Fail-safes are supposed to exist for a reason, to make sure that no matter how many mistakes any one individual makes, the worst-case scenario is never realized. A hospital in Oregon supposedly had fail-safes, but what happened there on December 1st, 2014 is simply proof that fail-safes are only as worthwhile as the people in charge of making sure they are followed.
Loretta Macpherson was a patient in the hospital, and she had been prescribed an anti-seizure medication. The prescription was sent down to the hospital properly, and this is where the situation began to go terribly wrong:
- First, a pharmacy worker filled the IV bag with the wrong medication, a medication used for inducing paralysis in people scheduled for surgery
- A second pharmacy worker failed to recognize the wrong medication in the IV bag
- A fire alarm led to Macpherson being shut in her room, alone, for at least 20 minutes
- A second nurse discovered Macpherson in respiratory distress. She was revived, but significant brain damage occurred, and she was taken off life support on December 3rd
In this situation, the fail-safes were absolutely pointless. Having a second pharmacy worker check the medication serves no purpose if they are simply going to sign off on whatever is in the bag. And having a second nurse monitor a patient does no good if neither nurse checks on a patient in respiratory distress more often than every 20 minutes.
Sadly, many hospital fail-safes are just as bad as the ones in Oregon. These redundancies are created as much to offer cover when the hospital makes mistakes as they are to actually improve patient care.
If you or a loved one has been the subject of medical malpractice, either in a hospital or an outpatient setting, it is up to you to make sure that the fail-safes that are in place are actually followed. It is only by holding these doctors and hospitals to account that change will actually take place. Please contact a qualified attorney who can help you take the necessary steps to help protect others.