Quaid Medical Screwup -- How It Happened

Sources tell TMZ that a pharmacy technician at Cedars-Sinai Medical Center mistakenly stocked a massive dose of a drug that ended up being given to Dennis Quaid's newborn twins.

Thomas Boone and Zoe Grace are in stable condition. But a well-placed source at Cedars tells us they are "still very concerned because of the bleed out," adding they won't know for another week if the mistake will cause "longterm effects."

Sources tell TMZ that pharmacy technicians stock the drug Heparin, used to prevent clots and flush out IVs. The drug comes in vials -- 10 units for babies, up to 10,000 units for adults. Protocol at the hospital is to keep the different units separated, but a technician accidentally put 10,000 units in the drawer where the 10 units were stored.

Last Sunday, both infants -- born November 8 by surrogate -- were each given two, 10,000-unit dosages. They began to bleed out just before midnight and were transferred to the neo-natal intensive care unit.

Cedars issued a statement last night, acknowledging the mistake and calling it a "preventable error." That's highly unusual. Also, the hospital claims seven patients were given the wrong dosages. Our sources say 13 patients got the wrong dosage.

Reader Comments

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76. We ( all the tax payers ) pay the pharmacy techs. a good salary because this cannot happen. I have passed out medication before and can promise that no one got any body elses meds. What ever happened to good help in this world?

Posted at 5:39PM on Nov 21st 2007 by donna

77. What happened to the five "rights" we learned in nursing school?
Right Patient, Right drug, Right dosage, Right time and Right way to administer? Then recheck all five if there is a discrimination in any one of them.

As I see it, the fault resides with the one(s) who administered this mistake.

Posted at 5:09PM on Nov 21st 2007 by Jacque

78. The Nurse should'nt be fired, she should be given a janitor's job.Dealing with babies,you should be thinking ahead, is this the right dosage. It only takes a sec,you are talking about a baby.

Posted at 5:15PM on Nov 21st 2007 by Fred Mitchell

79. Why can't the drug industry mistake proof the Rx containers so anyone in the position to administer medication knows at a touch if it is the wrong type/dose. They can shoot you up without reading the vial, but not without touching it.
I.E. bottle size, label texture, etc....????
It is done in manufacturing & assembly every day to prevent any mistakes,even for small $$$."Poki-Oki"
Look at an electrical plug. It can only go in one way.
I guess human suffering &/or life is not worth the $$$$$ to tool it!!



Posted at 5:36PM on Nov 21st 2007 by Odin Dixon

80. they should cut off the hands on whoever made taht mistake.

Posted at 5:30PM on Nov 21st 2007 by bossman

81. What does it mean to: "bleed out" ?

Posted at 5:33PM on Nov 21st 2007 by Laurie

82. I know I will be corrected if I am wrong. I believe it means bleeding from nose, mouth, eyes, ears, booty and maybe internally too.

Posted at 5:47PM on Nov 21st 2007 by you know

83. what an stupid mistake what happened to the 5 rights of drug administration if that nurse had been giving that dose to him or herself or to his or her own child would this had still happened???

Posted at 5:57PM on Nov 21st 2007 by Lorraine

84. I will tell you how it happened to all 13 patients. Once the pharmacy tech mis-stocked the drug,. those using it did not follow the safe administration:

right drug
right patient
right dose
right route
right time

It is as simple as that. I was a nurse for 45 years and do not know of any med error I made, in part because I went through that mental check list before removing the pills from the shelf, before getting them ready to administer, and before allowing the patient to take them or administering IV,. IM or sub q.
This error could have been made by a RN, LPN, Med Student, Intern, or Doc. and since 13 patients are involved, it was a failure on a number of care givers.

That we don't know yet, but for sure everyone fell into the trap of the right dose SHOULD HAVE BEEN on the shelf, but it does not excuse teh fact that several took it off the shelf without reading the bottle.

Posted at 6:20PM on Nov 21st 2007 by nancy petersen

85. Talk about spin. The way this story is written, the pharmacy technician seems to be the only one taking the fall due to stocking the wrong strength bottle in the drawer. How about a little accountability for the person(s) who administered the wrong dose over and over and over...not once did they check the vial? Wow.

Posted at 6:11PM on Nov 21st 2007 by PourFemme

86. It is so easy to point a finger at someone who makes a mistake having such dire consequences, but how would any of you like to be in their shoes with one mistake affecting so much? How can we expect them to be perfect when we know we are not? I still believe that "unless we walk a mile in someone else's shoes, we should not be their judge." No, I am not a nurse.

Posted at 6:31PM on Nov 21st 2007 by Judge Not

87. I am a nurse myself, and just because something is stocked where a certain drug is supposed to be, you are STILL supposed to check it again. EVERY time you administer any drug (and heparin is a drug), just before administering to the patient, you check the name band to make final confirmation you even have the right patient, you check the drug sheet for the dosage/etc and then check the bottle dosage. This nurse is THROUGH, I'd be surprised if the nurse didn't lose his/her license. Plus the tech who incorrectly put the drug in the wrong place has probably lost his/her job. Also, I would think that the state will pull a review of events, with possible penalties. That isn't even counting to what the patient's families (I am assuming all patients were infants), ALL that received the incorrect dosage of heparin do legally against the hospital, the nurse, the tech and anybody else involved. That is why, when I was practiced nursing (I am not anymore due to medical issues myself), I carried malpractice insurance. Even if a doctor is sued for malpractice, anybody who worked with him on the case at anytime would be included in the suit. ANYBODY down to the CNA (orderly). Thankfully I never had to defend against a malpractice suit, but I know one when I see one, and this is a big one.

Posted at 10:09PM on Nov 21st 2007 by NursieLane

88. This is the problem with th US medical system. Too many of the nurses are more interested in their next CIGARETTE and DONUT fix, than the welfare of the patients. They are beneath contempt!

Posted at 7:14PM on Nov 21st 2007 by JOHNNY ANGEL

89. This is the problem with th US medical system. Too many of the nurses are more interested in their next CIGARETTE and DONUT fix, than the welfare of the patients. They are beneath contempt!

Posted at 9:46PM on Nov 21st 2007 by JOHNNY ANGEL

90. To JUDGE NOT... I do JUDGE the US system of LPNs, RNAs, and RNs as fully GUILTY. Most are excellent, but far too many are food and cigarette addicted POS! Most of their shoes and butts are enormous- think Rosie Odonell x2!

Posted at 7:17PM on Nov 21st 2007 by JOHNNY ANGEL

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