When it comes to prescription drugs, an error at the pharmacy can put a patient’s health at risk.
The Troubleshooters have uncovered hundreds of prescription error complaints filed with the Department of Consumer Protection over the last two years. Some mistakes were so severe that the patients received the wrong drug or an incorrect dose.
Lauren Kagan, of Avon, was prescribed a medication that was supposed to help calm her nerves during a medical procedure, but she says what she received from the pharmacy put her life in danger.
“A trip to the ER would have been definite, for sure,” Kagan said. “But it was not definite that I would have survived.”
Kagan was scheduled to have an MRI, but she can become claustrophobic. She was nervous about getting body scans in such a confined space, so she says her doctor prescribed an anti-anxiety medicine. The recommendation was to take one to two of the pills. Shortly after she had the MRI, Kagan says the medical staffers became concerned about why she was suddenly becoming so groggy and confused.
“They were just curious to know how many of the pills I had ended up taking,” Kagan said.
She said she took the minimum dose — one pill. That decision may have saved her life.
“The doctor had meant for it to be a quarter of a milligram pill, but the pharmacist prescribed a two-milligram dosage,” Kagan said.
Kagan says her husband had to keep her from falling asleep. Taking the recommended two pills would’ve been sixteen times stronger than the dosage she was supposed to be getting.
“I feel like there should be no such thing as a mistake with prescriptions because life or death is on the line,” she said.
Between 200 and 300 prescription error complaints are filed with the Department of Consumer Protection per year, according to state data obtained by the Troubleshooters. In cases where people complained about getting the wrong medications, DCP data shows that nearly 78 percent of complaints were found to be valid. These patients were indeed given an incorrect prescription.
“It could be really simple but it could also be something very severe,” said Lora Rae Anderson, Director of Communications for the Department of Consumer Protection.
Searching through two years of data from the Drug Control Division of DCP, the NBC Connecticut Troubleshooters identified several complaints including:
- A woman in Enfield who had foot surgery who said she was prescribed 10-milligram opioid pills for pain, but received 80-milligram pills instead.
- A West Hartford patient who was supposed to get a prescription for an over-active thyroid, but said she received a medication for Alzheimer’s.
- An elderly man in New Haven who said he was prescribed what was supposed to be an anti-depressant but found out that, for two weeks, he was really taking a blood thinner.
- A man in Hartford who said he was prescribed an antibiotic but ended up with medication to treat seizures.
“If you’re talking about 50 milligram instead of 15 in say, an infant, that can be really very serious,” Anderson said.
In most cases, when a prescription error complaint is substantiated, the pharmacist will pay a civil penalty to the state to avoid potentially having his or her license revoked. Those fines could be hundreds or even thousands of dollars.
“If there is a routine problem, if the issue is really severe, the long and short is that the fine gets bigger and their license could be at stake,” Anderson said.
Since her medication scare, Kagan said she has learned to follow up by taking a number of steps, including to report a problem not just to the pharmacy, but also to DCP. She said she now double-checks prescriptions – both the labels and the pills.
“We take for granted what’s written on the label because we assume that’s what the doctor has wanted for us,” Kagan said.
The Department of Consumer Protection offers tips to protect yourself against medication errors:
- Open the bag at the counter. Check to be sure that you’ve been given is what you’ve actually been prescribed.
- Don’t sign too quickly. The agreement you sign acknowledges that you’ve gotten the information you need. Don’t sign it without checking first.
- Read the label carefully. Read every word. Check the name of the drug and directions for use. If the directions are unclear, ask the pharmacist to explain them. If the name on the label isn’t the name of your doctor, notify the pharmacist.
- Look at the drug itself. If it’s a refill, does it look the same as the previous prescription? Is it the same shape and color? If not, ask the pharmacist.
- Ask for printed information sheets. Ask the pharmacist if you need any additional counseling on the medication.
If you have issues with your prescription, complaints can be sent to DCP.DrugControl@ct.gov.
A few days ago, I made this post What is more important… getting your prescription(s) QUICKLY… or… CORRECTLY ? which was a CVS memo instructing their pharmacists to fill prescriptions when their computer system was “down/off line”
The various state pharmacy practice acts were created in a era when all pharmacies were owner/operator… in fact many of the earliest days of pharmacy, the local physician also served as the local pharmacist.
The “chain pharmacy” concept mostly evolved starting in the early 20th century. When I graduated from Butler University in 1970 there was more independent pharmacies in Indianapolis/Marion county than the ENTIRE STATE of Indiana has today. Back then there was a chain “Hooks Drugs” that was the TENTH LARGEST chain pharmacy in the country – with 243 stores – all WITHIN the state of Indiana, and there was about 75% of all pharmacies – in the country – were independents.
Today, abt 65% -75% of all community pharmacies are designated at “chain pharmacies” and there is two chains (CVS & Walgreens) have abt 10,000 chain store outlets – EACH.. with a total of community pharmacies being in the 65,000 area.
Several years ago Kevin McCoy published in the USA TODAY Chains’ ties run deep on pharmacy boards showing that the vast majority of the Boards of Pharmacies are dominated by chain pharmacy employees.
When the various state practice acts were law, the typical pharmacy was owned/operated by a pharmacist and thus the law focused on a “Pharmacist in Charge”… the person who was responsible to the board of pharmacy ( BOP) for the legal operation of the pharmacy.
Today, we have a situation where the ownership of the pharmacy – a minority part of the time – is the pharmacist in charge (PIC)… since the vast majority of pharmacy ownership is by a major publicly held corporation.
Today, the PIC has no say over the operation of the Rx dept… which he/she has the legal responsibility for its operation. Here is an example in Connecticut where the BOP are going to fine or suspend a Pharmacist for a medication error… which the vast majority of time can be traced back to a “failure of the system” within the Rx dept work environment.
When a entity (BOP) that is in charge of protecting the public’s health and safety and looks to blame individuals within that system..when it is common knowledge that the design of the system itself is the real underlying cause.. suggests that the BOP’s loyalty may be to some entity other than the general public ?
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