Report says death was due to drug error

Updated: December 16, 2009 - 11:07 PM

A pharmacist's mistake last August cost the life of a New Brighton nursing home resident, state Health Department investigators have concluded.

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A pharmacist's mistake last August cost the life of a New Brighton nursing home resident, state Health Department investigators have concluded.

The pharmacist, who is not identified in the Health Department report, sent the wrong formulation of a powerful antifungal drug that caused the resident's kidneys to fail and prevented effective treatment for cancer and fungal pneumonia.

The nursing home, Health and Rehabilitation of New Brighton, was not at fault because the drug was mislabeled as the one a doctor had ordered for the resident, according to a report by the Office of Health Facilities Complaints, made public Monday.

The pharmacist told investigators that he didn't know there was more than one formulation of the drug. The Minnesota Board of Pharmacy was notified of the error for possible discipline.

The drug Amphotericin comes in four formulations, including a traditional one that is more toxic to kidneys, the report said. Although the prescription called for a different formulation, the pharmacist supplied the traditional one on Aug. 1 and sent it to the nursing home with the wrong label. Two days later, another pharmacist discovered the error while making a quality review.

By then the resident had been given the drug and started to have difficulty. He was taken to a hospital on Aug. 4 and died Aug. 19 of cancer and kidney failure.

WARREN WOLFE