Chemotherapy may be the necessary treatment for a patient with cancer. The patient may trust her doctor’s treatment plan and recognize it as the only way to extend her life. However, that doesn’t mean that chemotherapy is without risks. Some of those risks are unavoidable due to the nature of chemotherapy drugs, but other risks can—and should—be avoided.
Chemotherapy Overdoses Are Preventable
Chemotherapy drugs are poisonous. That’s why they are useful against cancer: the drugs concentrate in the tumor and kill the cancer cells. The poisonous nature of cancer drugs also means they require careful handling.
There is only a small difference between the amount of chemotherapy that kills cancer and the amount that can kill a patient. The type of tumor and stage of the cancer determines the dosage, dosing interval, and route of administration. For these reasons, chemotherapy inherently presents a small safety margin—and a considerable risk of error. A chemotherapy mistake – which happens when a patient is already suffering from cancer – may result in pain, hemorrhaging, organ damage, infection, lower blood platelet counts, or death.
Who Is Responsible for Chemo Overdoses?
The answer depends on why the overdose occurred. Some possibilities include:
Doctors must consider numerous variables to find the correct dose of chemotherapy. Some of those variables include the patient’s…
- Organ function.
- Body surface area.
- Previous drug exposure.
- Existing medical conditions.
If a mistake is made by the doctor in determining how much chemotherapy should be provided to the patient, then the doctor may be liable for the patient’s resulting injuries. These mistakes can happen, for example, when the doctor fails to take a complete medical history, fails to order complete lab work, or fails to communicate instructions clearly. These errors can cause the doctor to prescribe the wrong dose of chemotherapy or the patient to receive the wrong course of chemotherapy.
The Person or Entity Providing the Chemo
Once the oncologist determines the correct dosage, then the chemotherapy order must be filled. Significant and dangerous errors may be made at this stage of treatment even if the doctor ordered the correct dosage of chemotherapy.
There is a significant increase in the number of chemotherapy mistakes when chemotherapy doses are prepared somewhere other than the oncologist’s office. Specialty clinics that fill chemotherapy doses do not know the patients that they are treating. Mistakes that could have been caught by medical staff and the patient’s own doctor may be missed by staff in a different facility. Some of the mistakes that can be made at this stage include:
- The failure to notice a decimal point in the drug dosage or to properly interpret the oncologist’s written prescription.
- Interruptions or distractions while processing the order.
- Mixing up the name of the drug with another drug due to abbreviations or similar names.
Any of these mistakes can be dangerous or deadly.
The Person Administering the Chemotherapy
Another cause of serious chemotherapy mistakes is when the person administering the medication makes an error. If the nurse or other person providing the drug to the patient incorrectly administers the chemotherapy, provides the wrong dose of chemotherapy, or provides the wrong chemotherapy drug, then serious harm can result.
The Drug Manufacturer
The drug manufacturer may cause a chemotherapy overdose by failing to appropriately label medications or by putting the wrong dose of medication into each vial. In 2012, for example, Bristol Myers Squibb recalled a chemotherapy drug after it was discovered that a vial was overfilled and could cause a patient to overdose on the chemotherapy drug. The recall affected 10 lots of BiCNU, an injectable form of the drug carmustine, which is used to treat brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphoma. An overdose of this drug could result in liver or kidney toxicity.
Determining Liability and Proving Negligence in Chemotherapy Overdose Cases
A doctor who ordered the chemotherapy, the person or entity who filled the chemotherapy, the person who administered the chemotherapy, or the drug manufacturer may be liable for providing the wrong dose of the medication(s).
In order to prove which party was liable for your injuries and the value of damages, your attorney may need to use many different types of expert witnesses, such as:
- Pharmacists or pharmacy technicians.
- People who can speak about your lost wages and other economic damages.
Additionally, it is important for patients to save any evidence that they may have, such as medical records, medication bottles, and treatment plans.
In order to determine if a mistake was made, our lawyers will consider the accepted standards and practice guidelines for providing chemotherapy. Guidelines such as those provided by the American Society of Clinical Oncology and ONS Chemotherapy Administration Safety Standards should be followed by oncologists, unless there is a good reason to deviate from them.
Compensation for Victims of Chemotherapy Mistakes
If a patient can prove that a doctor, pharmacist, nurse, or other person or entity was responsible for a chemotherapy overdose, then the patient or his survivors may be able to recover for his:
- Medical bills (past, current and future).
- Lost income (missed time from work).
- Pain and suffering.
- Mental anguish.
- Reduced quality of life.
- Loss of companionship.
- Burial/funeral expenses.
- Other losses stemming from the overdose.
In order to prove liability for a chemotherapy overdose claim, a victim, together with his attorney and expert witnesses, will need to prove the following:
- There was negligence: a failure to provide a reasonable standard of care.
- The negligence must have resulted in injury.
- The patient's damages must be the direct result of that negligence.
In some circumstances, punitive damages, which are designed to punish the liable party or parties, may also be available. These are usually awarded in cases involving gross negligence or willful intent to harm.
Victims Need a Lawyer Experienced in These Types of Cases
Chemotherapy overdose cases are complicated. In order to recover damages, you must prove who was responsible for the mistake.
Recently, Gray & White Law settled the case of a Kentucky patient who had been prescribed oral chemotherapy. The oncologist at his cancer treatment clinic wrote a prescription that was filled by pharmacy technicians at the clinic’s specialty pharmacy. While the prescription was for the correct dosage, the doctor’s handwriting was unclear and a decimal was incorrectly placed when the order was filled. The technician did not catch the mistake and a pharmacist never reviewed the order before it was provided to the patient. The patient became very sick and then the error was found, but it was too late. Irreversible damage had already occurred and the patient died. The defense argued that the patient should have noticed the mistake and that the patient was going to die anyway. We used numerous experts to hold the clinic accountable for failing to provide the proper oversight that is required for chemotherapy and to achieve a fair settlement.
This case was not an isolated incident. As more specialty pharmacies in Kentucky are filling chemotherapy prescriptions, more patients are getting seriously injured and as more cancer treatment centers open, the possibility of additional chemotherapy errors increases.
Accordingly, this is an issue that we take very seriously. In May 2015, Attorney Matt White published expert analysis on this topic in Medical Law Perspectives to educate other lawyers about how to handle chemotherapy overdose cases. The legal team of Gray & White will continue to advocate for those hurt by chemotherapy overdoses.