Prescription-Error: Preventable Human Error or Inevitable?

Posted on: February 24, 2008  |   Author: Peter
Filed Under: Drug & Device   |   Leave a Comment

Recently, a USA Today investigation revealed evidence of corporate policies within chain-store pharmacies that cause errors and harms consumers. While most errors go unnoticed or cause minor harm, the affects of prescription-error can sometimes be catastrophic. There are no comprehensive counts of prescription errors. Furthermore, no federal agency tracks prescription errors. In 2004, a five year old took the wrong prescription for tremors for two months, which was refilled four times during that period. Instead of medication to treat his tremors, the boy received a powerful steroid for older males. Because of the error, the child began eating more and was irritable. Consequently, the child’s height may be stunted and he may suffer liver disease. In another case, a thirty-one year old man died because he was unaware of the consequences of taking two painkillers, Tramadol and methadone. Pharmacies spend billions of dollars to reduce the rate of prescription-error, but as the baby boomers generation ages and Americans become more dependent on prescription drugs, there becomes an increased risk of error. According to an Auburn University study in 2003, 1 in 1,000 consumers receive prescriptions with life-threatening errors, or 3.7 million errors a year.
Prescription error can result from a pharmacist’s misunderstanding of prescriptions on the phone or their inability to read prescriptions written in abbreviations or codes by the prescribing physician. Many prescriptions sound similar, which increases the possibility of an error (Zoloft sounds similar to Zofran, Zomig, and Zyrtec). Also, technicians may cause errors by accidentally typing the wrong prescription information into the computer, selecting the wrong drug code, or filling the prescription with a drug that has a similar name. If the pharmacist fails to notice the technician’s errors, the consumer may be harmed.

Additionally, prescription error is often the result of pharmacies emphasizing filling prescriptions quickly rather then safely. First, pharmacies fill too many prescriptions while employing too few pharmacists. According to the investigation, 46% of chain-store pharmacists fill more than 160 prescriptions per day. Additionally, 59% believe the workload at their pharmacy is excessively high. One chain-store pharmacy said that a pharmacist might have as little as two minutes to verify the accuracy of a drug, its dosage, and its directions. To counter understaffing, pharmacists are forced to work longer shifts, causing exhaustion and ultimately contributing to error. Second, pharmacists are pressured by corporate requirements to fill quotas. Third, there is an increased reliance on pharmacy technicians that are lower-paid and lesser-trained. However, 54% of pharmacists feel there needs to be more technicians on duty and to reduce the workplace stress. Fourth, pharmacist incentive awards, such as bonuses based on increasing prescription volume, also places speed above safety. Lastly, pharmacists often fail to provide counseling to customers obtaining new prescriptions. Each of these can contribute to a prescription-error with life-threatening consequences.

So, how can prescription-errors be prevented? As physicians begin to prescribe pills to treat sickness (there was a 12% increase between 2002 and 2006), consumers must be confident that their pharmacist provides the correct medication. There is currently a pharmacist shortage, with only 240,000 in the United States. An increase in well-trained pharmacists would help understaffed pharmacies that rely heavily on technicians. Also, corporate policies should not encourage error by emphasizing speed and volume. The economic bonus realized from speed should be outweighed by the rare but catastrophic consequences that lead to costly litigation. Finally, consumers may take steps to minimize risk. Patients should know and understand the purpose of their medication, as well as, be aware of all possible side effects. The patient should inform himself on the medication and not be afraid to ask questions about the prescription. The patient should also speak with the pharmacist and receive counseling. Another simple step to take is to know what the medication looks like and examine the pills to make sure the correct pills were provided by the technician. Through an increase in pharmacists and greater corporate and personal accountability, minor and catastrophic prescription-error may be reduced.

Obesity: A Killer Disease

Posted on: February 18, 2008  |   Author: Justin
Filed Under: Public Health Policy   |   Leave a Comment

Research shows that two-thirds of Americans are overweight, and about one-third of American adults are obese. Obesity has reached epidemic proportions throughout this nation. Unlike most diseases, obesity cannot be cured with a pill or vaccine. In order to defeat it, one must eat right and exercise regularly. It is no secret that obesity is deadly, and studies show that the problem is only going to get worse. Obesity puts one at a greater risk of developing heart disease, high blood pressure, diabetes and several other serious health risks. The effects of obesity have such ravaging consequences that some have predicted that it will become the leading cause of preventable deaths in the United States by 2012. The CDC, in 2004, ranked obesity as the number one health issue facing America. Since 2004, the CDC has reported that the problem has only increased. If we do not win this battle against obesity, future generations could suffer similar fates as those during medieval ages against the plague.

The good news about this battle is that modest weight loss can drastically improve symptoms associated with obesity. Dietary improvements, regular physical exercise and behavioral changes can lead to significant weight loss that reduces the effects of obesity. Some studies show that just a five to ten percent weight loss can bring considerable health improvements. Governmental programs such as the FDA’s “Calories Count” and the Department of Health and Human Service’s “Small Steps” have helped the public further understand obesity and the importance of weight loss to combat its complications. However, is enough being done to defeat this disease? Could the government do more to prevent the spread of this epidemic? Does the responsibility lie solely with individuals? Comments?

The Constitutionality of Ohio’s Tort Reform and What It Means for Health Care Litigation

Posted on: February 12, 2008  |   Author: Alexander
Filed Under: Liability & Litigation   |   Leave a Comment

Since 1975, the Ohio General Assembly has taken steps to limit the amount of damages that can be awarded in a tort claim. Statutes promulgated by the legislature have been challenged in the Ohio Supreme Court and have been deemed unconstitutional each time. These statutes have limited medical malpractice damages to $200,000 if the case does not involve death, required trial courts to subtract mandatory collateral deductions from a plaintiff’s final award of compensatory damages, and required trial courts to order awards of greater than $200,000 to be paid in a series of periodic payments upon the motion of either party. The Ohio Supreme Court held that these statutes violated the due process and right to jury trial provisions of the Ohio Constitution. However, at the end of December, 2007, the Ohio Supreme Court upheld a 2004 state statute which limits the amount of non economic damages that can be awarded in tort cases.

The statute in question, R.C. 2315.18, requires courts to limit recovery for noneconomic damages to the greater of (1) $250,000 or (2) three times the economic damages up to a maximum of $350,000 or (3) $500,000. The limits on noneconomic damages do not apply if the plaintiff suffered “permanent and physical deformity, loss of use of a limb, or loss of use of a bodily organ system,” or “permanent physical functional injury that permanently prevents the injured person from being able to independently care for self and perform life-sustaining activities.” In Arbino v. Johnson and Johnson, 2007 WL 4569719, the plaintiff filed suit in federal court alleging that she suffered blood clots and other serious medical side effects from using the Ortho-Evra birth control medication.

In upholding R.C. 2315.18, the Court stated that the Plaintiff’s argument that the right to trial by jury was not impeded because other Ohio laws allow courts to change jury damages without running afoul of the Ohio Constitution or the Seventh Amendment. The Court also noted that while the statute limits certain types of noneconomic damages, it does not wholly deny them altogether and the remedies left are “meaningful.” The Court also stated that this would not foreclose some plaintiffs from bringing suit as they are still able to recover noneconomic damages up to $350,000. The court also rejected the Plaintiff’s Due Process and Equal Protection claims as the statute was “reasonably related to the general welfare of the public,” noting that the General Assembly made numerous findings with regard to the statute and determined that noneconomic damages are difficult to calculate and are inherently subjective.

The statute may be a turning of the tide for litigation of tort claims, including medical malpractice claims and medical device liability claims, in Ohio. While the statute’s proponents will argue that it will help to decrease health care costs in Ohio by limiting frivolous lawsuits and lowering malpractice insurance costs, trial lawyers opposing the statute will argue that the statute prohibits legitimate plaintiffs from litigating complex claims and take away the power of juries in a paternalistic manner. It is too soon to tell whether the statute has had any effect on malpractice premiums for doctors, but this may be another means by which litigation of complex claims will be discouraged in Ohio.

See generally: Arbino v. Johnson and Johnson, 2007 WL 4569719, Ohio Revised Code Section 2315.18.

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