A Texas jury has attributed the death of a 42 year old patient to an illegible prescription and has ordered the doctor who wrote it to pay $225,000 compensation to the patient's family. The total judgment of $450,000 included an equal award against the dispensing pharmacist.
The doctor, cardiologist Dr Ramachandra Kolluru, wrote a prescription for 20 mg Isordil (isosorbide dinitrate) for angina, every six hours. But, because of the illegibility of the prescription, argued Kent Buckingham, lawyer for the family of the patient, Ramon Vasquez, the pharmacist dispensed the same dosage of Plendil (felodipine), a calcium channel blocker used in the treatment of hypertension, for which the maximum daily dose is only 10 mg. A day after taking what equalled a 16% overdose of felodipine, Mr Vasquez had a heart attack and died several days later. The overall quality of care given by Dr Kolluru was not at issue, the jury heard; his illegible prescription was the sole reason for the judgment.
The case again raises the issue of the legibility of doctors' handwriting. Mr Buckingham pointed out: “Many doctors are having to stop and think, `That prescription I wrote illegibly this morning may result in an adverse verdict.' ”
Three policies issued over the past 7 years by the American Medical Association have urged doctors to “improve the legibility of handwritten orders for medications” and to review all orders for accuracy and legibility after writing them. Doctors with poor handwriting are advised to use direct, computerised order entry systems or at least to print or type medication orders. Dr Kolluru's lawyer, Max Wright, said after the trial: “This jury clearly questioned why in the electronic age... we're still using this antiquated system based on a three and a half by five inch piece of paper.”
A trustee of the American Medical Association, Donald Palmisaro, noted that reducing all sources of medication errors is a top priority of the National Patient Safety Foundation at the association. In addition, the US Adopted Names Council, housed in the association, aims to reduce such errors by helping drug manufacturers to avoid drug names that look or sound alike.
Figure 1.
The illegible prescription