Another pharmacy mishap, another young life cut short

Once again, we visit the issue of pharmacy mishaps. recently reported on the death of an 8-year old boy which the mother blames on a mistake made by a compounding pharmacy months prior. The boy, Jake Steinbrecher from Loveland, Colorado, had originally been taking clonidine in pill form. The pills were 0.1mg each and needed to be cut into fourths to achieve the required dosage of 0.025mg.

And then Jake outgrew that dosage and needed 0.03mg or about a third of a pill. From the story:

“But then he grew in size and we needed to go to a third,” Steinbrecher said. “And you can’t cut thirds so we went to compounding it.”

Jake’s new prescription called for 0.03mg doses dissolved in liquid form. They filled the prescription at Good Day Pharmacy in Loveland, Colorado, on Oct. 31.

“Within a few minutes, he fell into such a deep sleep his dad couldn’t wake him up,” Steinbrecher said. “I was pinching him and shaking him and I could not get him to open his eyes.”

They rushed Jake to the hospital where he was eventually airlifted to Children’s Hospital in Denver. He was having seizures, hallucinating and had swelling in his brain.

It turns out, that instead of a 0.03mg dose, he had gotten a 30mg dose. That was in 2015 October. Fast forward to June 7 of this year:

On June 7, Jake fell ill, and began vomiting and urinating blood. His mother rushed him to the hospital. His blood platelets were clotting throughout his bloodstream. This time, the little boy didn’t make it.

The story is still developing, but I wanted to get my thoughts on this out there. From my previous post on a similar situation (skip down to about halfway through or search for the phrase “And there are other situations similar to this”), compounding pharmacies are a favorite target of regulators. Maybe there is a sound reason to this, or maybe not. But often compounding pharmacies are the only choice for certain medications, and to be reduced simply to what CVS, Walgreens, etc are willing to mass dispense in pill form would spell disaster for a large number of patients across the country who currently depend on them.

It’s the “chilling effect” at work once again. When running a compounding pharmacy starts to be considered too much of a risk, fewer will do so, so there will be fewer in operation. Maybe this is exactly what “big pharma” wants in the long term. What the heck do they propose we do in cases like Jake’s where it’s simply impossible to cut a pill into the required dosage?

I can tell you that it’s certainly possible to get dosages wrong even at a non-compounding pharmacy. That said, a simple quick check on or a similar reference would have shown that a dosage of 30 mg was way out of whack. I am inclined to believe any decent pharmacist should have caught this error before it left the pharmacy.

A budget snafu in Las Animas County

This story out of Las Animas County, Colorado, is really disheartening. This recent news story from KRDO details the decision by County Administrator Leeann Fabec to refuse to pay any additional costs incurred by the sheriff’s department for the remainder of the year after December 15, stating that the department was over its budget by some $12,227. What this does is put sheriff Jim Casias on the hook personally for the department’s payroll, and raises the real possibility that his deputies will not get paid for the final two weeks of the year.

I haven’t found anything either way to indicate how this was resolved, this being a good week and a half after the December 15 cutoff. Some of the larger cities and towns may have their own law enforcement agencies, but what about the rest of the county? Either way, it could be a really bad deal for somebody: the residents who are without law enforcement officers for two weeks, the deputies who work with no guarantee of getting paid and who still have obligations to meet despite that, or sheriff Jim Casias being out personally for the deputies’ payroll.

I have nothing specifically against law enforcement officers working in a volunteer capacity; I do have a problem with those who have not specifically chosen to volunteer, being stuck working for free for whatever reason. The screw-up by the county’s bookkeepers who did not notice the sheriff’s department ran out of money, should not be a reason to stiff the deputies doing their jobs and expecting to be paid for them. Deputies on the payroll should be paid, the same as any other business that depends on paid employees to get the job done.

Yes, I’m taking the side of the deputies here. But I really approach this as more of a labor issue than a law enforcement issue. With a population barely into five digits (14,052 estimated in 2014), I doubt there are any major crime problems in Las Animas County. After a news report that the sheriff’s deputies may not get paid for working the last two weeks of the year, though, that’s always subject to change.

Now, I don’t fault KRDO for breaking the story, as this is in the public interest, and it was in fact their duty to break this story as soon as the facts were confirmed. This snafu is Ms. Fabec’s fault, either directly or indirectly. I’m not sure of the exact responsibilities of the county administrator, but it stands to reason that if Ms. Fabec can tell the sheriff he’s out of money, then she also had the ultimate responsibility to stay on top of it before the department actually went into the red.

I’ll be keeping an eye on this, and hope to post a follow-up with the resolution soon.