the mixture. Instead of investigating, Cropp dismissed her concerns and told her to have the medicine delivered anyway.
In most states, involuntary manslaughter occurs when someone that did not intend to cause death, acted so recklessly in causing someone else's death that they should have known it would cause death. It appears that the reckless conduct in this case that lead to criminal charges stem from three basic facts. The first fact is that the overdose of saline was so high that even a marginally competent pharmacist would know that such a high dose, 23 times higher than what was ordered, would kill a child. The second fact is that Cropp was specifically warned that something was potentially wrong with the medicine and he failed to investigate. The third fact is that the little girl died from the prescription error.
Scott Distasio
Florida Pharmacy Malpractice Lawyer
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
888-595-0022
21 Polo horses died in Wellington Florida on April 19, 2009 just before a Polo tournament that was to be held at the International Polo Club Palm Beach. All of the horses were owned by Venezuelan Banker Victor Vargas and were part of the same Venezuelan Polo team. On April 23, 2009, Franck's Pharmacy in Ocala Florida publically admitted the horses died as a result of one of their pharmacists committing a medication error. According to grrlscientist, the pharmacy error occurred because a Franck's Pharmacy employee compounding a vitamin mixture for the horses accidently mixed 10 times the normal dose of one of the ingredients.
Under Florida law, pharmacies are responsible for damages caused by pharmacy medication mistakes like this one. Because the horses are considered property, the owner is not entitled to pain and suffering damages. However, the owner is entitled to the replacement cost of the horses.
Scott Distasio
Florida Pharmacy Malpractice Attorney
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
888-595-0022
According to pjonline.com Pharmacist Elizabeth Lee of Windsor, Berkshire was charged criminally for mistakenly dispensing propranolol instead of prednisolone to a 72 year old woman that later died in the hospital. Ms. Lee had apparently been working a 10 hour shift without break at the time the prescription error occurred. On April 2, 2009, the British court gave her a suspended sentence of 3 months in jail and 12 months of probation for her actions.
In the United States it is highly unlikely that this type of pharmacy mistake would lead to such an extreme reaction. Simply put, such negligent conduct does not warrant criminal charges. Instead, under our system of justice, the state pharmacy board would have the right to civil remedies such as requiring continuing education classes, a civil fine, and in extreme cases, suspension of license. In addition the injured person would have a right to bring a personal injury lawsuit for monetary damages.
Scott Distasio
Florida Pharmacy Malpractice Attorney
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
888-595-0022
Orlando pharmacy error lawyer
One of the leading causes of pharmacy malpractice in Tampa and across the Nation involves pharmacists misinterpreting physician handwriting. This type of medication mistake leads to filling prescriptions with the wrong medicine and or the wrong dose of medicine. Typed electronically transmitted prescriptions would entirely eliminate prescription errors associated with sloppy handwriting.
Although electronic prescribing technology has existed for many years, doctors have been slow to use it. According to an article by Letitia Stein posted at www.tampabay.com, less than one in 10 doctors currently write electronic prescriptions. The University of South Florida plans to change that statistic.
On Monday March 16, 2009, Stephen Klasko M.D., the CEO of USF Health and Dean of the College of Medicine announced a public/private partnership between the University and private industry called PaperFree Tampa Bay. The goal of the program is to educate the regions 10,000 physicians about the electronic prescription technology that already exists. Doctors that have an electronic transmitting device like a smart phone, iphone, or Blackberry can enter prescriptions on software made by a company called Allscripts and electronically transmit it to the pharmacy. The PaperFree Tampa Bay partnership plans to make doctors aware of the system and teach them how to use it.
USF should be applauded for its efforts. The University has recognized the failure of the medical community to adopt life saving technology and they are doing something about it.
Scott Distasio
Florida Pharmacy Malpractice Lawyer
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES TAMPA
888-595-0022
According to an article written by Diane Chun and published by the Gainesville Sun, 3 year old Sebastian Ferreros died in October of 2007 of a drug overdose. On Wednesday, August 13, 2008, Edna Irizarry, the pharmacist that filled the prescription, agreed to pay a fine of $1000.00 and investigation costs of approximately $2460 for her role in the boy's death. The payments were part of a plea agreement with the Florida Board of Pharmacy that also requires Irizarry to attend an eight hour course.
The overdose occurred while Sebastian's physicians were trying to determine if he was growing properly. As part of a routine test, he was supposed to receive 5.75 grams of the amino acid arginine. Irizarry was the pharmacist that filled the prescription while working at the Shands Medical Plaza Pharmacy in Gainesville Florida. Unfortunately, the filled prescription contained more than 60 grams of the amino acid. Sebastian died two days after receiving the medication.
When a health care related professional makes a mistake, the State Board charged with regulating that particular professional investigates the event. The Board has the power to sanction the professional with penalties including fines, re-education, limiting practice areas, suspension, and even revocation of license. Irizarry's rather small penalty for her mistake is not unusual. Practitioners involved in mistakes that cause or contribute to death are often allowed to continue practicing. In this case, according to Gainesville Sun writer Diane Chun, the Board of Pharmacy agreed to Irizarry's monetary penalty because the blame did not lie with her alone. Instead it involved a "system breakdown" that involved multiple personnel.
Often the personal injury tort system works in conjuction with the states regulatory system. In this case, Sebastian's parents, Horst and Luisa Ferrero, brought a wrongful death lawsuit against the Shands Health Care System. The case was settled for $850,000.00. The Ferrero's have reportedly used the funds to campaign for a full-service children's hospital in Gainesville, start the Sebastian Ferrero Foundation, and work with The University of Florida College of Medicine to develop protocols to prevent similar accidents at Shands.
Scott Distasio
Florida Pharmacy Malpractice Lawyer
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
888-595-0022
Florida Medication Error Lawyer
Florida pharmacy malpractice lawyers have been waiting on guidence from the appelate courts on whether nursing home consulting pharmacists can be held responsible for their negligence. Unfortunately, at least one appelate court recently concluded they could not. On April 4, 2008 Florida's Second District Court of Appeal held in The Estate of Norma J. Johnson v. Badger Acquisition of Tampa LLC, 2008 W.L. 899280 that a consultant pharmacist hired by a nursing home does not owe a legal duty to a nursing home resident when the conduct in question involved giving negligent advice to the nursing home and or treating physicians. Mrs. Johnson was recieving medicine while living in the nursing home that was prescirbed by her physician and administered by the nursing home nurses. The consultant pharmacist had a contract with the nursing home to review nursing home records, review medication and administration records, review drug regimen records of the patient, provide training and oversight, and establish procedures for the pharmacy. The consulting pharmacist gave no advice directly to the nursing home resident and had no authority to alter or discontinue a resident's pharmacy regimen. Instead, the contract and state law limited the consulting pharmacist to providing advice to the nursing home resident's treating physician and the nursing home itself. The court, therefore, concluded that the duty to the resident rested with the treating physician and the nursing home instead of the pharmacist.
The Badger case is a setback for nursing home residents because the consulting pharmacy setup in that case is standard throughout the industry in Florida. Physicians and nursing homes nursing home abuse will point to the consulting pharmacist by testifying that they relied on the advice of the consulting pharmacist and therefore should not be held responsible for the outcome. Since the consulting pharmacist cannot be sued by the nursing home resident for pharmacy malpractice, the physician and nursing homes may have an empty chair to point to at trial. Nursing Home Neglect Lawyers should respond aggressively to this argument with a Motion in Limine citing case law that holds that nursing homes have a non-delegable duty to provide appropriate care to their residents. See NME Props. Inc. v. Rudich, 840 So.2d 309, 312,13 (fla. 4th DCA 2003)(holding that one can contract away the doing of a task but cannot contract away the ultimate legal responsiblity for a task you are required by law to perform). Unfortunately, some judges may allow the argument and use the Rudich case to fashion a jury instruction.
Scott Distasio
Tampa nursing home abuse lawyer
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
1-888-595-0022
Tampa Personal Injury Attorney
According to a story posted at http://www.local6.com/news/16045570/detail.html an Orlando area Walgreens misfilled a three month old baby's prescription for Histacol DM syrup. Apparently, the child was supposed to receive 1/4 ml of the syrup. However, Walgreens pharmacy typed the wrong dose instructions on the bottle. Instead of 1/4 ml, the prescription was mislabeled as 1/4 teaspoon. The dosing mistake led to the family giving their daughter six times the recomended amount of medication. Her parents told http://www.local6.com their daughter became non-responsive shortly after taking the medicine. Walgreens admitted the pharmacy mistake in a phone call to the family two hours after the mistake occurred. Unfortunately, the family had already given the first dose of the medication to their daughter. It appears, however, the error was caught in time to prevent any long term damage. The family rushed their baby to the hospital where she was stablized and sent home.
Stories like this shed light on the ongoing problem of pharmacy malpractice. Often such medication mistakes occur in part because of the pressure associated with high volume pharmacies that are understaffed. It is too early to tell if such prsesures led to this medication mistake. However, several personal injury lawsuits against Walgreens in the last two years have alleged the pressure to move quickly in filling prescriptions contributed to misfilled prescriptions that caused death. In fact, their have been at least three multimillion dollar jury verdicts against Walgreens since 2006 involving death as a result of pharmacy errors.
In this case, Walgreens offered the family $2000.00 as compensation for their mistake. The baby's mother is quoted in the article as saying "Two thousand dollars for almost killing my baby, Its almost like, don't bother." Her sentiments are not unusual. Family members often feel insulted by lowball settlement offers made by companies in situations such as this one. So why did Walgreens offer such a small amount? The truth is offering token hush money often works. The drumbeat of tort reform has conditioned people to think it is imoral to hold wrongdoers financially responsible for pain and suffering damages. For example, the baby's father apparently said "Don't get me wrong, we could use the money or $2000.00. But if this will save someone else's life, they can keep their $2000.00."
The fathers desire to hold Walgreens accountable by having the media report on the issue is commendable. But one story in the paper is not going to change anything. It is also true that Walgreens paying the family money for their pain and suffering is not going to change anything. Paying pain and suffering damages will, however, hold Walgreens accountable for the damages they have caused. Furthermore, the cumulative effect of media exposure and lawsuits, over time can change a wrongdoers incentive to continue with policies that cause harm.
Scott Distasio
Orlando Pharmacy Malpractice Lawyer
Distasio Law Firm
Helping Injured People
OFFICES: TAMPA
1-888-595-0022
Tampa Personal Injury Lawyer
On April 14, 2008, the Federal Bureau of Investigation raided three pharmacies in Pinellas County Florida. The Pharmacies are the Rx Shop at 5322 Duhme Road in Madeira Beach, the Rx Shop at 810 S. Fort Harrison Ave in Clearwater, and Seminole Drugs at 10720 Park Blvd. in Seminole.
It appears the FBI was not looking for pharmacy malpractice, pharmacy mistakes, or medication errors. According to their press release, the FBI , along with other law enforcement agencies, is investigating healthcare fraud. The circumstances surrounding how the FBI believes the fraud occurred is unclear at this time.
Scott Distasio
Tampa Pharmacy Malpractice Lawyer
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
1-888-595-0022
Tampa Personal Injury Attorney
As the number of prescription drugs consumed by Americans continues to increase, so do the odds that a pharmacy mistake will occur. Common pharmacy errors include misfiling prescriptions with the wrong medication and providing the consumer with the wrong dose of medication. The problems seem to have escalated as the retail drug store industry continues to consolidate through mergers and acquisitions. Their emphasis on increasing shareholder value at times can create a conflict with the pharmacist's duty to look out for the consumers' safety. According to Kevin McCoy and Erik Brady in their February 11, 2008 USA Today article "Five-year-old took wrong medication for two months" there appears to be evidence that corporate policies can contribute to prescription errors.
There are two ways a corporation can increase profits. The first way is to increase revenue. One of the corporate pharmacy policies meant to increase revenue also appears to lead to increased prescription errors. The policy involves encouraging individual pharmacies within the corporate chain to fill a larger and larger volume of prescriptions in a given time period. The encouragement can occur in many different ways. Some corporate chains have guidelines on the number of prescriptions a particular pharmacist should be able to fill in a given time frame. Some focus on increasing the use of pharmacy assistants that are paid less and have less education than pharmacists. Others give bonuses based in part on the volume of prescriptions filled.
The other way to increase corporate profits is to decrease costs. One of the largest cost components for a pharmacy is employee salaries. By decreasing the amount paid to individual employees and decreasing the number of employees necessary to perform the work, the chain stores can increase profitability. However, the emphasis on controlling the budgets, staffing levels, and hours worked of all of the pharmacies within the chain can lead to increased pharmacy mistakes when there are not enough qualified employees to perform job functions safely.
Scott Distasio
Florida Pharmacy Malpractice Attorney
DISTASIO LAW FIRM
HELPING INJURED PEOPLE
OFFICES: TAMPA
1-888-595-0022
Tampa Personal Injury Lawyer
|
