Phoenix Personal Injury Lawyer - Medical Malpractice

Walgreens Pharmacy Held Accountable for Prescription Error

Staff Writer — Tue, 16 Oct 2007 18:33:58 GMT

A Coconino County jury awarded one of the largest wrongful death verdicts to the family of a high school coach who died after taking a lethal combination of medications which should never have been dispensed together. The jury found that Walgreens pharmacy should have warned the patient and his physician about the lethal and toxic effects that the pain medications Tramadol and Methadone have when taken together. Presumably, the jury believed that the pharmacy had the last known opportunity to prevent a lethal combination of drugs from getting into the hands of a patient who did not have any idea about the toxic effects of these drugs when administered together. The jury likely concluded that Walgreens pharmacy should have discovered the extreme lethal dangers when technicians first input both prescriptions into the pharmacy computer system. Unfortunately, I do not believe that this prescription error was an isolated occurrence in pharmacies throughout the nation. Pharmacy prescription errors are a leading cause of death and injury in our country. Additionally, medical errors in general affect one in ten patients worldwide.

In this Arizona case, the jury awarded six million dollars to the plaintiffs who alleged pharmacy malpractice arguing that the:

Walgreens pharmacist who filled his prescriptions should have warned Warren and his doctor that the drugs shouldn't be used together. Technicians should have received a computer warning of the interactions, they argued.
Walgreen countered that Warren was negligent and caused his own death or that his doctor was negligent in prescribing the medication.

When you receive a prescription, do you believe that the pharmacist will dispense the right medication and not some similarly sounding drug? Do you believe the pharmacist will explain the proper dosage, administration and usage to you? Do you believe the pharmacist will warn you about any drug interactions you may face? Do you believe the pharmacist will give you an opportunity to ask questions? I believe safe administration of medication should be a priority in all pharmacies. I also believe that the wrong medication should never leave a pharmacy if the pharmacist and staff prioritize patient safety when dispensing controlled substances. I guess the Coconino County jury agreed.

For more information on this subject, please refer to the section on Drugs, Medical Devices and Implants.

Originally posted at InjuryBoard by Staff Writer

How Would Tort Reform Affect the Quality of Emergency Healthcare?

Staff Writer — Thu, 14 Jun 2007 07:00:00 GMT

In 1975, the California State Legislature passed the California Medical Injury Compensation Reform Act (MICRA) which placed a cap on damages for medical malpractice claims. According to this Act, an injured plaintiff cannot recover non-economic losses in excess of $250,000. This tort reform statute has been in effect in California for thirty-two years. Because this California law has been in effect for so long, perhaps we can look to this state to determine whether tort reform has been effective in improving the quality and price of medical care. In general, I believe private market conditions rather than government interference and regulation leads to higher quality and efficiency. This means that I do not believe that artificial caps on damages are effective in improving the quality and cost of medical care.

Today, I came across a shocking news story about the quality of emergency room care in at least one hospital in California. A patient who was bleeding from her mouth and crying out in pain while she was forced to wait more than forty-five minutes in the lobby of the emergency room at Martin Luther King Jr.-Harbor Hospital died because she did not receive timely emergency care. According to news accounts, family members tried to call 911 to receive timely medical care and transport the patient to another facility. Unfortunately, dispatchers refused to call paramedics after learning about her location. According to news accounts of the breakdown in patient care:

In the recordings of two 911 calls that day, first obtained by the Los Angeles Times under a California Public Records Act request, callers pleaded for help for Rodriguez but were referred to hospital staff instead.
"I'm in the emergency room. My wife is dying and the nurses don't want to help her out," Rodriguez's boyfriend, Jose Prado, is heard saying in Spanish through an interpreter on the tapes.
"What's wrong with her?" a female dispatcher asked.
"She's vomiting blood," Prado said.
"OK, and why aren't they helping her?" the dispatcher asked
'They're just watching her'
"They're watching her there and they're not doing anything. They're just watching her," Prado said.
The dispatcher told Prado to contact a doctor and then said paramedics wouldn't pick her up because she was already in a hospital. She later told him to contact county police officers at a security desk.

The patient died after suffering from a perforated bowel which according to the coroner, could have been surgically repaired if it had been caught in time. Clearly, the emergency medical care provided to this patient fell well below the standard of care required for emergency medical providers. In fact, according to press reports, the hospital had a history of patient safety problems. The federal government previously even warned this hospital about safety problems placing emergency room patients at immediate risk of harm. The hospital risked losing federal funding had it not improved patient safety.

What do caps on damages in medical malpractice litigation have to do with this California hospital? Perhaps nothing. However, I believe that possible litigation damage awards usually play a role in how people manage risks. Because risk management departments evaluate safety based upon exposure to damage awards, damage caps can play a role in the priorities placed on patient safety programs. Perhaps if this hospital placed more emphasis on patient safety, it would have had a more effective patient triage program in place rather than forcing a patient with a perforated bowel to wait in an emergency room lobby until she died.

I must admit that other than what has been reported in news stories, I know nothing about this hospital. However, I firmly believe that risk management departments place an increased emphasis on patient safety when facing an unlimited exposure to litigation risk . As a result, litigation can be an effective tool to promote safety. This hospital never faced a civil judgment beyond exposure to civil damages caps. Because such risks never existed in California, perhaps patients suffer from poor quality of care. Do you believe the hospital has adequate incentive to provide safe patient care? Do you believe that damage caps play a role in the safety decisions corporations and medical providers make? Would damage caps in California work in Arizona? Let me know your thoughts.

Originally posted at InjuryBoard by Staff Writer

Pharmaceutical Company Threatened Legal Action Against Physician Who Questioned the Safety of Diabetes Medication Avandia

Staff Writer — Thu, 07 Jun 2007 13:49:18 GMT

GlaxoSmithKline operates as the world's second largest pharmaceutical company behind Pfizer. It markets a vast assortment of medication to treat patients with health problems and, according to its annual report for 2006, the diabetes medication Avandia is one of the top six pharmaceutical products it markets throughout the world,

At 30th September 2006, GSK held second position in the world pharmaceutical market with a market share of 6.3%, behind Pfizer with a market share of 8%. GSK had six of the world's top 60 pharmaceutical products. These were Avandia, Lamictal, Seretide/Advair, Valtrex, Wellbutrin and Zofran.

In May, 2007, the Food and Drug Administration issued a medication safety alert claiming:

Safety data from controlled clinical trials have shown that there is a potentially significant increase in the risk of heart attack and heart-related deaths in patients taking Avandia. However, other published and unpublished data from long-term clinical trials of Avandia, including an interim analysis of data from the RECORD trial (a large, ongoing, randomized open label trial) and unpublished reanalyses of data from DREAM (a previously conducted placebo-controlled, randomized trial) provide contradictory evidence about the risks in patients treated with Avandia.

According to the FDA, based upon the data concerning possible heart related problems experienced after taking this medication, it advised patients to consult with their physicians about any heart-related concerns.

Its 2006 annual report mentions that Avandia accounted for approximately $2.4 billion dollars in sales in the United States alone:

GSK launched Avandia for the treatment of type 2 diabetes in 1999 and a combination product, Avandamet, for blood sugar control in 2002. The product group was expanded further in February 2006 with the launch in the USA of a fixed-dose combination treatment, Avandaryl, which combines Avandia with a sulfonylurea.
In 2006, sales of the Avandia product group grew 24% to Â£1.2 billion in the USA. In Europe, sales grew 39% to Â£217 million driven by the increasing use of Avandamet. Sales in International markets rose 17% to Â£234 million. The Avandia product group achieved in 2006 a market share by value in oral anti-diabetics of 37% in the USA and 19% in Europe, up 2 and 5 percentage points, respectively. In the USA, Avandamet prescription volume growth was adversely impacted by product supply issues during the year which have now been resolved.
In December, GSK presented data from the landmark ADOPT study, which demonstrated that Avandia is more effective than metformin, or a sulphonylurea, in long-term blood sugar control in type 2 diabetes. These data are in addition to those recently presented from the DREAM study, which showed that Avandia can reduce the risk of progression to type 2 diabetes. Data from both these studies are expected to be filed with regulatory agencies during the first half of 2007.

Based upon the sales volume alone, sales of this medication account for a huge source of profit for GlaxoSmithKline. In 1999, apparently after a medical researcher attempted to inform the pharmaceutical company about increased heart risks which have recently been disclosed publicly, company officers allegedly threatened litigation and:

warned him that some executives wanted to hold him accountable for a $4 billion drop in the company's stock.

The medical researcher testified in a congressional hearing this week that he wrote to the company and:

In a letter to SmithKline distributed at the hearing, Buse wrote: "Please call off the dogs. I cannot remain civilized much longer under this kind of heat."

In 2000, the researcher apparently outlined his concerns about increased heart risks to the FDA yet only recently did the oversight agency issue a safety alert about this medication.

If these reports present a true picture about conduct that occurred and safety concerns about the medication around since its release in 1999, do you believe that the Food and Drug Administration should have required a safety alert sooner? Should a pharmaceutical company properly threaten to sue a medical researcher who attempts to present safety concerns about a particular product? If you suffer from diabetes and have taken the medication Avandia, what medication safety information would you want to review with your doctor before making a decision to take this medicine? If you have heart disease and diabetes, would you want medication information concerning the possible risk of heart problems associated with Avandia?

In all fairness, the company continues to dispute whether the medication increases risk of heart problems. However, in my opinion, I would err on the side of disclosure of all research including increased heart risks and leave the decision about interpretation of study findings and whether to take the medicine in the capable hands of the treating physician and patient. I believe that the patient and doctor should have all tools and information available to them to properly evaluate risk and make proper decisions. If these public accusations are true, in my opinion, I am not sure patients were provided such an opportunity. What do you think?

Originally posted at InjuryBoard by Staff Writer

Child Cancer Patients and Medication Errors

Staff Writer — Sun, 27 May 2007 09:00:36 GMT

As if struggling with and battling cancer is not enough, according to a researcher at Johns Hopkins Children Center, children often must also face the additional battle of having to overcome problems relating to medication errors.

Children with cancer often get the wrong dose of chemotherapy or are given the drug at the wrong time, and many require treatment because of the errors, U.S. researchers said on Friday.

Medication errors involving the improper administration of cancer medication present serious challenges as children struggle to cope with their illness. Usually the errors involve administration of chemotherapy designed to kill cancerous cells. When administered improperly, chemotherapy can kill good cells and cause further health problems.

The Johns Hopkins Childrens Center has already been on the cutting edge of research recommending methods to avoid clinical errors in the administration of chemotherapy to child cancer patients. As far back as 2003, Johns Hopkins has recommended a systematic approach using chemotherapy audits to minimize risk of harm administering chemotherapy. Researchers previously recommended checks and double checks prior to administrating chemotherapy to minimize risk of medication error.

If somebody's child suffered consequences as a result of a medication error, should the care provider be held accountable for the resulting problems? Various tort reform initiatives would reject this notion and not hold the wrongdoer accountable for damages resulting from the medication misadventure. Is this an example of fairness? Frivolous litigation? Accountability? Do you believe that tort reform initiatives are the answer to the problems created by errors in the administration of chemotherapy medication? Rather than advocating tort reform under these circumstances, perhaps safe medication administration practices could be the answer to problems resulting from medication errors. What do you think?

Originally posted at InjuryBoard by Staff Writer

World Health Organization Reports that Medical Errors Affect One in Ten Patients

Staff Writer — Wed, 02 May 2007 19:30:00 GMT

According to the World Health Organization, healthcare errors affect one out of every ten patients worldwide. Based on this alarming trend, the World Health Organization prepared patient safety checklists to help professional healthcare providers avoid simple medical mistakes. By following the "Nine Patient Safety Solutions," the organization hopes to see substantial medical error rate reductions. The the nine safety solutions relate to the following:

1. Look-alike, sound-alike medication names;
2. patient identification;
3. communication during patient hand-overs;
4. performance of correct procedure at correct body site;
5. control of concentrated electrolyte solutions;
6. assuring medication accuracy at transitions in care;
7. avoiding catheter and tubing misconnections;
8. single use of injection devices; and
9. improved hand hygiene to prevent health care-associated infection.

In the past, I have commented on medication errors as a source of potentially severe problems in our healthcare system. The World Health Organization recognized this problem worldwide, included in its recent report a discussion about medication errors, and recommended error reduction strategies as its top patient safety priority. The organization proposes creating a systems approach to medication administration. Requiring redundant error checks in the medication distribution system before a patient actually receives drug therapy can minimize the possibility of medication error and in the long run improves overall patient safety. By the way, the World Health Organization considered neither medical nor pharmacy malpractice reform as a patient safety improvement technique or strategy. I believe the organization realizes that malpractice reform does not improve patient safety and may in fact accomplish the opposite result. Kudos to the World Health Organization for focusing on real patient safety and error reduction strategies and staying away from political rhetoric.

Originally posted at InjuryBoard by Staff Writer

Tort Refrom Criticism from the Oklahoma Supreme Court

Staff Writer — Thu, 21 Dec 2006 13:45:25 GMT

I recently came across an opinion from the Oklahoma Supreme Court released onto its web site on December 19, 2006 but not yet formally published which presents an interesting analysis of tort reform in the state of Oklahoma. The Oklahoma Supreme Court in an almost unanimous decision struck down a tort reform initiative requiring an expert affidavit of merit to accompany every new medical malpractice lawsuit. The court reasoned that requiring plaintiffs to obtain an affidavit from a professional expert confirming that a medical malpractice claim has merit creates an artificial burden and prevents access to the courts. According to the Oklahoma Supreme Court:

The affidavit of merit provisions front-load litigation costs and result in the creation of cottage industries of firms offering affidavits from physicians for a price. They also prevent meritorious medical malpractice actions from being filed. The affidavits of merit requirement obligates plaintiffs to engage in extensive pre-trial discovery to obtain the facts necessary for an expert to render an opinion resulting in most medical malpractice causes being settled out of court during discovery. Rather than reducing the problems associated with malpractice litigation, these provisions have resulted in the dismissal of legitimately injured plaintiffs' claims based solely on procedural, rather than substantive, grounds.

Interestingly, the Oklahoma Supreme Court reasoned further:

Another unanticipated result of statutes similar to Oklahoma's scheme has been the creation of a windfall for insurance companies who benefit from the decreased number of causes they must defend but which are not required to implement post-tort reform rates decreasing the cost of medical malpractice insurance to physicians. These companies happily pay less out in tort-reform states while continuing to collect higher premiums from doctors and encouraging the public to blame the victim or attorney for bringing frivolous lawsuits.

The Supreme Court cautions people reviewing this case on its web site:

NOTICE: THIS OPINION HAS NOT BEEN RELEASED FOR PUBLICATION IN THE PERMANENT LAW REPORTS. UNTIL RELEASED, IT IS SUBJECT TO REVISION OR WITHDRAWAL.

I do not practice law in Oklahoma nor do I understand what the effects of this legislation have been other than what has been described in the Supreme Court decision. Even in light of these cautioning remarks, this case presents an interesting and realistic assessment about the adverse consequences of tort reform initiatives. Arizona already requires an affidavit of merit for claims against professionals and perhaps this requirement has also created artificial limitations on access to the courts as a result. One commentator at a site known as the Greedy Trial Lawyer first remarked on the Oklahoma Supreme Court decision. I do not share the author's opinions inferred by the name of his site. However, kudos for pointing out the decision from the Oklahoma Supreme Court and for highlighting the importance of equal access to our court system.

Originally posted at InjuryBoard by Staff Writer

Medication Errors Cause Patient Harm

Staff Writer — Fri, 21 Jul 2006 11:38:55 GMT

Yesterday the Institute of Medicine issued a press-release concerning its report on medication errors. According to the Institute of Medicine,

Medication errors are among the most common medical errors, harming at least 1.5 million people every year, says a new report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and productivity or additional health care costs, the report says.
The committee that wrote the report recommended a series of actions for patients, health care organizations, government agencies, and pharmaceutical companies. The recommendations include steps to increase communication and improve interactions between health care professionals and patients, as well as steps patients should take to protect themselves. The report also recommends the creation of new, consumer-friendly information resources through which patients can obtain objective, easy-to-understand drug information. In addition, it calls for all prescriptions to be written electronically by 2010 and suggests ways to improve the naming, labeling, and packaging of drugs to reduce confusion and prevent errors.

Our firm has represented patients who have suffered harm as a result of medication errors so these figures do not surprise me. When prescription volumes increase and insurance reimbursement rates decline, pharmacies looking to reduce costs, rely more and more on cost-cutting techniques. Minimum wage pharmacy technicians now do more and more medication-dispensing work. In the past, specially trained pharmacists performed most prescription dispensing and patient counselling work. As technicians do more and more prescription-filling work, we logically see increases in medication error rates.

Our firm has represented several patitents who have suffered harm as a result of medication errors. One example comes to mind which highlghts these problems. We represented a patient who received a prescription for an allergy medication Zyrtec. Instead, for the next eighteen months, the patient received the anti-psychotic medication Zyprexa. The pharmacy missed several crucial opportunities to prevent this medication error. A trained pharmacist should have counselled the patient correctly on this prescription. Had proper counselling occurred, this error could have been prevented before the patient walked out of the pharmacy. Too often, we see similar medication errors occur in retail pharmacy and hospital settings. Even patients who try to play an active role in their healthcare can still become victims of poor safety procedures inside hospitals and pharmacies.

The Institute of Medicine recommended a series of low-cost changes in the way pharmacies, hospitals, doctors and patients interact. For example, before filling a prescription, pharmacies and hospitals now have to routinely decipher doctors' hand-written prescriptions. Lets face it, doctors' handwriting generally could use improvement and can be a great source of confusion and error. Available electronic prescription technology makes the hand-written prescription obsolete. Technology eliminates the need to decipher doctors hand-writing; so rather than requiring pharmacy and hospital employees to become experts in handwriting analysis, using available electronic prescription technology, the Institute of Medicine suggests that prescription error rates will drop,

Even more promising is the use of electronic prescriptions, or e-prescriptions. By writing prescriptions electronically, doctors and other providers can avoid many of the mistakes that accompany handwritten prescriptions, as the software ensures that all the necessary information is filled out--and legible. Furthermore, by tying e-prescriptions in with the patient's medical history, it is possible to check automatically for such things as drug allergies, drug-drug interactions, and overly high doses. In addition, once an e-prescription is in the system, it will follow the patient from the hospital to the doctor's office or from the nursing home to the pharmacy, avoiding many of the "hand-off errors" common today. In light of all this, the committee recommends that by 2010 all prescribers and pharmacies be using e-prescriptions.

Moreover, re-arranging the storage of medications on a retail pharmacy shelf based upon volume of use rather than based upon alphabetical listings can minimize the risk of a prescription misfill due to similarly sounding name. The Institute of Medicine suggests further:

Another way to reduce medication errors is to ensure that drug information is communicated clearly and effectively to providers and patients. Some errors occur simply because two different drugs have names that look or sound very similar. With this in mind, the committee recommends that the drug industry and the appropriate federal agencies work together to improve drug nomenclature, including not just drug names but also abbreviations and acronyms. At the same time, the information sheets that accompany drugs should be redesigned, taking into account research that identifies the best methods for communicating information about medications.

Everybody agrees that such high medication error rates are simply unacceptable. These recommended solutions do not cost a great deal and rely upon a systems approach to patient safety. Hopefully by highlighting the problem, the Institute of Medicine can use its leadership to implement these recommended low-cost solutions and rather than seeing 1.5 million medication errors each year, we can see vast improvements in the quality of medication administration.

Originally posted at InjuryBoard by Staff Writer

Using Technology to Reduce Medical Errors

Staff Writer — Wed, 14 Jun 2006 10:06:24 GMT

In the past, I have referred to a 1999 study by the Institute of Medicine which linked medical errors to the deaths of between 44,000 and 98,000 people annually. Recently, it has come to my attention that one error reduction strategy available to physicians involves the use of technology in doctors' medical practices. Unfortunately, according to an article in yesterday's Tucson Citizen, only sixty-four physician practices have signed up to participate in the new error reduction technology program which:

is designed to help small- and medium-size practices adopt electronic health-records systems, or EHRs, that give doctors immediate access to comprehensive, critical information about their patients.

Hopefully plenty more Arizona physicians will take advantage of this program and use technology to help reduce patient error rates. Errors in other careers may be somewhat forgiving. However, error rates in the field of medicine can lead to serious injury or death. As the physician who wrote the Tucson Citizen article stated, using electronic based health care records (EHR) can benefit patient care outcomes:

There's good evidence that information technology can be used to improve health care for patients. Take the treatment of diabetes, for example, a serious condition that affects 7 percent of all Americans. If not managed correctly, diabetes can lead to many serious complications, even death. Through automated, comprehensive monitoring and alerts, EHR systems can help doctors deliver more timely and complete care for their diabetic patients.

For this reason alone, I sincerely hope more physicians take advantage of what appears to be a revolutionary technology based program to assist doctors in improving the quality of care for their patients.

Originally posted at InjuryBoard by Staff Writer

Emergency Medicine Reform

Staff Writer — Wed, 03 May 2006 13:35:54 GMT

Yesterday, Governor Napolitano vetoed a measure passed by the Arizona legislature that would have heightened the burden of proof required to assert a claim against physicians arising out of poor emergency medical care. If Governor Napolitano had not vetoed this legislation, a patient victim would have to present "clear and convincing" evidence of medical malpractice when submitting claims against emergency physicians. Allegedly, fewer physicians practice emergency medicine because the standard of proof requires a showing of negligence by a "preponderance of the evidence." Has anybody thought that changing the burden of proof for emergency physicians will somehow lower insurance premiums for emergency care doctors? What doctors are not practicing emergency medicine? Are bad physicians who have harmed patients going to be encouraged to continue bad care because they know that patients who receive poor care will have difficulties suing them?

I find it interesting everytime I hear the argument that making access to the courts more difficult will improve patient care. Providing access to the courthouse has been a cornerstone method for citizens to help ensure the safety of our products and services. In my opinion, preventing access to our courts has the exact opposite effect. Citizens will be less likely to have safe high quality medical care. If we want a medical system that rewards mistakes, then lets close the courthouse doors. On the other hand, if we want to enjoy the highest quality medical care and research in our community, then we need to make sure that physicians and pharmaceutical companies who make mistakes and cause patients irreparable harm are held accountable.

Kudos to Governor Napolitano for vetoing House Bill 2315, the draconian legislation which would have limited access to our state court to provide redress for victims of negligent emergency care.

Originally posted at InjuryBoard by Staff Writer

Patient Errors in Hospitals

Staff Writer — Wed, 19 Apr 2006 10:11:35 GMT

Today I saw another blogger's post about increasing patient safety problems at our nation's hospitals as well as unique perspectives about these problems. Take a look at this post and its cynical implications on the medical malpractice reform debate in our country. I must warn you, however, that this overall blog site presents a completely different perspective and approach to the practice of law than I would ever suggest. Whether the other blogger is serious or not, our firm has absolutely no interest in approaching the practice of law the way suggested on this other blog site. However, the issues raised in this particular posting present such an interesting perspective about the tort reform debate that I thought it appropriate to make a reference.

Have you ever had to visit a hospital? If so, do you believe that the quality of care in our hospitals has been improving or deteriorating over the last ten to twenty years? Do you have any stories about patient errors committed in our nation's hospitals? Have you had any positive experiences in a particular Arizona hospital? If so, please share some of these stories. I am interesting in hearing about the good and the bad experiences you have had in Arizona hospitals.

Originally posted at InjuryBoard by Staff Writer