Woman wins $9.3 million for overdose of incorrect drug
News: A tragic mistake at a hospital left a woman permanently disabled when she was admitted to the hospital to treat a urinary tract infection but incorrectly received an overdose of the drug Lovenox (exnoxaparin sodium), a blood thinner commonly used to treat deep vein thrombosis. The mistake in medication usage, as well as the overdose, left the elderly woman confined to a wheelchair, which she will need to rely on for the rest of her life. Additionally, the woman will continue to suffer serious ongoing medical issues throughout her life as a result of the overdose. After a two and one-half week trial, the jury awarded the woman $9.3 million in damages for the hospital’s professional medical negligence in her treatment.
Background: Despite suffering from a urinary tract infection the 72-year-old patient was, by all accounts, a relatively active and healthy adult. In October 2007, the elderly woman was admitted to the hospital for treatment related to a urinary tract infection. While treatment for urinary infections can be fairly simple, these infections can create serious complications for the elderly, specifically kidney infections. Generally, treatment for a urinary tract infection involves the use of antibiotics to prevent the infection from spreading to the kidneys. In this case, a rigorous course of intravenous antibiotics was used via a tube inserted in her neck, to treat the infection and prevent it from spreading. However, a deep vein thrombosis (DVT) formed near the insertion point of the tube, and the patient was treated with Lovenox to dissolve the large blood clot. This medication is commonly used to treat and prevent DVT, which often can lead to pulmonary embolisms. It is often given to patients who are bedridden in hospitals. Unfortunately, there was a mistake in the proper dosage of Lovenox to administer to a female adult patient.
When the nursing staff came in to administer treatment, they failed to check with the patient’s chart to ensure that the proper dosage for the medication was being given, given her age and weight. Instead of receiving the Lovenox intravenously with a proper dosage, the female patient was given the dosage used for a 350-pound man.
To make matters worse, the nursing staff made the mistake of giving the patient more than should be administered to an adult patient based on their weight. The typical dosage of Lovenox for an adult varies depending on the underlying condition being treated. For example, for the treatment of DVT, the typical dosage is 1 mg/kg subcutaneously every 12 hours or 1.5 mg/kg subcutaneously once a day. If a mistake in dosing is caught early, it might be possible to treat this condition by holding off on additional doses to the patient and giving an antidote called protamine, transfusing the patient’s blood, and administering blood clotting agents to control additional blood thinning or internal bleeding. Sadly, for this patient, the hospital staff overdosed her by overestimating her weight by 50%.
Moreover, despite the hospital’s efforts, in this case the extent of the internal bleeding was severe enough to cause the patient go into cardiac arrest.Fortunately, the hospital staff was able to revive the patient. After revival, the patient needed multiple blood transfusions and required immediate surgical procedures to control the bleeding in her abdomen and to prevent additional damage to other internal organs. Additional medical complications arose, though, after she suffered a serious case of methicillin-resistant Staphylococcus aureus (MRSA), which left her in severe pain. As her condition continued to decline, a central line was inserted into her neck, which resulted in the formation of an orange-sized abscess. Eventually, after spending 75 days in the hospital, the patient was released. Ultimately, the overdose left the patient confined to a wheelchair for the rest of her life because she now suffers a permanent hernia as a result of the extensive swelling she suffered from the many blood transfusions needed to revive her. Additionally, she might require future medical treatments and surgeries.
After hearing the evidence presented at the eight-day trial on the hospital’s failure to adopt and comply with standard procedures to ensure proper patient dosing, the jury deliberated for an hour and a half before finding the hospital negligent in the patient’s medical care. The jury awarded the patient $9.3 million. This figure was based on the costs of her previous medical treatments, the anticipated ongoing medical treatments, as well as compensation for her loss of enjoyment of life and pain and suffering.
What this means to you: Mistakes can and do happen, despite the best efforts made by doctors and hospitals. It is likely that every registered nurse in the United States has made a medication error. There are almost four million nurses in practice at any given moment, so the number of errors can be staggering. Fortunately, most errors do not cause harm to patients and are noticed and reported quickly to prevent recurrence. While Lovenox is not considered a high-risk medication if given at the correct dose and by the correct route, any deviation from this puts the patient in harm’s way. There are more than seven "rights" to giving medication to a patient that must be followed by the nurse. It must be the right medication given to the right patient at the right time by the right route at the right dose for the right reason after the right assessment and the right education for the patient. Then the nurse must document all of this information on the medical record.
These "rights’ must be followed to minimize the harm associated with the any kind of medication routinely prescribed and administered in an inpatient setting. Even more care is taken if the medication is considered "high-risk." Most hospitals require an "independent double-check" by a second nurse before high-risk medications such as heparin, hydromorphone, and insulin can be administered. Creating a thorough protocol for recording and checking the patient’s record is one way to help minimize these kinds of dosing mistakes. Many hospital use 12-hour and 24-hour chart reviews in this regard.
Additionally, comprehensive electronic medical record (EMR) systems have provided physicians and pharmacists greater access to relevant patient information, including their medication profile at the click of a button. Great care must be taken to ensure that there is a well-established system of checks and balances to ensure that the medication administration record is accurate and actually corresponds to the medication the patient is receiving. Had this patient’s medication profile been reviewed by the pharmacist, the first medication error would have been noticed before the second one was committed.
Also, gone are the days of trying to track down the actual paper file to review the patient’s medical record. Also, paper medical record systems are often inefficient in terms of storage costs, and there is also the problem of transferability. Problems often arise when a paper-based record is needed in multiple locations. For example, one copy of the patient’s medical record might be needed at the hospital, one file at the internal medicine doctor’s office, and one file at a specialist’s office. With the EMR system, these files can be transferred and accessed with a much greater ease. Most importantly, when urgency is needed, these files can be accessed almost immediately.
In theory, all healthcare organizations are fully committed to providing the highest and safest quality of care to its patients. To remain true to this in practice, doctors and hospitals must routinely follow the established protocol for checking patient records forproper dosing.
Reference
- No. FBT-CV-10-6007019-S, Bridgeport County Superior Court, Bridgeport County, CT. Oct. 25, 2013. F