If you or a loved one has been affected by medication error in New York, our experienced New York medication error lawyer team can help. MDLaw Firm has recovered millions for victims of medical negligence across all five boroughs — call 347-524-5777 for a free consultation.
What Are Look-Alike Sound-Alike (LASA) Medication Errors?
Look-Alike Sound-Alike (LASA) medication errors occur when a drug is confused with another drug whose name is visually or phonetically similar. These errors can happen at any stage of the medication use process — prescribing, transcribing, dispensing, or administration — and the consequences range from temporary adverse effects to permanent injury or death.
The Institute for Safe Medication Practices (ISMP) maintains a comprehensive list of confused drug name pairs that are notorious for causing patient harm. Common examples include:
- Hydromorphone vs. Morphine — Hydromorphone (Dilaudid) is approximately five to seven times more potent than morphine. Confusing the two can cause a fatal opioid overdose.
- Hydroxyzine vs. Hydralazine — An antihistamine vs. an antihypertensive. Giving hydralazine when hydroxyzine was intended can cause dangerous hypotension.
- Celebrex vs. Celexa vs. Cerebyx — An anti-inflammatory, an antidepressant, and an antiepileptic — three drugs with nearly identical names but vastly different indications.
- Lamictal vs. Lamisil — An anticonvulsant vs. an antifungal. Missing Lamictal can cause seizures; unnecessary Lamisil can cause liver toxicity.
- Prednisone vs. Prednisolone — Different corticosteroid potencies; confusing them can lead to underdosing or overdosing.
[Link to: /medical-malpractice/medication-errors]
How LASA Errors Happen in New York Hospitals
LASA errors are a systems failure. They rarely occur because a single provider was careless — they occur because multiple layers of safety checks failed simultaneously. Understanding how these errors happen is critical to proving negligence.
Prescribing Errors
When a physician writes a prescription by hand, the name may be illegible or ambiguous. Even with electronic prescribing, auto-complete and drop-down menus can lead to selecting the wrong drug. For example, typing "hydr" into an e-prescribing system may surface both hydroxyzine and hydralazine, and a momentary click on the wrong entry sends the wrong order to the pharmacy.
Transcription Errors
In hospitals that still use paper order sheets or verbal/telephone orders, the opportunity for LASA errors multiplies. A nurse hearing "hydroxyzine 25 milligrams" over the phone may transcribe it as "hydralazine 25 milligrams." The Joint Commission has identified verbal order errors as a persistent patient safety threat and has recommended minimizing verbal orders whenever possible.
Dispensing Errors
Pharmacists in New York hospitals dispense thousands of doses daily. When two LASA drugs are stored adjacent to each other on pharmacy shelves — a practice known as "look-alike storage" — the pharmacist may grab the wrong product. The ISMP recommends Tall Man lettering (e.g., hydrOXYzine vs. hydrALAzine), separation of LASA drugs on shelves, and barcode verification to prevent these errors.
Administration Errors
At the bedside, the "five rights" of medication administration (right patient, right drug, right dose, right route, right time) are the final safety net. When a nurse fails to scan the patient's wristband or the medication barcode, the LASA error goes undetected. If the nurse then administers hydromorphone instead of morphine, the patient may receive a dose five times more potent than intended.
[Image: Hospital pharmacy shelf with LASA drug labeling and Tall Man lettering]
The Standard of Care for Preventing LASA Errors
New York hospitals and healthcare providers are expected to follow established patient safety standards to prevent LASA errors. The relevant standards include:
- Tall Man Lettering — Using mixed-case lettering to highlight differences between LASA drug names (e.g., predniSONE vs. prednisoLONE). The ISMP and FDA recommend Tall Man lettering for specific high-risk drug pairs.
- Barcode Medication Administration (BCMA) — Scanning both the patient's wristband and the medication package at the bedside to verify the correct drug is being given to the correct patient.
- Independent Double Checks — For high-alert medications, a second qualified healthcare professional independently verifies the drug, dose, route, and patient before administration.
- Physical Separation — Storing LASA drugs on different shelves or in different bins to reduce the chance of grabbing the wrong product.
- Computerized Physician Order Entry (CPOE) with Clinical Decision Support — E-prescribing systems that flag LASA drug selections and require confirmation.
New York's Patient Safety Center, established under Public Health Law (PHL) § 2805-j, requires hospitals to report adverse events to the New York Patient Occurrence Reporting and Tracking System (NYPORTS). Medication errors involving LASA confusion are reportable events under NYPORTS.
Proving Negligence in a LASA Medication Error Case
To prevail in a New York medical malpractice claim involving a LASA error, the plaintiff must establish four elements:
- Duty — The healthcare provider owed the patient a duty of care, which is established by the provider-patient relationship.
- Breach — The provider failed to meet the applicable standard of care. In LASA cases, this often means failing to use Tall Man lettering, failing to use barcode verification, storing LASA drugs adjacently, or failing to perform an independent double check for high-alert medications.
- Causation — The breach caused the patient's injury. This requires expert testimony linking the wrong drug to the specific harm suffered.
- Damages — The patient suffered quantifiable harm, such as additional medical treatment, prolonged hospitalization, permanent injury, or death.
Under New York's Certificate of Merit requirement (CPLR § 3012-a), the plaintiff's attorney must file a certificate with the summons and complaint confirming that a licensed physician has reviewed the case and found a reasonable basis for the claim.
Expert Testimony Requirements
New York follows the standard established in People v. Wesley (83 N.Y.2d 417, 1993) and refined by subsequent cases for expert witness qualifications. In LASA cases, you typically need:
- A pharmacist expert to testify about dispensing standards and ISMP recommendations.
- A nursing expert to testify about administration standards and the five rights.
- A physician expert (in the relevant specialty) to testify about the medical consequences of the wrong drug.
[Link to: /medical-malpractice/medication-errors/5-rights-of-administration]
Common Defense Arguments and How We Counter Them
Defense attorneys in LASA cases typically raise several arguments:
"The patient had an allergic reaction, not a medication error"
The defense may argue that the patient's adverse outcome was due to an allergy or underlying condition, not the LASA error. We counter this by obtaining the medication administration record (MAR), pharmacy dispensing logs, and electronic health record (EHR) audit trails to prove the wrong drug was dispensed and administered.
"The error did not cause the injury"
The defense may argue that even if the wrong drug was given, it did not cause the specific harm. We counter this with pharmacological expert testimony demonstrating the known effects of the wrong drug and the temporal relationship between administration and injury.
"The provider met the standard of care"
The defense may claim that the hospital followed all applicable safety protocols. We counter this by examining whether Tall Man lettering was used, whether barcode scanning was operational and used, whether LASA drugs were physically separated, and whether independent double checks were performed for high-alert medications.
"Comparative negligence"
New York follows pure comparative negligence under CPLR § 1411. The defense may argue that the patient contributed to the error (e.g., by failing to disclose allergies). Even if comparative negligence applies, the patient can still recover damages reduced by their percentage of fault.
Damages in LASA Medication Error Cases
New York does not cap medical malpractice damages. Potential compensation includes:
- Medical expenses — Past and future costs of treating the injury caused by the LASA error
- Lost wages — Past and future lost earnings
- Pain and suffering — Physical pain and emotional distress
- Loss of consortium — For the patient's spouse
- Wrongful death damages — Under EPTL § 5-4.1, if the LASA error was fatal
[Link to: /medical-malpractice/medication-errors/statistics-2025]
Statute of Limitations for LASA Medication Error Claims
Under CPLR § 214-a, the statute of limitations for medical malpractice in New York is two years and six months from the date of the act of negligence, or from the end of continuous treatment by the same provider for the same condition.
If the LASA error occurred at a municipal hospital (such as NYC Health + Hospitals facilities), a Notice of Claim must be filed within 90 days of the error under General Municipal Law § 50-e, and the statute of limitations is one year and 90 days under General Municipal Law § 50-i.
For minors, CPLR § 208 tolls the statute until the child's 18th birthday, but claims must be filed within 10 years of the negligent act.
Lavern's Law (CPLR § 214-a, as amended) may extend the deadline when the patient could not reasonably have discovered the malpractice until a later date — particularly relevant in LASA cases where the wrong drug was administered without the patient's knowledge.
Frequently Asked Questions
What is the most common LASA medication error?
The most common and dangerous LASA error involves opioids — particularly hydromorphone (Dilaudid) being dispensed instead of morphine. Because hydromorphone is five to seven times more potent, this error frequently causes respiratory depression and overdose. Other high-frequency LASA errors include hydroxyzine/hydralazine, celecoxib/celecoxib/cerebyx, and lamotrigine/terbinafine.
How can I find out if a LASA error caused my injury?
Request your complete medical records, including the medication administration record (MAR), pharmacy dispensing logs, and EHR audit trails. These documents show what drug was ordered, what drug was actually dispensed, and what drug was administered. An experienced medication error attorney can review these records with a pharmacist expert to determine if a LASA error occurred.
What is Tall Man lettering?
Tall Man lettering is a patient safety practice that uses mixed-case lettering to highlight the differences between look-alike drug names. For example, "hydrOXYzine" and "hydrALAzine" use uppercase letters to distinguish the portions of the name that differ. The ISMP and FDA recommend Tall Man lettering for specific high-risk drug pairs.
Can I sue the pharmacist for a LASA error?
Yes. Pharmacists can be held liable for dispensing errors. In New York, pharmacists are considered healthcare professionals and must meet the standard of care for their profession. If a pharmacist dispensed the wrong drug due to LASA confusion, the pharmacist and their employer (the hospital or pharmacy) can be named as defendants.
What is the ISMP List of Confused Drug Names?
The ISMP maintains a comprehensive list of drug name pairs that are frequently confused due to similar spelling or pronunciation. The list is based on reports submitted to the ISMP Medication Errors Reporting Program (MERP) and the USP/ISMP Medication Errors Reporting Program. The list is regularly updated and is considered the authoritative reference for LASA drug pairs.
How long do I have to file a LASA medication error lawsuit in New York?
Generally, you have two years and six months from the date of the error (or the end of continuous treatment by the same provider) under CPLR § 214-a. If the error occurred at a municipal hospital, you must file a Notice of Claim within 90 days and the statute of limitations is one year and 90 days. Lavern's Law may extend the deadline if you could not have reasonably discovered the error until later.
What compensation can I recover for a LASA medication error?
You can recover medical expenses (past and future), lost wages, pain and suffering, loss of consortium, and in fatal cases, wrongful death damages under EPTL § 5-4.1. New York does not cap medical malpractice damages.
This article is for informational purposes only and does not constitute legal advice. Prior results do not guarantee a similar outcome. No attorney-client relationship is created by reading this article or contacting MDLaw Firm.
If you or a loved one suffered from a medication error, contact our Medication Error lawyers today for a free, confidential consultation. Call 347-524-5777 or request a case review online.