Pharmacist Malpractice Video Case Study: Wrong Drug Involving a High-Alert Medication Results In $1M Settlement

Pharmacists face a variety of malpractice risk exposures in their profession, including wrong drug errors and wrong dose/strength claims—which represent first and second most common allegations asserted against pharmacists, as outlined in the Pharmacist Professional Liability Exposure Claim Report: 3rd Edition.

This video case study describes a wrong drug dispensing error involving a high-alert medication, which are drugs that bear an increased risk of causing patient harm when they are used erroneously. The high-alert drug in this case (methotrexate) is typically used to treat inflammatory arthritis, psoriasis, and certain types of cancer.

The case study involves an insured pharmacy under contract to an assisted living facility. The patient was a 78-year-old female living at the facility, who was prescribed a new prescription (metolazone) to reduce lower extremity edema. The following video case study is what occurred when the pharmacy dispensed the wrong medication (methotrexate), which was then administered to the patient for 10 days prior to her hospitalization and eventual death, and the civil lawsuit and policy limit settlement that followed.

In the video, you’ll learn:

• The patient’s relevant medical history
• The pharmacy individuals named in the lawsuit – the pharmacist technician, student intern, and licensed pharmacist preceptor on duty.
• A range of failures identified by an investigation following the incident
• The final cost of the malpractice lawsuit (policy limit settlement)
• Risk management recommendations specific to the handling of methotrexate, as well as general strategies

Additional Resources

• Pharmacist Professional Liability Exposure Claim Report: 3rd Edition