Court Upholds $33 Million Award to Mulberry Family Against Walgreens

Rebel78 said:

http://www.theledger.com/article/20...ds-33-Mil-Award-to-Hippely-Family-of-Mulberry

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No mention of the Pharmacist that checked the damned things?

Another example of how lawsuits in this country are bull****.

man i wonder how much Wags offered to settle the case.

so she was age 41, she had 24 years left as a productive adult (to age 65). Confounding factors: married, minor children. Yeah... $33M sounds about right. I think that's what the judgment against OJ Simpson was in the civil trial.

How does 33 million make sense?

Also, how does warfarin treat breast cancer?

I don't know how they arrived at that amount, but I can tell you if that was my mother, I would have gone after Walgreens and the Pharmacist (assuming script was legibly written for 1mg) for every penny they are worth. When you are filling scripts for a drug like Coumadin, you should automatically go into a heightened awareness mode and make damn sure the patient is getting what the doctor wrote for. No pharmacist can be expected to fill every script with 100% accuracy. Exception: Coumadin, among some others.

aelephant said:

How does 33 million make sense?

Also, how does warfarin treat breast cancer?

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The article's writer probably just decided to leave it as part of the treatment for breast cancer. I've heard that it's used post-mastectomy for lymphedema. Also this: http://www.ncbi.nlm.nih.gov/pubmed/9459316

Falanga A, Levine MN, Consonni R, Gritti G, Delaini F, Oldani E, Julian JA, Barbui T.

Hematology Dept, Ospedali Riuniti, Bergamo, Italy.

Malignancy is a risk factor for thromboembolism and anti-cancer chemotherapy can increase this risk. Prophylaxis of thrombosis with very-low-dose warfarin given concurrently with chemotherapy has a significantly reduced rate of thromboembolism in a randomized trial in women with stage IV breast cancer. In a group of 32 patients randomized in one center (16 subjects on warfarin and 16 on placebo), we have prospectively studied the plasma levels of: 1. Markers of 'in vivo' clotting activation (thrombin-antithrombin complex [TAT], prothrombin fragment 1+2 [F1+2] and D-dimer), 2. Factor VII (FVII), and 3. Natural anticoagulants (protein C [PC] and antithrombin [AT]). The aims of this study were: 1. to examine whether laboratory tests predicted those patients who developed thrombosis, and 2. to evaluate the effect of very-low-dose warfarin on hemostatic variables. The patients' hemostatic parameters were evaluated before entry into the study and after starting chemotherapy +/- prophylaxis, before each course for nine courses. Before-treatment results were compared to those of a sex and age-matched non-cancer control group. There was a significant elevation of plasma levels of TAT (p <0.001), F1+2 (p <0.001), D-dimer (p <0.0001) and FVIIa (p <0.05), as well as an increase of FVII proteolysis (p <0.05), whereas plasma PC and AT concentrations were not different from controls. After starting chemotherapy, markers of clotting activation were progressively lower in the group receiving warfarin prophylaxis compared to the group on placebo. Differences between the groups became statistically significant (p <0.01) after the 4th course of chemotherapy. Deep vein thrombosis occurred in two patients in the placebo arm. The results of this study indicate that before therapy, an hypercoagulable state is present in stage IV breast cancer, and after starting chemotherapy, abnormalities of hypercoagulation markers persist, however they are reduced by very-low-dose-warfarin. None of the laboratory variables could predict thrombosis in the single patient.

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The warfarin 1 mg dose prescribed by the physician makes sense that he was looking to prevent thromboembolism in the patient.

Excuse me for asking, but isn't this what you guys WANT? If you look in the thread about the pharmacist who was jailed, there are multiple people saying "The responsible party should have been the pharmacy for overworking him." Same for multiple other threads. It's Wags; is it a big leap to assume the pharmacist was overworked and understaffed? I'm surprised more people aren't happy about Wags being held accountable.

Music Man said:

I don't know how they arrived at that amount, but I can tell you if that was my mother, I would have gone after Walgreens and the Pharmacist (assuming script was legibly written for 1mg) for every penny they are worth. When you are filling scripts for a drug like Coumadin, you should automatically go into a heightened awareness mode and make damn sure the patient is getting what the doctor wrote for. No pharmacist can be expected to fill every script with 100% accuracy. Exception: Coumadin, among some others.

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I don't where you come from, but just to create a new screenname and blame the pharmacist is the most ignorant thing you could have done. If you are in pharmacy school right now, do they teach you about continuous quality improvement and medication errors? Obvious mistakes should not be condoned, but in this case we have not gathered all the facts about the pharmacist and environment created the mistake. You are just as stupid as Ohio pharmacy board. Instead of blaming your coworkers, grow up and unite, fight the monster that makes pharmacists work like a machine without a break and profit is above patient safety.

Wow...you call me stupid and then tell me to grow up in the very next sentence. Anyone else see the irony here? My entire argument was based on "If". Guess you ignored that part, huh? It's pretty darn simple. When you check a really narrow therapeutic index drug like Coumadin, you "read" the script, then you "read" the label, then you "open" the bottle and look at the tablet and make sure its the right pill. Each strength is a distinctly different color for this very reason. The 10mg and the 1mg couldn't look any more different, unless the 1mg was black I suppose. That's just 1 more foolproof measure in place for us. How many do you need? If you are being overworked by your big, bad, meanie monster employer to the point that you cannot stop and make 100% certain a NARROW THERAPEUTIC INDEX DRUG is being dispensed correctly then you need to get the hell out of the way and let somebody else more capable than yourself do it. The monsters don't make you do anything, this is a fundemental flaw in your thinking. I am so tired of hearing this argument. Working for monster companies is a strictly voluntary process. If you don't like it...leave. Your job skills are portable. If you cannot find a better working environment (for whatever reason) somewhere else, that's your fault, not Walgreens. If you continue to stay in such an environment that promotes grossly unsafe practices (that could easily get someone killed) then you are irresponsible and place your job security above the life of the patients who are paying you to be there. If this is you, you are the problem-not me. Here is my contribution: I don't work for the big, bad, meanie monster chains. You get paid alotamoney to do some pretty straightforward things. It ain't rocket science, folks. My question to you is this: If your mother came into your pharmacy while you were working and YOU did the final check on her Coumadin, is there a snowball's chance in hell that this would have happened to her? Sure, obvious mistakes will occur, but I bet you gonna make damn sure she gets the 1mg Coumadin and not 10mg. You know I'm right. Also, I didn't create a new screenname. Not sure where that came from. Lookie there...I did that all without calling you a childish, demeaning name. It did require a little restraint, though.

In the Walgreens system, for drugs like Warfarin 1mg/10mg and prednisone 1mg/prednisone 10mg, they actually have stars on them when you type them in. It is supposed to make them look different and help you avoid errors.

Do u think that hospital pharmacies don't make errors? Look at the Emily law case. And explain to me how the hell it's not a system error? And I bet u never work at walgreens because the script is reviewed remotely. Your local pharmacist sometimes have no idea how the script look like. So if the label says 10 mg and the pills in the bottle match the 10 mg discription. How the hell the pharmacist in charge know? And some exciting students like you argue why pharmacists do not counsel. With 500 scripts a day, good luck with that. Now MUSIC tell me if you are so good at blaming at that poor pharmacist, how the hell would you prevent from happening again? Do you keep the failing system and replace new pharmacists every pt death or you change the system and no one gets hurt?

Is it possibly the case of a decimal point and a trailing zero?
Honestly, a one time dose of 10mg warfarin is rare in itself. It definitely would not slip past me even if I was hyper-tired and super-drained of all vitality. Doses as high as 10mg are even recommended to be in divided daily doses. I'm sorry I'm gonna have to call pharmacist on this one. Retail really does deplete clinical common sense indeed!

RX CARE said:

Is it possibly the case of a decimal point and a trailing zero?
Honestly, a one time dose of 10mg warfarin is rare in itself. It definitely would not slip past me even if I was hyper-tired and super-drained of all vitality. Doses as high as 10mg are even recommended to be in divided daily doses. I'm sorry I'm gonna have to call pharmacist on this one. Retail really does deplete clinical common sense indeed!

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yeah i rarely see 10mg as a one-time PO dose inpatient side, in fact I think we do have to give it in divided doses...I'll double check tomorrow.

As for retail chains overworking their pharmacists...it's true, but as a pharmacist, you deal with it. It's YOUR license on the line, slow it down and make people wait if you need the extra time to ensure it's correct. With a narrow TI drug like warfarin, you give it a little extra "oomph" vs. some random amox dose, statin, or something else.

I, too, call pharmacist on this one...though the system is also the blame. Though I don't think the article mentioned the workload of that pharmacy. My safety class mentioned that MORE mistakes can happen when there's downtime or when it's less busy.

BID Coumadin? I would like to see any supporting evidence for that. A patient at the hospital I'm at now recently died from bleeding complications after receiving 5mg Coumadin BID, against the advisement of the pharmacy.

confettiflyer said:

My safety class mentioned that MORE mistakes can happen when there's downtime or when it's less busy.

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and your safety class was sponsored by walgreens or the research was supported by walgreens.

BMBiology said:

and your safety class was sponsored by walgreens or the research was supported by walgreens.

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nah the guest lecturer was from ISMP. I'll dig up the ppt later.

Music Man said:

BID Coumadin? I would like to see any supporting evidence for that. A patient at the hospital I'm at now recently died from bleeding complications after receiving 5mg Coumadin BID, against the advisement of the pharmacy.

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oh no not BID coumadin... 10mg PO x1 would be given as 2 x 5mg tablets, cuts down on a tech grabbing a 10mg tablet instead of a 1mg tablet. It's inpatient so the blister packs we use have the dose fairly prominent on the back, I can see this being an issue retail side with someone having to squint to read a number on the tablet.

At least I think that's up...I'll check the bin tomorrow when I'm in.

this is why i always double check the hardcopy when i verify the product

Music Man said:

BID Coumadin? I would like to see any supporting evidence for that. A patient at the hospital I'm at now recently died from bleeding complications after receiving 5mg Coumadin BID, against the advisement of the pharmacy.

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So what are you saying? the patient should have been on 10mg instead? Don't think it woulda made much of a difference...that's why regular INR monitoring is key....especially if a patient needs to be on wafarin that high. A 10mg pill of warfarin can shoot up the INR by up to 0.5 points in one day.

Article says this happened after several weeks of being on this medication. Aren't INR's initially supposed to be monitored sooner than that?

I'm sad that this incident has happened, but I'm glad Walgreens is being punished for some of the mistakes its' working conditions cause. When will safety be stressed instead of number of prescriptions verified? This was probably a POWER store since it is in Florida. Typing and reviewing are done remotely and verification is done by the tech correct? The pharmacist is basically a cashier?

crossurfingers said:

Article says this happened after several weeks of being on this medication. Aren't INR's initially supposed to be monitored sooner than that?

I'm sad that this incident has happened, but I'm glad Walgreens is being punished for some of the mistakes its' working conditions cause. When will safety be stressed instead of number of prescriptions verified? This was probably a POWER store since it is in Florida. Typing and reviewing are done remotely and verification is done by the tech correct? The pharmacist is basically a cashier?

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LOL they didnt have power in 2002

RX CARE said:

Is it possibly the case of a decimal point and a trailing zero?
Honestly, a one time dose of 10mg warfarin is rare in itself. It definitely would not slip past me even if I was hyper-tired and super-drained of all vitality. Doses as high as 10mg are even recommended to be in divided daily doses. I'm sorry I'm gonna have to call pharmacist on this one. Retail really does deplete clinical common sense indeed!

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I know what you mean...
A one time dose of 10mg warfarin was called in recently, and we didn't even have the 10s on the shelf. The script was dispensed with two 5 mg tablets.
That's how rare a 10mg script of warfarin is... we don't even carry it!

PharmDstudent said:

I know what you mean...
A one time dose of 10mg warfarin was called in recently, and we didn't even have the 10s on the shelf. The script was dispensed with two 5 mg tablets.
That's how rare a 10mg script of warfarin is... we don't even carry it!

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Yup...not included are drugs for infant like prelone, or for pain like morphine. Sometimes I see doctor puts 2.5 ml on morphine q 4 h. The script was entered correctly but obviously dosing will kill the patient. If you are the only pharmacist to handle the script, you know it's wrong. But if you have like 1 pharmacist to review sig, one review interaction, one review product, I can see that sometimes the mistake slips through in fast food pharmacy. If you are a good pharmacist and make one fatal mistake, it is devastating.

Yeah, I have to say, where the hell was the INR tests? This would of easily been spotted and stopped had she had been following normal protocol. Wonder what happened there

In the UK there have been similar problems with methotrexate. Now standardise on 2.5mg tablet to avoid the risk.
johnep

"Article says this happened after several weeks of being on this medication. Aren't INR's initially supposed to be monitored sooner than that?"

EXACTLY!!!!
I take HUGE issue with this article (and the ABC news segment) that shows the technician being interviewed (admitting she typed it at 10mg vs 1mg) but there is NEVER ever ever any mention of workflow, pharmacist, and HOW this could have happened.

On the ABC News (you can check it online) they even show the RX # and the store# that filled the RX.

The way they make it sound, the tech dispensed the medication ALL BY HERSELF.
Which I'm pretty sure doesn't happen, not even in Florida (where anything goes, like the 2000 elections.)

Apteka said:

"Article says this happened after several weeks of being on this medication. Aren't INR's initially supposed to be monitored sooner than that?"

EXACTLY!!!!
I take HUGE issue with this article (and the ABC news segment) that shows the technician being interviewed (admitting she typed it at 10mg vs 1mg) but there is NEVER ever ever any mention of workflow, pharmacist, and HOW this could have happened.

On the ABC News (you can check it online) they even show the RX # and the store# that filled the RX.

The way they make it sound, the tech dispensed the medication ALL BY HERSELF.
Which I'm pretty sure doesn't happen, not even in Florida (where anything goes, like the 2000 elections.)

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you're not kidding! When I moved down here from NY I was like "wtf, they are calling in Vicodin for a whole month?"