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Earlier this year, the Supreme Court of Texas affirmed the dismissal of a woman’s case after she failed to provide the requisite expert opinion supporting her claim within the required time period. In the case of Randol Mill Pharmacy v. Miller, the court determined that the a claim alleging negligence in a pharmacy’s compounding services qualifies as a “health care liability claim” and must therefore comply with the applicable rules governing those claims.

The Facts of the Case

The plaintiff in the case was prescribed a special prescription by her doctor to treat her Hepatitis C. The prescription was not available in a mass-produced form, so a pharmacy had to create the medicine in a process called “compounding.” However, after a few weeks of taking the medication, the woman suffered a serious adverse reaction, resulting in several blood transfusions and ultimately ending in her losing sight in both of her eyes.

The woman filed suit against the pharmacy, alleging that the pharmacy “breached their implied warranties in the design, manufacture, inspection, marketing, and/or distribution.” She also filed suit against the doctor, but it was severed and tried separately.

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Earlier this month, a CBS news affiliate published an article discussing pharmacy errors broadly and also focusing in on the fact that Walgreen’s Pharmacy is currently facing several lawsuits based on the alleged negligence of their pharmacists. According to the report, just this year two serious pharmacy errors have occurred at Walgreen’s stores across the country.

The first was a five-year-old boy who was somehow provided with anti-psychotic medication rather than his normal allergy medicine. Not only was the provided medication the wrong one, but the dose was ten times stronger than that which should be used for a child his age and size. The boy took two doses of the unprescribed medicine before his parents noticed the mistake. His parents told reporters that “he couldn’t breathe, he couldn’t talk” after taking the two doses. His parents were later told by doctors that if they had given him one more dose they may have lost their son.

The second situation involved a 15-year-old girl who was allegedly given schizophrenia medication instead of simple antibiotics. After getting home and taking the medication, she experienced blurred vision and a racing heart. The girl’s mother told reporters that, as she stood by her daughter’s side that day, she was afraid she was going to lose her. Thankfully, both patients recovered from the medication errors.

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Medication errors are a serious problem in today’s health care world. In fact, it is estimated that there are over 65,000 medication errors that occur across the United States each year, many with disastrous consequences. According to one article published by Modern Healthcare, some are suggesting that the industry shift over to the metric system to decrease the chance of a medication error.

The argument suggests that requiring doctors and pharmacists to document a patient’s weight in pounds is counterproductive and dangerous, given the fact that most medications are dosed according to the kilogram-weight of the patient. In other words, the prescribing physician or filling pharmacist must make the calculations to change a patient’s weight from pounds into kilograms.

While this doesn’t sound all that difficult, in the hustle-and-bustle environment that many doctors and pharmacists find themselves in on a daily basis, anything that can decrease the chance of an error should be considered.

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Earlier this month, a local Virginia pharmacy was shut down by state regulators after myriad safety violations were discovered. According to one news source, not only was the pharmacy shut down and its ability to operate suspended, but the lead pharmacist’s license was suspended.

Evidently, the pharmacy was the subject of two unannounced visits:  one in May 2014 and another in February 2015. After the second inspection, regulators called into question the pharmacy’s ability to “assure the quality, sterility, integrity, safety, and efficacy of drugs dispensed, along with its ability to safeguard against the diversion of drugs.”

According to the report, regulators discovered numerous issues during their inspections, including:

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When a person goes to their pharmacy to get a prescription filled, they hope that it is accurate. However, if there is a problem with the prescription—whether it be the dosage, the instructions, or the drug itself—the patient has an opportunity to review the prescription before ingesting the medication. However, this is not the case in the fast-paced environment of emergency rooms.

Medication errors in emergency rooms are frighteningly common and can carry with them devastating results. However, according to one recent article by the Pharmacy Times, a newly released study shows that there may be something that drug manufacturers can do to decrease medication errors in the surgical and emergency room settings.

Label Design and Its Effect on Error Rate

According to the new study cited in the article, several types of intravenous medications had their labels redesigned after having a team of pharmacists, anesthesiologists, and nurse anesthetists suggest changes that make the label more reader-friendly. The researchers then conducted a study using trainees where the trainee would have to select the requested medication in a fast-paced environment. Researchers used a control group that consisted of trainees using the old labels in order to compare the results.

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Recently disclosed federal court filings have revealed settlement agreements between the U.S. Government and PhyAmerica Corp, a Louisville, Kentucky company that is the nation’s second-largest operator of institutional pharmacies. One of the lawsuits focused on the company’s widespread misuse of Depakote, a seizure drug. According to one news source, the complaint alleged the drug was routinely being prescribed to elderly patients off label to treat other ailments that would have been better treated with the approved medications.

According to the article, the company was allegedly encouraging doctors to prescribe the drug to patients off-label because of an agreement with the drug manufacturer that gave the defendant financial kickbacks for prescribing Depakote. These were kickbacks that they would not have gotten for prescribing drugs that were approved to treat the underlying conditions.

The vast majority of the patients being misprescribed the drugs had their care being financed by the federal government through Medicare and didn’t notice the increased costs, although Pharmerica Corp. allegedly helped to defraud the government out of billions of dollars by encouraging the prescription of Depakote off label.

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When children are sick, they rely on their parents to provide them with the medical care and medication that they need. Most of the time, parents are able to determine what their child needs and can provide it to them on their own. However, since children’s bodies are so small, a dosing error can easily occur if a parent is not careful.

A recent article written by one of the pharmacists at the Poison Control Center at the Children’s Hospital of Philadelphia goes over some things that parents can do to help ensure that they do not accidentally administer too much, too little, or the wrong type of medication to their children.

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Earlier this month in Orlando, Florida, a woman collapsed and was admitted to the hospital after she was given a dose of medication by her pharmacist that was ten-times stronger than prescribed by her doctor. According to a recent report by one local Florida news source, the woman was filling her blood-pressure medication at a local Walgreen’s when she was provided with the wrong pills.

The woman had been taking the medication for a number of years and recalls noticing that the pills were a little larger than her normal prescription, but told reporters that she figured she had just been provided with a generic form of the drug. However, after she took just one pill she collapsed as she approached her bed; luckily it padded her fall.

Evidently, the pills that the pharmacist provided her were ten-times stronger than what her doctor had prescribed; rather than being 10mg, the pills were 100mg. The pills were the same shape, slightly larger, and had the same markings as her normal pills. When confronted about the error, the pharmacist told the woman’s husband that the 10mg pills were on the same shelf right next to the 100mg pills.

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Pharmacies are businesses. And, like all businesses, the number one goal of a pharmacy is to remain profitable. Of course, most pharmacists are good people and truly care about their patients. However, the pharmacists are rarely the ones making the staffing policies that can lead to pharmacy errors.

It has been argued by some sources that many, if not most, of the prescription errors that occur today are caused by overworked pharmacists. An understaffed pharmacy is much more likely to send out a prescription with an unprescribed medication, an incorrect dose, or a wrong number of pills.

This trade-off between the profit and safety has caused some concern over the past few years in the field. However, one new trend that is appearing in pharmacies across the country threatens to worsen the already imperfect system by applying another set of pressures on already overworked pharmacists.

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Earlier this month, one woman in New Zealand was forced to abandon her in vitro fertilization (IVF) attempt when she was provided the wrong dose of a necessary medication by her local pharmacy. According to a report by a New Zealand news source, the woman was undergoing a frozen egg transfer as part of her IVF treatment. As a part of that procedure, she was prescribed oestradiol valerate.

The medicine was faxed to her pharmacy. The receiving pharmacist typed in the first few letters of the medication, and the computer automatically populated the result: oestriol. The pharmacist filled the prescription for oestriol rather than oestradiol valerate.

When the woman went to pick up her prescription, she didn’t notice the mistake. She accepted the medicine from the pharmacist and began taking it according to the label’s instructions.

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