Compensation Claim Due to Wrong Medication Administration or Medication Dosage Error

What is Wrong Medication Administration or Medication Dosage Error?

A patient may be harmed due to the administration of the wrong medication or an error in dosage, giving the wrong medication instead of the correct one, administering the correct medication at the wrong dose, administering the medication via the wrong route, giving medication to the wrong patient, incorrect medication timing, failure to consider allergies or drug interactions, prescription errors, or the pharmacy dispensing the wrong medication.

Medication errors are one of the most sensitive areas of healthcare because medication directly affects the patient's body. The wrong medication or dose can result in allergic reactions, poisoning, organ failure, bleeding, respiratory depression, cardiac arrhythmias, loss of consciousness, coma, need for intensive care, permanent disability, or death.

The Ministry of Health's information on drug safety also states that drug safety is one of the most important components of patient safety. The Ministry emphasizes that problems that may occur throughout the entire process, from the moment a drug is requested to its effects after administration, can jeopardize the safety of both patients and staff; and that monitoring, recording, and establishing standard procedures for drug use are crucial in reducing these risks.

Therefore, medication errors are not a simple incident that can be dismissed by simply saying "it was a mistake." Physicians, nurses, pharmacists, hospitals, private clinics, or healthcare facilities must exercise care and diligence in the processes of prescribing, preparing, procuring, storing, administering, monitoring, and recording medication.

At what stages does a medication error occur?

Medication errors can occur at different stages of treatment. The first stage is the prescription or treatment plan stage. The doctor may have prescribed the wrong medication, determined the wrong dosage, or failed to consider the patient's weight, age, kidney and liver function, pregnancy status, allergy history, or other medications they are taking.

The second stage is the preparation and dispensing of the medication. The pharmacy may dispense the wrong medication, similar-named drugs may be mixed up, a different dosage of the same drug may be given, or the patient may be given incorrect instructions for use. Mixing up drugs with similar appearances or names is also possible in hospital pharmacies.

The third stage is medication administration. A nurse or healthcare professional might give medication to the wrong patient, administer the correct medication at the wrong dose, give medication through the wrong intravenous line, prepare an oral medication as an injection, incorrectly adjust the infusion rate, or mix up medication times.

The fourth stage is the follow-up stage. After the drug is administered, the patient may develop side effects, allergic reactions, a drop in blood pressure, respiratory distress, bleeding, altered consciousness, or abnormal laboratory results. If these symptoms are not noticed in time and the necessary intervention is not provided, the harm may worsen.

Are all drug side effects due to doctor or hospital error?

No. Not every drug side effect automatically means a doctor, nurse, pharmacist, or hospital error. A medically correctly chosen and administered drug can cause unexpected side effects in some patients. This does not always result in liability for damages.

However, it is important to consider whether the side effect was foreseeable, whether the patient's risks were assessed, whether the patient was informed, and whether timely intervention was provided when the side effect developed.

For example, if a patient is given a penicillin-group drug despite having a known penicillin allergy documented in their medical records, this cannot be considered a simple side effect. If a patient is known to be using blood thinners but is given a drug that could cause interaction, and severe bleeding develops, a drug interaction may have been overlooked. In the case of a patient with renal failure, a dose adjustment error arises if a high dose of a drug excreted through the kidneys is administered.

Therefore, the legal assessment hinges on the question: Is the resulting harm a medically unavoidable side effect, or did it occur due to a defect in drug selection, dosage, administration, monitoring, or the record-keeping system?

Doctor's Responsibility for Prescribing and Planning Treatment

In cases of incorrect medication or dosage, the primary responsibility often lies with the physician who prepared the treatment plan. The doctor should select the appropriate medication for the patient's diagnosis, determine the correct dosage, explain the duration and method of use, and plan necessary tests and follow-ups for medications with risks.

Prescribing medication without considering the patient's age, weight, pregnancy status, breastfeeding, kidney and liver function, allergies, existing illnesses, other medications used, and drug history may lead to claims of malpractice.

Dosage calculation is of paramount importance, especially in pediatric patients. Giving children adult doses, incorrect weight calculations, or incorrectly specifying syrup/ampoule measurements can have serious consequences. In elderly patients, renal function, risk of falls, altered consciousness, hypotension, and the use of multiple medications should also be evaluated.

A doctor's responsibility doesn't end with prescribing medication. The patient must be informed about how to use the medication, its important side effects, when to seek hospital attention, and whether it can be used in combination with other medications. The Patient Rights Regulation stipulates that patients must be informed about the important characteristics of the medications to be used, and also that they have the right to review and obtain copies of their medical records and files.

Medication Administration Responsibility of Nurses and Healthcare Personnel

In a hospital setting, medication is most often administered by nurses or other relevant healthcare personnel. Therefore, nursing administration records are of great importance in medication error cases.

Nurses or healthcare professionals are responsible for administering the right medication to the right patient, at the right dose, at the right time, via the right route, and in the right way. In practice, this principle is one of the fundamental control steps in drug safety. Administering medication without comparing the patient's identification bracelet, file information, treatment chart, medication label, dose, time, and route of administration can lead to serious errors.

According to Ministry of Health sources, ensuring drug safety includes practices such as: recording the medications used by the patient, writing the treatment plan legibly including the dosage, timing, and method of administration, having the medication administered by a nurse, monitoring medication adherence and side effects, providing the patient with a medication list upon discharge and transfer, and labeling high-risk medications.

For example, mixing the medications of two patients in the same room, incorrectly adjusting the infusion rate in the intensive care unit, administering the wrong insulin dose, giving too much blood thinner, overdosing on narcotic painkillers, or giving medication despite allergy warnings can all raise questions about the responsibilities of nurses and the hospital.

Pharmacy Dispensing Wrong Medication

Medication errors don't only happen in hospitals. Dispensing the wrong medication from a pharmacy can also cause serious harm. Pharmacists or pharmacy staff must correctly read the prescription, dispense the correct dose, provide the patient with necessary explanations about how to use the medication, and act cautiously in situations that could cause confusion.

Drugs with similar names, different dosages of the same drug, child and adult forms, syrup-drop-tablet distinctions, controlled-release drugs, and high-risk medications are all areas prone to pharmacy errors. For example, giving the wrong medication instead of a blood pressure medication, delivering a 50 mg dose instead of a 5 mg dose, giving the adult form of a child's medication, or writing incorrect usage instructions can cause harm to the patient.

Evidence is extremely important in pharmacy errors. Prescriptions, medicine boxes, barcodes, invoices, pharmacy labels, medicine leaflets, security camera footage, payment receipts, patient complaint records, and subsequent medical reports should be kept. If the patient is harmed after using the medication, the medicine box and any remaining tablets/ampoules should not be discarded.

Liability is greater with high-risk drugs

Some medications can have more serious consequences than others when misused. Insulin, heparin and other blood thinners, chemotherapy drugs, opioid pain relievers, potassium-containing medications, sedatives, anesthetic drugs, intensive care drugs, pediatric dose-sensitive medications, and some intravenous antibiotics can be considered high-risk drugs.

Hospitals and healthcare personnel have a greater responsibility to exercise caution when using high-risk medications. The name of the medication, dosage, route of administration, infusion rate, the person preparing and administering the medication, the person monitoring the procedure, the patient's identity, and post-administration follow-up must be recorded.

The Ministry of Health's approach to drug safety also supports this point. The Ministry states that establishing standard procedures for drug safety, ensuring that healthcare professionals meticulously adhere to these procedures, and keeping records of drug use are crucial for patient safety.

For example, an overdose of insulin can lead to hypoglycemia and loss of consciousness. An overdose of blood thinners can cause internal bleeding. Administering potassium incorrectly or too quickly can lead to cardiac arrest. Preparing chemotherapy drugs in the wrong dose can have life-threatening consequences. In these cases, excuses like "there was high demand," "it was an oversight," or "staff misunderstood" are often insufficient; the safety of the system's setup is also investigated.

Giving medication despite allergies

One of the clearest examples of medication errors is administering a drug or a drug from a similar group despite a patient's known allergy. Liability may arise if allergy information is present in the patient's file but ignored, if there is no warning on the wristband or electronic system, if the physician did not ask the patient about the allergy, or if the nurse ignored the warning.

An allergic reaction can range from a mild rash to a severe condition called anaphylaxis. Anaphylaxis can result in respiratory distress, low blood pressure, loss of consciousness, swelling in the throat, widespread rash, cardiac arrest, and death.

In such files, the patient's previous allergy history, hospital admission form, emergency department records, medication administration records, nurse notes, whether an allergy wristband was worn, electronic system alerts, and the post-anaphylaxis intervention process should be examined. If the allergy is known but not appearing in the system, not only the individual physician's fault but also the hospital's organizational failure should be discussed.

Overlooking Drug Interactions

Another significant type of medication error is the failure to consider drug interactions. If a patient is taking multiple medications, the interaction of the newly prescribed medication with existing medications should be evaluated. This is especially important for elderly patients, those with chronic illnesses, cancer patients, heart patients, psychiatric patients, those with kidney or liver failure, and those taking multiple medications.

For example, administering another medication that increases the risk of bleeding to a patient taking blood thinners, prescribing two medications that can cause arrhythmias together, prescribing medications that may interact with psychiatric medications, or failing to check for combinations that may impair kidney function can all give rise to liability for damages.

In cases of harm caused by drug interactions, the pharmacy, physician, and hospital systems can be examined together. It is important to determine whether the patient's medications are recorded, whether the pharmacy issued a warning, whether the doctor was aware of the risky combination, and whether the patient was informed.

Giving medication to the wrong patient in the hospital

Administering medication to the wrong patient is one of the most serious examples of medication safety breaches. This error often stems from a lack of patient identification, confusion of patients with similar names, absence of patient wristbands, mixed-up medication trays, overcrowding in intensive care units or wards, or deficiencies in the record-keeping system.

If medication is given to the wrong patient, the investigation focuses not only on whether the medication harmed the patient, but also on how the hospital's identity verification system worked. Healthcare facilities should verify the patient's identity before each medication administration, check the medication chart and wristband information, and establish a second verification mechanism, especially for high-risk medications.

In such cases, the nurse's medication administration form, patient wristband records, ward duty roster, medication preparation records, camera footage, and incident reports constitute evidence.

What are the potential harms of taking the wrong medication?

Incorrect medication or dosage can cause a wide variety of harms. In mild cases, nausea, vomiting, rash, dizziness, low blood pressure, or temporary weakness may occur. In severe cases, organ failure, kidney damage, liver damage, internal bleeding, cardiac arrhythmia, respiratory depression, seizures, coma, need for intensive care, permanent disability, or death may occur.

The harm from a medication error sometimes appears immediately; other times, it is only noticed days or weeks later. For example, a patient who receives an overdose of blood thinners may develop internal bleeding a few days later. If a drug harmful to the kidneys is given in the wrong dose, creatinine levels may rise subsequently. In chemotherapy drugs, a wrong dose can severely suppress the immune system.

Therefore, the causal link between harm and medication error should be evaluated through medical records, laboratory results, medication administration times, and clinical course.

Wrong Medication or Dosage Error at a Private Hospital

If a wrong medication or dosage error occurs in a private hospital, private clinic, medical center, or private healthcare facility, private law liability arises. A private hospital may be held liable not only for the individual error of a doctor or nurse, but also for deficiencies in its medication safety system, pharmacy organization, service records, staff training, patient authentication, and oversight.

In a private hospital, a contractual relationship exists between the patient and the healthcare institution based on the provision of healthcare services. Depending on the specifics of the case, consumer law, breach of contract, tort, and malpractice provisions may be considered together.

For example, if similar-named medications are mixed up in the hospital pharmacy, a nurse administers the wrong ampoule, and a patient is admitted to intensive care, the hospital cannot escape responsibility by simply saying "nursing error." This is because the hospital is obligated to establish and oversee a safe medication management system.

Wrong Medication or Dosage Error at State Hospital

If the wrong medication is administered or a dosage error occurs in a state hospital, city hospital, training and research hospital, or public university hospital, the legal recourse usually falls under administrative law. Healthcare in state hospitals is a public service. If this service is poorly provided, delayed, or not provided at all, the administration is considered to have committed a service defect.

Article 13 of the Administrative Procedure Law stipulates that individuals whose rights have been violated by administrative actions must apply to the relevant administration for the restoration of their rights within one year from the date they learned of the action, and in any case within five years from the date of the action, before filing a lawsuit. If the application is rejected or no response is given within thirty days, a full judicial review lawsuit may be filed within the lawsuit period.

In cases of medication errors at state hospitals, the defendant is often the Ministry of Health or the relevant public administration. At a public university hospital, the relevant university should be identified; at other public health institutions, the relevant administration should be determined. Applying to the wrong administration, missing deadlines, or failing to adequately specify the damages in the application may result in loss of rights.

What types of compensation can be claimed?

A patient who suffers harm due to incorrect medication or dosage may claim financial and non-financial compensation if the conditions are met.

Compensation claims may include medical expenses, intensive care costs, medication costs, new treatment costs, rehabilitation costs, physical therapy costs, medical device costs, transportation costs, caregiver costs, temporary disability, permanent disability, loss of earnings, and disruption of economic future.

For example, if a patient suffers a brain hemorrhage due to an incorrect dose of blood thinner and is left with permanent disability, treatment, care, rehabilitation, loss of productivity, and emotional distress should be considered together. If brain damage occurs due to an incorrect insulin dose, lifelong care needs and future economic losses may arise.

Compensation for emotional distress is claimed due to the patient's suffering, fear, intensive care period, risk of death, permanent disability, psychological trauma, violation of bodily integrity, and decrease in quality of life. If the patient has passed away, their relatives may claim compensation for loss of support, funeral expenses, and compensation for emotional distress.

How to Prove a Mistake in Prescribing Medication?

In medication error cases, the proof process is extremely important. This is because it must be documented which medication was given, when, in what dose, by whom, by what method, and for what reason.

Evidence that can be used includes prescriptions, treatment lists, medication administration forms, nurse observation records, doctor's order records, pharmacy discharge records, medication boxes, barcodes, medication preparation records, electronic patient records, laboratory results, vital sign records, intensive care unit records, discharge summaries, allergy records, adverse effect reports, camera recordings, incident reports, and witness statements.

The Patient Rights Regulation stipulates that patients can directly review and obtain copies of their health-related files and records, either directly or through their legal representative. Therefore, in cases of suspected medication errors, patients or their relatives should request the entire patient file, and especially medication administration records, in writing.

In pharmacy-related errors, the prescription, medication box, barcode, pharmacy invoice, delivery receipt, security camera footage, and the statement of the person dispensing the medication are important. In hospital-related errors, the patient file, nurse's schedule, medication chart, and electronic records are decisive.

The Importance of Expert Reports

In cases involving incorrect medication or dosage, the expert report determines the outcome of the case. Depending on the nature of the incident, the expert panel should include a physician from the relevant specialty, a clinical pharmacologist, a pharmacist, a nursing specialist, an intensive care specialist, a forensic medicine specialist, or a toxicology specialist.

The expert witness must answer the following questions: Which medication was administered to the patient? Was the medication appropriate for the diagnosis and treatment plan? Was the dosage correct considering the patient's age, weight, and organ function? Were drug allergies or interactions considered? Was the medication administered to the correct patient? Was the route and timing of administration correct? Was follow-up and intervention adequate when a side effect occurred? Is there a causal link between the harm and the medication error?

Incomplete expert reports must be challenged. In particular, simply closing the case by stating "it could be a drug side effect" or "it's a complication" is insufficient. The report should concretely examine drug administration records, dosages, laboratory results, clinical course, and the mechanism of harm.

Can a criminal investigation be opened?

If a wrong medication or incorrect dosage results in serious injury, permanent disability, or death, a criminal investigation may be initiated. Depending on the nature of the incident, the charges of negligent injury or negligent homicide will be discussed.

Criminal investigations examine whether doctors, nurses, pharmacists, or other relevant healthcare personnel have violated their duty of care and diligence. However, criminal investigations and civil lawsuits are different. A criminal case focuses on the criminal liability of individuals; a civil lawsuit aims to compensate the patient or their relatives for material and moral damages.

In investigations into medical procedures and practices by healthcare professionals, special authorization processes may also be required. Article 18 of Law No. 3359 stipulates a Professional Responsibility Board process for investigations into medical procedures and practices related to examination, diagnosis, and treatment carried out by physicians, dentists, and other healthcare professionals working in public or private healthcare institutions.

What should the patient or their relatives do?

If there is suspicion of a wrong medication or dosage error, the first step is to document the patient's medical condition. If a side effect, allergic reaction, loss of consciousness, bleeding, organ damage, need for intensive care, or other harm occurs, a medical report should be obtained immediately.

Secondly, all records should be requested in written form. Medication administration forms, doctor's order records, nurse observation records, pharmacy discharge records, laboratory results, intensive care unit records, and discharge summaries should be requested from the hospital. In pharmacy-related incidents, the medication box, barcode, invoice, and prescription should be kept.

Thirdly, a chronology of events must be established. When was the medication prescribed? Who prepared it? Who administered it? What dose was given? When did the patient's symptoms begin? When was the first intervention performed? When was the harm diagnosed? This chronology is vital for expert examination.

Fourthly, a distinction should be made between private and public hospitals. In private hospitals, liability arises under private law, consumer law, and malpractice; in public hospitals, recourse to the administration and full judicial review cases come into play. In pharmacy errors, the private law and criminal liability of the pharmacist and the pharmacy business should be evaluated separately.

Conclusion: Medication Errors Can Lead to Serious Legal Liability

Administering the wrong medication or making a dosage error is one of the most serious patient safety breaches in healthcare. Medication safety encompasses the entire process of prescribing, obtaining, preparing, administering, monitoring, and recording medication. An error at any point in this chain can permanently affect a patient's health.

Not every drug side effect is grounds for compensation. However, legal liability may arise from incorrect drug selection, incorrect dosage, administration of medication to the wrong patient, administration of medication despite allergies, overlooking drug interactions, failure to monitor high-risk medications, nursing malpractice, pharmacy delivery errors, or delayed detection of side effects.

The patient may claim compensation for medical expenses, intensive care costs, rehabilitation expenses, disability benefits, caregiver expenses, loss of future economic prospects, and moral damages. If the patient has passed away, their relatives may claim compensation for loss of support and moral damages.

Therefore, in cases where medication errors are suspected, medication boxes, prescriptions, barcodes, invoices, medication administration records, nurse observation forms, doctor's orders, laboratory results, and patient files should be collected without delay. A strong legal process is possible not only with the claim that "the wrong medication was given," but also with concrete evidence demonstrating what the medication was, in what dosage, by whom it was administered, how the harm occurred, and the causal link between this harm and the medication error.