According to a lawsuit filed last week in Colbert County, eight patients of Shoals Orthopedics and Sports Medicine, all being treated at the Colbert location connected with Helen Keller Hospital, received bupivacaine injections on or around October 29, 2013. The most common brand name for bupivacaine is Marcaine. Marcaine is generally given as a local anesthetic in a hospital setting.

In an earlier article, PNS reported that only seven of the plaintiffs in the lawsuit tested positive for MRSA; however, it should be noted that the eighth was diagnosed via “imaging,” either X-Ray, MRI, or PET scan, and a staph infection was indicated.

There have been no reports of other medical locations having problems with bupivacaine from the same batch, so it may be inferred the infection originated in the Shoals Orthopedics office. How did this happen?

bottle details

While many injectable meds are packaged in one-dose vials, many come packaged in vials that contain five, ten, or more dosages. These vials are packaged with a plastic cap, removable for aspirating the drug. Normally this cap is replaced once the drug is obtained, and the rubber membrane under the cap is wiped with an alcohol prep before the next use. Even if not swabbed down, the drug would ideally be refrigerated and there should be little chance of staph contaminating the membrane and ultimately the new needle for the next patient.

A more likely scenario is that a needle was reused. This can occur when two injections are given to the same patient–perhaps one in each knee. It also can occur if a used needle was injected into the bottle to draw the bupivacaine for a new patient, but this seems highly unlikely.

From the Center for Disease Control:

Transmission of life-threatening bacterial infections can occur when health-care personnel do not adhere to Standard Precautions and instead use medication in containers labeled as single-dose or single-use for more than one patient (1). This report summarizes the investigation of two outbreaks of invasive Staphylococcus aureus infection confirmed in 10 patients being treated for pain in outpatient clinics. In each outbreak, the use of single-dose or single-use vials (SDVs) for more than one patient was associated with infection transmission. In both investigations, clinicians reported difficulty obtaining the medication type or vial size that best fit their procedural needs. These outbreaks are a reminder of the serious consequences that can result when SDVs are used for more than one patient. Clinician adherence to safe injection practices, particularly when appropriately sized SDVs are unavailable, is important to prevent infection transmission. If SDVs must be used for more than one patient, full adherence to U.S. Pharmacopeia standards is critical to minimize the risks of multipatient use.

The lawsuit does not specify damages, but attorneys for the eight plaintiffs (seven former patients and executor of the eighth) have stated the amount will be:  “in an amount that will reflect the enormity of the defendant’s wrongful conduct in causing the plaintiff’ injuries.”

Winners in malpractice suits rarely recover more than the physicians are insured for. The amount of insurance Dr. Lee Nichols and Dr. Paul Davis carry would depend on past experience and the amount of surgery each does. Many physicians carry no more than one million in malpractice insurance. Since one of the eight patients allegedly died from the infection, one may infer his/her estate will receive the largest portion of any court award.

There are really no winners in medical malpractice suits.



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