Prescription error results in liver embolisation

23 February 2024

Our client was already taking Warfarin his GP prescribed Fluconazole and Miconazole. Unfortunately, the GP did not check the interaction of the medications resulting in serious consequences.
Prescription error results in liver embolisation

The Story

Our client was taking the blood thinning drug, Warfarin, when he visited his GP with a separate issue. He was prescribed further medication, Fluconazole and Miconazole, but the GP did not check the interaction of the drugs. Because of error he suffered an abdominal bleed and had to undergo a liver embolisation (a process where substances are injected directly into an artery in the liver to block or reduce the flow of blood to a tumour).

The details

Our client had undergone mitral valve surgery on three previous occasions (the most recent in 2014) and had made a good recovery each time. He was prescribed Warfarin, a medication used to reduce the risk of blood clots, and regularly attended his local anticoagulation clinic to have his INR level (a measurement taken to indicate how long it takes for blood to clot) to check the effectiveness of the Warfarin treatment.

In late 2019, he started suffering from a painful tongue. His GP diagnosed oral thrush and prescribed Fluconazole and Miconazole. However, his GP failed to consider the possible interactions between these medications and the Warfarin.

The impact

After taking the Fluconazole and Miconazole for a short period of time, our client developed pain in his leg. The pain got worse, so he visited the A&E Department. Blood tests showed that his INR was significantly abnormal. He was admitted overnight for observations and discharged the next day.

Two days later, he was feeling unwell and generally lethargic. He then suffered a fall at his home and was taken to hospital. At the hospital he fainted, and when he regained consciousness, he was unable to remember what had happened or where he was, so he was taken for an urgent CT scan. The scan revealed that he had suffered an abdominal bleed; a large haematoma (a mass of mostly clotted blood that us usually caused by a broken blood vessel) was detected in his liver.

Our client was then transferred to the specialist liver unit at the hospital for liver embolization. During this procedure, a clot was removed. He required a blood transfusion, and remained in hospital for four days, an experience which he found very traumatic. He explained that when her had undergone his cardiac procedures, they had been planned, and he had time to prepare for them; in this case, he had feared for his life.

How we helped

Arshid Mahmood, a paralegal at Shoosmiths, acting under the supervision of Alex Haider, Senior Associate, was instructed by our client to investigate a clinical negligence claim relating to the treatment he had received from his GP. Arshid obtained an independent medico-legal report from experts in general practice and hepatology, which established that the interactions between Warfarin and Fluconazole and Miconazole had caused his INR to rise. This in turn had caused a bleed to his liver for which he required liver embolisation. The GP expert explained that when these medicines are prescribed to patients an alert should appear on the GP’s computer system, warning of their interaction risk. In this case the defendant must have either overridden or ignored the warning when prescribing the combination of medications.

As a result of his experience, our client’s mental wellbeing was afffected. He developed anxiety in certain circumstances, and a need for cognitive behavioural therapy was identified. Our client works as an Uber driver, and his ability to earn was impacted by the episodes of anxiety, which prevented him travelling long distances.

A Letter of Claim was sent to the defendant. In response we received an admission that there had been a failure to recognise the potential risks of prescribing Fluconazole and Miconazole gel to a patient already taking Warfarin, and that the interaction of the medications had resulted in the need for liver embolisation.

We were able to achieve a five-figure settlement for our client and avoid court proceedings.



This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2024

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