When A Patient Is Harmed/Killed

We go to pharmacy school with the intention of joining a profession that will enhance the quality and quantity of life for the people we will be caring for. Being human, however, we will make mistakes. And when we make a mistake, someone suffers.
A pharmacist, statistics tell us, kills a patient every six to seven years we are in practice. Injuries of some severity are a little more common. And the type of practice does not seem to matter a lot. For the most part, we are unaware of what we have done because the patient’s health was otherwise poor, the patient engaged in medication abuse or misuse, the patient or family chooses not to pursue the matter, no one recognized the error or mistook its severity, etc. Pharmacists should not assume they are beating the odds just because they have not heard of incidents.
But what about when you know? What does a pharmacist do when she learns that she made an error and a patient has been harmed or died as a result? You have certain legal duties.
Though some will try this, NEVER try to hide a mistake. The old saying goes: “The truth will out” and it almost always does. Attempting to hide it or lying about the details will destroy—absolutely and fully– your career when the truth comes out.
Pharmacists think the first thing they should do is report this knowledge to their malpractice insurance carrier. This does no harm, but most carriers really only want to know after a lawsuit has been filed. However, death or substantial harm should be communicated as soon as you hear of it. Check your policy for reporting requirements—be aware of your reporting responsibilities.
If you do not have malpractice insurance, too late. You cannot quickly purchase a policy and be covered—the carrier will remind you that your policy went into effect after the incident/error occurred. Do call a lawyer immediately if you have no coverage, and find one with some experience in pharmacy law or malpractice litigation. As I have written time and time again, get your own malpractice insurance.
What if your malpractice insurance carrier is through your employer? Two issues here. First, your employer has the reporting responsibility. But this does not relieve you of making sure your employer is aware of the error; make a full report of the incident as soon as you know of it.
Second, something I have dealt with as a lawyer several times, pharmacists are often terminated after devastating errors, where a patient is killed or suffers harm that will be life-long. Malpractice carriers will then often try to escape covering that pharmacist by saying she is no longer employed at the covered entity. This is false; she is covered because she was an employee at the time of the error.
With reporting to the malpractice company done, the next question is: do you report the error to the state Board of Pharmacy? Many states have reporting requirements. Read over your state law or contact Pharmacy Law Source to see what your state requires. (You may not want to contact the Board to ask about this as this will put you on their radar.) One issue here is that some state Boards take the information that you self-reported and then use it to punish you. The idea of being punished after making an error—and having to learn to live with it—is not a desirable one for pharmacists. Keep in mind, though, that not reporting and getting caught later could result in substantially more severe sanctions. (The oft-discussed argument that being punished for required self-reporting is a violation of the pharmacist’s Fifth Amendment right against self-incrimination is the subject for another time and blog.)
Next, do you self-report to your state’s version of Pharmacists Recovery Network ({RN)? One of the most—if not the most—important issues after a pharmacist has made a devastating error is learning to live with what has occurred. How do you continue to practice? How do you go to work after killing a patient? How do you live with yourself?
The pharmacist must realize that she is human, just as human as any parent who forgets to pick up a child after school, an accountant who inadvertently transposes numbers on a spreadsheet, a mechanic who forgets to attach an important piece. With our errors, though, someone suffers. If we do indeed kill a patient every 6-7 years, how many other lives have we enhanced, if not saved entirely? Even this justifiable rationalization is not enough for many. The pharmacist should seek whatever help is needed to live with what has happened and to return to work.
The standard for reporting to a PRN would be whether the pharmacist is, after the mistake, incapable of properly performing her professional duties. If so, get help. Your state’s PRN should be able to guide you to the proper entity to help you. Keep in mind that the PRN representative may seek to have your license to practice suspended until the rep is assured you are ready to resume your professional duties. And remember that all other pharmacy personnel are also required to report you if you try to work and show yourself incapable of meeting your duties. If you need time out of pharmacy, take it.
Mistakes and errors are a sad but real part of pharmacy. Studies have proven that the best of us and the best types of workflow will not prevent them, much less reduce them significantly. Pharmacists have legal duties when these errors occur and should be prepared to meet them. Finally, the pharmacist should do whatever is needed to be able to continue her career.

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