Patient Rights Due to Wrong Medication or Wrong Dosage

What is Administering the Wrong Medication?

Misadministration of medication includes giving a patient the wrong medication instead of the one they are medically prescribed, prescribing the wrong drug, administering a medication that is not appropriate for the patient, using medication without considering allergy or contraindications, or administering medication via the wrong route. This error may stem from organizational shortcomings on the part of a doctor, nurse, pharmacist, hospital staff, private clinic, or healthcare facility.

Incorrect dosage refers to administering medication to a patient in excess, insufficient, at the wrong frequency, or for the wrong duration. Examples include giving a child an adult dose, failing to adjust the dosage in a patient with kidney or liver failure, administering a high dose of blood thinner, incorrectly calculating insulin doses, preparing chemotherapy drugs in the wrong dose, or adding the wrong amount of medication to a serum solution.

In health law, such errors are often medical malpractice, drug administration errors, doctor's error, nurse's error, pharmacy error , or hospital organizational failure . The Patient Rights Regulation covers all public and private healthcare institutions; it regulates the patient's right to receive information about their health status, the medical procedures to be performed, the risks, and treatment options. The same Regulation also explicitly recognizes the patient's right to review and obtain copies of their medical records.

In what ways do medication errors occur?

Incorrect medication or dosage can occur at many different stages. The error may happen when the prescription is written, when the medication is prepared at the pharmacy, when it is administered by a nurse in the hospital ward, during anesthesia in the operating room, in the intensive care unit, in the emergency room, or in the medication instructions given after discharge.

The most common medication errors include: administering medication to a patient that belongs to another patient, administering the wrong antibiotic, giving an allergenic medication despite a history of allergies, administering a high dose of blood thinner, incorrect insulin dosage, incorrect use of narcotics or sedatives, incorrect calculation of chemotherapy doses, administering medication to a child without considering their weight, prescribing inappropriate medication to a pregnant woman, administering medications with the same active ingredient together, overlooking drug interactions, adding the wrong medication to the intravenous system, administering medication intramuscularly or via a different route instead of intravenously, and administering expired or improperly stored medication.

The severity of a medication error varies depending on the nature of the medication and the patient's condition. While a simple painkiller error might only cause temporary discomfort in some cases, errors with blood thinners, insulin, heart medication, epilepsy medication, antibiotics, chemotherapy drugs, anesthetic drugs, or intensive care medications can lead to serious consequences such as death, organ damage, internal bleeding, coma, stroke, anaphylactic shock, or permanent disability.

Are all drug side effects due to medical error?

No. Not every drug side effect or allergic reaction automatically constitutes medical malpractice. Some medications have known side effects, and these can occur even with proper medical use. However, this does not mean that the healthcare provider or physician is absolved of responsibility in every case.

The following questions are important from a legal perspective: Was the medication truly necessary for the patient? Was the dose determined considering the patient's age, weight, illness, kidney and liver function, and current medications? Was the patient's allergy history investigated? Were drug interactions checked? Was the patient informed about the risks of the medication? Was timely intervention provided when a side effect occurred? Were medical records properly maintained?

For example, if a patient has previously reported a penicillin allergy and this information is recorded in their file, yet they are still given a penicillin-group medication, this constitutes a serious claim of negligence. Similarly, administering an adult dose of medication to a child patient without considering their weight, giving a high dose to an elderly patient without evaluating their renal function, or administering other medications that increase the risk of bleeding to a patient using blood thinners without proper control can also lead to liability for damages.

The Doctor's Responsibility When Prescribing Medication

When prescribing medication, a doctor cannot consider only the name of the illness and the general use of the drug. The patient's age, weight, pregnancy status, chronic diseases, allergies, other medications used, kidney and liver function, previous side effects, and ability to adhere to treatment must also be evaluated.

The doctor's responsibility is particularly sensitive with high-risk medications. Dosage, monitoring, and warning obligations are heavier with regard to blood thinners, insulin, chemotherapy drugs, antibiotics, opioid pain relievers, sedatives, heart rhythm medications, epilepsy medications, and intensive care medications.

According to the Patient Rights Regulation, patients have the right to be informed about their health condition, the medical procedures to be performed, the benefits and potential risks of these procedures, alternative methods, and the consequences of not accepting the treatment. Drug treatment should also be considered within this scope. Patients should be provided with the necessary explanations, especially regarding medications that carry a risk of serious side effects or need to be used for a long period.

A doctor prescribing medication does not mean their responsibility for treatment is completely fulfilled. Some medications require blood tests, monitoring of liver and kidney function, INR monitoring, blood sugar measurement, electrolyte control, or follow-up examinations. If the patient continues to use the medication without these tests and suffers harm, the doctor's responsibility for follow-up is also discussed.

Medication Administration Responsibility of Nurses and Hospital Staff

In hospitals, medication is often administered by nurses or other healthcare professionals. At this stage, identifying the right patient, the right medication, the right dose, the right time, the right route of administration, and maintaining accurate records are of paramount importance.

Errors in nursing practice can occur as follows: administering medication to the wrong patient, giving medication that does not match the doctor's order, preparing the wrong dose, administering medication through the wrong intravenous line, confusing the timing of administration, adding the wrong medication to an intravenous drip, failing to keep records after medication administration, or failing to monitor the patient's reactions.

In such situations, not only the nurse's individual responsibility but also the hospital's organizational responsibility comes into play. The hospital is responsible for the storage of medications, the separation of medications with similar names, the barcode system, the patient wristband system, the number of nurses, the workload, the medication preparation area, and the training and supervision processes.

For example, the mixing up of medications for two patients in an intensive care unit can be considered not only an act of individual negligence but also a deficiency in the hospital's systems and organization. Similarly, a shortage of nurses, the lack of proper medication preparation procedures, or inadequate record-keeping systems can lead to liability for damages, whether for a private or public hospital.

Liability Due to Pharmacy Error

Wrong medication isn't only something that happens in hospitals. Dispensing the wrong medication at the pharmacy, giving the wrong dosage, giving an adult dose instead of a child's syrup, mixing up medications with similar names, incorrect instructions for use, or failing to provide necessary warnings despite clear errors on the prescription can also cause harm.

In pharmacy errors, responsibility can be shared among the pharmacist, pharmacy employee, prescribing physician, and sometimes the healthcare institution, depending on the nature of the incident. For example, if the doctor wrote the prescription correctly but the pharmacy dispensed the wrong medication, the pharmacy's responsibility is prioritized. If the doctor clearly wrote an incorrect dosage on the prescription and the pharmacy dispensed the wrong medication without realizing it, both the prescription and the drug dispensing process are evaluated together.

In such cases, the original prescription or e-prescription record, pharmacy receipt, medicine box, barcode information, drug leaflet, instructions for use, communication between the patient and the pharmacy, and medical reports prepared after the incident are important.

Wrong Medication Administered at a Private Hospital

If a medical malpractice occurs in a private hospital, private medical center, or private clinic, legal action is often considered within the framework of private law and consumer law. A private hospital is responsible not only for the personal error of the doctor or nurse performing the procedure, but also for the entire organization of the healthcare service it provides.

Private hospitals are responsible for their prescription system, drug supply, pharmacy inventory, nursing services, patient wristband system, barcode control, drug storage procedures, emergency response capacity, record keeping system, and personnel supervision. Therefore, if a patient is given the wrong medication, not only the person who administered the medication but also the hospital management and the healthcare institution can be considered defendants.

The Law No. 6502 on Consumer Protection covers all types of consumer transactions and practices directed at consumers; the purpose of the Law is to protect the health, safety, and economic interests of consumers and to regulate measures regarding compensation for damages. The paid service relationship between private healthcare institutions and patients may be evaluated within the scope of consumer law depending on the specific case.

Therefore, in many cases involving medical malpractice at private hospitals, the competent court may be the Consumer Court. The prerequisites for litigation in the Consumer Court, such as mediation and monetary limits, should also be considered. However, cases involving serious bodily harm, permanent disability, or death should not be treated simply as consumer disputes; medical malpractice, monetary compensation, moral damages, and expert witness proceedings should be planned together.

Wrong Medication Given at State Hospital

If the wrong medication is administered in a state hospital, city hospital, training and research hospital, or public university hospital, in most cases the administration's negligence in providing services comes into play. This is because healthcare services provided in state hospitals are public services. If this service is poorly provided, delayed, or not provided at all, the administration may be held liable for compensation.

In this situation, instead of directly filing a compensation lawsuit against the doctor or nurse in the judicial system, it is generally necessary to apply to the relevant administration and then file a full judicial review lawsuit in the administrative court. According to Article 13 of the Administrative Procedure Law No. 2577, individuals whose rights have been violated by administrative actions must apply to the relevant administration 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 request is rejected or no response is given within thirty days, the lawsuit filing process begins.

In cases of incorrect medication dispensed at a state hospital, the defendant is often the Ministry of Health or the relevant public administration. At a public university hospital, the relevant university should be the defendant, and at a city hospital, the organizational structure of the service should be examined separately. Since filing a complaint with the wrong administration or missing deadlines can lead to serious loss of rights, the legal status of the hospital must be correctly determined from the outset.

What compensation can be claimed in case of incorrect medication or dosage?

A patient who suffers harm due to the administration of the wrong medication or incorrect dosage may claim compensation for both material and moral damages if the conditions are met.

Monetary compensation aims to cover the patient's economic losses. Additional treatment costs due to incorrect medication, hospital expenses, intensive care expenses, surgery costs, medication and test costs, physical therapy and rehabilitation costs, transportation costs, caregiver costs, temporary disability losses, permanent disability losses, loss of earnings, and disruption of economic future can all be claimed as monetary compensation.

For example, if a patient suffers internal bleeding due to an incorrect dose of blood thinner, requires intensive care, and loses the ability to work, they can claim compensation for treatment costs, loss of income, caregiver expenses, and permanent disability. If a severe allergic reaction occurs due to an incorrect antibiotic, emergency intervention, intensive care, psychological harm, and permanent damage must be calculated separately.

Compensation for moral damages is claimed due to the pain, suffering, fear, psychological trauma, impairment of bodily integrity, decreased quality of life, and life-threatening conditions experienced by the patient. The importance of compensation for moral damages increases if the patient has suffered permanent organ damage, paralysis, vision loss, kidney failure, intensive care, allergic shock, or prolonged treatment due to incorrect medication.

If the patient has passed away, their relatives can claim compensation for loss of support and moral damages. Spouses, children, parents, and individuals who had a supportive relationship with the deceased can request compensation for the material and moral damages they suffered as a result of the death.

How can it be proven that the wrong medication was given?

In medication error cases, the process of proving the error requires technical skill and meticulous attention to detail. This is because it's necessary to determine at what stage the error occurred: Did the doctor write the wrong prescription? Did the nurse administer it incorrectly? Did the pharmacy dispense the wrong medication? Did the hospital system mix up the medications? Did the patient misunderstand the medication instructions? The answers to these questions must be presented with evidence.

Evidence that can be used includes prescriptions, e-prescription records, doctor's order forms, nurse's medication administration forms, patient files, epicrisis reports, laboratory results, medication boxes, medication barcodes, pharmacy receipts, serum and medication preparation records, intensive care unit records, emergency intervention records, allergy records, patient wristband records, camera recordings, WhatsApp messages, pharmacy interviews, prescription screenshots, and expert reports prepared after the incident.

The Patient Rights Regulation allows patients to directly or through their legal representative or attorney examine and obtain copies of files and records containing information about their health status. Therefore, in a claim of medication error, it is necessary to obtain all patient files, medication administration records, and prescription/order documents in their entirety.

Failure to keep complete medical records, not recording medication administration times, missing nurse forms, not recording allergy information, or inconsistencies in the patient's file can all be considered against the hospital in a lawsuit. This is because maintaining accurate records is essential for the accountability of healthcare services, especially in high-risk procedures like medication administration.

The Importance of Expert Reports

In cases involving incorrect medication or dosage, expert reports often determine the outcome of the case. Depending on the nature of the incident, the court may obtain a report from an expert panel comprised of specialists in pharmacology, relevant clinical branches, emergency medicine, intensive care, internal medicine, pediatrics, anesthesia, infectious diseases, forensic medicine, or nursing practices.

The expert report should seek answers to the following questions: Was the medication appropriate for the patient? Was the dosage calculated correctly? Were the patient's age, weight, kidney and liver function, pregnancy status, allergies, and other medications taken into account? Was the prescription or order incorrect? Did the personnel administering the medication give the correct medication to the correct patient? Was timely intervention provided when a side effect occurred? Is there a causal link between the harm and the medication error?

According to Article 281 of the Code of Civil Procedure, parties may request that any deficiencies in the expert report be completed, ambiguities clarified, or a new expert appointed within two weeks of receiving the report. Therefore, in cases of medical malpractice, the report should be examined in detail; if the report is incomplete, contradictory, or outside the relevant field, an effective objection should be prepared.

Particular care should be taken to avoid closing the case by simply stating it is a "drug side effect" or "complication." The expert should thoroughly examine the patient's allergy history, dosage calculations, drug interactions, nursing records, pharmacy records, and the post-harm intervention process.

Informed Consent and Drug Therapy

Patients need to be informed about medication as well. Of course, detailed written consent is not required for every simple medication. However, for medications with serious side effects, high risks, long-term use, or those requiring special monitoring, the necessary explanations should be given to the patient.

For example, patients taking chemotherapy, blood thinners, insulin, immunosuppressants, psychiatric medications, anti-epileptic drugs, anesthetic drugs, or other medications with a high risk of serious allergic reactions should be informed about the method of use, side effects, warning signs, when to seek emergency medical attention, and follow-up appointments.

According to the consent and information provisions of the Patient Rights Regulation, patient consent is essential in medical interventions, and when obtaining consent, the patient or their legal representative must be informed and enlightened about the subject and consequences of the medical intervention.

If a patient is started on risky drug treatment without being adequately informed, and the patient seeks help late because they are unaware of side effects, leading to more severe harm, then lack of information can also be cited as grounds for compensation.

Can a criminal investigation be opened?

In some cases, administering the wrong medication or the wrong dosage can lead not only to a compensation lawsuit but also to a criminal investigation. If the patient is injured, suffers health problems, sustains permanent damage, or loses their life as a result of the error, charges of negligent injury or negligent homicide may arise.

Article 89 of the Turkish Penal Code regulates the crime of negligent injury; the current text prescribes punishment for a person who negligently causes pain to another person's body or causes impairment of their health or sensory abilities. In the case of death, the provisions of Article 85 of the Turkish Penal Code regarding negligent homicide may apply.

However, there are special permission procedures for investigations to be conducted regarding healthcare professionals. According to Article 18 of the Annex to Law No. 3359 on Basic Health Services, in investigations concerning medical procedures and practices related to examination, diagnosis, and treatment within the scope of the practice of the health profession by physicians, dentists, and other healthcare professionals working in public or private health institutions and foundation universities, the Professional Responsibility Board process comes into play.

Criminal investigations and civil lawsuits are different. While a criminal case investigates the criminal liability of healthcare personnel, a civil lawsuit aims to compensate the patient or their relatives for material and moral damages. However, statements in a criminal case, forensic medical reports, drug records, and expert assessments can be important evidence in a civil lawsuit.

What should a patient do if they are given the wrong medication?

If there is suspicion of incorrect medication or dosage, the patient or their family member should first keep all relevant documents. The medication box, prescription, e-prescription information, pharmacy receipt, hospital records, nurse's medication administration form, IV label, discharge prescription, doctor's correspondence, and any photographs should not be lost.

Secondly, patient files and medication administration records should be requested in writing from the healthcare facility. Doctor's orders, nurse administration schedules, barcode records, allergy records, and emergency intervention documents are particularly important in cases of medication errors within the hospital.

Thirdly, the harm must be medically documented. Reports of allergic reactions, bleeding, organ damage, intensive care requirements, neurological damage, kidney or liver damage, psychological impact, and incapacity for work resulting from incorrect medication should be included in the file.

Fourthly, it must be determined whether the incident occurred in a private hospital, a public hospital, a pharmacy, or a private clinic. This is because private hospital cases involve consumer court proceedings and mediation; public hospital cases involve administrative appeals and full judicial review; and pharmacy errors require separate assessment of private law liability.

Conclusion: Wrong medication and incorrect dosage errors can lead to serious legal liability

Administering the wrong medication or the wrong dosage should not be seen as simple negligence. Some medication errors can directly endanger a patient's life, cause permanent disability, lead to intensive care, or result in death.

In such cases, not every side effect is due to medical malpractice; however, not every "side effect" defense absolves the healthcare institution of responsibility. Legal assessment examines whether the correct medication was selected, whether the dosage was calculated correctly, whether allergies and drug interactions were checked, whether the medication was administered to the correct patient via the correct route, whether patient follow-up was conducted, and whether there is a causal link between the harm and the medical malpractice.

A patient who suffers harm due to incorrect medication or dosage may claim compensation for medical expenses, intensive care costs, disability benefits, caregiver expenses, permanent disability, loss of earnings, 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, medical records should be collected without delay, prescriptions and medication documents should be preserved, the chronology of the event should be established, the distinction between private and public hospitals should be correctly made, and claims for material and moral damages should be fully and completely presented.