Emily's Law (Emily's Act) is an informal name given to

Ohio Ohio ( ) is a U.S. state, state in the Midwestern United States, Midwestern region of the United States. It borders Lake Erie to the north, Pennsylvania to the east, West Virginia to the southeast, Kentucky to the southwest, Indiana to the ...

Senate Bill 203 (SB 203), which was signed into law in 2009. The law is named in honor of Emily Jerry, a two-year-old who died in 2006 from a

medication error A medical error is a preventable adverse effect of care (" iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, ...

during her last round of chemotherapy at Rainbow Babies and Children's Hospital in

Cleveland, Ohio Cleveland is a city in the U.S. state of Ohio and the county seat of Cuyahoga County, Ohio, Cuyahoga County. Located along the southern shore of Lake Erie, it is situated across the Canada–United States border, Canada–U.S. maritime border ...

. The law: "require(s) that pharmacy technicians be at least 18 years of age, register with the State Board of Pharmacy and pass a Board-approved competency exam; the legislation also includes specific provisions related to technician training/education, criminal records and approved disciplinary actions." Previously, "people with only a high school degree could walk into a job as a technician at a major hospital and begin working on medications with minimal training."

History

On February 26, 2006, Emily Jerry was undergoing her last scheduled round of

chemotherapy Chemotherapy (often abbreviated chemo, sometimes CTX and CTx) is the type of cancer treatment that uses one or more anti-cancer drugs (list of chemotherapeutic agents, chemotherapeutic agents or alkylating agents) in a standard chemotherapy re ...

with

Etoposide Etoposide, sold under the brand name Vepesid among others, is a chemotherapy medication used for the treatments of a number of types of cancer including testicular cancer, lung cancer, lymphoma, leukemia, neuroblastoma, and ovarian cancer. It is ...

to treat a yolk sac tumor which was diagnosed 6 months earlier. According to physicians responsible for her care, her prognosis was "excellent" and she was expected to be medically discharged following the completion of her last infusion. The pharmacy where Emily was receiving her care was short staffed due to being a weekend, and the pharmacy computer system was down for maintenance. Furthermore, Emily's chemotherapy was entered incorrectly as a stat order, and the pharmacist and technician were behind on other hospital orders and unable to take their scheduled

lunch break A break at work (or work-break) is a period of time during a shift in which an employee is allowed to take time off from their job. It is a type of downtime. There are different types of breaks, and depending on the length and the employer's p ...

. Etoposide is traditionally injected into a pre-prepared isotonic 0.9%

sodium chloride Sodium chloride , commonly known as Salt#Edible salt, edible salt, is an ionic compound with the chemical formula NaCl, representing a 1:1 ratio of sodium and chloride ions. It is transparent or translucent, brittle, hygroscopic, and occurs a ...

intravenous bag (IV) for dilution prior to administration. However, the pharmacy technician incorrectly filled an empty IV bag with

hypertonic In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membran ...

23.4%

, then added the Etoposide resulting in a solution containing 26 times more sodium chloride than was recommended. After compounding the incorrect medication the IV was given to a

pharmacist A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...

for sign-off, who failed to detect the medication error, and it was dispensed to hospital staff for administration. Upon administration Emily grabbed her head, cried out in pain, began vomiting, and slipped into a coma – she died three days later on March 1, 2006 after being taken off life support. The pharmacist, Eric Cropp, was terminated from Rainbow Babies and Children's Hospital on March 3, 2006, later stripped of his license by the Ohio Board of Pharmacy, and indicted for

reckless homicide Reckless homicide is a type of homicide and crime in which the perpetrator was aware that their act (or failure to act when there is a legal duty to act) creates significant risk of death or grievous bodily harm in the victim, but ignores the ri ...

and

involuntary manslaughter Manslaughter is a common law legal term for homicide considered by law as less culpable than murder. The distinction between murder and manslaughter is sometimes said to have first been made by the ancient Athenian lawmaker Draco in the 7th ce ...

by an Ohio

grand jury A grand jury is a jury empowered by law to conduct legal proceedings, investigate potential criminal conduct, and determine whether criminal charges should be brought. A grand jury may subpoena physical evidence or a person to testify. A grand ju ...

. On May 13, 2009 as a result of a

plea bargain A plea bargain, also known as a plea agreement or plea deal, is a legal arrangement in criminal law where the defendant agrees to plead guilty or no contest to a charge in exchange for concessions from the prosecutor. These concessions can include a ...

, Cropp pleaded no contest to involuntary manslaughter in exchange for dismissal of the charge of reckless homicide. Eric Cropp was sentenced to six months in prison, six months of house arrest, 400 hours of community service, and $5000 in court costs.

Legislation

Senate Bill 203 was introduced in the

Ohio State Senate The Ohio Senate is the upper house of the Ohio General Assembly. The State Senate, which meets in the Ohio Statehouse in Columbus, Ohio, Columbus, first convened in 1803. Senators are elected for four year terms, staggered every two years such t ...

in 2008 and signed into law January 7, 2009, by Governor

Ted Strickland Theodore Strickland (born August 4, 1941) is an American politician who served as the 68th governor of Ohio from 2007 to 2011. A member of the Democratic Party, he previously served in the United States House of Representatives, representing ( ...

. It amended sections 3719.21, 4729.99, 4776.02, and 4776.04 in addition to enacting section 4729.42 of the

Ohio Revised Code The ''Ohio Revised Code'' (ORC) contains all current statutes of the Ohio General Assembly of a permanent and general nature, consolidated into provisions, titles, chapters and sections. However, the only official publication of the enactments o ...

Controversy

Some pharmacy trade groups contest that

Cuyahoga County Cuyahoga County ( or , see ) is a large urban county located in the northeastern part of the U.S. state of Ohio. The county seat and most populous city is Cleveland. As of the 2020 census, its population was 1,264,817, making it the second ...

, the State of Ohio, and the Ohio Board of Pharmacy took excessive action against the supervising pharmacist. They contest that making Cropp out to be a pariah discourages pharmacists and hospitals to report medication-related errors, and actually increases the chances for patient harm.

References

{{reflist Ohio statutes