Medical error rant

[Skeptic Ginger]

Sadly a young man just died up at Western WA University of MRSA pneumonia. That is not the error I am ranting about but there are implications involved.

A few weeks back my son got an antibiotic for acne, Doxycycline, at the university's student health clinic. He said it didn't seem to be working and he had actually gotten worse. But he said they warned him to expect that and to keep using it.

This made no sense to me. Those instructions would be accurate for Accutane (isotretinoin) where a "flare" is experienced after starting treatment. But I've never heard of it applying to starting antibiotics. I don't treat any patients currently for acne and I always keep in mind someone with current information may know something I don't but still, I was pretty sure I was right. So I told him to go back and tell them what I said.

Kid's and Mom's relationships being what they are, he declined to do so and decided to wait for the next appointment in 6 weeks like they had told him. Oh well, it's his decision and this is not one of those arguments that is worth the fight.

Then Wed, the 20th, the student at the university died of MRSA pneumonia so I emailed my son about it, asking if he knew him and giving my Mom admonition to be careful at the school gym, and so on. My son already knows this of course, but I'm a Mom.

Then today he calls me. He went to take one of the antibiotics and they were clumped together in the bottom of the bottle. He looked closer at the label and found they had expired in 2002!!!! These were dispensed to him from the student health service. THEY EXPIRED 6 YEARS AGO!!!!!!

I am livid. A few months expired, it happens. A year, maybe. But expired 6 years ago and capsules clumped together in the bottom and not working!!!. This is unacceptable.

Think about it. What if my son had MRSA and they gave him antibiotics that should have been trashed 6 years ago? How many other kids got drugs that were no good? What if the kid who died had gone to the student health service earlier in the week? A delay in getting effective treatment could have been the actual cause of death. And what other ineffective drugs have they dispensed from the student health office?

I encouraged my son to take it to the school paper. He is not the activist I am so I doubt he will. But I am going to bring it up with our doctor here. We have an HMO so they are responsible for a contract with the student health at the university.

I'm going to contact the employee health nurse at the hospital and ask her to review the chart of the young man who died and see if he was seen at the student health service. If he was this expired antibiotic needs to be brought to someone's attention.

 

[DanishDynamite]

Do the American thing and sue them for a Billion dollars.

Seriously, that is unacceptable.

 

[technoextreme]

There is a problem with your argument. From my research on a similar disease for treatment it seems like it's hyper regulated. The medication may be given out by a doctor.

 

[drkitten]

Do the American thing and sue them for a Billion dollars.

Seriously, that is unacceptable.

But all too common.

The basic problem is that the doctors are incompetent.

In general, doctors at university clinics are the modern equivalent of the navy surgeons who fled the country rather than face a malpractice suit. The pay and working conditions are sufficiently bad (and the prospects for professional advancement are nonexistent) that only the desperate will consider such a job.

 

[Skeptic Ginger]

There is a problem with your argument. From my research on a similar disease for treatment it seems like it's hyper regulated. The medication may be given out by a doctor.

What are you talking about?

 

[Skeptic Ginger]

But all too common.

The basic problem is that the doctors are incompetent.

....

In this case, first the prescriber typically dispenses the medication and is ultimately responsible. Regardless, anyone who actually put his name on the bottle and handed it to him or got it ready to hand out should have checked the drug name and the expiration date. That is common sense. Then the clinic staff are also responsible and there should be adequate procedures in place to pull expired drugs.

This is one of those errors that any number of people should have prevented and didn't. They are all responsible.

 

[Skeptic Ginger]

...
In general, doctors at university clinics are the modern equivalent of the navy surgeons who fled the country rather than face a malpractice suit. The pay and working conditions are sufficiently bad (and the prospects for professional advancement are nonexistent) that only the desperate will consider such a job.

That's not true. Some of my colleagues work at the university health center at the U of WA in Seattle and I did clinical rotations there. The working conditions are great and the pay is standard. You get free tuition and stay in the university milieu. It's a good job.

 

[drkitten]

This is one of those errors that any number of people should have prevented and didn't. They are all responsible.

Yes. The reason is that almost all (US) university student health clinics are festering masses of incompetents who are almost universally one complaint away from having their medical licences pulled.

This applies to the staff physicians. This applies to the staff pharmacists. This applies to the staff nurses. This would apply to the guy that vacuums the rug if there were a licensure requirement for vacuuming.

But the alternative is to have no pill-rollers at all, because doctors who can get jobs at real hospitals won't touch the student death clinics with a barge pole.

(At the graduate school I attended, every physician except one had had their license suspended for disciplinary reasons at some point prior to starting at the clinic. At my undergraduate school -- which had a medical school attached --- it was even worse. A number of the medical staff were actually unlicensed, and were "practicing" ostensibly under the supervision of the medical faculty.)

 

[DanishDynamite]

In this case, first the prescriber typically dispenses the medication and is ultimately responsible. Regardless, anyone who actually put his name on the bottle and handed it to him or got it ready to hand out should have checked the drug name and the expiration date. That is common sense. Then the clinic staff are also responsible and there should be adequate procedures in place to pull expired drugs.

This is one of those errors that any number of people should have prevented and didn't. They are all responsible.

It is quite possible that they are all responsible. And good luck in making whatever case you intend to make. But shouldn't this thread be in Politics, Current Events or possibly Forum Community?

It certainly has little to do in Science.

 

[~enigma~]

Yes. The reason is that almost all (US) university student health clinics are festering masses of incompetents who are almost universally one complaint away from having their medical licences pulled.

This applies to the staff physicians. This applies to the staff pharmacists. This applies to the staff nurses. This would apply to the guy that vacuums the rug if there were a licensure requirement for vacuuming.

But the alternative is to have no pill-rollers at all, because doctors who can get jobs at real hospitals won't touch the student death clinics with a barge pole.

Aren't you assuming that no licensed doctor, pharmacist or nurse wants to work in a university clinic?

 

[Skeptic Ginger]

Do the American thing and sue them for a Billion dollars.

Seriously, that is unacceptable.

No harm, no sue. If my son had been seen there, given an expired drug and had a consequence from it, then suing for damages if the case isn't settled out of court is a patient's recourse for being harmed by such a blatant error.

This is a clinic in a university dispensing an antibiotic that was 6 years!!! past its expiration date where a student died this very week from an infection that was either not treatable or not treated in time. The latter is more likely but I have no idea if he was seen at this clinic or what the circumstances were for the treatment failure. Sometimes people just wait too long to be seen. Or they are seen early on, and then are reluctant to go back too soon when they get worse.

But in one scenario, he could have been given an ineffective drug that delayed his getting treatment in time.

 

[Skeptic Ginger]

Yes. The reason is that almost all (US) university student health clinics are festering masses of incompetents who are almost universally one complaint away from having their medical licences pulled.

This applies to the staff physicians. This applies to the staff pharmacists. This applies to the staff nurses. This would apply to the guy that vacuums the rug if there were a licensure requirement for vacuuming.

But the alternative is to have no pill-rollers at all, because doctors who can get jobs at real hospitals won't touch the student death clinics with a barge pole.

(At the graduate school I attended, every physician except one had had their license suspended for disciplinary reasons at some point prior to starting at the clinic. At my undergraduate school -- which had a medical school attached --- it was even worse. A number of the medical staff were actually unlicensed, and were "practicing" ostensibly under the supervision of the medical faculty.)

I'm afraid your sample size of one is not representative of the universities I am familiar with.

 

[Skeptic Ginger]

It is quite possible that they are all responsible. And good luck in making whatever case you intend to make. But shouldn't this thread be in Politics, Current Events or possibly Forum Community?

It certainly has little to do in Science.

Is this not the Science, Mathematics, Medicine, and Technology forum?

I don't intend to make any case. I intend to get an unacceptable condition that led to the error corrected.

 

[drkitten]

I'm afraid your sample size of one is not representative of the universities I am familiar with.

Of two, thank you. (My graduate and undergraduate schools weren't even in the same time zone.) The actual sample size is more like seven.... and I'm afraid that I have NEVER met a competent physician, pharmacist, or nurse at a university clinic.

 

[DanishDynamite]

Is this not the Science, Mathematics, Medicine, and Technology forum?

Yes, it is. It is not a forum for discussing legal grievances.

I don't intend to make any case. I intend to get an unacceptable condition that led to the error corrected.

And good luck to you. You have a good case as far as I can see.

But your case is hardly relevant to this forum.

 

[drkitten]

Yes, it is. It is not a forum for discussing legal grievances.

You're the one who brought up "legal." There's also the medical procedures question. What went wrong, what should have been done, what should be done differently to make sure that this kind of mistake doesn't get repeated in a situation where the consequence is more serious?

 

[DanishDynamite]

Of two, thank you. (My graduate and undergraduate schools weren't even in the same time zone.) The actual sample size is more like seven.... and I'm afraid that I have NEVER met a competent physician, pharmacist, or nurse at a university clinic.

It is interesting that some countries have doctors/clinics associated with universities. This isn't the case in my country.

Perhaps it is only of relevance when Universities become really, really big?

 

[DanishDynamite]

You're the one who brought up "legal." There's also the medical procedures question. What went wrong, what should have been done, what should be done differently to make sure that this kind of mistake doesn't get repeated in a situation where the consequence is more serious?

Yes, those are interesting questions. But they are not Science or Medicine questions. They are questions more suited for Social science or Politics.

 

[fuelair]

Sometimes, mileages vary for where things are discussed - and sometimes you need to make the choice to take one where more people who may gain from it will see it!!!

 

[DanishDynamite]

Sometimes, mileages vary for where things are discussed - and sometimes you need to make the choice to take one where more people who may gain from it will see it!!!

A good argument for placing this thread in Forum Community.