Medication Dosage Errors: How Pittsburgh Pharmacies and Hospitals Share Liability

When a doctor prescribes medication, we place our trust in a complex system. We trust the physician to calculate the correct dose, the hospital staff to administer it properly, and our local Pittsburgh pharmacist to dispense it accurately. Whether it is at a major UPMC or Allegheny Health Network (AHN) facility or a neighborhood pharmacy, the assumption is that the professionals involved are safeguarding our health. A medication error, particularly an incorrect dosage, shatters this trust and can lead to catastrophic, life-altering harm.

These devastating mistakes are more common than many people realize and can leave victims and their families wondering how this could have happened.

What Is a Medication Dosage Error?

A medication dosage error occurs when a patient receives a different amount of a medication than what was intended by the prescriber, or when the intended dose is inappropriate for the patient. This does not just mean an overdose; an underdose can be equally dangerous if it fails to treat a life-threatening condition.

These errors are a serious breach of the standard of care. Common examples include:

• Overdose: A patient is given too much of a drug. This can happen through a single large dose (e.g., 100mg instead of 10mg) or by administering doses too frequently (e.g., every two hours instead of every six).
• Underdose: A patient is given too little of a drug. This can render the medication ineffective, allowing a serious infection to worsen, a cancer to grow, or a heart condition to go uncontrolled.
• Decimal Point Errors: A misplaced or misread decimal point is one of the most common and dangerous types of errors. A prescription for “1.0 mg” that is misread as “10 mg” results in a tenfold overdose.
• Incorrect Calculation: Many doses must be calculated based on a patient’s weight, age, or kidney and liver function. A failure to perform this calculation correctly can lead to severe toxicity or underdosing.
• Wrong Strength: A pharmacy dispenses the correct medication but in the wrong strength, such as providing 50mg tablets when the prescription was for 25mg tablets.

Where Do Dosing Errors Happen in the Medication Process?

A medication travels a long path from the moment a doctor thinks of it to the moment a patient receives it. An error at any link in this chain can cause harm. This process is often called the medication-use system.

The key stages where errors occur include:

• Prescribing: This is the first step, where the physician selects the drug and dose. An error here—like miscalculating a dose for a child or failing to check for a drug interaction—starts a cascade that is difficult to stop.
• Transcribing: The prescription must be entered into an electronic health record (EHR) or pharmacy system. A nurse, clerk, or pharmacist who misreads the doctor’s order or makes a data entry error introduces a new mistake.
• Dispensing: This is the primary role of the pharmacy. The pharmacist must review the order, confirm its safety, retrieve the correct drug and strength, and label it with the correct instructions.
• Administering: This is the final step, usually performed by a nurse in a hospital or by the patient at home. The nurse must verify the “Five Rights”: Right Patient, Right Drug, Right Dose, Right Route, and Right Time.

How Can a Hospital Be Liable for a Dosing Mistake?

Hospitals in Pittsburgh and across Pennsylvania can be held responsible for medication errors that occur within their walls. This liability can stem from the negligence of their employees or from the hospital’s own institutional failures.

Negligence of Hospital Staff (Vicarious Liability)

A hospital is generally liable for the negligent acts of its employees, including nurses, staff physicians, and hospital-employed pharmacists.

Physician Negligence: A doctor who prescribes a dose that is dangerously high or low for a patient’s condition, weight, or age has failed to meet the standard of care.

Nursing Negligence: This is a very common source of liability. A nurse may:

• Fail to check the patient’s wristband, giving medication to the wrong person.
• Misread the order or the medication label.
• Incorrectly program an IV infusion pump, delivering a drug too quickly.
• Bypass safety protocols in the EHR system, ignoring critical warning alerts.

In-House Pharmacy Errors: Hospital pharmacies are busy places. A pharmacist who fails to catch a doctor’s obvious prescribing error or who dispenses the wrong dose to the nursing floor contributes to the harm.

Hospital Corporate Negligence

Under Pennsylvania law, hospitals themselves have a direct duty of care to their patients. This is known as “corporate negligence.” A hospital can be held liable not just for its employees’ errors, but for its own systemic failures that led to the error.

These failures can include:

• Inadequate Staffing: When a hospital is understaffed, nurses are rushed, overworked, and responsible for too many patients. This creates a high-risk environment where mistakes are far more likely.
• System and Protocol Failures: The hospital may lack essential safety protocols. For example, it might store “look-alike, sound-alike” drugs next to each other in the pharmacy, inviting mix-ups.
• “Alert Fatigue”: Modern EHR systems have safety alerts for high doses or drug interactions. However, if a system is poorly designed and floods staff with constant, low-level warnings, they may develop “alert fatigue” and begin to ignore them—including the ones that matter.
• Failure to Supervise or Vet Staff: A hospital can be liable if it fails to properly train its staff on new medication systems or if it continues to employ a nurse or doctor with a known history of safety violations.

What is a Pittsburgh Pharmacy’s Responsibility?

Pharmacies, from large chains like CVS and Walgreens to independent local drugstores, are not just passive pill dispensers. Pharmacists are highly trained professionals who serve as a last line of defense for patient safety. They have a legal and ethical duty to ensure a prescription is safe and appropriate.

Liability for a pharmacy often arises from:

• Dispensing the Wrong Strength: A patient is prescribed 20mg of a medication, but the pharmacy fills it with 40mg tablets.
• Providing Incorrect Instructions: The prescription is correct, but the pharmacist types the wrong instructions on the bottle (e.g., “Take two tablets” instead of “Take one”).
• Transcription Errors: The pharmacist or tech misreads the doctor’s prescription and enters the wrong dose into their computer system.
• Failure to Counsel: A pharmacist has a duty to counsel patients on new medications, explaining how to take them safely.
• Failure to Catch an Obvious Error: This is a critical point of liability. A pharmacist cannot blindly fill a prescription that is clearly dangerous. If a doctor prescribes a dose that is known to be toxic or makes no sense for the patient (like an adult dose for an infant), the pharmacist has a corresponding duty to flag the prescription, contact the doctor, and verify the order. Simply “following orders” is not a valid defense.

The Problem of “Look-Alike, Sound-Alike” (LASA) Drugs

A specific and recurring source of medication errors involves Look-Alike, Sound-Alike (LASA) drugs. These are medications with different names that look or sound similar, or different drugs with similar packaging.

For example:

• Hydroxyzine (an antihistamine) vs. Hydralazine (a blood pressure medication).
• Celebrex (an anti-inflammatory) vs. Celexa (an antidepressant).

A mix-up between these drugs can be disastrous, not just because the patient fails to get the medicine they need, but because they receive a medicine they do not need—often at a dosage that is completely inappropriate for the new, incorrect drug. Liability for a LASA error can be shared. A hospital may be negligent for storing them in adjacent bins, and a pharmacist or nurse can be negligent for grabbing one without double-checking the name.

How is Liability Shared in Pennsylvania?

In many medication error cases filed in the Allegheny County Court of Common Pleas, liability is shared. The harm is often the result of a chain reaction of negligence.

Consider this scenario:

• A doctor at a hospital hastily writes a prescription with an ambiguous decimal point.
• The in-house hospital pharmacist is busy and fails to call the doctor to clarify the dose.
• The nurse on the floor is rushed and misreads the order, programming an IV pump with a tenfold overdose.

In this case, all three parties—the doctor, the pharmacist, and the nurse—were negligent. Under Pennsylvania’s “Joint and Several Liability” rules, a complex analysis is required to determine who pays for the victim’s damages. The hospital would be vicariously liable for the actions of its doctor, pharmacist, and nurse. If the error involved an outside pharmacy, that pharmacy could also be named as a defendant.

An experienced legal team will investigate every step of the medication-use process to identify all responsible parties and hold them accountable for their role in causing the patient’s injury.

What Evidence is Needed in a Medication Error Case?

To successfully pursue a claim for a dosage error, strong evidence is required. This is not something a patient can or should try to gather alone. A law firm will secure and analyze these items.

Key pieces of evidence include:

• The Complete Medical Chart: This includes all doctor’s orders, progress notes, and nursing notes.
• The Medication Administration Record (MAR): This is a critical document that shows what medication was given, when it was given, and who gave it.
• Electronic Health Record (EHR) Audit Trails: These digital logs can show, keystroke by keystroke, when an order was entered, who viewed it, and if any safety alerts were overridden.
• Pharmacy Dispensing Records: These records from the pharmacy show the prescription, the dispensing date, and the pharmacist who verified it.
• The Prescription Bottle and Pills: The bottle itself, with its label, is key evidence. The remaining pills can also be tested to confirm they are the wrong strength.
• Expert Testimony: To prove a case, it is necessary to hire medical experts (such as physicians, pharmacologists, or nursing professionals) to review the evidence and testify that the standard of care was breached.

What Damages Can Be Recovered?

The harm from a dosing error can be immense. An overdose of a blood thinner can cause a catastrophic brain bleed. An underdose of an antibiotic can allow sepsis to take over.

A lawsuit seeks to recover compensation, known as damages, for these harms. In Pennsylvania, a victim of a medication error may be entitled to:

Economic Damages

• Additional Medical Bills: The cost of treating the harm caused by the error (e.g., ICU stay, corrective surgery, rehabilitation).
• Lost Wages: Income lost while the patient was out of work recovering.
• Loss of Future Earning Capacity: If the injury is permanent and prevents the patient from returning to their career.
• Future Care Costs: The long-term costs of therapy, medication, or home nursing care.

Non-Economic Damages

• Pain and Suffering: Compensation for the physical pain and emotional trauma of the injury.
• Loss of Life’s Pleasures: Compensation for the inability to enjoy hobbies, family activities, and daily life as before.
• Disfigurement: For permanent scarring or physical changes.

Wrongful Death Damages

If the medication error is fatal, the patient’s surviving family members may pursue a wrongful death and survival action to recover damages for their losses.

Contact Our Pittsburgh Medication Error Lawyers for a Free Consultation

If you or a loved one suffered a serious injury due to a prescription overdose, underdose, or other pharmacy or hospital error, you do not have to face the consequences alone. The attorneys at Caroselli, Beachler & Coleman have dedicated their careers to fighting for injured individuals in Pittsburgh and throughout Pennsylvania. We have the knowledge and determination to investigate your case, consult with leading medical experts, and build a strong claim for the full compensation you deserve.

We invite you to contact our office today at 866-565-4949 or complete our online form for a free, no-obligation consultation to discuss your case. Let us help you determine the best path forward.