"Walmart - Live Better" :-\

cue the chorus...

"Why would anyone shop at Wal-Mart, they got what they deserved."

Now that that is out there, let's concentrate on the kid's health, instead of blaming the victim.

First of all, who on earth would prescribe Oxycodone for this?

That's just out of hand, and it's asking for trouble. Let's give the kid a small does of liquid heroin for his strep throat.

The fact that it's Walmart notwithstanding (sure, we could question working conditions, pressures, inadequate hiring practices, etc), it's not irrational to think this could happen just about anywhere you fill a prescription (and probably has).

What's more troubling, however, is that there is ZERO way for the consumer to tell whether what they're ingesting is safe, barring a second opinion. Every single time you take something it's like playing Russion roulette.

What safeguards, in addition to the ones supposedly already in existence, can be put into place to prevent this sort of atrocity?

Next time I get a prescription I'm going to ask them to taste it first.

PS - I'm not sure what Russion roulette is. My guess is what I was really talking about is Russian roulette.

PPS - And by "is" I meant "was".

Stupid tenses.

Rather, stupid me.

@Gilbert:
It hasn't come up since I was a kid and got strep throat a lot, but given the choice between pills and something that needs to be mixed by some $8/hr pharmacy tech, I would choose pills. I think you are far less likely to get a bad pill that made it through QA, than get an overworked pharmacy tech who screws up a mixture.

Honestly though, why do we still have medicines that require hand-mixing? I can understand it (_maybe_) for something obscure, but for a commonly prescribed narcotic (or any narcotic)?!

@valtr0n: Agreed. We've all had strep before and while it can be painful, prescribing such a powerful pain killer is irresponsible.

@valtr0n: Sigh. It's not that uncommon - my wife got prescribed hydrocodone (called "Tussionex" in this form, more commonly called Vicodin) for what was essentially a bad cough. It's pretty standard to prescribe someone with symptoms making them absolutely miserable some kind of narcotic so they can rest.

The doctor prescribed what they felt was appropriate to help with the patients pain. I have take that medication in pill form and yeah, it can be something you shouldn't want to take. But the issue is not why he took it but that WalMart screwed up caused significant pain and suffering to the family and could possibly have ruined the young mans life. They need to pay and they should get that checkbook out asap.

Sure, it's great that Walmart "acknowledged" the error - but are they Taking It Seriously?

@vespolina: Of course they are taking it seriously. Since that prescription was 20x too powerful, that soon-to-be-fired pharmacist cost them 19 high-priced orders of oxycodone.

Walmart does not tolerate waste.

Wow. I've had strep, most recently about a year and a half ago. Quite literally, within an hour of starting antibiotics the pain lessened, and kept lessening noticeably.

I can't imagine wanting or asking for a pain reliever of any kind just for strep.

@Crim Law Geek: Agreed. The only times you hear of someone taking the wrong pill are those in which someone else's prescription was given by mistake. This explains the rationale behind always checking your labels!

@vespolina: Yes, but since he went to a hospital, and not back to Wal*Mart for treatment, it means they have no responsibility.

Heroin was originally sold as a cure for addiction to morphine and as a cough suppressant. Despite the fact that it eventually became clear that heroin isn't a good cure for addiction to morphine, heroin is apparently still considered to be a good cough suppressant.

[en.wikipedia.org]

Just goes to show you that you can't keep a good cough suppressant down.

Oxycodone for a strep throat?! Where is this doctor and can I become their patient? I've had serious injuries that they've forced me to use Ibuprofen because they're so hyper-worried about addiction (which is NOT a problem I assure you, I just happen to have neon dyed hair which automatically makes me an addict). And this is a KID!

Target did this to my Ex with blood pressure medication. It made his BP drop dangerously low, and he couldn't stay awake.

WTF with pharmacists these days? They figure that now that they don't have to fill birth control they can lax on everything else?

Hmmm. Where's the Pharma packaging on this?? Many industries clearly package commercial grade high potency stuff different from that of end consumer product of the same item. Several have referenced the presence of the doctor as well and I agree. Personally the 'script should be legible with the dosage, the pharmacy should hand the 'script back to customer marked 'filled'. If they customer desires they can check what is being dispensed with what is tendered for consumption vs the doctors original.

It just might have prevented this tragedy.

To you idiots with the to keep criticizing the doctor and/or the patient about the medication itself...where the hell is your medical degree? Wait...don't have one? Then shut the hell up.

I personally have suffered strep throat so badly that I required IV hydration because my fever was so high AND needed serious pain medication because I was near screaming and in tears every time I swallowed. Every patient is different, and that's why hwe have doctors and prescriptions in the first place.

This story is about a mistake that the pharmacist made, pure and simple.

@Crim Law Geek: Other than the obvious "less water, cheaper to ship." The oxycodone can be prescribed in a variety of doses. Instead of now storing 12 different concentrations (I don't know how many off the top of my head) you take one concentrated amount and dilute it to the right concentration. There are also other medications, especially topical ones, which will be custom mixed based on the application (ointment, cream, multiple ingredients...)

What might help in the future is to have a good color reference chart so that when you look at the liquid, after it is poured out you can at least gauge if the dilution is close.

I never got anything more than penicillin for strep throat. Must have been the strep throat from hell if that kid was getting oxycodone for it.

I'm not a usually proponent of "Sue them up the butt like there's no tomorrow," but for this I'd make an exception.
Clearly, negligence on the part of the Wal-Mart pharmacist should result in a hefty settlement.

@Lars: Uhm, not all strep throats feel the same. Even different infections in the same person at different times can vary a LOT.

Like @toddy33, I've had a case where it was painful enough that there was no way I could swallow a pill. It was torture enough swallowing liquid.

(In addition to not blaming the victim, I'm also not blaming the posters who thought strep didn't need such a prescription... I assume if you've only had it in a milder form, it *would* seem extreme.)

And this is exactly why narcotics should only be dispensed by a hospital. If I had a penny for every time I have corrected a walmart pharmacist I could own walmart. If they cant get it through their effing head that when a doctor prescribes a 20 day antibiotic regimen for a child due to recurring ear infection, that they cant give you 20 days worth of liquid at once (the antibiotic in question in liquid form had a shelf life of 14 days after mixing) how can you trust them with narcotics?

@The_IT_Crone: "WTF with pharmacists these days? They figure that now that they don't have to fill birth control they can lax on everything else?"

I don't have stats to back this up, but I suspect that errors at pharmacies are much more infrequent than they were 50 years ago. I think we just hear about the mistakes a lot more frequently because news travels quicker.

Operations engineers have spent a lot of time and money poka-yoke'ing the hell out of pharmacies to try to reduce medical errors. It's a lot cheaper to invest in designing safe systems than to pay out on lawsuits like this Wal-Mart is not facing.

Pharmacists are continually overworked without enough qualified help, and the big stores (not just Wal-Mart, but all of them) are notorious for this. There are too many pharmacies and not enough pharmacists. My dad's a pharmacist and he's terrified that something like this will happen to him. I'm sure the pharmacist feels absolutely awful. He's thinking about leaving a job that he just started because when he gets to work in the morning, he already has over 100 prescriptions to fill on top of the 12 hour day ahead of him. Mistakes are bound to happen when you're being worked like that, and he's not willing to risk it.

I wouldn't be shocked about Walmart fessing up. They're setting up the pins to decrease the chance of a lawsuit; in case of a lawsuit, get a relaxed judgement by immediately claiming culpability; scapegoat the pharmacist and any other throwaway people related to the incident; and play the good guy the whole time as a PR move. All they have to do now is wait for the family to act, then they can knock 'em all down. They probably won't even have to review their shitty pharmacy standards.

@TipsyRussell: I meant my dad's thinking about leaving his new job, not the pharmacist in the story.

What I would like to know is what was written on the bottle the pharmacy gave the kid? What concentration was written on the bottle.

I'm assuming it's was the concentration the doctor wrote, but can't make out the pictures.

For those of you who asked who give Oxycodone for strep, are any of you doctors? I asked because I'm in med school and all the books I've come across stated that Oxycodone can be given in strep throat and in some cases must be given.

Recently, I had my simvastatin refilled at a Duane Reade here in NYC. When I checked the contents, I noticed the pills were a different color than usual. I went back to the pharmacy, and sure enough, they had filled my script with the wrong meds. They kind of laughed it off as a funny mistake. Ha ha.

@afrix: have to agree here, usually ibuprofen is enough, and if not, usually within 2-3 days the antibiotics have kicked in. I had my kidney removed 3 weeks ago, and even though the Dr prescribed 30 Dilaudid pills, I only used 3, and have used ibuprofen since (ocassional 1/2 percocet at night so I can be comfortable enough to sleep) I cant even imagine a doctor giving oxycodone for strep throat. Maybe I should have gone to their doctor, I would have gotten some really good pain meds.
However, this is completely Walmarts fault, more training is needed for the pharmacy techs, and Walmarat needs to shell out the big bucks.
I wonder is it the actual pharmacist that mixes this, or just a tech?

@Mr_Human: wow, I would think that's more than just a funny mistake, good thing you knew to check, but as someone else said with pills it is easier to do that, you may not have noticed with liquid

Before I had a tonsillectomy a few years ago, I used to get recurrent strep throat and tonsillitis. A couple of times the pain was so severe that NSAID's like ibuprofen just didn't cut it. Everyone has different pain thresholds.

walmart wont pay now. the guy went to a different mechanic and the evidence got contaminated. if he just would have went back to walmart first before the evidence was contaminated im sure they would have worked something out.

@valtr0n: Are you a doctor, or do you just play one online?

@hypochondriac: The stick-on label says "TAKE ONE TEASPOONFUL EVERY 4 HOURS AS NEEDED FOR THROAT PAIN" I can't make out what the concentration on the Oxycodone is on that label. It looks like there's a 25 in there. If 100mg/teaspoon was 20 times too much, the dosage should have been 5mg/teaspoon, or 1mg/mL. I did a search on liquid oxycodone concentrations and 1mg/mL is a valid concentration, as is 20mg/mL. I couldn't find any information as to what the concentration of the pharmacy bottle would be.

I feel sorry for the kid, but accidents do happen. Pharmacists are human. I hope his recovery is quick.

@toddy33:

Exactly, unless you have a degree in medicine, stfu about why he was prescribed oxycodone. Strep throat can be quite serious and aside from the pain issue, if the kid had a concurrent cough, oxy or a similar drug would be a reasonable choice as it is a cough suppressant. Everybody on the internet is an expert...

Poor kid. I honestly hope he pulls through.

Hmmmm, I recently noticed that my pharmacy has started printing descriptions of pills on the label with shape, color, and markings of what should be inside. This makes me realize what a really good idea that is.

@Crim Law Geek: "Honestly though, why do we still have medicines that require hand-mixing?"

More specific dosing, which leads to better therapy. (We're not all 180-lb. white males.) Different delivery mechanisms, which can lead to easier consumption (magic mouthwash FTW). Different mixes of meds for people with different problems or allergies.

My cat gets his meds at the compounding pharmacy, which compounds for people and pets both. He can't be pilled, so we get his antibiotics (when he has a UTI) in a transdermal form that can be rubbed on his ears and absorbed through the thin skin there. Since animals come in so many different sizes, they can also provide common medicines in the proper dose for your pet's weight. One they do a lot of at the compounding pharmacy is medicine-in-lollipops for very sick kids in severe pain who are resisting taking yet another medicine. They also do a lot for older people with problems swallowing, or who have to take many medicines every day.

@TWinter: You can also buy a book with thousands of common pills described and pictured with whats on the front/back, etc., for about $6.95 -- pediatricians used to recommend parents have one on hand -- or you can use those newfangled intertubes the kids are all talking about to look up pill appearance. For folks whose pharmacy doesn't do the descriptors.

We are, however, shocked that Walmart seems to actually be acknowledging the error . . .

Actually, the only statement from Walmart that I see in the posting or linked article is "This is a very sad situation. Our thoughts are with this young man and his family," which falls far short of accepting any liability whatsoever.

I know a lot of folks down here that use Wal-Mart pharmacy and I haven't heard of any problems with them. It's not fair to assume all pharmacy techs are incompetent because of this one incident.

Having said that, Wal-Mart definitely needs to cough up some green for this poor kid and his family.

Unfortunately, these kind of errors are inevitable. Pharmacists are dispensing massive quantities of drugs, and even at a 99.99% accuracy rate (number that's completely made up), 1/10000 prescriptions will be screwed up. No amount of training will completely prevent every mixup. I'd say that it would almost be better to make everything over-the-counter (except antibiotics) so that the patient is the one responsible for his or her own health, not the pharmacist (this wouldn't be legal, however).

This appears to be a simple pharmacist error.

Would this error have happened at another pharmacy or does Wal-Mart have deficient hiring practices or inappropriate procedures or systems in place to prevent errors?

I have strep throat right now. i took a hydrocodone last night. i took it so hopefully i would get a few hours of sleep. i never noticed before but when you are sleeping you swallow every now and then. But right now everytime i swallow it is excruciating. So i took 1/2 a pill and did sleep 9pm-1am without waking up, that is the longest i have slept in three days. I can imagine that was what this teen and his mother were hoping for. It may not have been, gee my throat hurts lets take vicodin, but hoping for relief for more serious pain. If there had been a liquid form I definitely would have chosen that option.

Where Walmart may be liable is the manner in which the pharmacy is operated, and what internal controls may or may not be present. I imagine there are specific operational requirements mandated by the state as well. If they were in violation of state law or have other control problems, Walmart could be in a serious world of hurt. The pharmacist is royally screwed either way.

As for the kid, Godspeed fella. Sorry about your luck. I hope for a full recovery.

There are several medications I've gotten from a pharmacy that require hydrating or dilution. You see this most often with kids drugs, since they can't take pills very well sometimes. Antibotics are often in powered form in the bottle, so they put the right amount of water for the right concentration.

We've gotten prescriptions filled from Walgreens incorrectly, too. My daughter got double dosed for a month on a medication, and my wife got higher dosages of a antibiotic. Fortunately, neither was health impacting. You should ALWAYS have the doctor explain the dosage and usage, and double check the prescription yourself with the pharmacist.

Very sad...