Medication errors are often quite clear on their face, at least as far as the initial event is concerned. A common error is that someone receives the wrong medication.  This may be due to an error in prescribing or an error in dispensing. 

Circumstances of medication mismanagement are rarely quite so clear.  In this case, the patient was taking 10 medications, all correctly prescribed and dispensed, yet the patient winds up deceased.  I was asked to help determine if the patient’s medications contributed to the patient’s demise.

Certain aspects of the case were indeed clear:

–The prescriptions were properly written.

–The dose and directions for each individual prescription were appropriate.

–The medications were accurately dispensed.

So what could go wrong?  For each medication, on their own, very little.  The confounding factor was the potential cumulative effects of all the medications in one person, simultaneously.  There are several critical factors that must be screened and monitored:

–The cumulative side effects of the medications, such as several that may cause central nervous system depression—the slowing of brain function.  

–Drug-drug interactions, where two or more medications create a response that neither medication alone would be expected to cause.

–Drug-disease interactions, where one or more medications gives the appearance of a clinical condition that did not previously exist.

–The patient’s existing clinical conditions.

For this case, detailed research and analysis was designed to determine if there was a greater than 50% likelihood that the patient’s medications could have contributed to their cause of death.  Once the information was gathered, two key factors played a role in my opinion that there was a greater than 50% likelihood:  The patient’s existing clinical condition combined with the fact that nine of the patient’s 10 medications are either contraindicated or to be used with caution with the patient’s clinical condition.

This does not mean that the patient should not have received any of these medications.  What it does mean is that proper, diligent management is essential to the success of therapy and the safety of the patient.

As an attorney, you rely on a detailed, well-researched and unbiased analysis and assessment of your case.

Arthur Wernick, PharmD is the owner of Clinical Pharmacy Research Group.