Expired Prescriptions Shouldn’t Mean Death

When an expired prescription for a life-sustaining medication preceded the death of Kevin Houdeshell, a 36-year-old Type 1 diabetic, many wondered how a senseless tragedy could have been averted.

Houdeshell, unable to refill his prescription or contact his health care provider, was found dead in his Ohio home Jan. 8, 2014, after he went nine days without insulin.

Here is what his family believes happened.

On Dec. 31, 2013, Houdeshell was out of insulin. He tried to get some at the pharmacy, but his prescription had expired, which had never happened before. Because of the holidays, he couldn’t contact his doctor, Insulin.com reported.

A day later, his work sent him home with flu-like symptoms. Most likely, however, Kevin was suffering from diabetic ketoacidosis (DKA), which is caused by elevated blood sugar levels.

Symptoms of DKA mimic flu-like conditions: vomiting, dehydration, and confusion. His parents told Insulin.com they believe their son stayed home until his death, refusing to have friends come over for fear he would give them the flu.

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To honor his life, Houdeshell’s family pushed for legislative change.

House Bill 188 quickly moved through the Ohio Legislature and was signed by Gov. John Kasich in December. The new law, while it is pending review from the Ohio State Board of Pharmacy, is scheduled to go into effect on March 23.

The law will allow for certain medications related to diabetes, asthma and heart disease to be filled by pharmacists if a customer has made reasonable attempts to contact their physician, but has been unsuccessful. Narcotics and pain medication refills are not included in this legislation.

“This law is a game-changer for all Ohioans who suffer from chronic diseases,” the Ohio Pharmacists Association stated in a news release the day of the bill signing.

Other states are now expressing interest in adopting the guidelines as well.

“It’s an unfortunate set of circumstances to enact change,” said Brett Bartlett, a pharmacist in Arizona, told LifeZette. “It took both the death of this man and a pharmacist’s ineptitude to create a catalyst for change in a pharmacist’s ability to function as a practitioner.”

A pharmacist for 15 years, Bartlett has experienced growing concerns in his profession with the balance of legal, ethical and moral standards. This is a case that highlights all three.

“Why didn’t that pharmacist just give him a vial and work it out later?” asked Bartlett, who believes any pharmacist who might read this patient’s story would be beside themselves. “Many would have just given the guy what he needed and figured it out later.”

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The outcome could have been completely different.

Bartlett explains that this case revolves around a medication that, by law, requires a prescription. But a pharmacist, when looking at the records, should see a patient with a long history of filling insulin. “What, then, is morally and ethically correct?”

“There’s more concern and legal tape for people on chronic pain meds, but you can still do what’s in the best interest of the patient to continue care,” Bartlett said. “And pharmacists have an oath: ‘To consider the welfare of humanity and relief of human suffering my primary concern.'”

The news has many pointing their fingers at a broken health care system; but in fairness, the pharmacy is only a single link in the chain of survival with a chronic disease, especially with something like Type 1 diabetes, which demands a patient’s vigilant attention.

All eyes and ears appear to be on the health care system and why this was allowed to happen. “They definitely (take some) blame, but what about the patient? What was his responsibility?” asked Bartlett.

Houdeshell didn’t use emergency assistance at a hospital or an urgent care center – both of which either had insulin on hand or would provide him with a new prescription. We can only hope that the pharmacist provided him with an emergency contingency plan and shared the importance of follow-up care after he refused to refill his expired prescription.

As a parent of a diabetic, Bartlett wonders, “What happened in this time period? Most diabetics are well aware of the complications and risks without insulin — death being one of them.”

Considering all the obstacles a person with Type 1 diabetes faces in their lifetime with the disease, an expired prescription should never lead to their demise.