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Pregnant woman dies from taking painkillers

David Landes · 9 Nov 2011, 10:45

Published: 09 Nov 2011 10:45 GMT+01:00

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In May 2010, the woman went into cardiac arrest and collapsed on her kitchen floor.

She was rushed to the emergency room, where doctors performed an emergency caesarian section in a desperate attempt to save the life of her nearly full-term foetus.

However, both the woman and the child died.

A subsequent autopsy revealed that the woman had died from a lack of oxygen to the brain caused by drug poisoning.

Upon further analysis, doctors discovered the woman had been taking the morphine-like painkiller Tramadol.

The woman had last visited her local health clinic in the summer of 2007, at which point she was prescribed the painkiller to help her cope with irritable bowel syndrome (IBS), despite the fact that the medication is known to make the condition worse.

The doctor continued to renew the woman's prescription via telephone, but never asked whether the woman was pregnant.

In 2009 and 2010, other doctors prescribed the woman sleeping pills and cough medicine that contained ethyl morphine, without ever seeing the woman in person or inquiring if she was pregnant or on birth control.

Following the woman's death, the incident was reported to Sweden's National Board of Health and Welfare (Socialstyrelsen), which concluded that the doctor who prescribed the Tramadol had acted inappropriately in her treatment of the woman.

In its report, the health board explained that Tramadol carries a risk of addiction and treatment “should be reviewed frequently”.

In addition, the drug “should not be given during pregnancy” because of the risks it poses to the foetus.

Story continues below…

“That a doctor should inquire about pregnancy and contraception when writing prescriptions for fertile women is basic knowledge for the trade,” the Health Board wrote.

Following the incident, the health clinic has also changed its procedures so that women are always asked whether or not they are pregnant before renewing prescriptions over the phone.

David Landes (david.landes@thelocal.se)

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Your comments about this article

11:42 November 9, 2011 by Shaky
The doctor has been "rapped" for prescribing painkillers that killed a pregnant woman! He or she should be in prison!!!

Over the last few days Michael Jackson's doctor has been put away for manslaughter for giving him drugs that led to his death, but this Swedish doctor just gets a slap on the wrist.

11:45 November 9, 2011 by old jack
Beyond sad and sickening. Of course the doctor prescribed crap medication. The most modern and most helpful/healing medications often don't exist in Sweden. Quality requires expense.

Too many doctors in Sweden do not really even care about the well-being of their patients. We're often seen as whining cost units to be pushed away as quickly as possible. Plus, familjeläkare, to my understanding, have a lower level of education than in other countries. And we always hear that lower salaries (and system-related frustrations) means that fewer Swedes choose to become doctors.

Health care has been underfunded for years. How many patients does a familjeläkare (or other doctor) usually have? Too many patients per doctor means low quality care (and death even). Phone times are probably seen as a cost saving measure as well. How many people have to be maimed and die before we all shout together and demand humane treatment?

Doctors should also learn from their patients and gain competence over the years. If doctors in Sweden don't have access to new medicines, treatments, technology how are they going to learn from their patients? We all grow together or suffer together.

How are we as a society educating and paying those who are most important to us? The blame lies with everyone.
12:41 November 9, 2011 by ggg33
This is very sad, but part of if not most of the blame is on the women, E.g. when my pregnant wife has been speaking on the phone with a doctor, my wife informs the doctor that she is pregnant when the remedy involves taking a medicine, even if it is just a topical cream.
13:07 November 9, 2011 by eppie

Agree, of course there might be some negligence from the doctors site, but come on....being pregnant/takling heavy medicine and not telling your doctor you are pregnant isn't a very smart thing to do.

Especially in Sweden where people would lynch a pregnant woman if they see here sipping on a glass of wine because it is so irresponsible.

I don't like to have to make these comments at such a sad event, but I think the comments of old jack and shaky are just way off.
13:23 November 9, 2011 by missjane30
I don't think this is just the doctor's fault...common sense would dictate that a) you tell your doctor that you are pregnant, b) you should REALLY tell your doctor that you're pregnant when he prescribes a morphine based medication.

What I don't understand is why a doctor would call in a script for something so strong without having the woman first come to the office for a check up? I know when I was on morphine for about 6 months (surgery), my doctor made me come in for a "med check" each time I needed a refill. As annoying as I found having to go to him every month, it was for my own good, as well as his.

Oh well, sadly this can't be changed now. Her poor family must be beside themselves.
13:43 November 9, 2011 by dadu
What happened to the family doctor in Sweden? Building a rapport and trust with your doctor? How can a doctor subscibe medication on the phone..he needs to meet with his patient, know the history, make his patient feel cared for..not the contrary...and it takes them 2 weeks to call you!..most people would die of neglect by then!))..care cannot be given on the phone!

My mother got first hand experience of this.....she was treated like a nuisance to be dealt with...finally when the doctor called..after never having met my mum..(oh but they took blood tests!) she was given the wrong medication by a doctor in Sweden...on the phone..(no doctor had any time to see her and there were no doctors in hospital!!!!) she decided to return back home to Malta ..where she made an appointment to see her doctor within 24 hours...waited 5 minutes..and got all the care and respect she needed..!

@old jack and @shaky..I agree with you totally!
14:06 November 9, 2011 by old jack
Accoding to WHOM, the woman didn't tell that she was pregnant? For all we know, the doctor didn't even remember who she was. It is very common for medical journals to have errors, for information to be recorded wrong, or not reported at all. So, we're supposed to trust that the woman never mentioned this, and that the authority-figure doctor of course would never lie about this because all doctors are wonderful humans?! How could she be so near to delivery and not have regular doctor visits? There are unanswered questions here.

Re #4, "I don't like to have to make these comments at such a sad event, but I think the comments of old jack and shaky are just way off."

I'm not sure which comments (or all) were just way off. I pretty much listed a series of facts. You can choose to ignore those facts and blame the victim. I, on the other hand, think it's wise to own up to problem patterns in the system. This is how things get better. This is how we help people. This is how we improve and save lives.

A lot of specialists and patients think (most) familjeläke stink. Doctors have said that Sweden is slow to get new medications, treatments. Surgeries available elsewhere are not available in Sweden. Nurses go on strike for more pay. There is a shortage of doctors - it's been in the papers. Doctors go to Norway for more money, and who knows where else. Funding has been cut back - it's in the papers. And the phone services where you call for advice are designed to keep costs down by disuading people to see a doctor - just as the ambulence services. On Swedish threads, people often refer to the system as treating patients like a cheap car factory.

And of course doctors learn from each other and their patients. They read medical journals, attend conferences, talk to other doctors about what works for their patients, etc. I think it must be very frustrating to be a skilled physician and have so many road blocks in the Swedish system.

And I agree with Shaky regarding the lack of personal responsibility. This is a common theme. And it's extremely dangerous in the medical profession. In Sweden, it is very difficult to fire people, so doctors who butcher and molest people even, do not lose their jobs. People who can't fulfill the basic job requirements should be fired and replaced with individuals with higher skills, etc. I do not know what degree of responsibility this woman holds for what has happened, but it is very easy to see that elements of this story are part of a larger pattern of problems.
15:19 November 9, 2011 by Migga
@ old jack #2

"And we always hear that lower salaries (and system-related frustrations) means that fewer Swedes choose to become doctors."

Sorry but this is simply not true. The latest figures show more Swedes then ever being accepted at University to become doctors. They have even added new spots to the programs.

With Swedes studying abroad and coming back home it`s not far off for Sweden to be self-sustained with doctors.
15:30 November 9, 2011 by Shaky
How can you say it's her own fault she died. What kind of person are you?

The doctor should know about the health of each patient, what drugs they are taking etc. It's all in the file of each patient. As far as I'm concerned that doctor was not doing his or her job properly. They should be held responsible for there actions. You're supposed to be able trust what your doctor says and does. How would you like it if one of your loved ones was treated in the same way?
16:57 November 9, 2011 by cattie

It is not good enough it is low accountability.

As @old jack pointed out this lack of accountability is "part of the larger pattern of problems."

The Swedish system is based on assuming that professionals all have the highest personal standards in their work. That, and assuming that regulatory enforcement agencies are well-funded. Both of those assumptions no longer apply. The work ethic has changed, and budget cutbacks mean less double checking.

The answer is rather simple, although it may be unpalatable to some. Begin enforcing the law through civil actions and beginning awarding PUNITIVE damages. When there is a cost-saving motive in having best practices, it will be prioritized. Perhaps the punitive damages can be paid to watchdog organizations instead of plantiffs to avoid the "lawsuit lottery jackpot" problem.

This applies to many areas of safety and health in Sweden, not just healthcare.
17:14 November 9, 2011 by J Jack
Hands up any dudes that have Swedish partners who get painkillers, antidepressants, and other prescriptions from their doctors on the phone without regular supervision and have to stand by and watch the results? People will continue to die from this, more so from the long term side effects such as alcoholism, bad weight management and family abuse.
18:17 November 9, 2011 by krrodman
We have very few facts here, but let's examine what we know.

1. A dumbass doctor prescribed tramadol to a woman over the telephone. No excuses, especially since he had not examined her for an extended period of time.

2. The woman, and her unborn child, died as a result of a cardiac arrest.

While it is easy to connect the dots between the tramadol and the cardiac arrest - and the story would have us believe that there is a connection - there is a big problem:

Tramadol, unlike pure narcotic agonists, causes very little respiratory depression. So, unless she took an overdose(accidental or otherwise), or unless there was a cocktail of medications involved, there is no way that tramadol caused a narcotic death.

Yes, the doctor who prescribed tramadol to this patient was reckless and foolish. The problem with the story is that tramadol did not cause her death......
19:54 November 9, 2011 by workforthesoup
Doctors Fault, Doctors Fault, Doctors Fault. He/She should be behind bars.

Ofcourse, its easy to blame it on the woman, but the doctor has the responsibility to know the physical, mental condition of the patient before prescribing ANY medicine!
20:55 November 9, 2011 by krrodman

Please read my post.

While the doctor should never have given this woman Tramadol without examining her, there is NO reason that tramadol should have caused her death. The advantage of tramadol over other narcotic medicines is that is does NOT cause respiratory depression.

Why did this lady die? The tramadol is a red herring.
21:26 November 9, 2011 by eddie123
#15... do not forget this part of the story:

"In 2009 and 2010, other doctors prescribed the woman sleeping pills and cough medicine that contained ethyl morphine, without ever seeing the woman in person or inquiring if she was pregnant or on birth control."

it is the combination of the Tramadol and the other drugs from elsewhere that resulted in this woman's death. however, why she didn't mention that she was pregnant still leaves much to be desired.
03:57 November 10, 2011 by Kahmoudi
I'm stunned that someone who hasn't been seen by a doctor since 2007 can still get medicine over the phone. I can't get albuterol without a yearly checkup yet this woman was able to get a highly addictive painkiller and sleeping pills for years just because she wanted it. I'm not a doctor yet I was able to find this and be concerned:

"The 2010 Physicians Desk Reference contains several warnings from the manufacturer, which were not present in prior years. The warnings include more compelling language regarding the addictive potential of tramadol, the possibility of difficulty breathing while on the medication, a new list of more serious side effects, and a notice that tramadol is not to be used in place of opiate medications for addicts. Tramadol is also not to be used in efforts to wean addict patients from opiate drugs, nor to be used to manage long-term opiate addiction."

"Tramadol is associated with the development of physical dependence and a severe withdrawal syndrome.[35] Tramadol causes typical opiate-like withdrawal symptoms as well as atypical withdrawal symptoms including seizures."

"Tramadol withdrawal lasts longer than that of other opioids"


Vicodin, Percoset and Ambien junkies need to move to Sweden and get their fixes whenever they want. After all it's probably free and no one will stop them.

Even though the doctor was a fault for handing out prescriptions so readily the patient must also bear some kind of responsibility in this day and age when information is so readily available. I check all my prescriptions to see how they interaction just in case my doctor or pharmacy misses something.


15:50 November 10, 2011 by old jack
Re #9 "And we always hear that lower salaries (and system-related frustrations) means that fewer Swedes choose to become doctors." - "Sorry but this is simply not true. The latest figures show more Swedes then ever being accepted at University to become doctors. They have even added new spots to the programs."

Thank you for this info. Perhaps I should have said that lower salaries and system-related frustrations dissuades many Swedes from becoming doctors. Though again, this is what I have heard, and that doctors leave for more pay.

I did find that new university slots had been added to help fulfill the shortage of doctors, and that bc there had been limited spots, some students chose to study outside of Sweden instead, and hopefully return, as you wrote.

Also, I mentioned that we hear/read that Sweden has a shortage of doctors, but something from one of the student förenings perhaps said that some didn't think that Sweden necessarily had a shortage of doctors but that doctors were not able to put more time toward their patients bc of other duties (such as what I don't know). Maybe it said something like doctors in the US spend 80% of their time with patients, while it was much much lower in Sweden. Don't remember the numbers. But that Sweden was looking at adopting an approach that would let doctors spend more time on patients and less time on other tasks - administative duties, paper work?

I still don't understand how Sweden came to have a shortage of doctors or an administrative shortage that gets added to the doctor workload. I did also read though about what has been discussed regarding a shortage of doctors means that they will keep their jobs even when they are negligent. I wonder too if this is related to cost bc I imagine it costs the tax payers a ton of money to educate a doctor. If they get fired, then the tax payer has also lost this investment. How do we get around that? More checks and balances to prevent negligence? I don't know...
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