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'Illegible' Doctor Faces Living Nightmare

Sonia Chopra

A Texas cardiologist who is reportedly the first doctor held liable by a jury in a fatal medication mix-up because the pharmacist could not read his handwriting, believes he has been handed down a life sentence.

"I don't think I will ever get over it. Each time I use my hand, especially for writing prescriptions, I remember what happened. It's a constant thing. I know I have to deal with but it has been terribly difficult for me," said Ramachandra Kolluru, 48, who now prints his prescriptions.

The plaintiff, Teresa Vasquez, 41, contended that her husband Ramon Vasquez, 43, a heart patient died because Thomas Updyke, a pharmacist at the Albertson Pharmacy, Odessa, who was unable to read Kolluru's handwriting, gave him not only the wrong medicine, but also at eight times more than the recommended dosage.

The jury agreed. They held Kolluru, the pharmacist and the pharmacy liable and awarded the widow $450,000; most of the money will be paid by the pharmacy.

Kolluru, however, feels that he was made a scapegoat.

"Someone died. The jury had to lay the blame, so they laid it on me. I do not believe that I was responsible. The pharmacist should have checked with me," said Kolluru, who added that his practice had not suffered because of the case.

He defends his handwriting.

"It would not win prizes but I believe it would have passed the legibility test," Kolluru said.

The case points to an alarming danger as more and more medications are invented and names get more similar. Six months ago, the subject was a Dateline special. It has also been the focus of stories by the Associated Press and The New York Times. Two weeks ago, Kolluru, Wright and Vasquez appeared on Good Morning America television program.

Pharmacist Michael Cohen of the Institute of Safe Medication Practices in Washington said thousands of patients have been harmed because some pharmacist has misread what a doctor has prescribed.

"We are bringing more drugs into the market and the names all sound similar," Cohen said.

Cohen offers some examples of similar sounding medications: Celebrex, a pain medication and Celexa, the anti-depressant and Cerebex, the anti-seizure medication all sound similar. Norvasc, a blood pressure medication and Navane, the tranquilizer sound alike. So do the tranquilizer Zyprexa and the antihistamine Zyrtec.

In June 1995, Vasquez was given a prescription for Isodril for heart pain caused by valve problems. Kolluru's prescription was for 20 milligrams of Isodril to be taken four times a day.

The pharmacist thought the handwritten prescription was for Plendil, a drug for high blood pressure, which is mostly taken for 10 milligrams a day. So, the patient received the wrong medication with the wrong dosage -- he was given the wrong medication at eight times more than the recommended dosage.

According to Kolluru's lawyer, Max Wright, the dosage should have been a red flag for the pharmacist.

"Even if he thought it was Plendil, the dosage amount was abnormally high. I find it hard to understand why he didn't just pick up the phone to call the doctor. It's common sense," said Wright, who described himself at being "very unhappy" with the jury's decision.

One day after Vasquez took the medication, he was taken to the emergency room. Two weeks later he died.

At the trial, Wright called two expert witnesses who testified that Vasquez's heart was so weak that he was about to die and the wrong medication did nothing to hasten the end.

Kent Buckingham, a medical malpractice lawyer agreed that his client's husband was very ill and estimated that Vasquez probably had a year to live.

"But when you have only one year, that becomes more valuable and cherished. We have no problem what the care and treatment Dr Kolluru gave my clients. By all accounts, he was an excellent doctor but his bad handwriting and therefore the wrong medication hastens my client's death," said Buckingham, adding that this was perhaps the most unusual case he had ever tried.

"Usually I find the care and treatment of doctors inadequate," said Buckingham, who appealed to the jury to send a message about inefficient doctors.

"I won the case because I wanted them to understand that bad handwriting is inexcusable and if they failed to render judgment, it could be their families next," Buckingham said.

That personal appeal was exactly the problem, argued Wright.

"The case was reduced to a very simplistic one. The jury interpreted the case as laymen. They couldn't read the prescription was why they were swayed. But they weren't supposed to be able to read it. Pharmacists and doctors should be the only ones to be able to do so," Wright said.

Wright also said his client should not be the one to pay out any money and in the end, it may turn out that Kolluru will pay a small amount.

In an out of court settlement, Albertson Pharmacy, who would not comment on the case yesterday, agreed to pay Vasquez's widow and her three children $450,000, while denying liability. And since the law does not allow double benefits to be paid out to the victim, Kolluru's payoff amount could be as little as $25,000.

The judge will rule in two weeks but that's what Wright is predicting. Buckingham himself refused to comment on the outcome.

He said his client Teresa Vasquez was away in Mexico and was unreachable but he did add that she was pleased at the verdict and has hoped that the judgment would prompt doctors and pharmacists to be more careful.

"So that this tragedy will never happen again to any other family. If that is prevented, she feels that her husband has not died in vain," Buckingham said.

Wright said the best thing that came out of the case was the spirit of humanity that survived. Moments after the October 14 verdict was announced, Kolluru walked up to the widow and hugged her and three children.

"This was a man who is noble and has honor. He knew that he had lost, he was shocked but his first instinct was to reach out to the other side. I was in awe. I respect him," said Wright, who added that it was the first time in two years that Vasquez had cried so freely.

Kolluru came to the United States in 1975. He had graduated from the Government Hospital in Andhra Pradesh and had worked there for a year. He married another physician and moved to Westwood Medical Center, Texas. He has a son and a daughter. Their ages are 21 and 11 respectively.

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