Middlesex County, NJ
$1,200,000.00 Recovery from Defendant Pharmacy mistakenly fills prescription for 50 mg. of Primidone with 50 mg. of Prednisone – 83 year old patient suffering from Type 2 Diabetes experiences increase in blood sugar that lead to a transient ischemic attack and death 63 days after hospitalization
This case involved a 83 year old patient who presented to the non-party neurologist with hand tremors, and was prescribed 50 mg. of the anticonvulsant, Primidone, which was to be taken once per day. The plaintiff contended that although the correct prescription was brought to the defendant pharmacy, they negligently provided an extremely high dosage of 50 mg. of Prednisone. The patient had type 2 diabetes that was well controlled with diet. The plaintiff contended that the patient taking the Prednisone for approximately three weeks, resulted in an extensive elevation of glucose and led to a series of TIAs and congestive heart failure. The plaintiff also maintained that the steroids left the patient very vulnerable to infection, and that during an approximate two month hospitalization, the patient developed conditions such as c-diff infection and MRSA, as well as required numerous procedures, including a tracheostomy and gastrotomy. The patient was conscious during most of the period. He requested to be transferred to a hospice, and was transferred four days before his death.
In June 2008, the patient was referred to the neurologist for hand tremors and slight imbalance. After the examination, the neurologist prescribed 50 mg. of Primidone to be taken once per day. The patient and his daughter, who indicated that they were not familiar with the medication, took the prescription to the defendant pharmacy and picked it up the next day. One June 13, the patient began to take the medication and proceeded to continue ingesting it until it was stopped early that first week in July.
The evidence reflected that the decedent had his blood taken regularly since childhood because of anemia, and in recent years, his results were sent monthly to his primary care physician. After taking the medication for several weeks, the blood work showed his blood sugar to be extremely high.
The proofs showed that although the patient had a history of type 2 diabetes, he did not previously require medication. After the spike was noted, his primary care physician placed him on Amaryl to reduce blood glucose levels, which he took. His blood was taken again, approximately two weeks later, and showed continued high levels of blood sugar, in addition to an indication of an infection; however, a chest x-ray and renal studies showed that they were normal. The patient developed leg swelling, and was advised to decrease his salt intake, which did not have an effect. The patient’s tremors began, and during an appointment with his PCP on July 11, 2008, it was realized that the pharmacy dispensed the wrong medication.
The next day, he began to slur his words, and one side of his face was drooping. An ambulance was called, his blood pressure was documented as low, and the patient was taken to the hospital by ambulance. He was diagnosed with a TIA, and admitted to the stroke unit. His blood sugar was still high, and he was placed on intravenous insulin. He then developed congestive heart failure, which the plaintiff contended was related to the Prednisone.
The plaintiff maintained that the improper administration of Prednisone led to a downward spiral, and caused 65 days of severe conscious pain and suffering. The patient underwent numerous procedures, including a tracheostomy, gastrotomy, the placement of a chest tube, the placement of a rectal tube, and ultimately had renal failure, and was placed on dialysis. Approximately two months after starting the steroids, the patient was transferred to hospice at his own request. He died four days later.
The plaintiff’s expert clinical pharmacist would have contended that 8 mg. of Prednisone is considered a high exposure to an individual with elevated sugar levels, and that, in this case, the patient was given over six times that amount.
The plaintiff would have also presented an infectious disease expert who would have causally related the patient’s transient ischemic attack, subsequent conditions, and infections, as well as the surgical procedures to the extraordinarily high dosage of Prednisone. The infectious disease expert would have also testified that the decedent suffered significant conscious pain and suffering during the hospital admission. The patient’s daughters would have further testified to observing such conscious pain and suffering. The plaintiff contended that prior to the negligence, the patient was active, and was able to care for his wife who had Alzheimer’s disease.
The case settled prior to trial for $1,200,000.00. The defendant pharmacy was self insured for the first $750,000.00. The remainder was covered by insurance.
REFERENCE: Plaintiff’s clinical pharmacist expert: Joanne DaPrano, R.Ph from Syracuse, NY. Plaintiff’s infectious disease physician expert: Michael Silverman, M.D. from Philadelphia, PA.
A.U. v. Defendant pharmacy Docket no.: MID-L-3123-09, 7/15/14
Attorneys for plaintiff, David J. Pierguidi and Charles A. Cerussi of Cerussi & Gunn, P.C. in Shrewsbury, NJ.
COMMENTARY: The plaintiff obtained a very significant recovery in this case involving the death of a man in his early 80s. It is felt that the nature of the negligence, in which the prescription for anticonvulsant was mistakenly filled with a very high doses of Prednisone, leading to the death of this elderly man, be expected to result in a particularly large verdict if the case had been tried. Additionally, the plaintiff would have emphasized that throughout the more than two months hospitalization, the conscious pain and suffering was particularly severe. In this regard, the plaintiff stressed that because of the downward spiral, the decedent required numerous procedures, including a tracheostomy and gastrotomy. In this regard, in addition to the hospital records detailing the decedent’s course, the testimony of treating physicians and nurses, as well as the compelling description by the daughters, who visited the decedent regularly, would clearly have had a strong impact on the jury.