Shared Liability? Consultants, Pharmacists, and the EP
Shared Liability? Consultants, Pharmacists, and the EP
There are distinct, separate duties when a physician prescribes and a pharmacist dispenses medication to a patient. Two non-ED cases clearly delineate the general respective responsibilities. In Morgan v Wal-Mart Stores, Inc., a 12-year-old boy was diagnosed by his physician with attention deficit hyperactivity disorder and prescribed desipramine (Norpramin; Sanofi-Aventis, Bridgewater, NJ). The physician testified that she showed the patient's mother an entry for tricyclic antidepressants in the Physicians' Desk Reference. The entry described common side effects associated with this class of medications, such as dry eyes and mouth and increased heart rate, and the physician explained that the child should be watched closely for rapid heart rate. Two years later, after multiple medical visits to a variety of providers, the child died from hypereosinophilic syndrome, which is a rare complication of desipramine therapy. The parents brought suit against Wal-Mart, alleging that it was negligent in the sale of desipramine "by failing to properly warn intended users of the hazards and harms associated with the use of the product." The court ruled that the pharmacist had no duty to warn the patient of side effects. The physician was held liable for $1.012 million.
Thus, a pharmacist is not determined to have a duty to warn a patient of medication side effects. Multiple other state courts have reached the same conclusion: it is the physician's duty to warn of potential side effects.
In Frye v Walgreen, the plaintiff contended that, in the act of placing warning labels on medication bottles, the pharmacist is obligated to warn of all potential drug side effects. The court ruled that imposing such a duty would discourage pharmacists from placing any warning labels on drug containers. The responsibility to warn was again ascribed to the physician: "Consumers should principally look to their prescribing physicians to convey the appropriate warning regarding drugs, and it is the prescribing physician's duty to convey these warnings to the patients".
Courts have held that pharmacists owe purchasers of prescription medication "the highest practicable degree of prudence, thoughtfulness and vigilance and the most exact and reliable safeguards consistent with the reasonable conduct of the business in order that human life may not constantly be exposed to the danger flowing from the substitution of deadly poisons for harmless medicines". A pharmacist who inaccurately fills a prescription is therefore liable to the customer for resulting harm. A pharmacist is bound to safely fill a medication.
A pharmacist may be held liable for adverse outcomes, particularly if a medication is knowingly dispensed in a way that the pharmacist judges to be harmful. In Brooks v Wal-Mart Stores, a patient was prescribed prednisone 80 mg QID (four times a day), an excessive dose. The pharmacist called the physician to confirm the dose and filled the prescription as written. The medication error was recognized 10 days later, however, the patient developed Nocardia pneumonia and cerebral aspergillosis. He underwent numerous hospitalizations and surgeries, and suffered renal failure. The court ruled, "A pharmacist must exercise his own judgment as to whether any dosage prescribed, even if confirmed by the prescriber, would be harmful to the patient. If he determines the dosage would be harmful, he has an obligation not to fill it." The patient was awarded $2.5 million.
These cases should raise the physician's awareness of the duties and obligations when prescribing medications. Practically, it is impossible to warn patients of every possible side effect of a given medication. However, common and anticipated side effects should be clearly communicated to patients. It cannot be assumed that the pharmacist will do this, as they are not legally obligated to do so. To minimize physician liability, patients should be encouraged to read package inserts, handouts, and ask any questions they may have about their medication.
Pharmacists and Physicians
There are distinct, separate duties when a physician prescribes and a pharmacist dispenses medication to a patient. Two non-ED cases clearly delineate the general respective responsibilities. In Morgan v Wal-Mart Stores, Inc., a 12-year-old boy was diagnosed by his physician with attention deficit hyperactivity disorder and prescribed desipramine (Norpramin; Sanofi-Aventis, Bridgewater, NJ). The physician testified that she showed the patient's mother an entry for tricyclic antidepressants in the Physicians' Desk Reference. The entry described common side effects associated with this class of medications, such as dry eyes and mouth and increased heart rate, and the physician explained that the child should be watched closely for rapid heart rate. Two years later, after multiple medical visits to a variety of providers, the child died from hypereosinophilic syndrome, which is a rare complication of desipramine therapy. The parents brought suit against Wal-Mart, alleging that it was negligent in the sale of desipramine "by failing to properly warn intended users of the hazards and harms associated with the use of the product." The court ruled that the pharmacist had no duty to warn the patient of side effects. The physician was held liable for $1.012 million.
Thus, a pharmacist is not determined to have a duty to warn a patient of medication side effects. Multiple other state courts have reached the same conclusion: it is the physician's duty to warn of potential side effects.
In Frye v Walgreen, the plaintiff contended that, in the act of placing warning labels on medication bottles, the pharmacist is obligated to warn of all potential drug side effects. The court ruled that imposing such a duty would discourage pharmacists from placing any warning labels on drug containers. The responsibility to warn was again ascribed to the physician: "Consumers should principally look to their prescribing physicians to convey the appropriate warning regarding drugs, and it is the prescribing physician's duty to convey these warnings to the patients".
Courts have held that pharmacists owe purchasers of prescription medication "the highest practicable degree of prudence, thoughtfulness and vigilance and the most exact and reliable safeguards consistent with the reasonable conduct of the business in order that human life may not constantly be exposed to the danger flowing from the substitution of deadly poisons for harmless medicines". A pharmacist who inaccurately fills a prescription is therefore liable to the customer for resulting harm. A pharmacist is bound to safely fill a medication.
A pharmacist may be held liable for adverse outcomes, particularly if a medication is knowingly dispensed in a way that the pharmacist judges to be harmful. In Brooks v Wal-Mart Stores, a patient was prescribed prednisone 80 mg QID (four times a day), an excessive dose. The pharmacist called the physician to confirm the dose and filled the prescription as written. The medication error was recognized 10 days later, however, the patient developed Nocardia pneumonia and cerebral aspergillosis. He underwent numerous hospitalizations and surgeries, and suffered renal failure. The court ruled, "A pharmacist must exercise his own judgment as to whether any dosage prescribed, even if confirmed by the prescriber, would be harmful to the patient. If he determines the dosage would be harmful, he has an obligation not to fill it." The patient was awarded $2.5 million.
These cases should raise the physician's awareness of the duties and obligations when prescribing medications. Practically, it is impossible to warn patients of every possible side effect of a given medication. However, common and anticipated side effects should be clearly communicated to patients. It cannot be assumed that the pharmacist will do this, as they are not legally obligated to do so. To minimize physician liability, patients should be encouraged to read package inserts, handouts, and ask any questions they may have about their medication.