Medical error rant

[annexw]

Thanks skeptigirl, that all makes sense. I appreciate the answers.

I have never seen pre-packed pills, but all mine have been from a pharmacy and not a clinic. To be honestly I didn't even know clinics could do that (maybe in Canada there are different rules). The pills I had were gel caps like...um...Tylenol gel caps or Advil. I think those would qualify as the soft ones.

It would seem you have some extremely valid concerns. I hope your son finds something out.

 

[Skeptic Ginger]

Soft gel caps are squishy like they have fluid inside. Regular gel caps can be easily crushed and they might rebound into shape but they are not really squishy like soft caps.

Vitamin E, fish oil, flax seed oil and stool softeners like colace or ducosate come in soft gel caps. I have not seen Tylenol or Advil in soft caps. If they are sticking together I suggest you keep the little dehydrator packet you find in the bottle in there or make sure you are putting the lid on tightly. They really shouldn't be sticking together even in the heat. It's not a huge deal with over the counter pain meds. Either those work or you know they are not working. But for prescription meds, you could be getting a sub-therapeutic dose from improper storage and not know it.

Doesn't matter if my son takes up this cause, Mom's going on a rampage. I feel terrible that the student health care is substandard and I am going to make a polite but huge stink over it. What if it contributed to the other kid's death? What if the care is really bad there? I am not letting this go unnoticed. It's like I said, a couple months past the expiration date is a med error that happens, it shouldn't but people are human. Six years past the pull date is not a simple human error. It is negligence and/or incompetence.

 

[Professor Yaffle]

Clarification - when I said "at least" in my previous post, I just meant that I only knew about the UK, and not about any other countries. I was'nt saying anything about whether I thought this was a good state of affairs or not, but I see now how it could be read like that.

 

[biostudent]

Thanks skeptigirl, that all makes sense. I appreciate the answers.

I have never seen pre-packed pills, but all mine have been from a pharmacy and not a clinic. To be honestly I didn't even know clinics could do that (maybe in Canada there are different rules).

It can happen in Canada. It just doesn't happen very often. I always prefer to fill my prescriptions at an actual pharmacy because clinics (and even hospitals) always just sort of magically produce pills in record time, which has always bugged me. Pharmacists count out the pills in front of you, so at least you know where they came from.

 

[Asolepius]

Not wishing to worry you even more, but if the capsules really were that old there is a substantial risk of Fanconi syndrome.

 

[Skeptic Ginger]

Not wishing to worry you even more, but if the capsules really were that old there is a substantial risk of Fanconi syndrome.

Actually I'm glad you found an actual source for this info. I had just read it on a couple of answer pages that didn't offer much in the way of checkable sources for the info. And this is important.

But now I have an image of the bottle from my son and while the date does look like 02, I checked with the distributor and from the lot number it turns out to have expired in 05/2008 not 2002. It also is the label from the distributor and not one created by the clinic.

So, I am calm again. I'm glad it didn't turn out to be as bad as it looked. But

Tetracycline toxicity is probably caused by anhydro-4-epitetracycline, a degradation product that is formed when the drug is stored for long periods or kept in a moist environment. The metabolite decreases oxidative metabolism and energy production.

is still an issue.

There is still the issue of proper storage before dispensing the pills. They are clumped together and it also turns out these are not capsules, they are enteric coated pills.

The enteric coating is chipped off many of the pills. The typical shelf life is 2 years. So this bottle has been on the shelf close to 2 years either at the distributor or in the clinic. The chipping shows a lot of handling, but probably doesn't significantly hurt the pills.

The clumping together, OTOH, does indicate exposure to moisture which does affect the potency of the pills. Hopefully breakdown due to moisture wasn't enough to cause the degradation mentioned above. So a replacement supply is still in order.

Sorry for two pages of a theoretical medical problem rant.

 

[Asolepius]

But now I have an image of the bottle from my son and while the date does look like 02, I checked with the distributor and from the lot number it turns out to have expired in 05/2008 not 2002. It also is the label from the distributor and not one created by the clinic.(

In other words, it hasn't expired at all? Or did I blink and miss half of this year?

 

[The Gnomon]

My recommendations:
1. Never go to a physician who dispenses her/his own medication (excepting, of course, highly qualified specialists administering treatments in a hospital or similar setting)
2. If your medication isn't working, don't take someone's word that you should just keep on with it - get an expert opinion.
3. Don't go to any office or clinic without checking on the credentials of the professionals. Contact your state licensing board (or web site) to check.

A college student is intelligent enough to be able to find out reliable information. Do it.

 

[Skeptic Ginger]

Gnomon, I dispense meds all the time. I dispense prophylaxis for infectious disease exposures as well as treat latent inactive TB. Sending my patients to a pharmacy would incur unnecessary expenses for such routine treatments.

Of course people should get advice of professionals. But I also encourage my patients, buyer beware. In medicine that essentially means ask questions, look at labels, and sometimes get second opinions for things when you are not getting better and you feel you are not getting satisfactory answers.

(There is a balance there. Sometimes people just keep going to different providers until they get the answer they want rather than the correct answer.)

In this case I am not concerned the clinic is staffed by unlicensed professionals. But I am concerned about quality of care. I'll see what they have to say about the storage conditions of the doxycycline when my son goes back to the clinic.

 

[Skeptic Ginger]

In other words, it hasn't expired at all? Or did I blink and miss half of this year?

Apparently it was a case of a poorly printed date that looked like a 2 but was an 8 after all. It does look like a 2, I have the image he sent me. But the bottle had a lot number that was readable. I called the distributor and said, "it was a drug my patient was taking from another clinic and I couldn't read the date".

Here's a tip for you all. When you call a distributor or drug manufacturer, never let on you are the patient. They immediately clam up. But if you say you are a provider they are helpful. In the latter case you are a customer or a potential customer. If you say you are the patient they don't want to say anything that might upset the provider who is their customer.

 

[biostudent]

Here's a tip for you all. When you call a distributor or drug manufacturer, never let on you are the patient. They immediately clam up. But if you say you are a provider they are helpful. In the latter case you are a customer or a potential customer. If you say you are the patient they don't want to say anything that might upset the provider who is their customer.

Creepy, but thanks.