Pharmacists have duty to consult prescriber, court says
David B. Brushwood
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Pharmacists have a legal duty to screen prescriptions for potential problems and to consult with the prescriber when necessary to resolve problems in the patient’s best interests. An Ohio court has addressed the basis of this responsibility and the argument that prescribers either do not welcome, or will not heed, concerns expressed to them by pharmacists.
Background
The plaintiffs alleged negligence by the defendant pharmacy in dispensing lamotrigine to a 6-year-old patient. The lawsuit claimed that the dispensing pharmacist erred by not providing warnings to the patient and by failing to consult the prescriber about an excessive dose and off-label use to treat bipolar disorder.
The court said that the pharmacist testified “he knew lamotrigine was a dangerous antipsychotic drug when used for a child under 16 years of age. He knew that dosing was calculated by age and weight. He knew the prescription was ‘red flagged’ by [the pharmacy’s] computer DUR system. He failed to obtain the 6-year-old plaintiff’s weight and failed to call the minor plaintiff’s physician. He testified he could have easily done so and that he could have obtained the necessary information in 5 minutes or less. He was also aware that exceeding the dosage guidelines carried an increased dangerous risk for children. He failed to warn the plaintiffs of the dangers associated with the use of the drug at this dosage level.”
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The defendant pharmacy moved to dismiss the case, arguing that “courts across the country have ruled as a matter of public policy that a pharmacist has no duty to warn a patient of a drug’s contraindication, or to warn a patient of the consequences of taking the drug.”
Rationale
In considering the motion, the court said, “The better public policy argument for imposing a duty to warn is the pharmacist’s role as a ‘safety net.’ Pharmacists have an equal (if not greater) knowledge of the pharmacology and contraindications of drugs than many physicians. Why have any DUR policies if a pharmacist is merely the processor of the physician’s prescription and simply the pill counter? Certainly, most pharmacists would be insulted to know that physicians and courts of law view pharmacist expertise as limited to the perfunctory manual rote duty of filling prescriptions. This court fails to see the logic in not adding a duty to warn as one last layer of protection for a patient when a physician prescribes a drug that a pharmacist has reason to know has potentially disastrous side effects.”
The pharmacy contended that even if the pharmacist had consulted the prescriber, there would have been no changes in the prescription because prescribers do not accept advice provided by pharmacists. The court disagreed, noting testimony provided by a physician expert witness. That expert testified, “The pharmacist’s job is to educate the doctor when a prescription is written that is dangerous or inaccurate. I think that if a pharmacist calls you up and says that you’re giving a potentially dangerous dose of a drug and you don’t change it, you probably won’t be practicing medicine very long.”
The court concluded from this testimony that “a physician called by a pharmacist and warned of the high potential for harm for an overdosage of the drug for the child’s weight and age would likely modify the dosage or cancel the prescription.”
The pharmacy’s motion to dismiss the case was denied.
Discussion
Prescriptions that pose potential problems for patients rarely need to be processed immediately. There is ample time to consult the prescriber and resolve questions that a pharmacist may have. This is not a matter of obstinately refusing to process a prescription without consultation. Rather, it is an inability to provide medication to a patient without clarifying matters related to dosage, drug–drug interactions, or other concerns about patient safety. It is the prescriber who has caused these concerns, and it is the prescriber to whom a pharmacist must turn for resolution.
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