Child's Death Raises More Questions About Blood-Thinner

(April 2) -- Nebraska health officials have admitted that 23-month-old Almariah Duque may have died from an overdose of the blood-thinner heparin, raising more questions about the use of the drug on infants.

Overdoses of heparin have been linked to several deaths and illnesses.

Almariah's parents, Greg and Kenya, brought their daughter to the Nebraska Medical Center in Omaha for a liver, kidney and bowel transplant in December. The Texas natives were referred to the hospital because of its reputation as a leader in intestinal surgeries.

The initial procedure went well, but Almariah later suffered an infection. She was readmitted to the hospital in early February. She died Wednesday afternoon. Soon after, hospital officials released a statement admitting that an overdose of heparin may have been to blame.

"It appears an overdose of the blood thinner heparin may have contributed," the statement reads. "This is a matter of the highest concern for The Nebraska Medical Center. This death has been a deeply troubling and emotional incident for everyone at the hospital."

The statement goes on to offer "our deepest apologies" to the Duque family, as well as a commitment to pay for the toddler's funeral arrangements.

But apologies can't placate a family in shock.

"It feels like somebody ripped her from our hands," Kenya Duque told CBS Dallas News.

This is only the latest instance of an infant being killed, or dangerously harmed, by an incorrect dose of heparin. In 2008, a hospital in Corpus Christi, Texas, admitted that 14 infants in neonatal intensive care had suffered from heparin overdoses. Two of the babies later died, though hospital officials said the deaths weren't necessarily linked to heparin, because the babies had been seriously ill before the incident.

In September 2006, overdoses were given to six premature babies at Methodist Hospital in Indianapolis, according to USA Today; three of those infants died.

One year later, the twins of actor Dennis Quaid were administered quantities of heparin 1,000 times the appropriate dose by doctors at Cedars-Sinai Medical Center.

The twins survived, but Quaid sued the drug-maker, Baxter International, arguing that its vial labels made it difficult for hospital workers to distinguish different dosages. He's also lobbied Congress to institute stricter repercussions for human error in medical care.

"These mistakes that occurred to us are not unique," he told 60 Minutes in 2008. "They happen in every hospital, in every state in this country."

Heparin is commonly administered after surgeries or, in Almariah's case, during kidney dialysis, to keep blood in IV lines from clotting. But an incorrect dosage can lead to immediate consequences, because a patient can quickly start bleeding internally.

Greg Duque, Almariah's father, told the Omaha World-Herald that his daughter received the wrong dose of heparin for five hours before hospital employees noticed. They then informed him that "the setting on the IV pump was not checked properly."

In 2008, the U.S Joint Commission filed a report on anti-coagulant use among pediatric patients. The commission noted that "pediatric patients are problematic to treat, specifically because the medications are formulated and packaged primarily for adults."

As a result, heparin doses are mixed by pharmacists or nurses, rather than combined in an automated process, leading to a greater risk of error.

It's a risk that some hospitals are no longer willing to take. Penobscot Bay Medical Center in Maine stopped using heparin in 2008, noting that saline solution can be substituted as a lower-risk alternative.

Other hospitals, like the Nebraska Medical Center where Almariah died, are simply instituting new safeguards. Nurses are instructed to double-check dosage labels, verify them with a pharmacy staffer, and use dose-stop technology to automatically control intravenous drugs.

Despite their loss, the Duques say they have no plans to take action against the hospital. Instead, they just want medical practitioners to learn from the mistake that likely caused their daughter's death.

"We just want her voice to be heard and for this to never happen again to any child or adult," they said in a statement. "We believe this was an honest mistake but one that needs to be corrected."