Pharmacy Error Injury Lawyer Blog

Monetary Bonuses Convince More Physicians to Use Electronic Prescription Programs

February 26, 2009 | Lebowitz & Mzhen

Recently, my father attempted to relive his glory days on the football field with unfortunate results. While attempting to imitate some of the great wide receivers of his day, he ruptured his Achilles tendon and required surgery. I accompanied him to one of his follow up visits to his doctor’s office and was surprised to see the level of technology the doctor used when treating patients. In prior posts, Maryland medication error attorneys have extolled the virtues of computerized prescription programs, but I was still surprised to see how efficient those systems are when used in the day to day operation of a busy doctor’s office.

The doctor who treated my father asked him a series of questions about how the surgical site was healing, his pain, and any other prescriptions he was taking, and examined my father’s range of motion. The doctor entered all of that information into a computer terminal in the examination room and returned, within minutes, with a print out that contained my father’s prescription. Additionally, the doctor’s office electronically sent the prescription ahead to a local pharmacy.

Last month, Medicare and certain private health care plans began paying doctors bonuses for using similar E-prescription software. The private health care plans provide doctors with extra payments for services along with free equipment, such as PDA’s, if they use computerized prescription software. Medicare’s bonus amounts to 2% of charges billed to Medicare for 2009 and 2010. This translates into approximately $1,700 to $3,500 a year per doctor. As a result of the new incentives, the number of doctors using E-prescription programs has doubled over the past year and, nationwide, nearly 70,000 doctors use these programs.

Electronic prescription programs not only reduce the risk of medication errors, but they also help lower patients’ health care costs by suggesting low cost generic alternatives to expensive name brand medications. In a recent study, researchers at a hospital in Milwaukee, Wisconsin discovered that E-prescription software saved patients a substantial amount of money by allowing more doctors to prescribe safe generic prescriptions.

Additionally, by reducing the time a patient has to wait in a pharmacy to receive a prescription, E-prescription programs ensures that more Americans will fill the prescriptions their doctor’s prescribe. Fortunately, nearly all big box pharmacies and many independent pharmacies accept electronic prescriptions. This allows doctors, like my fathers, to forward prescriptions ahead of the patient and reduce the amount of time a sick or injured patient has to wait in a pharmacy waiting area.

Under the stimulus package, the government plans to invest $ 50 billion dollars over the next five years in technological advancements in health care. The Maryland medication error attorneys at Lebowitz & Mzhen Personal Injury Lawyers will carefully watch these advancements as they arise in the future.

External Resource

Wall Street Journal article

Reminder after Reading a Story from Institute for Safe Medication Practices (“ISMP”)

February 20, 2009 | Lebowitz & Mzhen

One of the sources of information that we read regularly is published by the Institute of Safe Medication Practices. Recently, the ISMP wrote about individuals who were using a dosage cap from one over the counter medication, to measure medication from another medication.

When the measuring cups were swapped as described above, the result was that the individual taking the medication received an overdose of medication. Just as a reminder, Maryland medication error attorneys at Lebowitz & Mzhen Personal Injury Lawyers recommend that measuring cups stay with the produce that they are designed to measure so that easily avoidable, but potentially dangerous, errors are avoided.

Children at Maryland Schools Rely on School Nurses for Proper Medication

February 17, 2009 | Lebowitz & Mzhen

As the parent of children in elementary school, I recently received a call from the school nurse who reported that one of my kids was sick. I was impressed with the professionalism and competence shown by the school nurse.

When I was in the nurse’s office, with children as young as age 5, I noticed how careful school nurses must be to make sure that these young children receive only the appropriate medicines. The nurses must make their decisions based upon their knowledge, training and experience, and must carefully consider the prior authorizations and advice given by the parents who might have anticipated school house illnesses of their children.

The Maryland State Department of Education has adopted policies regarding the role of school nurses as developed by the American Academy of Pediatrics (“AAP”).

Chewing Some Prescription Medications Can be Harmful

February 12, 2009 | Lebowitz & Mzhen

In litigating Maryland pharmacy error cases, our pharmacy negligence attorneys have learned some interesting facts about different drugs, their effects, and the proper manner they are designed to be ingested. Drug manufacturers design medications with a specific method of patient ingestion in mind. Some drugs are designed to be administered through an IV, some are slow release medications that must be swallowed, and others are specifically designed to be chewed and released quickly into the patient’s blood stream.

Other methods of ingestion also exist, for example, some drugs must be taken in form of eye, ear, or nose drops. Still other medications are designed to be absorbed through a patient’s skin.

The varying methods of drug transmission can be daunting and many patients place too much confidence in their pharmacist or doctor and fail to ask questions so that they completely understand their dosage instructions. The Institute for Safe Medication Practices published the story of a woman who suffered from similar overconfidence and died as a result of a negligently prescribed medication. The story is a warning for others to make sure they understand their dosage instructions.

A doctor prescribed an 83 year old patient Cardizem to control her blood pressure. The patient chewed the pills since the pills were too large to swallow. As a result, the patient’s heart rate slowed to dangerous levels, and the woman’s family contacted her pharmacist for assistance. The pharmacist suggested that the physician prescribe a form of the same drug that came in chewable capsules.

Months later, the patient returned to her physician for a check up and the physician put her back on Cardizem without warning the patient not to chew the pills. The patient subsequently began to chew the pills, over time became weaker and died three weeks later.

This story reminds us of the need to carefully question our health care providers until we fully understand the dosage instructions that come along with our prescriptions. According to the patient’s family, she was a smart and alert woman, who just put too much faith in her providers’ instructions and failed to ask questions.

In Maryland and D.C., People With Visual Impairment Suffer From Pharmacy Errors

February 9, 2009 | Lebowitz & Mzhen

Americans suffering from vision loss are at an increased risk for injuries caused by pharmacy errors. In a recent survey, the American Federation for the Blind (“AFB”) reports that nearly 20 million Americans suffer from some form of significant vision loss and many have suffered injuries due to their inability to read prescription names or dosage instructions. Maryland pharmacy error attorneys join the AFB’s call for Congress to take up legislation to develop safeguards for this class of citizens susceptible to medication errors.

As we have discussed in previous posts, medication instructions are notoriously confusing and difficult to read even under the best of circumstances. The AFB report is accompanied with personal stories describing how people with vision loss can suffer disproportionately from pharmacy negligence.

In one situation, the legally blind parents of an infant nearly lost their child due to their inability to catch a pharmacy prescription misfill. The parents managed several prescriptions for their child, but they were unable to read the labeling on the bottles. A pharmacist misfilled the prescription with a medication that was potentially lethal to the child. Fortunately, the parents were able to catch the error before it was too late.

In another anecdote, a respondent to the survey explained that a negligent pharmacist dispensed twice the amount of insulin that the man’s prescription required. Since the respondent was not able to read the medicine’s label, he took a double dosage of insulin, passed out from hypoglycemia, and had to receive treatment at a local emergency room.

Currently, there is no federal or state law requiring that pharmacies provide medication dosage or side effect information in Braille. Unfortunately, the AFB reports that devices to assist the vision impaired with medication labeling are not widely available.

External Links

AFB Survey

Hospital Uses New Computer System to Reduce Pharmacy Errors

February 5, 2009 | Lebowitz & Mzhen

In earlier posts, the Maryland pharmacy error attorneys at Lebowitz & Mzhen Personal Injury Lawyers have discussed how computerized prescription entry programs decrease the risk of patient injury due to pharmacy errors. A study at the Norwalk Hospital in Norwalk, Connecticut is another example of how these systems work.

Recently, I spoke on the phone with a friend who lives in Norwalk and who is currently expecting her first child. As we talked about her child’s upcoming birth and the plans of her and her husband, she mentioned that the hospital where she is likely going to deliver her baby was in a local paper for being one of the safest in the nation. A recent newspaper article highlights how Norwalk Hospital in Norwalk, Connecticut employs a computerized prescription program that has, in part, helped earn nationwide recognition for patient safety. The computer system allows physicians at the hospital to electronically submit prescriptions with dosage instructions to the pharmacy, bypassing the necessity for doctors to write a hardcopy of the prescription. This procedures largely eliminates the possibility that the doctors’ handwriting will be misread.

Dr. Stephen O’Mahony, the associate chairman of medicine and a medical quality officer at Norwalk Hospital commented that, “With the old way we were doing things there was the chance of there being transcription errors, meaning a patient could get the wrong medication, but now there is no chance of [hospital pharmacists] reading it wrong.”

During the three years since the hospital introduced the computerized system, medication errors have decreased from an average of 13 errors per 1,000 patients to 2 errors per 1,000 patients. Additionally, the hospital has noticed a decrease in the length of hospital stays for Medicare recipients from an average of 7 days down to 5.7 days.

The electronic system not only prevents medication errors, it also uses a “best practices” approach to suggest the appropriate drug therapy for particular patients. For example, if a patient comes to the hospital suffering from a heart attack, the computer system will remind the doctor to prescribe aspirin. Also, when a doctor treats a person suffering from pneumonia, the system will prevent the doctor from discharging the patient until the patient has received a flu shot. With features such as these, the hospital’s computerized prescription program helps reduce the time patients suffer from their current aliments, and it also helps reduce the risk of further health problems.

External Links

Newspaper Article

New York Pharmacies to Provide Foreign Language Prescription Instructions

January 30, 2009 | Lebowitz & Mzhen

Maryland pharmacy error attorneys serve a number of clients who do not speak English as their first language. Some of these clients have raised the issue of not being able to receive prescriptions or dosage instructions written or spoken in their native languages from big box pharmacies. The attorneys at Lebowitz & Mzhen Personal Injury Lawyers believe that this shortcoming places a large number of citizens in danger of harmful pharmacy errors. According to the 2000 US Census, 667,357 Marylanders speak a language other than English in their homes.

As we discussed in an earlier post, Maryland pharmacists must provide medication counseling to patients when requested, and must provide written dosage instructions with prescriptions. Counseling and written instructions in English are useless to a pharmacy patient that has difficulty understanding the language.

Pharmacy Today reports that following an undercover investigation by New York Attorney General, Andrew Cuomo, Rite Aide and CVS have agreed to provide medication instructions in languages other than English at their New York locations. The investigation began after reports that pharmacies failed to provide side effect information and drug interaction warnings in patients’ native language. New York Rite Aid and CVS locations will now provide dosage and side effect information to patients in Russian, Spanish, Chinese, Italian, French and Polish. The companies also agreed to provide assistance using an over the phone translation service.

Our attorneys believe that Maryland pharmacies should follow suit and help ensure that all patients fully understand their medication dosage instructions and other relevant information.

Medication Errors in Maryland Pharmacies May be Reduced with Periodic Brown Bag Check Ups

January 28, 2009 | Lebowitz & Mzhen

In many of our earlier posts, we have discussed the threats posed by medication errors in Maryland pharmacies. The Maryland pharmacy error attorneys at Lebowitz & Mzhen, LLC suggest that our clients take an active role in their health care in order to prevent prescription errors. Consumers should get as much information about their medications as possible, direct questions about their medications to their doctors, nurses, and pharmacists, and persist until these questions are answered clearly and understandably.

Individuals with chronic medical conditions are at increased risk for prescription errors. These patients often receive a number of prescriptions bearing various dosage instructions from different physicians. Maryland medication error attorneys suggest that their clients, especially those with chronic conditions, schedule a “brown-bag check up” with their pharmacist and primary care doctor. During a brown bag check up a patient gathers all of their prescription and over the counter medications and has them reviewed by health care professionals for dangerous interactions. Additionally, the pharmacist or doctor ensures that the medications are labeled and filled correctly, double checks the prescribed dosage strengths, and screens the drugs for serious side effects.

Maryland medication error attorneys believe that pharmacy patients should take advantage of prescription counseling provided by pharmacists to help reduce their risk of injuries caused by pharmacy misfills. A brown bag check up may help prevent injuries caused by jumbled medication dosage instructions. Under complex medication regimes, it is easy for confusion to cause a potentially harmful medication error.

Pharmacy Malpractice Insurance Companies Advice to Pharmacists Facing A Claim: Admit Nothing

January 21, 2009 | Lebowitz & Mzhen

There are many reasons why I believe that someone injured due to a Maryland pharmacy error should hire an attorney. One of the reasons is that pharmacists are instructed by their malpractice insurance companies to avoid admitting that they have done anything wrong, even when the pharmacist knows that he or she was sloppy, careless, wrong or negligent, and that injury and harms resulted to the patient.

The instruction to pharmacists to be silent in the face of causing injury to a pharmacy customer was re-emphasized in a letter sent within the last two weeks to pharmacists by a very large pharmacists’ malpractice insurance carrier. The letter contained a plastic card which the pharmacist was told to “KEEP THIS CARD IN A SAFE PLACE.” The full instructions to the pharmacist, as contained on the card, stated:

WHAT TO DO IF YOU’RE SUED:

1. Contact. . . [insurance company] as soon as you are aware of a potential claim.
2. Do not discuss claim with anyone – including the patient.
3. Do not sign/accept any document without approval from your. . . [insurance company] Claims Consultant.
4. Do not admit liability or agree to any settlement proposal.
5. Report any communication you receive immediately to your. . . [insurance company] Claims Consultant.”

So, while your local pharmacist may be pleasant, nice, and generally helpful, if that same pharmacist has been negligent, do not expect the pharmacist to be open and forthright with you. By following the common instructions given by his or her malpractice insurance company, the pharmacist will act as if everything is fine, without acknowledging errors or injury.

Maryland Passes Law to Regulate Pharmacy Technicians

January 19, 2009 | Lebowitz & Mzhen

In the past, when you filled a prescription at a Maryland pharmacy, you may have wondered about the training received by the technicians behind the counter. In some cases, technicians have attended nationally accredited pharmacy technician training programs. Other time, however, the pharmacy technician training is limited to training received on the job.

Under a new state law, all Maryland pharmacy technicians must attend and successfully complete training approved by the Maryland Board of Pharmacy.

By February 28, 2009, any person working in a pharmacy, except for clerical workers, must receive certification from the Board of Pharmacy. In order to receive the certification, the applicant must already be a registered pharmacy technician or be enrolled in an accredited training program approved by the Maryland Board of Pharmacy. After an applicant completes a Board approved training class, the technician must then pass an examination within six months to continue working at the Maryland pharmacy.