My mom’s assisted living stopped her daily thyroid medicine, which she has been on her whole adult life. They didn’t tell anybody. The staff and myself noticed a physical decline and three months later ended up in severe hypothyroid crisis in the ICU. she was diagnosed with a life-threatening myxedema coma. My question is who is at fault? The facility is blaming the primary doctor and the way he wrote his prescription., I am blaming the facility for not being aware that a thyroid medication is something that’s just not stopped or discontinued. also the pharmacy should have called the doctor to clarify the order as there were 3 available refills. The facility is covering their butt by saying that the doctor wrote the order for 30 days with three refills and that since he specifically wrote “x30 days” it justified them stopping the med WITHOUT calling for the refills! And WITHOUT telling family. I had multiple conversations with the on site nurse and staff about moms declining physical abilities and excessive sleepiness. I decided to take her to the hospital and asked for a copy of her medication list on the way to the hospital and that’s where I discovered this medication error. When mom moved into this assisted-living facility, she had a sign over her full management of her prescriptions to the pharmacy that the facility uses so I feel like it was up to them to properly manage her prescriptions and call her doctor if they had an issue. Also the nurse at the facility should’ve been an advocate for Mom and known the problem. I’m frustrated. She could have died.
Your story will help a lot of people.
Fortunately I receive a monthly report of the medications dispensed from the pharmacy and the sharing of this story has made me realize that I need to pay close attention to that report. Dfischer1212, thank you for sharing your unfortunate story.
Someone above the Med Tech should have questioned the thyroid refill when it got down to the last couple of pills.
Big takeaway is that on top of everything else a family member should review meds given each day on every visit be it a daily, weekly or monthly visit. A lot of mistakes in healthcare get made with meds.
My dad was in a care home for the last 6 weeks of his life. He had a syringe driver to administer morphine and other end of life drugs. When the usual dose was no longer having the desired effect, the nurse was on hand to give an extra injection to stabilise his condition and deal with the pain.
Mum also had access to a nurse, but we would have to call the palliative care team and wait until a district nurse became available to come out to her flat.
Both my mum and dad had good end of life care with very good pain management. Look at what other families have said about the care in whichever AL facility you are considering, as they may also be good.
Just please be aware that the care will never be perfect. Neither can the care be that's provided at home. People aren't perfect.
Wishing you all the best.
Even if you decide not to pursue anything legally, check with your state's Department of Labor, Licensing and Regulation board. It may go by a different name in your state. They may answer your questions and you can file a complaint with them against everyone you feel should be held accountable. It won't bring financial compensation but it does give satisfaction knowing they will be investigated and penalized if evidence of neglect is found.
Also check with your state's Department of Public Health. AL's may not be held to the higher standard that SNFs are, but they probably will investigate as well.
Just remember your mother will still be there unless you move her. In the mean time take your time to gather your facts so you are prepared for whatever. Try not to share your thoughts out loud at the AL, let them think you are concerned about the doctor. As a suggestion to everyone here, take time to review your LOs chart from time to time. We learned the hard way like OP and found things after our father was hospitalized due to a serious diabetic event and he had never had diabetes that we were aware.... an elevated glucose test was in the records from a few weeks earlier but no one ever told us. If nothing else, ask for regular copies of the MAR and if there are red flags then ask to see the whole chart. This applies to AL, SNF, Rehab facilities and even Hospitals.
One problem with lawsuits, we learned the older a person gets the less likely a lawsuit will be won and if so the value on an older person's life is not as high as a younger healthy person... even if they die. So find all the facts you can and you may still want to take them to an attorney because most will do a free consultation and if they take the case it will only cost a percentage if they win. Look for an attorney that has experience with facilities... they will know your chances for success. Again, no facility wants to be investigated.
Whatever you choose, try to focus on the main issue when you are complaining. If your laundry list is too long, the crux of the problem can get watered down.
I would state the facts, as simply as possible. Use bullet points.
State what the mistakes were, what you noticed and flagged up, and what the outcome was - your mum's worsened health and treatment in the ICU.
Whether your mum recovers is not the issue - she experienced a drop in health and wellbeing and her life was put in danger. She should never have experienced this trauma and nor should you: it was preventable.
Instead of asking which professional was to blame - the doctor for how the script was written, the care facility for not realising that thyroid medication is ongoing and requesting a repeat, or the pharmacy for not flagging it up - you point out that there were failings at each point, which need to be addressed to avoid a repetition of this happening to anyone else.
Demand to know what safeguards are in place and what policy changes will now be made.
If you or your mum are out of pocket because of the hospital visit, or your mum now requires extra care that is more costly because of these failings and the consequences, then you do need to ascertain who bears the most responsibility. You may need a lawyer for this, as you would need to make a claim against the responsible party.
If the damage is physical and emotional, without any financial burden, you may find that getting all parties to make policy and safeguarding changes will help you to move forward. Knowing that you will have helped others can be healing.
Certain our OP should contact an attorney and I hope she does and comes back to tell us. But you won't win it that way. RNs don't pass meds at ECFs for the most past. Rare as hen's teeth.
Again, this is just my opinion about who is ultimately responsible, but doctors in the hospital are not the doctors who normally take care of my mother - they are "hospitalists", and they do not consult with the family doctor, so they make their own decisions, and her family doctor does not know what those are. Sometimes, it feels like I am just chasing a crazy train trying to keep it in sight and trying to figure out where it is going to end up.
We who are caregivers are sometimes afraid to speak out or cause waves because these workers in ALs are the ones who have our loved one's lives and comfort in their hands. We, caregivers, have to be experts in all fields anymore and even detectives. It is exhausting, but when I think about the amount of promises made to us before my mother moved into AL, then the "changes" made over time for the AL's benefit and ease, then the continued yearly rise in price of rent and care, and the excuses and rationalizations and blame game after "mishaps or mix-ups", I have begun to research other options for mother. However, for those of us who are not ultra-wealthy, the choices are very sparce.
If you are able to afford a one-time visit to an attorney for advice, perhaps it might help with the frustration and anger to have an expert's opinion on this. Also, I have been writing my elected officials, which probably won't do any good, but helps me vent (respectfully) with the frustrations we have gone through in the past year about the quality of these ALs and skilled nursing facilities, medical care, etc.
I hope your mother is doing well now. Your situation is multiplied thousands of times and will only get bigger as we caregivers (baby boomers, then our children) find ourselves the care-receivers. It seems we can plan, prepare, and save as much as we possibly can, but it will never be enough. Profit and the bottom line have replaced altruism, professionalism, and responsibility in too many areas. Please know that all of us who love and care for someone are wishing you well. I hope that the crisis of elder care in our country is somehow, someway fixed so that we know our children and grandchildren will have peace of mind for themselves.
I am now getting off my high horse, so someone get me a ladder or at least a pillow to soften the fall!
So, I would talk to every single person that had a hand in this major f-up. Your poor mom! I would ask them to tell you what their policy is and how they can prevent this from happening in the future. If they don't have a policy, the obviously need one!!! THings like this are too darn important for these facilities that are taking in lots of money have taken responsibility for to just drop the ball.
I'm so sorry you had this upsetting experience. I wish you and your Mom better care going forward.
If a prescription is specifically written "x 30 days" (in medical language "times thirty days") then that means it is to be given for 30 days ONLY.
The order should have been written "QD" meaning "every day". Or "daily".
Extended care facilities are NOT hospitals and do not have medical personnel. They have only medication nurses who will administer medications as ordered by the MD.
Any real nurse would know that thyroid medications CANNOT be discontinued. They would call and question such an order. I think you should find out if there is a real RN in charge of patient medications at your facility.
Deterioration of a patients condition in care is sadly often missed because it is more or less the norm.
I am so sorry. Whomever is to blame here, the outcome will be the important thing. There is no compensation without serious injury that is ongoing. So if your mom recovered, it is unlikely that a personal injury or med mal attorney will take this case. It is, however, worth discussing. If you are POA ask for the medical records of the nursing home to take to the attorney with you.
For example, I’m sure the prescription did include “daily” or QD as you mention, we just haven’t heard it. No pharmacy could fill a prescription that was written “x30” or even “x30 days”, because there has to also be a dose frequency. Without it—are the 30 pills twice a day, once a day, once a week, as needed every 6 hours? It’s not a valid prescription without a frequency.
But it also would be common and required for the number of pills dispensed per refill to be laid out. In the handwritten days would be “#30” (not x30 but we are getting this second hand). So having “30” isn’t necessarily an error either, in fact some sort of dispense number is also required for it to be valid. And then “11 refills” if planned for a year.
The total intended duration of the treatment is sometimes spelled out also but sometimes just implied by the #of refills. E-prescriptions have changed this I think, maybe required to be explicitly laid out now.
So what happened? Hard to tell what happened here. I would ordinarily suspect that either the MD did not write any refills (though we are told 3 refills were written), or the nursing home/pharmacy didn’t call for a refill, Or something is off with the “length of therapy/duration” field if any. But I can’t understand this as all decent EHRs (and I assume pharmacies) require that these be consistent —that the duration of therapy (if any), the dispense #, and the #of refills to all match up. So I can’t see how an MD could have written for 30 pills (daily), three refills, and the length of therapy field (if any) only being 30 days—that doesn’t match up.
As you say there is also a backup failure— a failure of common medical sense/knowledge by the facility RN (if any) and pharmacy that this is not a med that can be stopped. And maybe noticing the mismatch between the refills (still existing) and the length of therapy. (Not necessarily their primary job but they are backup and all meds are coming through them). Anyway, what would have happened after the refills ran out?
So unfortunate…hope the OP’s mom does ok. Primarily this is a communication error, seemingly caused by transitions between facilities, only question is how it happened (and how to learn from/prevent).
My Mom was on meds for Graves desease. When she went into the hospital she was on a pill everyother day. I told them this. I had given her a pill the day before so she was due onevthe next day. She went into rehab after that and it took 2 weeks before I got a care meeting. In that meeting my Moms Thyroid med was not listed. I asked why had she not be getting it. I was told because the Doctor at the hospital stopped it. I was livid and the case nurse upset. I called the hospital and found out that the doctor ordered a test and found Moms numbers normal and because she was getting a pill everyother day, stopped them. A GP stopped a prescription that her Specialist had ordered. I talked to her Specialist and he said no harm done.