Would You Prevent This Death?
A Preventable Death?
How could a pharmacist prevent the death of a world class athlete?
March 4, 1990. One of the best college basketball players in the United States dropped dead on the basketball court during a game. His name was Hank Gathers and he was a big, strong center for the team from a small Catholic school in California. Loyola Marymount. Hank had unlimited potential as a professional in the NBA. He was also young, black and a male. That dangerous blood pressure group.
Hank Gathers was prescribed atenolol to control his blood pressure. According to a medical myth that quickly spread, this kid quit taking the medication because he felt “weak”. He just didn’t seem to have the same spring in his legs. Loyola Marymount was coached by Paul Westhead. The game was run and gun. They averaged 122 points a game. This was not the style of game for a big guy with his exercise tolerance compromised by a beta blocker. He quit atenolol and died on the basketball floor after a monster slam dunk, during a WCC conference tournament game 18 years ago today.
Who dropped the ball and has at least collateral responsibility for this kid’s death. How about the prescribing physician? Didn’t he know? Couldn’t he see the real probability that this amazing basketball player’s energy would tank and that he could be non-compliant?
How about the pharmacist? Was it the pharmacist’s job to take Hank Gathers by the collar, look him in the eye and demand that he get it?
“Hank, you have to take this medicine. You cannot stop it. You are young and I know that you think you are invincible, but your blood pressure is so high that you could end up like JR Richard of the Astros.”
“Who is JR Richard?”
Never Surrender ipod “He was a Cy Young Award candidate. A terrific pitcher for the Houston Astros. Young, black and male and he fell over in center field at the Astrodome running wind sprints. A stroke. He never came back.”
“I’ll be okay, man. I will be okay. Just give me my medicine so I can go to practice. We are in a tournament right now.”
Mandatory pharmacist counseling on every new prescription was absolutely not the practice in California in 1990. Congress had just passed the OBRA law in 1989. I’d guess that something like this went on when Hank got his Tenormin.
“That was Hank Gathers,” the star-struck pharmacist gushes to the pharmacy clerk. “Hank Gathers. The Loyola basketball star. I shoulda got his autograph.” In 1990, I’d put money on it that the pharmacist did not have thought one about Hank’s exercise tolerance.
The 21st Century? Eighteen years later. Our focus is entirely different. Modern pharmacists have very good eyes these days. They know that it is their job to give personal counseling. Most conscientious pharmacists would envision Hank on the court, sucking air trying to play Paul Westhead’s game. I am a 40 year feet-on-the-floor pharmacy veteran and even I would look out at this famous basketball player, look down at the prescription, and say “Oh oh”. Would you, a modern pharmacist, call the prescriber and suggest a drug more suited to a world class run and gun basketball player, like losartan? Or would you drop the ball? When he died would you whine, “The doctor should have told him.”
These are not rhetorical questions. I’d like to hear your answers.
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At the time, you do what you know to do. Beta-blockers were first-line therapy during that time. ACE’s were here, but wouldn’t have been considered for first-line treatment.
A patient MUST take responsibility for their own health and treatment and it isn’t uncommon for a person of his age to think short-term instead of long-term. He should have gone to his pharmacist and discussed his problems and asked what other options were available.
In the environment that we all work in it is not reasonable to think that the pharmacist could call all his/her patients to ask why they didn’t get their medications refilled.
In a perfect world, doctor and pharmacist should both have thought twice about the effects of beta-blockers. With that being said, I cannot honestly tell you that if George Clooney walked in my store with ANY rx, that I would be able to stand up, much less think, unless it was just a totally in-your-face screwed up rx! I’m just a girl that happens to be a pharmacist- not a miracle machine! Wish I could honestly say differently, but I can’t. Sorry Jimmy!
Starstruck factor aside, we learn in pharmacy school that there are just some drugs that the names, whirrr, whirr, click, click, whoa, set the wheels/gears turning; what’s this guy doing on this drug? Double-take, whirr, whirr, hmmmm. Then, verbal interaction with patient possibly prescriber.
Granted, there aren’t that many that the names get the old gears rolling, but when the pharmacist has enough time, say 3.5 min. for order entry (check allergies, drug history, age, etc.) and processing whirrr, click, click (weight, right dose, correct prescriber, etc.).
I filled in at a shop several months ago. For that crud that was going around (I’d seen half a dozen or more ER scripts come in) ER doc had written for erythromycin 333 TID. I think to myself. Hmm. Docs have been writing for another antibiotic all day, why PCE 333? She says she’s not allergic to anything. Hmmm. I wonder what else she’s taking. Nothing. She’s in my shop for a $4 script. Excuse me, excuse me, Ma’am are you taking anything else? Yes? Blood pressure drugs? You have the bottles in your car? Let me see them, please. You already showed them to the physician. Yes, please, go get them from your car. It’ll be just a minute, we’re not too busy. I don’t have your history and I want to fill your prescription properly.
She came back with several bottles, just as I suspected; some potentially interacting with erythromycin, so I called the ER physician, and just as I thought he’d not recalled interactions with erythromycin, and furthermore, as he’d been very busy that day in the ER of that small town, the allergies had been noted incorrectly, so he changed the drug, and furthermore he was very appreciative that someone was looking out for his patients. When I gave the woman her script, we spent a few minutes going over some symptomatic relief measures.
True story.
In your local fast drug pharmacy. We truly weren’t that busy, just the usual rushes in between a 150 Rx Saturday, just the (God bless him!) tech and I.
I wish I could tell you that I absolutely would have made the right call on the atenolol in 1990 but I can’t. I can tell you that I believe I would have made the call on March 4, 2008. Not necessarily because I am older and wiser but because I started on a beta blocker three weeks ago and I feel like my energy level is in the pits. Lets just say I understand it better now. But, I would not consider quitting it without first consulting my doctor because I know the importance of it to my health. I am a pharmacist afterall. But most 20 something young people in apparent good health may not know, hell, probably don’t know this. And that has to be at least in part our role as pharmacist, to advise (encourage is a better word) them to make no changes in their therapy without first consulting their doctor. All in a 2 to 3 minute conversation. Thats my job and I like it that way.
I have never heard this kid’s name.. how would I know he played basketball? I have no appreciation for sports at all. Besides, most stores I’ve worked in, the cashier asks if they have questions or want counseling, if they don’t I never get the opportunity to speak to them and they leave with an information sheet. I do not think it is right, but it is what you do when you do not know your customers and fill over 300 RXs a day. Everyone jumps from pharmacy to pharmacy for their coupons and fuel perks, you never know if it is a new medication or if they have been on it for 30 years anymore.
Loyola Marymount University is a Jesuit school in Los Angeles. I’d give odds that
every pharmacist within 10 miles of the campus knew who Hank Gathers was. I mean, the guy was really tall and he was a hero down there, riding a wave of publicity.
I’ve been on atenolol for years, and I’m full of energy. Go figure.
Of course you would have gotten his signature. Right when the tech asked “you dont have any questions about your medicine, right? Sign here”.
Thats what I always get when I go to the pharmacy.
Hank Gathers didnt simply have HTN either - he had some type of cardiomyopathy that predisposed him to arrythmias, so beta blockers were his only option.
YES! I HOPED I would not be the only one!!!