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New England Medical Malpractice Blog

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Will Rhode Island Lyme disease program cause pharmacist error?

Lyme disease is an illness caused by a bacteria carried by ticks. The disease can cause severe headaches, neck stiffness, arthritis, joint pain, facial palsy and problems with short-term memory. Rhode Island is one of 14 states with Lyme Disease-carrying ticks and is a hotspot for Lyme disease cases. Pharmacies have expanded their role in prescribing medicines across the state under what is called collaborative practice agreements and are now able to give doxycycline to patients who have been bitten by ticks within a 72 hour window. Some feel that pharmacist error in diagnosing and assessing the tick bite will lead to increased antibiotic resistance.

The new program allows individuals who have been bitten by a tick to come into a pharmacy and receive a dose of the antibiotic without a prescription after answering questions about the tick and their condition. The patient will choose the tick that bit them from a chart of potential disease-carrying types of ticks. The pharmacy should follow CDC guidelines for Lyme disease assessment.

In some cases, the individual seeking treatment did not bring in the tick or a picture of the tick when choosing the tick from the poster. Opponents argue that the evidence used to claim that doxycycline can prevent Lyme disease is weak. From a public health standpoint, overprescription of antibiotics leads to widespread antibiotic resistance.

How will pharmacists in Rhode Island be held accountable to the standards? Does the pharmacist have a role to play in pharmacist error if a person receives the antibiotic without showing evidence of the tick? A pharmacy error can cause harm to an individual’s health. If a person has been harmed by a pharmacist’s error, a personal injury attorney can assist with filing a claim for monetary damages.

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Examining the different types of pelvises

There are many things that an expectant mother in Providence County can do to help avoid the potential of delivery complications, such as maintaining a healthy weight or taking prenatal vitamins. However, there are also certain factors beyond a mother’s control that can end up impacting their deliveries, as well. One of these is the size and shape of her pelvis.

Clinical research has shown there to be four common types of female pelvises. The website Parent24.com lists these different types (along with impact their size and shape may have on a pregnancy) below:

  • Gynaecoid: The widest and broadest pelvis type, a gynaecoid pelvis is the least likely to cause trauma to an average-size baby.
  • Android: An android pelvis has a heart-shaped brim, thus making it much more narrow in the area of the sub-pubic arch. This can contribute to longer labors, forcing mothers to move around more often to assist with a baby’s descent.
  • Anthropoid: With a wide outlet yet narrow sections in other areas of the pelvic cavity, an anthropoid pelvis type can slow delivery if a baby does not engage in an anterior position.
  •  Platypelloid: The kidney-shaped brim of a platypelloid pelvis type makes it somewhat more difficult for a baby to descend into the mother’s pelvis, yet easier to complete delivery once he or she is in due to its roomy outlet.

Why would it be important for women to know what type of pelvis they may have? Because a baby with a head or body too large to enter the pelvis (a condition the American Pregnancy Association knows as cephalopelvic disproportion) may need to be delivered via C-section. A simple ultrasound done during one’s prenatal care can spot the type of a mother’s pelvis and allow caregivers to plan ahead to avoid unnecessary complications.

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When STDs are mistaken for UTIs

Those in Providence County who may have a sexually transmitted disease may certainly want to know that. Unfortunately, as some of our clients here at DeLuca and Associates have had the misfortune to find out, the potential of misdiagnosing an STD may be high. Many of the symptoms indicating the presence of an STD may be similar to other ailments. In men, these are often easier to differentiate. Yet if you are a woman, the question of whether or not you may have an STD may be harder to answer.

STDs often mimic the same manifestations of another disease common in women: urinary tract infections. The telltale symptoms of a UTI are typically frequent and painful urination. However, these are also common with the following STDs:

  • Trichomoniasis
  • Gonorrhea
  • Chlamydia
  •  Genital herpes

Recent studies seem to indicate that your chances of having an STD mistaken for a UTI depend upon the diagnostic treatment you receive and the location where you are seen. Data shared by the Journal of Clinical Microbiology showed that of over 260 women seen in a hospital emergency room with the aforementioned systems, 64 percent who were later confirmed to have an STD were initially diagnosed with a UTI. The common diagnostic test to confirm the presence of an STD is a urine culture. Yet the ASM study results show that 57 percent of those diagnosed with an UTI did not receive this test.

ER doctors may feel as though they do not have the same amount of time to dedicate to you compared to your primary care physician. This may explain why they might assign a UTI diagnosis without confirmatory tests. Still, your status should be their primary, despite any perceived time constraints.

You can learn more about why misdiagnoses happen by exploring our site.

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The risks of unprofessional cosmetic surgery

Cosmetic surgery has never been more popular for residents of Providence and elsewhere in the country. With average fees ranging from $371 for Botox injections to $6,550 for a facelift, plastic surgery is becoming more affordable for those in almost every income bracket. However, states the American Society of Plastic Surgeons, it is vital – and can save lives – only to choose physicians who are officially certified in cosmetic surgery procedures.

Some complications of plastic surgery are unavoidable, while others may be the result of a doctor error or unprofessional conduct, points out TotalBeauty. For example, some people are more likely to scar after a surgical procedure than others. Factors may include genetics, skin pigmentation and the type of procedure involved. Even the most qualified cosmetic surgeons may be unable to prevent patients from developing scars.

On the other hand, there are many so-called professionals who have no business performing the cosmetic procedures they offer. It is becoming increasingly common for dentists to offer Botox treatments or for gynecologists to provide facial wrinkle-filling services. These procedures may result in serious complications, including temporary blindness from Botox that is injected in the wrong place.

In some cases, the results of unprofessional plastic surgery can be fatal. Medical spas exist that offer procedures such as liposuction, which should be performed under general anesthesia but are done under local anesthesia in the spa facility. Patients have died from respiratory depression, an effect of local anesthesia overdose.

Some people choose inexperienced or unethical plastic surgeons because of the significantly lower rates they charge. However, when it comes to safety, as well as protecting their looks, it may be best for patients to put their trust in a certified surgeon who knows what he or she is doing.

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The potential for misdiagnosis of cervical spinal stenosis

Like most in Providence County, you likely accept the fact that certain aspects of your health may begin to deteriorate as you age. Yet that does not mean that you should be forced to live with daily pain and discomfort. Yet we at DeLuca and Associates Ltd understand that the trouble with providers dismissing your pain as being age-related without investigating its cause lies in the potential for the underlying condition to worsen, taking an even greater toll on your quality of life.

One of the more common age-related issues that you may begin to experience (particularly after the age of 50) is cervical spinal stenosis. This is caused by a narrowing of the spinal canal at or near the neck. Eventually, the canal compresses to the point of actually pinching your spinal cord. As your reach this point, you may begin to experience initial symptoms, which according to the website Spine-Health.com may include:

  • A heavy feeling in the outer extremities
  •  Intermittent pains in the arms and legs
  • Impairment of your fine motor skills
  • Difficulty enduring physical activities

If left untreated, cervical spinal stenosis can progress on to more serious symptoms such as loss of bladder and bowel control and/or permanent paralysis.

The treatment for this condition is to undergo surgery to decompress the affected area of the spinal canal. However, some doctors may be reluctant to diagnose this condition and to recommend this course of treatment, choosing instead to write your symptoms off as being normal for your age. If, however, you believe the problem to be more pervasive, you may need to assert your authority over the control of your care.

You can find more information on your potential to be misdiagnosed by a doctor by continuing to explore our site.

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What are drug administration routes?

Most in Providence County may tell you that drug errors occur when a healthcare provider gives a patient the wrong medication. While this certainly may be among the more common types of medication mistakes, the truth is that drug errors can occur any number of different ways. Almost as important as receiving the right drug is being administered the recommended dosage at the correct concentration. Beyond that, the administration route must also be considered. What are drug routes? They are the various methods through which a medication is introduced into your body.

If you are like most, then you envision a medication administration as you popping a pill into your mouth. Yet the website Healthline.com actually lists several different drug routes that providers may utilize. Listed below are the various methods through which drugs are dispensed:

  • By mouth: Oral pills or liquids, sublingual medications, buccal drugs (held inside the cheek)
  •  By nasal passage: inhalants, nasal sprays, nebulizer treatments
  • By injection: intramuscular or subcutaneous injections
  • By skin: transdermal patches, topical ointments
  • By delivery mechanism: intravenous infusions, enteral administrations via a G- or J-tube
  •  By other body openings: eye drops, ear drops, rectal suppositories

Why is the route through which a medication is delivered important? The method through which a drug enters the body influences how much or how strong of a dosage you will receive. For example, if your doctor wants a medication to have an instant effect, he or she may choose to introduce it directly into your bloodstream rather than having it metabolize through your liver. An overly concentrated dose could then have catastrophic effects due to it not having been detoxified through metabolism. Along the same lines, a diluted dose given orally may not allow the drug to serve its purpose, thus prolonging your pain and suffering.

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Who are the members of your surgical team?

When you are scheduled for surgery in Providence County, you may feel as though the only provider that you are placing your trust and confidence in is your surgeon. In reality, however, complex surgical procedures are almost never performed by a single provider. Your procedure will typically require an entire surgical team if it is to be completed successfully. Understanding who the various team members are and what their responsibilities may be during your surgery may be helpful information for you to have prior to entering into the operating room.

According to the Encyclopedia of Surgery shared by Advameg, Inc., your surgical team will likely consist of your surgeon, an anesthesiologist, a certified registered nurse anesthetist and an operating nurse. Their specific duties are described as follows:

  • The surgeon: Your surgeon’s role may the easiest to define. He or she is the one who leads the surgical team, and in most cases, performs the actual procedure.
  • The anesthesiologist: Your anesthesiologist manages your pain through the administration of a local or general anesthetic, or by conscious or deep sedation.
  •  The CRNA: A CRNA will typically assist the anesthesiologist by monitoring your anesthetic levels and the function of the mechanisms delivering your medication. In some cases, he or she may step in and fulfill the role of the anesthesiologist entirely.
  • The OR nurse: Your nurse provides you with your comprehensive care, including your pre- and postoperative treatments. He or she assists the surgeon during your procedure through tasks such as retrieving tools and implants and monitoring your vital signs.

In certain cases, surgical technicians and even secondary surgeons may be called in to assist with a procedure. Once you know the role that each team member fulfills, it may be easier to assign liability if an error occurs during your surgery.

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Kroger sued after pharmacy dispenses wrong medication

Many in Providence County, after having been written a prescription by their doctors, may go to their local pharmacies fully expecting those orders to be filled correctly. To prevent errors from happening, pharmacies may even have safeguards in place such as computer systems that warn them they may be dispensing the wrong medication. Yet even with added measures such as these, medication errors continue to happen. When they do, one’s only logical conclusion when trying to explain such mistakes may be to attribute them to human error.

That’s the claim that is being made in lawsuit filed by an Ohio man. The man received what he believed was high blood pressure medication from the pharmacy at a local Kroger store in late 2013. Shortly after beginning to take the medication, we began to experience disorientation and vomiting to the point of becoming severely dehydrated. He was eventually hospitalized and diagnosed as being in renal failure. After having the medication examined by another pharmacist, his wife discovered that he had actually been given an anti-seizure medication by the Kroger pharmacy.

A review of the Kroger pharmacy’s records showed that one tech assumed after looking at the pills that the order was correct due to the fact that both medications looked similar. Another was shown to have overridden the pharmacy’s computer system after it alerted him that the medication was incorrect.

A failure to adequately ensure that medications are correct or to heed to warnings given by verification systems may certainly be seen many as negligence. Those who suffer because of such negligence may wish to speak to an attorney to discuss what their options may be in pursuing legal action.

Source: WXIX “Man claims wrong medication from Kroger accelerated kidney failure” Baldwin, Michael, Aug. 14, 2016

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Defining medication omission errors

Most people in Providence County would likely associate errors involving a patient’s medication to instances where he or she was either given an incorrect dosage of a prescribed medication or administered the wrong medication altogether. While such errors certainly rank among the more common types of medication errors, another less-apparent yet potentially as damaging a mistake is a medication omission. The American Society of Health-System Pharmacists defines an omission error as “the failure to administer an ordered dose to a patient before the next scheduled dose, if any.”

Medications prescribed to attack infectious agents or assist with a course of treatment may be vital in producing positive patient outcomes. Thus, the omission of a medication could very well be just as serious as too much of it being given. One may wonder how it can be possible for a clinician to overlook the administration of medication (particularly those administered intravenously) given the many delivery methods and protocols in place to account for them. A study undertaken by the Pennsylvania Patient Safety Authority revealed the following to be among the most common reasons why IV medications were never given:

  • IV medications not sent with patient during transfer, or not being connected, hung, or started upon his or her arrival in a new unit.
  • IV pumps or drug delivery systems never being activated.
  • IV lines becoming occluded or being mistakenly clamped.
  • IV’s being accidentally discontinued or stopped.
  • Empty or defective IV bags not being replaced.
  • Nurses becoming distracted.

To prevent omission errors, the ASHP strongly recommends nurses stick to scheduled administration times and document any refusals by a patient to take a prescribed medication or any medication availability issues. A lack of such documentation in a patient’s medical record could be seen as evidence a required medication was never given.

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Wisdom tooth surgery may come with serious risks

It is common for teenagers and young adults across America, including in Rhode Island, to have their wisdom teeth pulled. In most cases, the procedure results in little more than a few days of mild discomfort and swelling. However, there may be more risks involving wisdom teeth surgery than people realize. Some complications may cause lifelong pain, while others can be more serious or life-threatening.

What are the most common risks associated with wisdom tooth extraction? According to ABC News, at least 11,000 patients each year suffer from permanent nerve damage, which may cause numbness, tingling, loss of function or chronic pain. Many patients develop “dry socket,” which is a painful condition at the site of the extraction that can cause infections or further damage without treatment. In rarer cases, a patient’s jaw may be broken, infections may spread to internal organs or the patient can develop serious bleeding issues.

General anesthesia that is given to remove impacted teeth may also cause problems, such as allergic reactions or oxygen deprivation. In one tragic case, a 17-year-old girl died after she was deprived of oxygen and went into cardiac arrest. In a lawsuit, her parents accused the surgical staff of negligently failing to react to the medical emergency in time to save the teenager’s life.

Is wisdom tooth extraction a necessary procedure for most people? The issue needs more research, according to the Center for Advancing Health. Some dental professionals insist that the benefits of wisdom tooth surgery outweigh the risks. Impacted molars, they say, may damage adjacent teeth or cause infected abscesses or tooth decay. However, others say that impacted wisdom teeth cause problems in only about 12 percent of cases. The American Public Health Association suggests that wisdom teeth should only be removed if there is a clear need to do so.

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