Medical error rant

[Chris Haynes]

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

Actually several years ago I knew a doctor who worked at Hall Health Center (university medical clinic named for a person whose last name was "Hall"). She was a real doctor who was working there because the hours and location worked better for her as a working mom. She was just as competent as the doctors at any private clinic.

Oh, and I the last doctor I went to while a student at Hall Health was a medical resident who started a practice family practice, which is where I now go for my medical treatment.

Anyway, that is not pertinent to the problem that the pharmacy at another university (which does not have a medical school) gave out (or sold) expired antibiotics. This is unacceptable, even for Whatcom County.

Skeptigirl, while your son does not have cause to bring legal action against WWU, the least your son can do is go back to the pharmacy and ask them why they gave him expired medication.

By the way, the student that Skeptigirl refered to was not treated at the university but at St. Joseph Hospital:
http://seattlepi.nwsource.com/local/6420ap_wa_mrsa_death.html
... they gave him massive doses of antibiotics, which should have been up to date (since I bet they were intravenous).

It is also a reminder that college students, due to the close quarters they live and party in, need to keep up their influenza, meningococcal and other vaccines up to date.

 

[biostudent]

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?

I think it's more a consequence of being in a really big country. Students sometimes have to move pretty far away to go to school, and they need doctors... (that is definitely the case at my university. Students not only come from all over the country, but they come from other countries as well. Local doctors are not always able to take them on as patients.)

Skeptigirl: Tell your son that he needs to make a stink about it so that no one else gets hurt.

 

[biostudent]

It is also a reminder that college students, due to the close quarters they live and party in, need to keep up their influenza, meningococcal and other vaccines up to date.

 

[Chris Haynes]

Sadly a young man just died up at Western WA University of MRSA pneumonia. ....

Message from that TV news story: wash your hands!

(oh, and in case you missed my earlier message, make sure your vaccines are up to date)

 

[Jorghnassen]

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.

Actually, while I never used the medical services at my alma mater, everyone else who did found the doctors there incompetent... And anyone needing medical attention at my current place of employment usually go to Toronto. So that's a few more completely independent anecdotes.

I should add that dentists establishing practices around university campuses are also not to be trusted.

 

[This is The End]

I was going to add a few more examples of low standard health care services at Universities before I stopped to think of other normal (City) hospitals I’ve been to as well.

It seems it may have more to do with the size of the population the hospital is serving, whether it be a city or University. If it serves below a certain minimum population (and possibly above a certain max. pop.) the standards drop exponentially. This may possibly explain the conflicting observations so far in the thread.

Though, it should be noted, cities and Universities would likely have different min. and max. ranges since most Universities operate at a lower capacity (usually quite low, below 10%) for 1/4 of the year (usually summer months). It varies how this is reflected in population figures (census returns).

This per-capita standards issue seems to also be the case with the schools themselves (education at all levels really), not just health care.

As for the OP, sorry to hear of anyone being exposed to such hazards. It may help some, who can't completely relate with expired medication, to imagine finding out a restaurant you frequent was serving several year old meat. With a lapse that large, someone involved must have some responsibility (civil, legal, or both).

Everyone should be attentive everyday in making sure organizations (businesses, utilities, etc.) operate correctly and safely, as well as being on the lookout for outright scams and illegality.

 

[BlackKat]

First hand experience with MIT's medical services. While I was not there as an adult, but rather a child seeing a pediatrician. I can say that they are hands down the best set of doctors and healthcare workers I've ever seen.

The problem with making blanket statements is that they are often incorrect (yes I know that I just made a blanket statement).

Just as two hospitals literally next door to each other can be worlds apart in their quality of care, so too can clinics. There are competent and incompetent doctors everywhere, sometimes in the same office or department.

And this is quite the appropriate forum for this discussion as:
a) It's a medical topic
b) It's skeptigirl - who has made positive contributions to EVERY medical thread on this forum as long as I have been here and surely longer than that

 

[Deetee]

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?

This is a perfectly acceptable forum to discuss the ramifications of a medical issue.
DD: it was actually you who brought up the medico-legal aspects with your suggestion to sue, and therefore took the discusion into this area .

Several points- The doctors who prescribed the doxycycline may not have given the best advice - "carry on even though it has got worse", but there may be some logic behind it as bad acne does often need quite prolonged course of antibiotics. (In homeopathy this is called an aggravation, and is a sign the treatment is correct! )

The error was made with the dispensing in pharmacy - does no-one there check the drugs they stock? Time expired drugs should never be dispensed. Its OK to use most drugs after their expiry date -they are likely to remain effective for quite a long time after this, but 6 years is ridiculous. There must be a way to take this complaint back to the dispensers and the student health service - they must wake up and do something about it.

Doxycycline is actually one of the few antibiotics effective against MRSA.

 

[Ivor the Engineer]

Perhaps the Pharmacist trained here in the UK:

http://www.telegraph.co.uk/news/mai...uni20.xml&sSheet=/news/2006/04/20/ixhome.html

A university has been caught lowering a pass mark to 26 per cent to prevent widespread failure of students, a landmark ruling under the Freedom of Information Act has disclosed.

The proof that up to 14 per cent was arbitrarily added to the scores of trainee pharmacists to save the university's reputation has renewed concerns over the dumbing down of degrees in the move toward mass higher education.

...

De Montfort, a former polytechnic, had denied claims that pass rates were manipulated, but material obtained by The Times Higher Education Supplement, published in today's edition, shows that marks were raised for five modules, one of which was maths, an essential component of the training of hospital and high street pharmacists.

 

[Rocko]

Yeah, I was going to say - surely in the US drugs are dispensed by pharmacists, not the doctors themselves? In which case, the fault for this must lie entirely with them?

 

[Professor Yaffle]

At least in the UK, student health services often stock their own drugs rather than giving a prescription to be filled by the pharmacy.

Regarding the OP, I have just finished reading Bodies by Jed Mercurio, so nothing surprises me...

 

[technoextreme]

Yeah, I was going to say - surely in the US drugs are dispensed by pharmacists, not the doctors themselves? In which case, the fault for this must lie entirely with them?

It depends. In this situation I wouldn't be surprised that the doctor himself dispensed the medication on a daily basis. They do it with TB and I wouldn't be surprised that they do it with other diseases. The antibiotics are so potent that they can wreck havoc with your body and the disease itself can't be fun if you screw up the treatment.

 

[geni]

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?

Probably more to do with nationalised healthcare. While in the UK you may have a GP clinic that acts as the de-facto univeristy clinic if students are living off campus they may well register with local GPs. Since students tend to fairly healthly (and when not healthly it tends to be more an A&E issue) I'm not aware of this causeing a problem).

 

[Skeptic Ginger]

....
Doxycycline is actually one of the few antibiotics effective against MRSA.

For the common community acquired strain, USA 300, several classes of drugs are still effective, including tetracyclines and trimethoprim-sulfa. One of my concerns here is like in many places, the USA 300 strain has been a growing problem in the Seattle and Vancouver areas in the IV drug abusers for 5-6 years. (WWU is in Bellingham, between those two cities.) Giving someone 6 year expired antibiotic that CA MRSA is still susceptible to in an area with many MRSA cases is practically a crime since it is begging to increase the scope of drug resistance by undertreating the infection.

The young man who died no doubt was treated with IV vancomycin. Look at this article on the USA 300 strain. Intermediate Vancomycin Susceptibility in a Community-associated MRSA Clone. This was published in the CDC's Emerging Infectious Diseases a year ago.

We describe a case of treatment failure caused by a strain of USA300 community-associated methicillin-resistant Staphylococcus aureus (MRSA) with intermediate susceptibility to vancomycin and reduced susceptibility to daptomycin. The strain was isolated from the bone of a 56-year-old man with lumbar osteomyelitis after a 6-week treatment course of vancomycin for catheter-associated septic thrombophlebitis.

That expired doxy was practically criminal in my book.

HC, I know the death occurred in the hospital. I have actually contacted someone up there to share my information. What I was saying was there is an outside chance the kid went to the student health center when he initially became ill. They may or may not have treated him if they did see him and it may or may not have involved expired drugs. Chances are nothing from the student health directly contributed to the kid's death. But I think it was important for the people investigating the death to at least be aware of the problem. Then if there is a record he was seen at the student clinic they can follow up there as well.

BTW, for those of you flu vaccine naysayers, there's about a 99% chance even with the mismatch of vaccine this year that the influenza vaccine could have saved this kid's life. His initial infection was influenza from what I understand. Even if it didn't prevent the infection, the flu would have still likely been milder. His is the second death in a young person attributed to influenza in our state this year.

Health Advisory: Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection

From October 1, 2006 through September 30, 2007, 73 deaths from influenza in children were reported to CDC from 39 state health departments and two city health departments. Data on the presence (or absence) of bacterial co-infections were recorded for 69 of these cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were infected with Staphylococcus aureus. The number of these deaths in which pneumonia or bacteremia due to S. aureus was noted represents a five-fold increase over the 2 previous influenza seasons. No pediatric influenza deaths have been reported to-date this season locally.

That was a county news report for January.

Here's a state news report for February Recent respiratory deaths prompt state disease prevention reminders - Whatcom County investigating death attributed to MRSA-pneumonia

A 20-year old student at Western Washington University died Thursday from what local health officials have identified as MRSA-pneumonia, which is rare. Last week, an 18-year old Pacific County resident died from respiratory failure. The cases are not linked.

The 18 year old was reported as influenza death. He didn't have MRSA pneumonia and I do not know if he had any health problems that contributed to the death.

 

[Skeptic Ginger]

double post deleted

 

[Skeptic Ginger]

Yeah, I was going to say - surely in the US drugs are dispensed by pharmacists, not the doctors themselves? In which case, the fault for this must lie entirely with them?

If you get a prescription you take it to a pharmacy and the pharmacist or a pharmacy assistant dispenses it. And there are even laws limiting how I as the prescriber can dispense drugs directly to patients.

In this case the clinic dispensed the drug. That means either the provider who prescribed the drug also dispensed it, or the provider told someone else in the clinic to dispense it. That someone would have to be licensed as well like a nurse. They are all supposed to know better and you are supposed to check expiration dates, not only when you hand it to the patient, but also you need a system of checking the drugs on the shelves for expired drugs.

This was a failure in many ways.

 

[Skeptic Ginger]

At least in the UK, student health services often stock their own drugs rather than giving a prescription to be filled by the pharmacy.
...

At least? That can actually increase errors such as in this case. The pharmacy acts as a system check.

Though errors in transcription increase when the pharmacy fills prescriptions rather than providers dispensing the drugs.


Edited to add, Oh, I see Ivor's post now.

 

[Skeptic Ginger]

Actually several years ago I knew a doctor who worked at Hall Health Center (university medical clinic named for a person whose last name was "Hall"). She was a real doctor who was working there because the hours and location worked better for her as a working mom. She was just as competent as the doctors at any private clinic.

Oh, and I the last doctor I went to while a student at Hall Health was a medical resident who started a practice family practice, which is where I now go for my medical treatment.

Anyway, that is not pertinent to the problem that the pharmacy at another university (which does not have a medical school) gave out (or sold) expired antibiotics. This is unacceptable, even for Whatcom County.

Skeptigirl, while your son does not have cause to bring legal action against WWU, the least your son can do is go back to the pharmacy and ask them why they gave him expired medication.

By the way, the student that Skeptigirl refered to was not treated at the university but at St. Joseph Hospital:
http://seattlepi.nwsource.com/local/6420ap_wa_mrsa_death.html
... they gave him massive doses of antibiotics, which should have been up to date (since I bet they were intravenous).

It is also a reminder that college students, due to the close quarters they live and party in, need to keep up their influenza, meningococcal and other vaccines up to date.

Oh my Gawd! Look at this from the PI article!

His roommate had taken him to the school clinic on Feb. 14.

Now I am really going to get loud!!!

Tomorrow, I will personally call the Whatcom County Public Health officer investigating the case.

My son will be going back to the clinic to complain Monday as well. He didn't want to contact the school paper but he was definitely going back to the clinic. And he has a new camera so he is going to take pictures of the bottle and clumped pills before taking it back to them.

 

[annexw]

I'm a bit confused as to how he knew the antibiotics were expired.

Admittedly I'm in a different country and perhaps we do things differently here, but when I get a script for antibiotics (many tooth infections. Ouch) I take the script to the pharmacy and they type up the label, stick it on the bottle and count out how many pills I'm meant to have. The pills come from one of the giant pill bottles in the back.

Honestly, if I saw that the expiry was 2002, I would first think "huh?", then "Meh, typo". Maybe I'm wrong and the label is auto-generated, but that seems pretty high-tech for my punty pharmacy.

Occasionally, the gel-coating on the pills clumps them to the bottom of the pill case due to the heat in my car/office/bag.

Also, I *always* get the spiel about taking all my antibiotics. Something about trying to limit antibiotic strains and people stopping taking their pills when they feel better even though there is still an underlying infection. I thought this was a standard pharmacy spiel? Again, perhaps I'm wrong.

I only have my consumer knowledge to go by here so maybe I'm out of line, but did your son actually check with the pharmacy that the lot was expired? If they were, then a jump to the telling the paper would not be out of order, but it could have been something as simple as a typo.

Oh, I was typing as you were posing, I see he is going to the clinic. That seems logical. Good luck in finding some answers.

 

[Skeptic Ginger]

I'm a bit confused as to how he knew the antibiotics were expired.

Admittedly I'm in a different country and perhaps we do things differently here, but when I get a script for antibiotics (many tooth infections. Ouch) I take the script to the pharmacy and they type up the label, stick it on the bottle and count out how many pills I'm meant to have. The pills come from one of the giant pill bottles in the back.

Honestly, if I saw that the expiry was 2002, I would first think "huh?", then "Meh, typo". Maybe I'm wrong and the label is auto-generated, but that seems pretty high-tech for my punty pharmacy.

Occasionally, the gel-coating on the pills clumps them to the bottom of the pill case due to the heat in my car/office/bag.

Also, I *always* get the spiel about taking all my antibiotics. Something about trying to limit antibiotic strains and people stopping taking their pills when they feel better even though there is still an underlying infection. I thought this was a standard pharmacy spiel? Again, perhaps I'm wrong.

I only have my consumer knowledge to go by here so maybe I'm out of line, but did your son actually check with the pharmacy that the lot was expired? If they were, then a jump to the telling the paper would not be out of order, but it could have been something as simple as a typo.

Oh, I was typing as you were posing, I see he is going to the clinic. That seems logical. Good luck in finding some answers.

These are good questions, I asked them myself, but I'll explain how we know.

Sometimes you get the original bottle with the original label and the patient label is affixed over it. Not this case. But I asked my son, was the label with his name separate from the label with the date? And it was. I mentioned before about the rules for dispensing drugs without using a pharmacist. What the clinic does is get the prescriptions ready, label them with the drug, amount in the bottle and expiration date. Then you either fill in the patient's name by hand, or add an additional label with the patient's name to the bottle.

This clinic got the pre-prepared bottle of capsules off the shelf and wrote my son's name by hand on the label. With the pills being clumped up, the drug not working, and the way I know a clinic prepares drugs to be dispensed without a pharmacist, I'm pretty sure the 2002 date was accurate. Sometimes you put 12 months from the time you make up the pill bottles for an expiration date. But still the real exp date wouldn't be that long for doxycycline. It doesn't have a 6 year shelf life.

As for your own capsule clumping experience, I'd look into that. If moisture is getting into the bottle, that could actually affect the drugs in the capsules. Those soft gel caps will stick to each other like vitamin E or fish oil, that is not a problem. But hard gel caps like the ones antibiotics are in should not be sticking together.