Pharmacist Not Liable for Harm Resulting from Physician’s Mistake

On February 29, 2008, the Alabama Supreme Court issued an opinion ruling that a pharmacist and pharmacy owe no duty to their customer for a physician’s prescribing mistake. The plaintiff sought to impose liability on a pharmacist not based on the theory that a drug dispenser has a duty to warn customers, but rather that the pharmacist breached his duty of care to the customer when the pharmacist gave the patient’s doctor allegedly incomplete dosing information. A wife, as the administratrix of her deceased husband’s estate, sued Springhill Hospitals, Inc., d/b/a Springhill Memorial Hospital (SMH), among other defendants, alleging wrongful death resulting, in part, from the negligence of SMH’s pharmacist. After the jury returned a verdict in favor of the estate for $4 million in punitive damages, SMH requested the trial court for a judgment as a matter of law, a new trial or a reduction in the amount of the punitive damages award. The trial court denied SMH’s motions, and SMH appealed to the Alabama Supreme Court. The deceased had gone to the SMH emergency room complaining of severe knee pain. The attending physician, a physician with approximately 22 years of experience, conducted a physical examination and ordered a blood test, a uric acid test and an X-ray. The physician diagnosed the patient’s pain as an attack of gout in his knee. The patient accepted the third treatment option involving the prescription colchicine. The physician testified that after referring to the Physician’s Desk Reference that he had in his office, he sent a prescription to the SMH pharmacy for the patient, prescribing a loading dose of colchicine to be taken orally. When SMH’s pharmacist received the prescription, he telephoned the physician to tell the doctor that although 2 mg. is the proper loading dosage when colchicine is administered intravenously, it is not the proper loading dosage when the drug is administered orally. The physician asked the pharmacist for the proper oral dosage, which the pharmacist gave the doctor. The physician testified that he knew, based upon his training and experience, the prescription dosage of colchicine, as reaffirmed by the pharmacist, and that “an overdose of colchicine could be life-threatening.” The physician further testified that the pharmacist did not ask the doctor any questions about the patient, nor did they physician volunteer any information. At the conclusion of the doctor’s conversation with the pharmacist, the doctor altered the patient’s prescription and prescribed a loading dose of one 0.6 mg. tablet of colchicine, which the SMH pharmacy sent to the doctor and which the patient took while he was at the hospital. The doctor also wrote the patient a prescription for sixteen 0.6 mg. tablets, which could be refilled twice. The SMH pharmacist was not aware that the doctor was going to prescribe any tablets beyond the one tablet dispensed by the SMH pharmacy. The physician’s prescription for sixteen 0.6 mg. tablets of colchicine did not indicate the maximum number of pills that could be taken. The patient began having adverse symptoms that continued to worsen. He was eventually admitted to another hospital, and he died two days later. The case is important because it expands the application of Alabama’s learned-intermediary doctrine. In cases involving complex products, such as those in which pharmaceutical companies are selling prescription drugs, the learned intermediary doctrine generally states that a manufacturer’s duty to warn is limited to an obligation to advise the prescribing physician of any potential dangers that may result from the use of its product. The law typically relies on the expertise of the physician intermediary to bridge the gap in special cases in which the product and related warning are sufficiently complex so as not to be fully appreciated by the consumer. The adequacy of the warning is measured by its effect on the physician to whom the manufacturer owed a duty to warn, and not by its effect on the consumer. On appeal, SMH argued that the trial court erred by refusing to apply Alabama’s learned-intermediary doctrine, which SMH alleged served to eliminate the pharmacist’s liability and SMH’s vicarious liability. The estate argued that the learned-intermediary doctrine is limited to the defense of product liability actions. The Court relied upon its previous learned-intermediary doctrine decisions to determine that the doctrine was applicable, as neither prior case limited the Court’s review or holdings to product liability issues. The Court then determined the ultimate question on appeal to be whether a pharmacist should be liable for harm to a physician’s patient resulting from medication prescribed by the physician. The Court again relied upon its rationale in prior cases to explain that “the physician, not the pharmacist, has the medical education and training and the knowledge of a patient’s individual medical history necessary for properly prescribing medication; therefore, it is the physician, not the pharmacist, who should bear the liability for mistakes in prescribing or dosing the medication,” Walls, 887 So. 2d 886. Accordingly, the Court reversed the trial court’s judgment and rendered a judgment as a matter of law in favor of SMH, agreeing that the learned-intermediary doctrine forecloses any duty of care owed by a pharmacist for prescribing mistakes made by a physician. April 2008