Medication Mixup Causes undue Pain and Suffering.

Betty PayneAfter being released from Fort Sander's hospital for what was thought to be routine hip surgery, performed by well known surgeon Dr. Gray, Betty Payne was taken home by her husband Al Payne and son Joseph for recovery after a night in the hospital.  Her doctors at Fort Sanders gave her two prescriptions.  A Pharmacist at Cunningham Drug Store filled these and Betty was taken home to recover.  After two days Betty’s condition began to worsen.  She became feverish and the foot opposite her surgical implant began to turn red from what was later described as a septic poisoning. At that time Joseph called the doctors at Fort Sanders and they advised him to get his mother back there as quickly as possible.  It had been discovered that the doctors had prescribed the wrong medication.  One doctor had prescribed blood thinner and one a blood coagulant.  The pharmaist had failed to catch this error, which was his duty to do.  The emergency ambulance was called, located just a few hundred feet from Mr. Al Payne’s house in Tazewell but the staff and director, had no idea where Mr. Payne lived.   This along with the fact that a cash $200 deposit to the ambulance at time of picking up the person being transported resulted in Mr. Joe Payne having to put his mother in the family car and transport her to the hospital himself.  Mr. Payne had to do this on several occasions because of the service not knowing where Mr. Payne lived and their lack of response to his calls for assistance.

Mr. Payne took his mother to St. Mary’s hospital. had treated her for arthritis related illness.  She trusted these men, as did the rest of the family.  After a month in ICU she was given no hope of survival unless her leg was removed below the knee.  But before this the family was told to bring all the family in, as the likelyhood was very great she would not survive the surgery.  This resulted in her son, George Edward Payne being called home from his post in Johannesburg, South Africa while on call for then United States Department of State late in 1980.  His brother Joseph Payne called the Command Center, U.S. Department of State, a number the family always kept in case of an emergency, to inform them to inform him he was urgently needed back home in Tennessee that his mother had been given little chance to live by her doctors.>
The younger two children of Mrs. Payne, Joe and Betsy had been given the assignment of recovering their mothers’ leg from the hospital infirmary and were informed that it had been disposed of. This limb was going to be used as evidence of wrong medication being administered.

PersriptionHydrocortisone (Cortef)
Therapeutic actions

Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use.
Incompatibilities:
Do not mix or inject at Y-site with amobarbital, ampicillin, bleomycin, dimenhydrinate, doxapram, doxorubicin, ephedrine, ergotamine, heparin, hydralazine, metaraminol, methicillin, nafcillin, pentobarbital, phenobarbital, phenytoin, prochloperazine, promethazine, secobarbital, tetracyclines.

Beef Heparin
The primary use of
heparin relates to it’s ability to prevent clotting of blood.
Heparin is used to prevent a condition known asdeep vein thrombosis (DVT). This condition is associated with the formation of blood clots in the blood vessels in the leg. These blood clots can sometimes travel to the lungs and block blood vessels there, resulting in a serious condition known as pulmonary embolism.

Heparin inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both in vitro and in vivo. Heparin acts at multiple sites in the normal coagulation system. Small amounts of heparin in combination with antithrombin III (heparin cofactor) can inhibit thrombosis by inactivating activated Factor X and inhibiting the conversion of prothrombin to thrombin. Once active thrombosis has developed, larger amounts of heparin can inhibit further coagulation by inactivating thrombin and preventing the conversion of fibrinogen to fibrin. Heparin also prevents the formation of a stable fibrin clot by inhibiting the activation of the fibrin stabilizing factor.
The following medications may affect how heparin works or increase the risk of side effects:  any medications that affect how well the blood clots (e.g., ASA, nonsteroidal anti-inflammatory drugs (e.g., indomethacin, hydrocortosone, dextran)

I have found only one website that says that these medications could be administered under a very controlled situation, under constant survallance. Dr. William N. Smith was asked to come by and check on my mother after checking out of the hospital following her amputation, but even he asked me to administer the shots to abdomen with a long syringe after only a couple visits. This was the norm while caring for my parents the next 5 years living in Claiborne County.

Phlebitis 1992 Study on Phlebitis Not an open wound
Studies have looked at the effectiveness at reducing phlebitis using heparin and hydrocortisone, given alone or together, and of glycerine trinitrate, but no recommendations can be made. In addition to the lack of evidence to support their use,the potential for adverse reactions may outweigh potential benefits.

A controlled study in 1983
Previous reports have suggested that infusions of lidocaine (lignocaine) cause a high incidence of phlebitis. We investigated the possibility of reducing this high incidence by the addition of small amounts of heparin or hydrocortisone (or both) to the infusate of lidocaine. One hundred patients with acute myocardial infarction who were to receive a 48-hour prophylactic infusion of lidocaine (2.25 mg/min) were randomized to have one of the following added to their infusate in double-blind fashion: (1) placebo; (2) heparin (4,000 units/24 hr); (3) hydrocortisone (20 mg/24 hr); or (4) heparin and hydrocortisone. After 48 hours the incidence of phlebitis was 94 percent in the control group but only 41 percent in the group receiving heparin and hydrocortisone (p less than 0.005). Had the infusion been stopped after 24 hours, the incidence of phlebitis would have been 56 percent in the group receiving placebo, but only 19 percent in the drug-treated groups (p less than 0.01). We conclude that infusion of lidocaine causes a high incidence of phlebitis which can be markedly reduced by adding heparin or hydrocortisone (or both) to the infusate and limiting the duration of the infusion in a given vein to 24 hours.

References:

http://www.joannabriggs.edu.au/pdf/BPISEng_2_1.pdf
http://www.merck.com/mmpe/print/lexicomp/phenytoin.html
http://bodyandhealth.canada.com

http://www.e-radiography.net/

http://www.medbroadcast.com/


Although the sympathy offered by many made the pain of my mother's illness a little easier the ongoing inability of not only people in the community that we, my mother and father and myself, lived but from some other members of my own family to understand that these two older family members needed help other than that which I gave and was more than willing to give. Not until years later was there a serious effort to help my mother, nearer to her death in 1999. Most of this help was not without a cost though. It became more apparent that the material value of her worth was probably the most important thing, as after her death a final value of the property that was known as "The Farm", finally was estimated in the neighborhood of $900,000.00 and was divided equally without any question. But, my mother had not only suffered almost an entire year close to death, she had lost an eye and a leg to what doctors admitted were mistakes they had made. One reason that the family had decided not to take any legal action was that several of my nieces worked in the medical profession in the Knoxville area. Another was that my father had some of the best insurance that was offered through the Rural Letter Carrier Association. I know because I filed years of claims to them and his secondary carrier Mutual of Omaha and later to Medicare. Also the fact that I was willing to give a good part of my life to caring for both her and my father lost it's meaning after the only member that seemed to remotely appreciate it, George Eddie, passed away just after Mother in 2000. But, such is life and I am at least vindicated by being able to "POST" my slant on my own website.