Poor handwriting on scrip brings negligence ruling
The poor handwriting of physicians is such an ingrained part of American culture that most people do not even consider whether doctors should take any substantial steps to improve the legibility of what they write. A recent case in Texas, however, suggests that physicians’ poor handwriting is a serious matter that can lead to a patient’s death, or at the very least, a financial liability for the doctor and possibly the hospital.
In what is believed to be the first such verdict, a Texas jury attributed the death of a 42-year-old man to an illegible prescription and ordered the doctor and pharmacist to pay $450,000.1 The physician’s attorney tells Healthcare Risk Manage ment that the case is much more than just a fluke; he says the case should be a clear warning to risk managers that juries will not tolerate sloppy handwriting that puts a patient’s life in danger.
The Texas case should not have hinged on the prescription itself, according to Max Wright, JD, the malpractice defense attorney in Midland, TX, who represented the doctor. Though the plaintiff argued otherwise, Wright insists the misfilled prescription did not lead to the man’s death. Other problems caused the man’s death, he says, but the jury latched on to the poorly written prescription and clearly indicated contempt for such sloppy work. "I think that this jury looked at this prescription, decided they couldn’t read it, and decided the case on that basis. I interviewed them, and they said everybody testified that this prescription led to a great big overdose and so that must have had something to do with his death. I think they were wrong about that, but they indicated that the prescription was something they just could not excuse."
The incident began when Ramach andra Kolluru, MD, a cardiologist, wrote a prescription for Ramon Vasquez. The prescription was supposed to be for 20 mg of Isordil every six hours to treat Vasquez’s angina. Because the prescription was written poorly, the pharmacist provided Vasquez with Plendil, normally used to treat high blood pressure, at the 20 mg every six hours dosage. The maximum daily dosage of Plendil is only 10 mg. (See copy of the prescription, above.)
One day after taking a 16% overdose of Plendil, a drug he was not supposed to be taking at all, Vasquez had a heart attack. He died several days later. When the Vasquez family sued the physician and the pharmacy, the jury ordered them to share equally in the $450,000 verdict. After the case, the jurors indicated to the attorneys that they would have been willing to award a higher amount if the plaintiff’s attorney had requested a certain figure.
Overall care not an issue
At trial, the case centered almost exclusively on the handwriting on the prescription even though Wright says the prescription error did not directly cause the man’s death. The overall care provided by Kolluru was not challenged, and Vasquez’s widow even indicated in court that she intends to continue seeing the cardiologist for her own care and would recommend others to him. The only problem, according to the widow and her attorney, was the prescription that was filled incorrectly.
The plaintiff’s attorney, Kent Buckingham, JD, focused on the prescription during the trial as the cause of Vasquez’s death. Buckingham argued that it was time for society to stop tolerating poor handwriting as just a quirky part of the medical system and hold Kolluru, as well as the pharmacist, responsible for the prescription error.
Though he acknowledged that the prescription was filled incorrectly, Wright says he argued that the man’s death was the result of the pharmacist’s error or natural causes that had nothing to do with the prescription. He says he was very surprised by the verdict finding the physician responsible. "No matter how much we talked about the real cause of the man’s death, they had that prescription in front of them and couldn’t forget it," he says. "The medical testimony was complicated sometimes, but the prescription was something they could really grasp and understand. He got the wrong medicine — easy to understand."
Even the prescription itself was the subject of some debate in the courtroom. Wright provided an expert witness, a physician, who looked at the prescription and testified that he could understand it and would have filled it properly if he had been the pharmacist. Wright acknowledged that the witness could read the prescription much better than any layman, simply because he is familiar with the expected medications and dosages, but he says he expected that to be a positive point. He hoped the testimony would show the jury that medical professionals can read prescriptions that look like gibberish to others.
Instead, the testimony backfired.
"The jury said that as soon as my witness said he could read the prescription, they dismissed the rest of his testimony," Wright says. "That’s how strongly they felt about it. They figured that if he said he could read it, he must be lying, so there goes his credibility with that jury."
The case might be just one bad episode for a single doctor and pharmacist, but Wright says he fears otherwise. The Texas case received so much publicity that juries may be sensitized to the issue, he says, and the reaction of the Texas jury suggests bad handwriting can be a red herring for plaintiffs’ attorneys to throw in front of a jury. "This verdict does have implications. The case proves that bad handwriting is more than a theoretical problem. It certainly should put health care professionals on notice of how the public views this problem."
Wright says that, as a malpractice defense attorney, he has long been concerned about the poor handwriting of physicians. Most physicians will admit they have poor handwriting, even on crucial medical documents like prescriptions, but they are not compelled to do anything about it, he says. "So many hospital records are poorly written, more by physicians than by nurses. It represents a real risk management problem. I’ve had cases were the medicine was easy to defend, but it was made hard to defend because the poorly written record was so hard to read. It happens more often than people might think."
Wright says he divides poorly written records in to three types: illegible, scrawled, and cryptic. The first can’t be read by anyone, even the doctor who wrote it. Scrawled records sometimes can be deciphered, but they are unnecessarily difficult to read. And cryptic records can be clearly written but don’t give enough information.
"The cryptic writer doesn’t write down much on the record," he says. "Maybe it’s enough for him to understand, but it doesn’t do much for anyone else. And three years later when you’re in court, it’s not much help to anyone at all."
Reference
1. Teresa Vasquez, et al v. Ramachandra Kolluru, Ector County (TX) District Court, Case No. A-103,042.
Source
o Max Wright, 505 North Big Spring, Suite 300, Midland, TX 79701. Telephone: (915) 686-0080.
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