Thursday, July 9, 2009

An Important Malpractice Precedent

The Vancouver Sun has an interesting article about a recent malpractice case. The article discusses the case of Shawn Kahlon, who had a bout of lower back pain ten years ago. Mr. Kahlon had spinal tuberculosis; however, the diagnosis did not occur until a full year after he started having the back pain. By then, the TB had already spread to his brain and caused severe damage.

In 1999, Mr. Kahlon went to a physician who ordered a CT scan in the hopes that it would provide insight into the back pain. The radiologist noticed some abnormalities and wanted Mr. Kahlon to come in for a follow-up scan with contrast dye. Scans using contrast dyes do have risks associated with them (as does EVERY procedure you do in the hospital...or even life...seriously, even walking up stairs has associated risks, so don't think any hospital procedure is completely safe); however, most patients go through contrast dye scans without any complications (as always, you should ask your physician if you are going through a contrast dye scan and you have any concerns). The article states that Mr. Kahlon's physician had noted in his chart that Mr. Kahlon seemed hesitant about undergoing the scan.

Unfortunately, two key speakers were not able to provide testimony for this trial. Mr. Kahlon's TB meningitis had left him with cognitive impairments so he could not take the stand. Also, Mr. Kahlon's family physician had died a year earlier, so he too could not take the stand. Thus, a considerable number of assumptions must have been made throughout this trial.

The issue that I found most interesting about this trial is that it set a very important precedent for future malpractice cases. The judge cleared the physicians of any liability and found that the hospital and health authority were 70 percent liable, and Mr. Kahlon was 30 percent liable. This was an important precedent because it protects the physicians. Finding the physicians liable would have been similar to telling every physician in Canada that they need to chase their patients to ensure they followed through on the advice they were given, a task that does not need to be put on our already over-worked doctors.

Unfortunately, the article did not really go into detail about how the hospital was responsible. It seems to me like Mr. Kahlon was told he needed a contrast dye scan and he decided not to do it. If that is actually what happens, then it seems to me that Mr. Kahlon is 100 perecent liable. Regardless, this was a very unfortunate case and hopefully Mr. Kahlon will be able to make a partial, if not complete, recovery.

Wednesday, July 8, 2009

Bad Pharmacy Tech or Bad Training?

I'm going to start this post with a disclaimer to ensure that you don't misinterpret what I'm saying. I am commenting on pharmacy technicians that are bad at their job. I am not saying all pharmacy techs are bad at their job, in fact, I'm sure many are very well trained and professional.

The other day I went to a local chain pharmacy. I want to tell you the name of this chain, but I'm too poor to afford council if they decide to take legal action. I went to the pharmacy to fill a prescription for a couple of vaccines. Normally, when you fill a prescription for medication, the pharmacist gives you the drugs, explains how to take them and any possible side effects or drug interactions. With vaccines, however, it seems that the pharmacy tech is deemed competent enough to sell the vaccines to the client without pharmacist assistance.

This particular pharmacy tech brought me the vaccines from the back of the pharmacy. She then billed me over $100 for the vaccines. I asked her why the bill was so high because I have a fairly good extended health plan so I was surprised the vaccines weren't covered. She explained that many insurance plans do not cover the cost of vaccines and that my insurance "probably" didn't cover them either. I insisted she double check and it turned out that she was wrong. This pharmacy tech should have done her due diligence and investigated whether my insurance covered vaccines instead of assuming it didn't, but if this was her only mistake I wouldn't have any grievance with her.

After she adjusted the price, I paid and she said goodbye. Being a medical student I knew that some vaccines need to be refrigerated if they aren't being administered immediately, so I asked her if I needed to refrigerate these vaccines. She confirmed that they did need to be stored in a fridge. What if I didn't know that some vaccines needed to be refrigerated? I don't think that vaccine storage procedure are common knowledge, are they!? What kind of training did this pharmacy tech have? She shouldn't be assuming that I have up to date knowledge about vaccine storage; in fact, she shouldn't assume I know anything. Even if I had told her I was a med student, which I didn't, even then she shouldn't assume I know a thing about vaccine storage! We aren't taught that kind of thing in class, at least not in first year.

My final problem with this pharmacy tech occurred when I asked her if I had to wait two weeks before the vaccine's protective effect was active. I asked because I remembered from class that the adaptive immune response takes about two weeks to develop memory cells to specific infectious agents, but I wanted to double check that this was also true for the adaptive immune response to vaccines. The pharmacy tech said that she didn't know. Now, if you are going to give me a vaccine, you should probably know how it works. Maybe knowing about vaccine activation delays isn't part of a pharmacy tech's job description, but if that is the case, they shouldn't be the ones giving the vaccines to the customer. I feel the onus is on the person selling the vaccine to tell the customer pertinent information regarding its storage, activity, and any other information that may affect the customers health. To make matters worse, the pharmacy tech, after saying that she didn't know about the activation delay, didn't even bother to ask the pharmacist. She just walked away. I had to insist she find the information for me.

The situation I went through was only a small hassle, but the problem is that I wasn't given important information. Since I've been taught about vaccines, I was able to ask the right questions, but what happens to the customer who doesn't have a background in health care? I'm not sure if this was a case of poor training or an irresponsible employee...either way, it's a problem.