Micotil can be a killer
Todd Neeley
DTN Staff Reporter
OMAHA (DTN)--On the evening of March 8, 2003 Saronville, Neb., farmer Rourk Erickson maneuvered an 800-pound heifer into a squeeze chute in the back of his 90-year-old barn west of Sutton.
He made his way to a veterinarian room at the other end and loaded a syringe with 10 to 12 cubic centimeters of Micotil 300, an antibiotic used to treat bovine respiratory disease.
While carrying the needle in his right hand and walking through a narrow alley to the chute to vaccinate the animal, a horned heifer ready to calve charged from a pen to his right.
The blow from the animal ramming a fence panel knocked Erickson to the ground. The force drove the needle into his groin injecting an unknown amount of Micotil.
Erickson, 38, became dizzy and nauseous within seconds, struggled to his feet and back to the vet room where he called his wife for help.
He died at a Hastings hospital within an hour of the accident, after doctors told him there is no known antidote for the drug.
His mother, Reta Erickson of Sutton, said she wants Micotil banned, but so far that hasn't been done and there's no sign that it will anytime in the near future.
Instead she continues to spread the word about the drug's dangers to farmers, friends and government representatives.
"Some people have told me I'm doing this as therapy," she said. "I just feel I have to do this to keep somebody else from dying. I can't let it get to me so much that I get sick over it, but it has ruined our lives."
The drug produced by Elanco Animal Health of Indianapolis, a subsidiary of Eli Lilly and Co., provides farmers with a single-injection therapy intended to treat BRD and reduce stress on cattle as a result of shipping.
According to information from the Food and Drug Administration, there have been 14 Micotil-related deaths reported worldwide. So far two have been classified as accidental, including an incident involving a 50-year-old farmer from South Dakota.
Art Davis, an occupational fatality investigator for the Nebraska Workforce Development Department of Labor, said word of the drug's dangers has traveled quickly.
France and Ireland took action this year, temporarily limiting public use of Micotil.
Davis said both governments ordered consumers to return the drug to veterinarians and to temporarily restrict its administration to licensed vets while its status is reviewed.
Dennis Erpelding, a spokesman for Elanco, said the action taken in France and Ireland was done to provide labeling and other packaging information updated since the Erickson accident.
According to a report filed by Davis, Rourk Erickson likely died from an injection of 8.5 to 10.5 cubic centimeters of Micotil after an initial investigation found about 1.5 cubic centimeters in the syringe left at the scene.
The Micotil label recommends about 1.5 cubic centimeters for every 100 pounds, or about 12 cubic centimeters for the 800 pound animal Erickson was ready to vaccinate.
Micotil is popular because of its effectiveness. It offers a low-volume dosage at a single-injection site, which helps farmers and ranchers save money and time.
A 1999 FDA survey found that 70 percent of all feedlots used Micotil as part of the initial treatment to prevent BRD.
Searching for answers
In the 17 months following the accident, Rourk Erickson's wife, Debra, sold the family farm and moved with her two children to Sutton. To this day, Reta Erickson said, Debra has not talked about the accident.
Reta Erickson, however, continues to contact national ag groups, experts, doctors and has shared her family's story with veterinarian students. She also has contacted other families dealing with tragedy at the hands of Micotil.
In the weeks following the Erickson accident, the drug was banned from use at the United States Department of Agriculture's Roman L. Hruska Meat Animal Research Center east of Hastings after officials decided Micotil wasn't worth the danger to employees.
While human deaths have been caused by Micotil injections of 3 cubic centimeters or less, Reta Erickson said she believes her son didn't know about the potential dangers of the drug.
That's especially true, she said, because of the way he held the syringe in his right hand as he walked through the barn that fateful evening.
"He'd want it banned," she said, "especially if it would have happened to one of his children."
As a result of the accident, the FDA required the company to make changes to the human warning on Micotil's label. It now indicates that Micotil "has been associated with fatalities."
The drug's new prescription pad lists first-aid treatments and new handling and administration techniques and recommends specific syringe sizes. Producers and veterinarians now must sign prescription pads at the time of purchase.
The company filmed training videos and DVDs for vets and producers, created laminated dosage sheets and safe handling cards, adverse drug experience wallet-sized cards and recommends the exclusive use of the single-hand injection method.
The Elanco materials now advise users to keep children and other bystanders away from work areas where Micotil is in use, to restrain all animals, identify an exit route, to be aware of uneven or changing walking surfaces in a work area, to keep needles covered until use, to never carry loaded syringes in clothing and to not work alone.
As for animal safety, company literature advises farmers and ranchers to use squeeze chutes and head gates, minimize handling stress in accordance with animal behavior and to adjust vaccination activity to the temperament of each animal.
Elanco materials say those who administer the drug should do so from a top-down angle while avoiding needle penetration of underlying muscle.
Despite the changes, two more farmers have died--one by accidental injection and the other by suicide.
Erpelding said the Ehrich accident in April occurred when an animal attempted to get away during vaccination. The accidents have raised awareness within the company of a need to better educate Micotil users, Erpelding said.
"We've been doing a lot of things and we've probably gotten more specific about handling techniques," he said. "Our goal is to get out some of this stuff for education purposes."
Along with label and other changes, Erpelding said, Elanco officials have been conducting "major-education programs" with Micotil distributors across the country. This is to re-enforce the need for proper drug handling and administration techniques.
The Ehrich death probably would not lead to further changes in labeling or education programs about Micotil, he said.
"It looks like the changes we made would account for the circumstances of the second accident," Erpelding said.
Between 1992 and 2000, Davis said, there were 2,392 Micotil-related accidental punctures, scratches and injections of greater than 2 cubic centimeters reported in the United States.
Information from the Rocky Mountain Poison Control Center shows about 3 cubic centimeters would be fatal to humans. But in some cases, humans have survived accidental injections of up to 5 or 6 cubic centimeters in cases in which the drug didn't make it into the bloodstream.
Micotil was introduced in Canada in 1990 and on the U.S. market in 1992.
The federal government does not independently track the number of Micotil accidents and relies on local coroner reports and adverse drug reaction reports filed by drug companies and others.
Despite the changes made by the drug company, Erickson said she will stay vigilant in educating others to show that her son's death was not in vain. The family filed a lawsuit, which is pending.
"Almost all my life I have dreamed," she said, "not nightmares or anything like that, but just dreaming. And since the accident I no longer dream of anything that I'm aware of. I am sure some would say I should see a shrink and tell me the meaning of this, but I can neither afford it and don't really feel it is necessary. It is just one of the ramifications of all of this and it will abate or I will just go on to doing something else in my life."
Date: 9/2/04
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