Pharmacists And Pharmacies Make Prescription Errors That Kill Or Injure

27 Jul 2007

The misfilled prescription is becoming more common. It could be described as an epidemic in the health-care community. Recent television programs have featured stories on misfilled prescriptions and many patients have discovered that the pill in the container is not what was ordered.

Why Do These Preventable Mistakes Occur?

One potential cause is the similarity between some drug names. For example: Levoxine vs. Lanoxin, Eldepryl vs. enalapril, quinine vs. quinidine. Picture a poorly written prescription for Norvasc (or is that Navane?), or Procanbid vs. probenecid. Another frequent source of confusion is the use of drug suffixes, like SR or XL. In one instance, a prescription for Procardia XL, 30 mg once per day, was filled as Procardia 10 mg, dispense 40 tablets.

In a study of 500 pharmacist malpractice claims conducted by Pharmacists Mutual Insurance Company, the following types of errors were identified: Wrong Drug Dispensed -- 52%, Wrong Strength Dispensed -- 27%, Wrong Directions Given -- 7.4%, for a total of 86.4% of errors that could have been prevented.

What are some of the factors that contribute to these mental lapses?

A Pharmacy Today survey (published December 15, 1996) asked, "What could cause dispensing errors?" Of 187 responses from 171 pharmacists and 16 pharmacy paraprofessionals, insufficient filling time and too many distractions were identified as two of the major areas of concern. Ringing telephones and customer questions unrelated to medication were frequent sources of interruption. Unrealistic workload requirements, inadequate technician assistance, and a nonsupportive system (with no provision for one person to check the work of another) were also identified as factors that can increase the rate of error. In short, many dispensing errors are caused by stress, distraction, or lack of backup.

None of these causes justify the harm that can be caused by a misfilled prescription.

According to the law, pharmacists have a responsibility to the patients who depend on them to practice according to acceptable standards of care for the profession. Such standards may be established by a professional organization, such as the American Pharmaceutical Association, a subspecialty board, or a state board of pharmacy. Such standards seek to establish proper procedures for ensuring that pharmacists fill, compound, dispense, and label prescriptions correctly.

All professionals are expected to act in accordance with the accepted standard of care of the particular profession. Where there is more than one accepted standard of care the professional must act within at least one of the accepted standards.

When something goes wrong and there is a deviation from the standard of care, an error occurs. Any action or conduct that deviates from the standard of care is negligent, and the pharmacist/pharmacy may be considered liable for the act.

Whether a patient would have a reason to pursue a claim against a pharmacist or pharmacy depends often upon the answer to this question: "What injuries or damages did the patient suffer?" A major injury like a heart attack or stroke, or a patient who is left permanently disabled as a result of the injury is more likely to bring a lawsuit than an individual with minor injuries.

In addition to the breach of the standard of care for the profession, there are several other theories of liability by which a claimant may proceed in legal action against a pharmacist/pharmacy.

Claims of breach of implied warranty and breach of expressed warranty are viable. Breach of implied warranty stems from the warranty of merchantability of a product (ie, fitness for sale for its intended purpose). For example, a prescription that was adulterated with another product or contaminated with bacteria is no longer fit for its intended purpose. During the l-tryptophan/Eosinophilia Myalgia Syndrome (EMS) litigation, many pharmacies were sued vicariously because they sold an adulterated product, even though they did not adulterate the product.

Breach of expressed warranty occurs when a pharmacist makes any expressed claim about a product that the product fails to meet. For example, the pharmacist might dispense a generic form of a drug to a patient and tell that patient, "This is the same thing as the other drug and will work just as well."