Woman dies after pharmacy refuses to give her EpiPen

For those who are not aware what an EpiPen is, it is essentially a large one-use syringe which contains a chemical called epinephrine. This is used as an emergency treatment for life threatening allergies, a condition known as anaphylaxis. A common form of anaphylaxis is an allergy to peanuts, although some people are allergic to other kinds of nuts, cigarette smoke, rubber, and plenty of other things, both natural, and human-made. The treatment for anaphylaxis is derived from a military application for treating those who have been exposed to nerve gas.



I work as a teacher, and earlier in the year I had to sit a short course on anaphylaxis and the administration of the EpiPen (and its rival the Anapen), as my workplace has a student suffering from this condition. It is an extremely high priority that all staff are aware of anyone suffering from anaphylaxis, and know what to do if they suffer an attack. A person who has an anaphylactic reaction can die within a few minutes.The EpiPen not a cure, it simply can postpone the anaphylactic reaction buying a little time in which to seek proper medical treatment.

en.wikipedia.org...

The reason I'm writing this thread is that I came across this article today, where a teenage girl was denied access to a Pen as she did not have a prescription, and as a result she died. Somewhat depressingly she died outside a pharmacy.

www.smh.com.au...

A teenage girl has died outside a pharmacy in Ireland after a staff member refused to give her family an EpiPen to inject her for a nut allergy because she didn't have a prescription.

Emma Sloan, 14, was out for dinner in Dublin with her family when she accidentally ingested a sauce containing nuts that she mistook for curry, the Irish Herald reported.

"I'm so angry I was not given the EpiPen to inject her. I was told to bring Emma to an A&E department. Emma was allergic to nuts and was very careful. How could a peanut kill my child?

I feel that this is a tragic and unnecessary death, and I imagine that the person who did not sell her the Pen must feel shattered. I do feel that it is unfair to lay the blame on them, as dealing with the health of the general public is a legal minefield, and giving prescription medication without a prescription can leave one open to large fines and even imprisonment. In my place of work I am not permitted to give a student an aspirin or Panadol for a headache. I am however permitted to give them an injection via the EpiPen.



It is important to be aware that those suffering from anaphylaxis (especially at the age of the girl in question) should be aware of their condition, and always have an EpiPen (or whatever proprietary name the epinephrine injector comes under) at hand. I feel that it is unfair of the mother to lay the blame on the pharmacy. the girl was careless with what she ate (and unfortunately if you suffer anaphylaxis you cannot afford to be careless), and the girl or someone in her family should have been carrying the Pen. Of course it is a tragedy, and of course the family are going to be devastated, but I do not feel that laying the blame on the pharmacy (who are constantly navigating a minefield we call the health system) is of any benefit to anyone.

reply to post by cuckooold


Sad, but this says a lot about her responsibility regarding something that could and did kill her.

Why didn't she carry one as a matter of habit if she knew she was allergic to nuts?

That is so tragically sad. It's a shame we live in such a litigious society that things like this happen. If they had given her the epipen she may have died anyway and the family could have sued the pharmacy for dispensing medications without authorization.

The family should have had the epipen on them at all times in case something like this happened, but things do happen, people are people and we forget things... especially if we are not expecting to need it for a short period of time.

There are a number of medications I believe should be available OTC and this is just one of them. In a perfect world we would all have money to go to the doctors and get prescriptions, but it is not a perfect world and this is a condition where she should have been able to just buy it without visiting the doctor just to renew the script.

I feel for this family. It's awful any which way you look at it.

reply to post by cuckooold


I disagree. we should not accept that refusal to help anyone under distress to be ok, especially if it results in death. I do agree that the blame is not all on the pharmacist but it shared by how the structure is set and society in general, if something is wrong we should attempt to fix it even if we have a reasonable explanation of why it is broken.

I also would expect a parent to be more forceful if facing a similar situation (presential), most parents would not accept the refusal peacefully and be resigned to a child die (or even suffer). So the reason to deny help can not be rationalized only to procedural barriers but on a rightful assessment of circumstances. The definition of involuntary manslaughter is based on the unlawful killing of a human being without malice aforethought, so the keyword is unlawful is it lawful to deny assistance in a life or death situation ?

reply to post by Panic2k11


I did not say that we should refuse to help people in distress, not at all.

There are however reasons that these laws exists, rightly or wrongly, and it is the choice of the individual whether to break these laws, and they should be prepared to accept the consequences of these actions. Pharmacies are like lightning rods for people wanting certain drugs, and there is a constant stream of people doing everything under the sun to obtain drugs without a proper prescription. How a pharmacist is to adequately judge if a person is telling the truth or not, especially if the person is not known to them, should be taken into account. People can, and do abuse the EpiPen, as essentially it is a dose of adrenaline.

How the pharmacist is to know if this girl is serious, or just a teenager wanting to 'get high' is worth considering.

Perhaps her past reactions weren't severe enough to where the doctor thought an epipen was warranted.

I'm a bit on the fence here. The use of Epipen is not without any dangers. In some cases it can cause cardiac arrhythmias and death. But they are minimal. You always need to go to an emergency room after using it. While different sources say different things about the use you can wonder what would be the consequences for the pharmasist if she had no allergic reaction but did suffer cardiac arrhythmias or even worse... death.

People are people and everyone forgets stuff but in this case well check check and double check if it was my daughter.



EDIT:

I want to add a quote from the Irish Independent here:

A senior member of staff at the Hamilton Long pharmacy told the Irish Independent that they had been advised by gardai to make no public comment whatsoever about the incident.

A member of the pharmacy profession in Dublin later told this newspaper that regulations prohibit the dispensing of epipen injections without a prescription.

It is classed as an 'S1B' drug containing adrenaline and has the potential to do harm. Pharmacists are not allowed to give the injection.

~~~

A member of management at Jimmy Chung's said the satay sauce had a sign over it which read: "Satay Sauce. Nuts Contained."

The restaurant owner Tony Shek said later: "We heard nothing about it. The staff are often asked by family members if foods contain nuts. But nothing was mentioned to any staff yesterday."

Mother's agony as teenage girl dies from peanut allergy on city street

To me this is no different to the case of the nurse who refused to give cpr to somebody who was having a heart attack.
You can stand back and say well I don't want to be sued, but then you have to live with that persons death on your conscience, although these people probably don't have them, which is why they don't help in the first place.

And if the pharmacy HAD given an epipen, they would have been breaking the law for dispensing controlled medications without a prescription. And if the girl had STILL died despite having been given the epipen, the family would have sued them for dispensing medications without a prescription..

The Pharmacy couldn't possibly come out of this one safely by giving the epipen. They did the only thing they could do. They'd have been far better going to an ER not a pharmacy.

Im sorry, I know it sucks that the girl died, a tragedy, but I'm still siding with the pharmacy on this one.

If she had such a strong allergy then why did she not have the EpiPen?

Its a difficult one, but i feel for the pharmacist, s/he probably done the right thing.

What if he gave that and it was that which killed her which is very possible, adrenaline needs to be given in a very controlled fashion where a patient can be monitored. That is why when they have to use their pen they are then taken off to A&E and seek medical advice.

The best thing her family should have done was first of all have a pen and secondly phoned for a Ambulance rather than heading off to the nearest pharmacy and hoping to just get a pen because they asked for it.

It's a tragedy but I sure don't blame the pharmacy. Even if they'd given it to her, everything went perfect and she dropped dead 2 days later from something mysterious? Someone could argue the case that something about why the prescription was needed, ignored and dispensed anyway is the cause of the delayed death .... End of career for a Pharmacist and in this country anyway, maybe quite a bit more for legal sanctions.

Heck... We could probably go a long way by passing a law on the federal level and other nations follow suit perhaps? Basically saying that REGARDLESS of profession, training, lack of training or general intelligence...absolutely every human being alive today has 0 liability coverage by the legal system IF....they are acting in distress with someone dying or likely TO die and are acting in good faith to save the life for lack of other help or options available in time.

That should have allowed this girl to be given what she needed ..with 0 fear of losing one's whole livelihood and maybe freedom altogether for an action taken in mercy, not crime.

nerbot
reply to post by cuckooold

 

Sad, but this says a lot about her responsibility regarding something that could and did kill her.

Why didn't she carry one as a matter of habit if she knew she was allergic to nuts?

Maybe she just forgot that day and the pharmacy was the easiest answer.
Jeez...she was only a kid.
Why couldn't the pharmacist just help?

reply to post by AFewGoodWomen


Because the duty pharmacist would have lost his licence, been fired, and faced criminal charges.

Panic2k11
reply to post by cuckooold

 

I disagree. we should not accept that refusal to help anyone under distress to be ok, especially if it results in death. I do agree that the blame is not all on the pharmacist but it shared by how the structure is set and society in general, if something is wrong we should attempt to fix it even if we have a reasonable explanation of why it is broken.

I also would expect a parent to be more forceful if facing a similar situation (presential), most parents would not accept the refusal peacefully and be resigned to a child die (or even suffer). So the reason to deny help can not be rationalized only to procedural barriers but on a rightful assessment of circumstances. The definition of involuntary manslaughter is based on the unlawful killing of a human being without malice aforethought, so the keyword is unlawful is it lawful to deny assistance in a life or death situation ?

edit on 23-12-2013 by Panic2k11 because: (no reason given)

THIS!!!!!

The pharmacy had her record or could access them instantly. She had a known allergy. And this was life and death.

There is no excuse for this kind of behavior. She died for no reason, at the discretion of someone.

If I am having an allergic reaction like this, I'm headed to the hospital, not the pharmacy. I don't know how it works in Ireland, but in the US, a pharmacy could be sued, shutdown and possible jail time for giving out medication without a prescription. It's a sad story, but the ill person should have had wits enough have called 911 or go to the hospital.

I would have risked losing my job and helped her anyways...consequences be damned.
I couldn't just watch someone die when I had the power to do something about it.
I wouldn't be able to forgive myself.

-Peace-

reply to post by cuckooold


And this is why I don't have faith or trust in our medical community, when profits are valued over human life than you know there's no hope for any real help if you are sick, dying, or traumatized.

LeatherNLace
If I am having an allergic reaction like this, I'm headed to the hospital, not the pharmacy. I don't know how it works in Ireland, but in the US, a pharmacy could be sued, shutdown and possible jail time for giving out medication without a prescription. It's a sad story, but the ill person should have had wits enough have called 911 or go to the hospital.

by the time a wagon comes or she had been seen in ER she still would have died.

Wow, so sad, she was in a pharmacy too, mega dose vitamin C would have most likely helped in lue of an epipen.

I have researched and found that vitamin C works great for anaphylaxis episodes, even most snake bites, bee stings etc......

WilsonWilson
To me this is no different to the case of the nurse who refused to give cpr to somebody who was having a heart attack.
You can stand back and say well I don't want to be sued, but then you have to live with that persons death on your conscience, although these people probably don't have them, which is why they don't help in the first place.

I totally agree with this. No rule, stupid regulation or fear of a lawsuit would allow me to watch a human die in front of me/because of me if there would be anything whatsoever that COULD save him, be it likely or not..