Lists of the Bizarre, Intriguing, and Informative: 10 Alarming Results of Human Error

Although everyone errs, some mistakes result in more serious consequences than others. An error may result in a vicious animal attack, the demolition of a home, automobile crash injuries, an emergency room visit, patients' deaths, or aircraft or train fatalities. Even when corrective measures are taken after the fact, the damage, injury, or death has already occurred. These 10 alarming results of human error may remind us just how important it is to exercise caution and deliberation in everything we do.

10 Forced Landing

During a personal, cross-country flight in October 2014, a commercial pilot flying a Cirrus SR22 airplane was approaching his destination. At an altitude of 1,524 meters (5,000 ft), his engine conked out, and he landed in “an open field.” The crankshaft had broken “due to fatigue that had initiated from multiple origins.” The damage was caused by maintenance personnel's improper tightening of the crankshaft, which resulted in a shifting of the No. 2 bearing, an “insufficient clamping force of the crankcase saddle surfaces,” and, ultimately, a shutdown of the engine. (LINK 1)

9 Lion Attack

A lion being moved inside its facility at the Dallas Zoo injured a zookeeper after the victim forgot to lock a door inside the lion's enclosure. As another employee, behind locked doors, “distracted” the lion, the zookeeper used pepper spray to escape. The zookeeper, scratched and bitten, recovered at a local hospital. Gregg Hudson, president and chief executive officer of the Dallas Zoo, assured the public that the incident did not constitute “an exhibit failure,” nor did the lion have a chance to “enter any public areas.” The August 2014 incident, he said, was caused by the zookeeper's “mistake” in “not following procedures,” a matter which would be “addressed.” (LINK 2)

8 Demolished Duplex

In 2006, Billy L. Nabors Demolition employees demolished a northeast Dallas, Texas, duplex a block away from the building they should have torn down. The owners of the duplex, Lindsay Diaz and Alan Cutter, had planned to repair damages to the building caused by a 2015 tornado. The chief executive officer of the demolition company told reporters his crew thought they were destroying the right building. The incident was “no big deal,” he said.

Lindsay disagreed. “How do you make a mistake like this? I mean, this is just the worst,” she said. Dallas' city manager, Brian Funderburk, said he thought the error “a very big deal,” since the Diazes were now forced to rebuild, rather than repair, their home. Google Maps has since reoriented the map's pin so it indicates the “correct location.” At this time, the situation concerning the demolished home remains unresolved. (LINK 3)

7 Uncertain Paternity

Twenty-six couples may not know who fathered their children. A “procedural error” that occurred “from mid-April 2015 to November 2016” at UMC Utrecht, a Dutch fertility clinic, may have resulted in women's ova being fertilized by sperm from a donor other than the “intended father[s]” during intra-cytoplasmic sperm injection treatments. The mishaps occurred when “one of the fertility clinic's lab technicians” failed to replace the “rubber top” on each of the pipettes used “to inject sperm cells.” After finding “traces of sperm” on the rubber top, the technician “raised [an] alarm over the possibility of wrong fertilization.” The clinic is investigating the matter and working on plans to prevent the same error in the future. (LINK 4)

6 Emergency Room Visit

In April 2016, in England, a 63-year-old woman, experiencing a potentially fatal reaction to poison she'd mistakenly used to brew her tea, was rushed to a hospital emergency room. Upon being admitted, she was vomiting, had an irregular heartbeat, and felt lightheaded, but she recovered, after being treated. Thinking she'd used leaves from a comfrey plant, which a friend had advised her would help her insomnia, she'd, instead, used leaves from a foxglove plant, which can slow the heart. The product she purchased at a store was mislabeled as containing comfrey.

Within “a few hours” after she'd drunk the tea, she began to experience symptoms. Doctors suspected the tea was the cause of her symptoms, because she had no history of “heart problems” and was not taking any medications. Using the Internet, doctors discovered that comfrey resembles foxglove. A sample of the woman's blood revealed high levels of the compound digoxin, for which they administered an antidote. After five days, her heart rate returned to normal, and she was discharged from the hospital. (LINK 5)

5 Severe Burns

A 21-year-old woman's visit to Wellington's Wakefield Specialist Centre on March 20, 2015, for a 15-minute colposcopy examination, following “an abnormal smear,” almost resulted in her immolation. The procedure used acetic acid, which was supposed to have been diluted to five percent. Instead, due to a labeling error by the pharmacy that supplied the compound, the acetic acid was used at full strength, resulting in the woman's receiving extreme pain and “severe internal burns.” Her ability to have a baby is also in doubt.

She has had to endure months of treatment for the burns, has incurred substantial medical bills, and has suffered enormous stress. In a letter to the woman, the Newtown Mall Pharmacy's directors, Mark Newton and John Phipps, assured the woman they were investigating the matter and offered her a $50 voucher for “travel costs” related to her “readmission to the clinic.” She is seeking “compensation” from the pharmacy for her medical bills, and her family has “lodged a complaint with the health and Disabilities Commissioner.” (LINK 6)

4 Nursing Home Residents' Deaths

In April 2016, after one of its nurses administered 10 times the amount of morphine a resident had been prescribed, the Mahnomen Health Center in northwestern Minnesota was “cited for neglect.” The resident, who was in hospice care, suffering from “chronic kidney disease,” died an hour and a half after the “medication error.” The Minnesota Department of Health reported that the nursing facility “failed to have adequate policies in place to ensure medications were transcribed accurately and then administered correctly.”

A nurse questioning a colleague concerning the dose the resident was receiving was told the amount was accurate. Within 15 minutes of giving the man the fatal dose, the error was detected, and he was given Narcan to counteract the effects of the overdose, but, by then, he was breathing at a rate of “a mere two breaths per minute ,” and he died before another dose of Narcan, requested by his family, could be administered. (LINK 7)

A similar incident occurred at Minnesota Golden Living in October 2015. A “transcription error” resulted in a resident's failure to receive a blood thinner for nine days. The resident “was known to have a history of stroke and atrial fibrillation” and was being treated with the anticoagulant warfarin. A licensed practical nurse recorded the warfarin prescription on another resident's chart, and, for nine days, the mistake “went unnoticed,” until a hospital “called to check on laboratory results.” The resident, removed to a hospital, died of a stroke and respiratory failure. According to a Minnesota Department of Health report, Minnesota Golden Living was found to be negligent in monitoring and evaluating its nurses. (LINK 8)

3 Hospital Patient's Death

Loretta Macpherson, a 65-year-old Oregon hospital patient, was supposed to receive fosphenytoin, an anti-seizure drug. Instead, a pharmacy worker gave her rocuronium, a “paralyzing agent” frequently used for surgeries. The prescription had been entered correctly in the medical records database, “the pharmacy had received the correct medication order,” and the intravenous bag was “labeled properly.” The pharmacy worker's mistake was compounded when a second employee failed to detect the pharmacy worker's “error while checking the vials of medication and the IV bag.”

The patient received the rocuronium on December 8, 2014, in the emergency room, shortly before a fire alarm sounded, and “Macpherson's door” was locked “to protect her from potential fire hazards.” Although she was resuscitated, Macpherson, who'd had a heart attack, “suffered brain damage” and was removed from life support after two days. Three members of the hospital's staff were placed on “paid administrative leave,” and the hospital has taken steps to prevent similar errors in the future. (LINK 9)

2 Jet Crash Fatalities

1.6 kilometers (1 mi) offshore and 25 meters (82 ft) below the sea, Russian divers found parts of a Russian military Tu-154 jet that crashed into the Black Sea on December 25, 2016. Eleven of the aircraft's 84 passengers and eight crew members were recovered with the jet's fragments. Transport Minister Maxim Sokolov said the investigators were focusing on “possible pilot error or a technical fault.” Terrorism, he said, was “was not among the main theories” concerning the cause of the jet's crash, because “the military plane was under reliable protection.” Magomed Tolboyev, “a decorated Russian test pilot,” said it was certain everyone aboard the aircraft perished in the crash. “There is no chance to survive in such a situation,” he said. (LINK 10)

1 Train Accident Fatalities

Most train accidents in India are caused by human error. In a four-month period, 18 of 21 such accidents were caused by such mistakes. However, Comptroller and Auditor General reports cite “manpower shortage, financial bottlenecks and delay in installing anti-collision devices” as contributing factors in the accidents. Between 2010 and 2011, 93 train wrecks have resulted in more than 250 deaths. Errors on the part of railway workers are responsible for 90 percent of the fatalities. In one case, the driver of a Chennai Beach-Vellore Cantonment Mainline Electrical Multiple Unit train was speeding and “skipped red signals before crashing into the stationary Arakonam-Katpadi passenger train near Chitheri station.” Although safety officers have discussed the problem, “no concrete steps have been taken to address the issue.” (LINK 11)

LINK 1:

http://generalaviationnews.com/2016/10/12/maintenance-error-leads-to-cirrus-owner-pulling-chute/

LINK 2:

http://www.khou.com/news/local/texas/keepers-error-leads-to-lion-attack-at-dallas-zoo/259139906

LINK 3:

http://www.digitaltrends.com/web/google-maps-error-house-demolition/

LINK 4:

http://www.techtimes.com/articles/190616/20161229/fertility-clinic-investigates-possible-mix-up-that-may-have-left-26-women-fertilized-with-wrong-sperm.htm

LINK 5:

http://www.livescience.com/57064-herbal-tea-foxglove-error-life-threatening-problems.html

LINK 6:

http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11515870