A pharmacist at Anne Arundel Medical Center was charged yesterday with reckless endangerment and practicing without a license after officials said she accidentally provided morphine instead of a common medical solution for three newborns in the critical care unit.
Martin L. Doordan, president of Anne Arundel Health System, the hospital's parent company, said yesterday that Susan E. Kron, the pharmacist, has been fired. In addition, Larry Bierley, director of the pharmacy, said he has resigned.
In its investigation, the hospital found that Ms. Kron did not renew her pharmacist's license after it expired in September, officials said.
Ms. Kron, reached at her home in Crofton last night, said she had not been notified of charges and would not comment. She had been an employee at the Annapolis hospital since 1986 and had worked the night shift for the last two years, hospital officials said.
"We don't have any reason to believe it was intentional," said Anne Arundel County State's Attorney Frank R. Weathersbee. But he said Ms. Kron, 45, put the babies at risk of death or serious injury by accidentally filling the syringes with morphine. "I think, if we're correct, what she's done is gross negligence, and that's the standard for the charge of reckless endangerment," he said.
The charges stem from a Jan. 31 emergency in which three newborns in the hospital's critical-care nursery suffered breathing difficulties and were placed on ventilators for eight to 36 hours.
That episode came one month after a previously unreported accident involving the critical-care nursery. In that incident, a different pharmacist gave a baby an overdose of vancomycin hydrochloride, an antibiotic, by drawing the medicine from a bottle for adults. The baby suffered no long-term damage, hospital officials said.
One of the newborns in the Jan. 31 incident is at home. Hospital officials said yesterday a second is to be released shortly. And the third, born premature, should remain in the hospital for several more months.
Hospital officials say none of the babies suffered long-term damage.
The reckless endangerment charge carries a maximum five-year sentence, $5,000 fine or both. The licensing charge carries a maximum one-year sentence and/or a $1,000 fine.
At a news conference yesterday, hospital administrators called the episode an accident and repeatedly said the hospital is safe.
Dr. Jack Lord, hospital vice president, described the Jan. 31 episode and its aftermath.
He said Ms. Kron received a late-night call from the critical-care nursery ordering extra syringes filled with heparin, a blood thinner used to flush newborns' intravenous tubes, which occasionally clog with fluids, nutrients and medications. The last supply of 100 tubes had run out and the nurses needed an extra handful.
Two similarly shaped bottles stood side by side in the pharmacy refrigerator. One was filled with heparin, the other morphine. The morphine bottle is twice as large as the heparin bottle and sealed with a red cap, hospital officials said.
Ms. Kron grabbed the morphine, filled five to six syringes and sent them to the critical care ward, Dr. Lord said. The first baby, born premature, was given one syringe, which contained roughly a teaspoon of morphine, at 5 a.m. About a half-hour later, the next baby, a full-term newborn, was given three times as much morphine. By 8 p.m., the third baby was given a syringe of the opiate. Within minutes of each shot, the babies struggled to breathe and were placed on ventilators. Dr. Lord said he did not detect a pattern until the last baby had breathing problems, at which point the nursery was evacuated, scrubbed and inspected, and all the babies were given urine tests for signs of infection or poisoning.
The mystery was not solved by the discovery of a drug-laden syringe or tearful confession, he said. Rather, investigators concluded that the morphine must have been administered in place of the heparin solution because the concentrations in the babies' urine samples were identical.
Hospital officials said Ms. Kron's failure to renew her license is a relatively minor matter. The Maryland Board of Pharmacy requires pharmacists to renew their licenses every two years. About 3,700 pharmacists go through the process each year, and only about 100 fail to renew, board official Tamara Banks said.