Pharmacy mistake killed horses

[bajunganut]

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Wow, just read that the 21 Polo horses that died a few days/week ago was due to a pharmacy mistake!

Only horses treated with the compound made from Frank's Pharmacy in Florida became sick and died within 3 hours of treatment. Other horses that were not treated remain healthy and normal.

Poor Frank.... well, I guess it's better horses then people 😕

 

[67echo]

wow...

http://www.suntimes.com/1540982,w-polo-horses-dead-pharmacy-mistake-042309.article

 

[FAMUPharmD09]

Wow, just read that the 21 Polo horses that died a few days/week ago was due to a pharmacy mistake!

Only horses treated with the compound made from Frank's Pharmacy in Florida became sick and died within 3 hours of treatment. Other horses that were not treated remain healthy and normal.

Poor Frank.... well, I guess it's better horses then people 😕

Hope Frank had liability insurance🙁

 

[aboveliquidice]

Wow, just read that the 21 Polo horses that died a few days/week ago was due to a pharmacy mistake!

Only horses treated with the compound made from Frank's Pharmacy in Florida became sick and died within 3 hours of treatment. Other horses that were not treated remain healthy and normal.

Poor Frank.... well, I guess it's better horses then people 😕

Wow... Very few animal prescriptions are filled by a pharmacist (most are written, filled, and sold in-house).

Does this mean that the likelihood of dying from a pharmacist filling an animal prescription is proportionately higher than humans?

 

[fhx06]

Wow... Very few animal prescriptions are filled by a pharmacist (most are written, filled, and sold in-house).

Does this mean that the likelihood of dying from a pharmacist filling an animal prescription is proportionately higher than humans?

😵 Interesting way of looking at it but I suppose yes, it is.

 

[Vitamin K]

😵 Interesting way of looking at it but I suppose yes, it is.

Not necessarily...Frank's is a veterinary pharmacy according to the articles I've read. That's their specialty.

 

[Argentium]

lol got this in my inbox from CNN "breaking news." that's a lot of money though ... horseys are expensive

 

[njac]

these were trained polo ponies, valued at approximately $200K/each.

The people I know who use Frank's will continue to do so if they can - they've had great service.

 

[eightball]

there will be lots of $$ changing hands here.


crazy thought:

21 cute ponies= media uproar

100,000 patients succumb to med errors/ year, where is the media in this situation?

 

[powertoold]

100,000 patients succumb to med errors/ year, where is the media in this situation?

Because it's like beating a dead horse...............

 

[eightball]

Because it's like beating a dead horse...............

what?

 

[njac]

Because it's like beating a dead horse...............

TOO SOON!

 

[powertoold]

Anyway, the pharmacy / veterinarian must have done something horribly wrong. I don't understand how some vitamins and minerals could have a 100% horse mortality rate.

 

[njac]

Anyway, the pharmacy / veterinarian must have done something horribly wrong. I don't understand how some vitamins and minerals could have a 100% horse mortality rate.

when it's a combination product including potassium and magnesium it absolutely can.

Each 100 ml of Biodyl contains
Cyanocobalamin (Vitamin B12)......0.05 g
Sodium selenite..100 mg
Potassium aspartate semihydrate ...1.000 g
Magnesium aspartate tetrahydrate... 1.500 g
Excipient q.s. .. 100 ml

Indications
Fatigue, convalescence, poor start in young animals, travel sickness, conditioning racehorses and jumpers, myopathy-dyspnea syndrome in calves (delayed type), white muscle disease, muscular dystrophy in herbivora, stiff-lamb disease, enzootic paraplegia in lambs, myositis in horses, azoturia (tying-up).


Dosage :
· Horses : slow intravenous or intramuscular injection : one injection of 20 ml per animal every 4 or 5 days (total of 4 to 5 injections).


An equine vet friend commented on a horse board how she and other vets have discussed how difficult it is to kill a horse - sometimes you don't have enough of the proper euthanasia drugs and they may try "throwing the kitchen sink" at them. It's tough.

 

[aboveliquidice]

when it's a combination product including potassium and magnesium it absolutely can.

Each 100 ml of Biodyl contains
Cyanocobalamin (Vitamin B12)......0.05 g
Sodium selenite..100 mg
Potassium aspartate semihydrate ...1.000 g
Magnesium aspartate tetrahydrate... 1.500 g
Excipient q.s. .. 100 ml

Indications
Fatigue, convalescence, poor start in young animals, travel sickness, conditioning racehorses and jumpers, myopathy-dyspnea syndrome in calves (delayed type), white muscle disease, muscular dystrophy in herbivora, stiff-lamb disease, enzootic paraplegia in lambs, myositis in horses, azoturia (tying-up).


Dosage :
· Horses : slow intravenous or intramuscular injection : one injection of 20 ml per animal every 4 or 5 days (total of 4 to 5 injections).


An equine vet friend commented on a horse board how she and other vets have discussed how difficult it is to kill a horse - sometimes you don't have enough of the proper euthanasia drugs and they may try "throwing the kitchen sink" at them. It's tough.

Potassium certainly has the potential to kill - you cannot hang more than 40 meqs at a time just because of the potential for killing someone... Still - 3hrs is a rapid death via medication.

 

[prevacid]

this gives more credence to the compounding pharmacies need regulation crowd

 

[eventualeventer]

Potassium certainly has the potential to kill - you cannot hang more than 40 meqs at a time just because of the potential for killing someone... Still - 3hrs is a rapid death via medication.

Or slow, if it's potassium IV.

Stupid question from a non-pharm person, but if the horses' kidneys were functioning properly, would potassium given q4-5 days have any real (sustained/consistent) effect? It seems to me that daily oral electrolyte supplementation would be more effective in that regard; wouldn't the kidneys excrete any excess K+ pretty quickly (unless it were a really high dose)?

Several vets I know use Franck's for pergolide prescriptions, and they and their clients have been happy with it thus far.

 

[njac]

Or slow, if it's potassium IV.

Stupid question from a non-pharm person, but if the horses' kidneys were functioning properly, would potassium given q4-5 days have any real (sustained/consistent) effect? It seems to me that daily oral electrolyte supplementation would be more effective in that regard; wouldn't the kidneys excrete any excess K+ pretty quickly (unless it were a really high dose)?
.

I'm thinking this is given as a day of competition boost. The K and Mag may be for immediate electrolyte replacement - as you know a polo match is pretty intense. It makes more sense to do a daily supplement, but sometimes it's hard to get horses to drink water with the electrolyte powder in it, and you want to keep them drinking (especially in Florida).

I know when I was competing a lot we would mix electrolyte powder in their grain or buy a paste to manually administer. But that's not easy when the horse assumes you have bute or dewormer.

 

[BMBiology]

http://news.bbc.co.uk/2/hi/americas/8015487.stm

A Florida pharmacy has revealed that the dosage of the medication it prepared for 21 polo ponies that died earlier this week was "incorrect".

Franck's Pharmacy said the horses' medication was prepared "on an order from a veterinarian".


People always assume it is the pharmacy's fault when something goes but a lot of times, it is the prescriber's fault.

 

[Vitamin K]

http://news.bbc.co.uk/2/hi/americas/8015487.stm

A Florida pharmacy has revealed that the dosage of the medication it prepared for 21 polo ponies that died earlier this week was "incorrect".

Franck's Pharmacy said the horses' medication was prepared "on an order from a veterinarian".


People always assume it is the pharmacy's fault when something goes but a lot of times, it is the prescriber's fault.

It doesn't matter. The whole purpose of having a pharmacy dispense is their ability to check dosing. If they didn't know the usual safe dose, they should have looked it up.

My guess is that, because they died due to "hemorrhaging", it may be an osmolality issue (assuming it was IV).

 

[aboveliquidice]

http://news.bbc.co.uk/2/hi/americas/8015487.stm

A Florida pharmacy has revealed that the dosage of the medication it prepared for 21 polo ponies that died earlier this week was "incorrect".

Franck's Pharmacy said the horses' medication was prepared "on an order from a veterinarian".


People always assume it is the pharmacy's fault when something goes but a lot of times, it is the prescriber's fault.

The press release (from Franck's) stated that the strength of one of the ingredients was incorrect.

Either it was written poorly and the pharmacy didn't catch it - or it was compounded incorrectly and the verification failed.

Both possibilities place blame on the pharmacy / pharmacist - the question is whether or not it is a shared blame.

 

[WVUPharm2007]

Because it's like beating a dead horse...............

HAHAHAHAHAHA. Excellent.

 

[BMBiology]

The press release (from Franck's) stated that the strength of one of the ingredients was incorrect.

Either it was written poorly and the pharmacy didn't catch it - or it was compounded incorrectly and the verification failed.

Or maybe...just maybe the prescriber wrote it clearly but the strenght was incorrect. By law, it is not the pharmacist's fault. If it is what the prescriber prescribed, then it is the prescriber's fault. Don't believe? Look at the court decisions.

 

[fhx06]

From the article:

Lechuza also issued a statement to AP acknowledging that a Florida veterinarian wrote the prescription for the pharmacy to create a compound similar to Biodyl, a French-made supplement that includes vitamins and minerals and is not approved for use in the United State.

I find this statement very interesting since it can be argued in terms of liability and risk.

 

[aboveliquidice]

Or maybe...just maybe the prescriber wrote it clearly but the strenght was incorrect. By law, it is not the pharmacist's fault. If it is what the prescriber prescribed, then it is the prescriber's fault. Don't believe? Look at the court decisions.

How does restating half of my post make a compelling point? Written poorly - pharmacy didn't catch it... as in a lethal dose of a medication that the pharmacist should not have approved.

I can have prescribers write for 160 meq KCl IV all day long - It doesn't make me any less liable if I let it pass through the door.

 

[BMBiology]

I can have prescribers write for 160 meq KCl IV all day long - It doesn't make me any less liable if I let it pass through the door.

Liable? Not by law. It has been ruled that the responsible of the pharmacist is to dispense what the prescriber wants. We all know there are many bad prescribers out there but why is pharmacist malpractice so low? because by law, the prescriber is held liable, not the pharmacist.

 

[Vitamin K]

How does restating half of my post make a compelling point? Written poorly - pharmacy didn't catch it... as in a lethal dose of a medication that the pharmacist should not have approved.

I can have prescribers write for 160 meq KCl IV all day long - It doesn't make me any less liable if I let it pass through the door.

I think BM thought by "poorly written" you meant "poor penmanship". That's why he restated it. Misunderstanding?

 

[aboveliquidice]

Liable? Not by law. It has been ruled that the responsible of the pharmacist is to dispense what the prescriber wants. We all know there are many bad prescribers out there but why is pharmacist malpractice so low? because by law, the prescriber is held liable, not the pharmacist.

Here is what actually happened:

Quoting anonymous sources (in the South Florida Sun-Sentinel), La Nacion, newspaper of Argentina, reported Friday that the 21 Lechuza Caracas team horses scheduled to play in Sunday's polo match were injected with a lethal dose – 10 times the intended amount – of selenium, a trace mineral that is poisonous to horses in high doses. The newspaper reported that 0.5 mg/ml was prescribed but the compound actually contained 5 mg/ml.

I am pretty sure mechanical medication errors fall under liability.

As to liability concerning dosage - That is an ongoing point of contention. Pittman vs. Upjohn, 890 S.W.2d 425, (1994) - The court found the pharmacy defendant had a duty "greater than merely filling the physician's prescription correctly." The court said "the pharmacy, as well as the physician, owed [the patient] the duty to warn" of the "symptoms and dangers of complications that might arise from the use of micronase."

There was no liability in this case - because the person who took the medication causing damage was not the patient, but instead a grandson. There was no way the prescriber or the pharmacist could have known that the medication would be used in this manner.

Had it been the grandparent that had been injured - We would have had a different conclusion.

While this is referring to potential side effects of a medication - The ruling specifically stats that there are duties beyond simply filling a prescription correctly. By this judgement, a foundation has been set by which pharmacists can be held liable - even if the Rx is correct - for negative outcomes (such as death).

 

[BMBiology]

Here is what actually happened:

Quoting anonymous sources.....There was no liability in this case

Anonymous sources? no liability? Is that all?

 

[BMBiology]

While this is referring to potential side effects of a medication - The ruling specifically stats that there are duties beyond simply filling a prescription correctly. By this judgement, a foundation has been set by which pharmacists can be held liable - even if the Rx is correct - for negative outcomes (such as death).

When did you become a legal expert? If this 15 yr old case is so important as you claimed, wouldn't pharmacist be sued left and right? Why are pharmacists malpractice fee so low? Come on, you can find better cases than that.

 

[aboveliquidice]

When did you become a legal expert?

Pharmacist - We're all supposed to be legal experts - some how, I bet even you know your legal responsibilities.

Feel free to disprove anything I wrote above - rather than posting an endless ramble of questions. I've got a feeling you would rather spend two seconds playing devil's advocate without agenda than add anything of value to the discussion.

What I could not find - one way or another - was a case concerning inappropriate dosing and pharmacist liability. Many cases that were close - but none dealing with just this specific issue - What case were you referring to Bm?

 

[MountainPharmD]

Remember we are talking about animals, not people. The law is quite different in both situations because animals are considered property. As far as pharmacy law goes it won't matter if it is an animal or a human.

Look at the recent melamine tainted dog food scandal. The owners of the animals who died wanted to sue for pain and suffering along with actual damages. The courts ruled they could only sue for the actual damages, such as the original cost of the animal plus medical care. You cannot sue for pain and suffering for a property loss.

 

[aboveliquidice]

Remember we are talking about animals, not people. The law is quite different in both situations because animals are considered property. As far as pharmacy law goes it won't matter if it is an animal or a human.

Look at the recent melamine tainted dog food scandal. The owners of the animals who died wanted to sue for pain and suffering along with actual damages. The courts ruled they could only sue for the actual damages, such as the original cost of the animal plus medical care. You cannot sue for pain and suffering for a property loss.

Good point - I think someone stated 200k / horse - plus possible damages from failure to compete / advertising, etc...

Mo'money, Mo'problems?

 

[museabuse]

I work at a retail chain. We occasionaly get a rx for hycodan tablet, tramadol, mobic from a vet office or dogs or cats. Should I know if this is a correct dose... because up until now I always assumed the vet knows much more about doses for animals than I do. I don't think I have any resources available in my pharmacy to find out the correct dose. Maybe I should just refuse to fill them. I would never compound something for an animal though.

I once was reading the board minutes and there was a complaint about a pharmacist because a vet left a rx on voicemail for tramadol for a cat I think and the pharmacist heard tylenol. Luckily the owner knew the rx was wrong because apparently tylenol is lethal to cats... I never knew tylenol was lethal to cats... did you? If you had an rx for tylenol written for a cat from a vet by would you have filled it or would you have looked it up first?

 

[MountainPharmD]

Good point - I think someone stated 200k / horse - plus possible damages from failure to compete / advertising, etc...

Mo'money, Mo'problems?

Oh yeah, someone is going to pay no doubt. I am sure the pharmacy and/or pharmacist will receive some sort of sanction from the board of pharmacy if it is found they violated any rules and regulations.

What I remember from the dog food scandal, damages were limited solely to the cost of the animal and associated medical care directly related to the melamine. People were arguing the dog was like a member of the family and thier kids were scared forever ect.

 

[fhx06]

If the compound is not approved for use in the US but is requested by a veterinarian to be made, would you guys consider the liability to be more on the veterinarian or on the pharmacist? I understand that pharmacists are suppose to verify doses and treatments but if the medication in question is not even approved for US use, should the pharmacist have filled the order, verified the order, or proceeded under the assumption that the vet has the formulation correct?

I don't have access to Clinical Pharm or any specific resource to tell me what Biodyl is composed of but if there are no standard dosing references for this compound in the US I don't think it is justifiable to say the blame is strictly on the pharmacy.

 

[fungikid]

I think the pharmacist should have researched the formulation more (in terms of safety, etc.), and double-checked with the vet. If the vet insisted on using the custom formulation, it should only be the vet who is liable. Part of a pharmacist's job is NOT to assume prescriptions are correct.

 

[Vitamin K]

I work at a retail chain. We occasionaly get a rx for hycodan tablet, tramadol, mobic from a vet office or dogs or cats. Should I know if this is a correct dose... because up until now I always assumed the vet knows much more about doses for animals than I do. I don't think I have any resources available in my pharmacy to find out the correct dose. Maybe I should just refuse to fill them. I would never compound something for an animal though.

I once was reading the board minutes and there was a complaint about a pharmacist because a vet left a rx on voicemail for tramadol for a cat I think and the pharmacist heard tylenol. Luckily the owner knew the rx was wrong because apparently tylenol is lethal to cats... I never knew tylenol was lethal to cats... did you? If you had an rx for tylenol written for a cat from a vet by would you have filled it or would you have looked it up first?

Right. But you work in a retail pharmacy, not in a veterinary pharmacy. And the Rx apparently was written for 0.5 not 5mg/ml.

 

[skypedudepharm]

wow that is sad who would make a stupid mistake like that. buy anyways you learn from your mistakes

 

[Vitamin K]

wow that is sad who would make a stupid mistake like that. buy anyways you learn from your mistakes

You. Me. Anyone.

Don't be so naive to think that you're above making simple mistakes. I don't think there's a pharmacist around who hasn't made some type of error. It just turned out that Frank's error lead to a terrible outcome that was widely publicized. The second you start thinking you're immune to screwing up, you open yourself up to some pretty horrible possibilities. Even the most careful person is going to slip up at some point.

 

[Fuzzychickens]

So some rich people didn't get to see a bunch of riders on $100,000 horses smack a ball around with a mallet.

A pharmacy error involving one human ranks higher than the attention this story is grabbing.