USA Today Article: Inside a pharmacy where a fatal error occurred

I agree. Pharmacists need to advocate for patient safety. It is a sad day if we expect patients to fight for their own safety.

Thank you MountainPharmD, PharmDstudent, and azPharmD2B for your comments.

BMBiology,

I've already stated that pharmacists should, of course, be actively involved in efforts to improve quality outcomes. I never suggested that patients should fight our battle for us; you misinterpreted and misrepresented my comments. The thing is, though, it's not just our battle. We're not talking about the battle to improve working conditions for pharmacists, we're talking about the battle to reduce pharmacy errors. Naturally, the pharmacists would indirectly benefit, but this is a fight for everyone affected, not us alone.

You've criticized my assertion that we do not have the time or money to organize an effective campaign. I simplified my statement for the sake of brevity. It isn't that we don't have the time or money. It's just that there aren't enough of us willing to contribute our time and money to this cause; we're not sufficiently motivated, or we have more pressing demands. You mention that we earn around $100,000 per year, but that's before taxes. The average full-time pharmacist takes home around $60,000 to $70,000. That's a nice salary, but life is increasingly expensive. People have mortgages, car payments, insurance, student loans, and children; they have to save for retirement and college tuition. And the last thing most working pharmacists want to do with the little free time they have is think about pharmacy affairs.

I'm not saying that we don't share any responsibility. I'm not saying that we should expect others to fight without us. I'm simply saying that it's naive and unrealistic to think that there are enough pharmacists sufficiently dedicated to this effort, who are able and willing to contribute the time and money necessary to achieve any meaningful result. It's a matter of organization. It's really easy to say, "We need to act!" But who's going to get the ball rolling? You could wait indefinitely for someone to make that sacrifice.

There's a big difference between contributing to an effort like this, and initiating it. As I've already mentioned, political lobbying requires excellent organization and lots of money. The best way to address this issue is to establish a non-profit foundation with employees who can work day after day to achieve the necessary changes. And, in my opinion, there's no better group to look to than those whose lives have been shattered by pharmacy errors. These people have the money, the time, and the motive. If we wait for pharmacists to organize such a venture, it will never get done. There are around 250,000 of us; at best, you might get 5% to contribute $1,000. In truth, even that's probably optimistic. But say we could raise $12 million ourselves. Just one of these families could give more than that. It wouldn't take many of them to raise $100 million, and that's the sort of money that can buy politicians and set things in motion. And, they have the credibility and the horrific stories that attract much needed attention.

I agree that we should help, but I believe it's naive to think that we're in a position to lead the effort. The public has a responsibility here, too. We didn't get airbags and seat belts because the automobile manufacturers insisted on it.

In APhA, I think the number of student members equal the number of professional pharmacist members, and that is wrong. We should use our existing organizations to lobby for us. So many pharmacists are uninvolved. They complain about the way things are, but don't do anything about it.
In Illinois, historically, the provisions of the Pharmacy Practice Act have been dictated by non-pharmacy entities because the pharmacy organizations were too busy fighting each other. Last year, they worked together, presented a united front, and was able to get most of what they wanted into the act. One of the things which they weren't able to change was the Pharmacy Tech minimum age. It is still 16, but they were able to include a provision that requires all Techs to be certified within 2 years of being licensed.

BMBiology said:

If pharmacists are not willing contribute as you claim then why would you expect the victims to contribute millions of their own money and to raise hundreds of millions of dollars? FYI, engineers were the ones that did the science that show the importance of airbags and seat belts to the public. If it weren't for them, there wouldn't be airbags and seat belts required in every car.

I think we should lead, while you don't. I have a different mindset than you and I am glad. I think the profession is fortunated to have pharmacists like William Kennedy. I think we need more pharmacists like him.

http://www.usatoday.com/money/industries/health/2008-02-11-prescription-errors-kennedy_N.htm

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For one thing, William Kennedy is retired; he has time to serve in pharmacy organizations now if he wishes. Anyway, big deal. So he's a member of an industry organization and he's granted an interview to a reporter or two? That's fine and good. Hell, it's great, but it's not going to start any fires. That whole article comes off as a rant about poor working conditions and corporate greed; the implications to the patient, although featured, are hardly emphasized. Just because someone's a member of a club, it doesn't mean they're making a difference. In the end, what matters is results. The sort of changes that are needed will not be achieved by such simple measures, nor by any single group.

I'm all for pharmacists leading the way, but who's going to do it? Getting pharmacists to contribute might not be that difficult once someone's already organized the effort, but finding one or a few pharmacists willing to sacrifice the capital and time to get things started is. Many pharmacists are overworked as it is; they simply don't have the energy to commit to such a venture. And pharmacists who have never personally harmed a patient are not sufficiently motivated; they just don't feel responsible. Retired pharmacists may have the time, but they no longer have a vested interest in improving the situation.

Your heart is in the right place, but you seem unrealistically idealistic. Who's going to fight harder for change? The guy who wants to make sure he gets his 30-minute lunch, or the woman who lost her child? The lady who wants a shorter shift, or the man who lost his wife? These people have more motive than we to lobby for safer pharmacy practices. And again, they have the time and money to get things started.

Twenty and thirty million dollar settlements are not uncommon for pharmacy-related fatalities. There are lots of people out there who have received such large awards; it would not be a difficult task for them to pull their resources and come up with $100 million or so. After they established a foundation, we could then join in the effort by helping write letters to congressmen and donating some of our money to the foundation. The foundation employees (pharmacy professionals) and the families could meet with lawmakers to review available data and share their stories.

It could take forever and a day to collect enough money from pharmacists to pull off such a campaign. Less than ten of these families could get things rolling with the stroke of a pen. I think all your talk of action and involvement is admirable, but I'm being realistic. You could spend a decade just lobbying other pharmacists to support such an agenda. Or, you could approach families like these to serve as the emotional anchor and financier of the effort, in order to more efficiently establish a group capable of real action.

And, FYI, the engineers didn't bother with air bags and seat belts until there was a demand. And it wasn't the engineers or the auto manufacturers who demanded them.

pharmdch said:

FYI, the engineers didn't bother with air bags and seat belts until there was a demand. And it wasn't the engineers or the auto manufacturers who demanded them.

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This is off topic but I find this comment pretty funny. So all of a sudden, the public demanded this thing called air bags? John Hetrick, an engineer, created the airbags. Lets give him some credits.

http://en.wikipedia.org/wiki/Airbags

acetyl said:

Who takes 22 pills of anything in a 36 hour period?

Sure the sig was wrong and the company is at fault, but I wish more people would take responsibility for their own actions.

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correct
i think maybe the tech meant take as directed instead of take as needed. take as directed is not bad, although it shouldnt be used for controls. Walgreens and CVS has problems of trying to save money by reducing the amount of techs during a shift and doing as much rx as possible. if u go to a new walgreens u will see only 1 tech there bc according to them if its 100-200 scripts a day then u just need 1 or 2 techs. ive been in retail for years so its not some random comments.

BME103 said:

This is off topic but I find this comment pretty funny. So all of a sudden, the public demanded this thing called air bags? John Hetrick, an engineer, created the airbags. Lets give him some credits.

http://en.wikipedia.org/wiki/Airbags

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You're right, it's off topic. Of course I'm not suggesting that the public proposed the creation of a specific safety feature that did not previously exist. John Hetrick may well have invented the original airbag, but he had little to do with its widespread adoption by the automobile industry. The public played an instrumental role in promoting the legislation that made airbags mandatory safety equipment in the United States.

Furthermore, the fact that he was an engineer is insignificant. He wasn't working for the automobile industry. He was just a concerned citizen who saw a solution to a problem.

Air bags and seat belts may not have been the best example to illustrate my point, but I agree with MoutainPharmD that most consumer/patient safety groups or initiatives have been brought about by people who have experienced some tragedy. Consider Mothers Against Drunk Drivers (MADD), for example; this group has achieved considerable success with their social campaigns to raise public awareness of the dangers of driving under the influence. Many of their members are people who have lost loved ones in traffic accidents, and they've taken an active role to help address the problem. I just feel that these families could do the same to help reduce pharmacy errors.

re the walgreen error: inexcusable, every error is. but, errors will happen, eventually, with no reason good enough, ever. it happens. sadly. my comment is that our health care system is deplorable and broken in so many ways, and, this overload is just one small aspect of it. after owning my pharmacy for 35 years, a store that started in 1893, i cannot wait to close the doors and give up the fight of my own volition. just too many inequities, mental injustices to witness on a daily basis. we have made errors, unfortunately, not serious, but we have . health care is denigrated, increasingly a political football and profit well for the insurance cartel. if you really go into health care from altruism, humanity, it is a hard, hard road, to witness the collusion, corruption , usurpation of the provider and patient's decisions and power by the political and insurance machine, to the detriment of all but them. travesty after blatant travesty has created a system where sad occurences like this error is all too common.
all venues - hospitals, pharmacies, offices - are all buckling under the poorly run and beseiged system today.
answers? not enough space here to elucidate, but, it has to be addressed fairly by the powers that be first. how sad is the regression , in the midst of so much advance in technology and knowledge, in juxtaposition to all of that, i have seen in my years. so very sad, especially when i think of the capability we all have today to do better.

steve giordano said:

re the walgreen error: inexcusable, every error is. but, errors will happen, eventually, with no reason good enough, ever. it happens. sadly. my comment is that our health care system is deplorable and broken in so many ways, and, this overload is just one small aspect of it. after owning my pharmacy for 35 years, a store that started in 1893, i cannot wait to close the doors and give up the fight of my own volition. just too many inequities, mental injustices to witness on a daily basis. we have made errors, unfortunately, not serious, but we have . health care is denigrated, increasingly a political football and profit well for the insurance cartel. if you really go into health care from altruism, humanity, it is a hard, hard road, to witness the collusion, corruption , usurpation of the provider and patient's decisions and power by the political and insurance machine, to the detriment of all but them. travesty after blatant travesty has created a system where sad occurences like this error is all too common.
all venues - hospitals, pharmacies, offices - are all buckling under the poorly run and beseiged system today.
answers? not enough space here to elucidate, but, it has to be addressed fairly by the powers that be first. how sad is the regression , in the midst of so much advance in technology and knowledge, in juxtaposition to all of that, i have seen in my years. so very sad, especially when i think of the capability we all have today to do better.

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Rants come with this territory, but solutions are much more appreciated.

BME103 said:

This is off topic but I find this comment pretty funny. So all of a sudden, the public demanded this thing called air bags? John Hetrick, an engineer, created the airbags. Lets give him some credits.

http://en.wikipedia.org/wiki/Airbags

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Not that this really has anything to do with the current discussion but....Please do not quote wikipedia as a credible source of information. Wikipedia is unedited or fact checked user submitted information. Basically its worthless other than entertainment value.

BME103 said:

This is off topic but I find this comment pretty funny. So all of a sudden, the public demanded this thing called air bags? John Hetrick, an engineer, created the airbags. Lets give him some credits.

http://en.wikipedia.org/wiki/Airbags

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Are you using a second sign-on BMBiology? Sneaky...

BMBiology said:

That makes sense.

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I'm just thinking... but both IDs start with upper case "BM" and both of the sign-up dates are in 2003. You and BME103 talked about that engineer guy too. Maybe it's just coincidental or maybe I'm right?
I'm using a little bit of intuition too. I'm an INFP- introverted, intuitive, feeling, perceiving. Or maybe it's just my perception????

BMBiology said:

You talked about being realistic but you seem to forget that these families only received a portion of the settlement after lawyer fees and expenses. In addition, as the article indicated, these families entered a confidential agreement that bars them from discussing the case so your idea is not very practical when you consider the facts.

"...Walgreens in December settled the lawsuit with his family in a confidential agreement that bars any discussion of the case."

http://www.usatoday.com/money/industries/health/2008-02-12-pharmacy-errors_N.htm#uslPageReturn

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Oh, good grief! This is becoming juvenile.

The average personal injury lawyer takes approximately one-third of the settlement. For particulary large awards, they will usually agree to less. If a victim's family receives a $20 or $30 million settlement, they'd still have plenty of disposable income even after taxes, legal fees, and medical bills.

As for confidentiality agreements, they may not be able to discuss specific details of their case, but they can still talk in generalizations about pharmacy errors and how they affect people. Also, some families don't settle. If awarded a settlement by a jury, no confidentiality clause applies.

There will always be complications with any approach. There's no simple way to fix a problem like this. But I believe my solution is more practical than waiting in vain for the day when pharmacists unite for the common good.

BMBiology said:

and there's also another person who created a screen name very similar to mine when I posted in the HICP thread (BMBiologiey).

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That was in 2005- different year .

BMBiology said:

When did you become a lawyer? You honestly think Walgreens did not cover their butt when they settled with these families? Don't be so naive.

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Jesus. What's your problem? I did not express any legal expertise. That said, mom's a tax attorney. I grew up around enough lawyers to know what they charge. Even if I hadn't, it's public information.

I'm sure many of the families did sign confidentiality agreements, but not all of them. Like I said, some cases have gone to trial. If a jury awards a settlement to the family, no confidentiality agreement applies. And again, a confidentiality agreement does not bar the family from supporting initiatives to reduce pharmacy errors. Many of the details of these cases have already been publicized. They may not be able to go to a congressman and say, "Walgreens admitted fault for killing my baby, and paid me $30 million to settle." But basic information such as, "My daughter died as the result of an improperly dispensed prescription," is not generally off limits. Furthermore, there are ways of getting around them. Friends and family may know what happened, but they didn't sign anything.

BMBiology said:

Maybe you have not read the article entitled "many lawsuits against pharmacies settled in silence".

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And yet, a simple google search will reveal details of numerous pharmacy settlements.

This is no longer a productive discussion. It's derailed on some agenda to refute everything I say simply for the sake of being argumentative.

BMBiology said:

Please calm down. This is only a forum after all.

Okay fine, find some then. You speak like you are smarter than these corporate lawyers. They settled out of court for one reason - silence.

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Excuse me. Like you didn't just mock me with the lawyer comment.

As for your request, one of the videos posted by "pharmgrl5" on the first page of this thread features such a case. Specifically, a Florida jury awarded $25.8 million to the family of Beth Hippely, who died as the result of an error by a Walgreens pharmacist. There are plenty of pharmacy cases that have gone to court and resulted in significant jury awards. I'm not going to bother searching Google all night. If you're interested, you can find several in just a matter of minutes. At a law library, finding lots more would be trivial.

Are you a pharmacist or a student? I don't know about you, but I'd certainly claim to be as intelligent as the average attorney. I'm sure there are attorneys smarter than me (my mom's smarter than me), but I'm confident there are also attorneys less intelligent. I could just as easily have gone to law school as pharmacy school. In fact, I'd say law school is probably less rigorous than pharmacy school, though it's difficult to compare since the two are so different. Being a successful attorney depends more on business savvy and networking than intelligence.

BMBiology said:

you claimed there's "no shortage" of victims but yet, you can only find one? How is this one family gonna raise hundreds of millions of dollars?

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I never said hundreds of millions, I said $100 million.

Since you asked so nicely:

"An Illinois Circuit Court jury awarded $31 million to the estate of Leonard Kulisek, who was given the wrong drug at a Walgreens pharmacy in 2001."

And how 'bout one more, since I'm certain your response will be, "You can only find two?"

"A jury ordered Thrifty Payless Inc. to pay $30.6 million to the family of a girl left brain-damaged after the drugstore botched a prescription order." SANTA ANA, California (AP) -- July 16, 1998


It's conceivable that the three families I've mentioned could collectively contribute $15 or $20 million, while still having plenty left to ensure a very comfortable life. There we go. I'm already at 20% of my $100 million goal.

AngelaCL said:

Lots of doctors write for patients to take 1-2 tablets Vicodin q-4-6h, which is up to 18 in a 36 hour period. It's possible the patient was used to taking less potent painkillers on a schedule similar to that and thought methadone would be the same.

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oops, wrong post

pharmdch said:

It's conceivable that the three families I've mentioned could collectively contribute $15 or $20 million, while still having plenty left to ensure a very comfortable life. There we go. I'm already at 20% of my $100 million goal.

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I do think it is rather unrealistic to expect lottery lawsuit/settlement winners to contribute any amount of money to anything but themselves.

What we need is patients who have been harmed to act as a advocate for change. This type of support is free and very powerful. Take Mothers Against Drunk Driving as a example. The big corporate pharmacy machines of Walgreens and CVS essentially are buying silence when they settle out of court.

Pharmacists have cheap malpractice insurance compared to physicians. I don't know enough about, because I'm not a pharmacist yet, but there has to be a reason as to why. Right now I'm thinking that pharmacists don't have to pay out large sums, because the corporations that they work for do it for them.
I know it seems like slave work every day for a retail pharmacist, but
if the corporations are paying for errors, they have control over those pharmacists.
This is my prediction: once pharmacists have to pay out the millions of dollars in settlements(insurance payout) that are being paid by the corporations right now, they'll have control over the work environment.

MountainPharmD said:

I do think it is rather unrealistic to expect lottery lawsuit/settlement winners to contribute any amount of money to anything but themselves.

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Lol. Yeah, I agree. That's what I meant when I said in my initial post that most of them are greedy, self-serving opportunists. The most receptive to offering assistance would probably be mothers who have lost a child; Hell hath no fury like a woman scorned.

MountainPharmD said:

This type of support is free and very powerful. Take Mothers Against Drunk Driving as a example.

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I agree that MADD is a highly effective organization, but it's hardly free. They receive tens of millions in contributions every year. The annual compensation of their executives totals more than one million, and they spend a fortune on advertising, lobbying, and organizational expenses. Per law, their tax filings are public; you can review their finances right from their Web site.

pharmdch said:

I agree that MADD is a highly effective organization, but it's hardly free. They receive tens of millions in contributions every year. The annual compensation of their executives totals more than one million, and they spend a fortune on advertising, lobbying, and organizational expenses. Per law, their tax filings are public; you can review their finances right from their Web site.

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Sure thats where they are now. When they first started they were a grass roots organization started by those who were affected by the tragedy of drunk driving. There is no reason why the same thing can't happen for prescription drug errors.

PharmDstudent said:

Pharmacists have cheap malpractice insurance compared to physicians. I don't know enough about, because I'm not a pharmacist yet, but there has to be a reason as to why. Right now I'm thinking that pharmacists don't have to pay out large sums, because the corporations that they work for do it for them.
I know it seems like slave work every day for a retail pharmacist, but
if the corporations are paying for errors, they have control over those pharmacists.
This is my prediction: once pharmacists have to pay out the millions of dollars in settlements(insurance payout) that are being paid by the corporations right now, they'll have control over the work environment.

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We have inexpensive malpractice insurance because we work for large corporations. It is very unlikley we will be personally sued and our employer will be left out of it.

Medical doctors have high malpractice because they are not employed by large corporations. They are in a way indepedant contractors and responsible for their own malpractice. There is a big difference.

MountainPharmD said:

Sure thats where they are now. When they first started they were a grass roots organization started by those who were affected by the tragedy of drunk driving. There is no reason why the same thing can't happen for prescription drug errors.

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That's probably true, though I'm not certain it would be as successful. MADD has something going for it that a prescription error prevention group wouldn't. There is someone in virtually every community in this country that has been personally affected by drunk driving. Pharmacy-related tragedies are simply not as prevalent, and would not elicit the same degree of support and sympathy from the general public.

pharmdch said:

That's probably true, though I'm not certain it would be as successful. MADD has something going for it that a prescription error prevention group wouldn't. There is someone in virtually every community in this country that has been personally affected by drunk driving. Pharmacy-related tragedies are simply not as prevalent, and would not elicit the same degree of support and sympathy from the general public.

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Are you sure about that? 4 billion prescriptions filled last year....Walgreens and CVS on every corner......

MountainPharmD said:

We have inexpensive malpractice insurance because we work for large corporations. It is very unlikley we will be personally sued and our employer will be left out of it.

Medical doctors have high malpractice because they are not employed by large corporations. They are in a way indepedant contractors and responsible for their own malpractice. There is a big difference.

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Yeah. That's my point. The corporations(employers of pharmacists) pay for the settlements right now.

MountainPharmD said:

Are you sure about that? 4 billion prescriptions filled last year....Walgreens and CVS on every corner......

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I think she's talking about tragedies other than expensive co-pays. I don't know of anyone, personally, that was adversely harmed by a prescription error.
On the other hand, I don't know of anyone hit/killed by drunk driver.

This is a difficult analogy. Driving drunk seems common. I used to live in an area that had a lot of bars and restaurants. I was always scared of drunk drivers. Thankfully, nothing ever happened.

Prescription errors seem rare. I've only seen a few errors, other than the doctor's name or the date written, in the past 3 and half years. None of the errors were fatal- very minor errors if you will. Some of the errors were from a pharmacist's negligence and the others were from a nurse's negligence. Doctors write negligent scripts too.
Mountain Dewd- you gave a great example of excessive Tylenol dosing associated with hydrocodone.

PharmDstudent said:

Yeah. That's my point. The corporations(employers of pharmacists) pay for the settlements right now.

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Which will always be the case since sucko corporate pharmacy has taken over the world.

MountainPharmD said:

Are you sure about that? 4 billion prescriptions filled last year....Walgreens and CVS on every corner......

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Well, no. I can't be certain. That's part of the problem. With few exceptions, pharmacies are not required to document and publicize prescription error data, even in the event of a death.

Still, I'm confident that there are a lot more people who personally know someone harmed by a drunk driver than by a pharmacy error.

PharmDstudent said:

I think she's talking about tragedies other than expensive co-pays.

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That's hilarious!

I'm a guy, by the way. I'm curious if you simply assumed that I'm female because you are (assuming that you are), or if you detected something effeminate in my posts?

PharmDstudent said:

On the other hand, I don't know of anyone hit/killed by drunk driver.

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Hmm. You may not know of anyone injured or killed by a drunk driver, but you're probably aware of at least one incidence of drunk driving in your community at some period during your life. If you don't, I'd wager you're in the minority.

pharmdch said:

That's hilarious!

I'm a guy, by the way. I'm curious if you simply assumed that I'm female because you are (assuming that you are), or if you detected something effeminate in my posts?



Hmm. You may not know of anyone injured or killed by a drunk driver, but you're probably aware of at least one incidence of drunk driving in your community at some period during your life. If you don't, I'd wager you're in the minority.

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Oh no! Not this again... I've mixed up the genders before. You brought up MADD- Mothers Against Drunk Driving. You also talked about families a lot. I don't even like to talk about family stuff, and I'm female. I have little to say about the family unit other than what my latest fortune cookie wrapper said: the unit of the body is the cell, the unit of society is the family, but I'm not really sure that I believe it !

PharmDstudent said:

I have little to say about the family unit other than what my latest fortune cookie wrapper said: the unit of the body is the cell, the unit of society is the family, but I'm not really sure that I believe it !

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It's highly situational. In some circles, the unit of society is the pimp.

Mmm. I love Asian cuisine.

pharmdch said:

It's highly situational. In some circles, the unit of society is the pimp.

Mmm. I love Asian cuisine.

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Yeah. I had Chinese food for dinner on Valentine's Day. It was a nice surprise.

So what's your background? What type of pharmacy work do you do?

I work as an intern for a retail pharmacy. We don't have a drive-thru; that's really nice. My pharmacists are veterans of retail. I've heard so many funny stories. I laugh every day at work. It's a "trip" if you will. I plan on staying there until I finish pharm school. I might pick up a part-time job this summer at an institutional pharmacy, but I'm not sure yet.

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

I am a nurse and most nurses b**** and moan about working conditions but never do anything about it. But some do care, and it is those few who have lobbied against the medical-industrial machine in order to pass legislature that protects patients with a nurse-patient ratio. It was the CNA. You have the Guild for Professional Pharmacists. http://www.gfpp.org/ How many of you belong to that organization? How many of you write to that guild to push this agenda?

I think this issue is as important as the nurse to patient ratio and you should work as hard as the CNA to get it out to media and to lobby your position to have laws passed to protect patients. You have the research to back it.

I've never heard of the GFPP. The big pharmacy organizations are APhA, ASHP, AMCP.

genesis09 said:

I've never heard of the GFPP. The big pharmacy organizations are APhA, ASHP, AMCP.

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This is more of a union, rather than just an organization. There are numerous huge nursing organizations but they have done very little to advance nursing in terms of staff ratios. It has been the unions that have worked diligently, which is why I suggested this organization.

geekgolightly said:

This is more of a union, rather than just an organization. There are numerous huge nursing organizations but they have done very little to advance nursing in terms of staff ratios. It has been the unions that have worked diligently, which is why I suggested this organization.

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I worked for a union pharmacy in Colorado. I did not think they did much for us until I moved and worked for a non-union store. Unions just may be the answer for Pharmacists.