Pharmacy Law: Overriding a Computer Alert Leads to Liability

MARCH 01, 2009
Joseph L. Fink III, BSPharm, JD

Dr. Fink is professor of pharmacy law and policy at the University of Kentucky College of Pharmacy, Lexington.

Issue of the Case

When a pharmacist ignores a computer- generated warning about a potential drug?drug interaction, and the patient subsequently dies from an overdose of the medication, how shall the liability be shared among the various parties?

Facts of the Case

A patient in a southwestern state requested a refill of his prescription for tramadol at a chain pharmacy. The next day, he presented a prescription for methadone at the same pharmacy. A computer alert was presented on the screen for the pharmacist, based on information in the pharmacy chain's computer software database. This alerted the pharmacist to the potential for possible drug interactions. The pharmacist did not counsel the patient about this cautionary message.

In addition, evidence was presented at trial that the pharmacist increased the methadone dosage without consulting the prescribing physician.

The patient subsequently died from the effects of the toxicity of the 2 medications.

A wrongful death lawsuit was filed by the 2 surviving children of the deceased patient, as well as his parents. Such a lawsuit is a civil claim for causing the death of a person. These suits are filed by surviving relatives.

As a defense, the pharmacy chain argued that the principal cause of the patient's death was the negligent prescribing decisions of the physician and the decision of the patient to leave the pharmacy without counseling by the pharmacist.

The Court's Ruling

The jury concluded that the failure of the pharmacist to warn the patient of the possible adverse consequences of using the 2 medications together was the principal cause of the patient's death. The state where this case arose uses the contemporary legal rule of comparative negligence?the jury is to sort out and assign blame or culpability in a fashion proportional to the cause of the damages. This comparative negligence rule replaced the traditional rule of contributory negligence that indicated that if the plaintiff contributed in some way, even a very minor way, to his or her own damages, there was a total bar to recovery.

In this instance, the jury decided that the pharmacy chain was 97% to blame; the prescriber contributed to the damages at a level of 2%; and the patient himself was 1% to blame.

The jury verdict awarded $2 million to each of the 2 surviving daughters of the deceased patient/plaintiff and $1 million each to the surviving parents of the plaintiff. Press reports indicated that this total $6-million verdict may well be the largest ever in a civil lawsuit in the county where it was decided. At this writing, the case decision is being appealed by the pharmacy chain.

The Court's Reasoning

Because this is a trial court decision by members of a jury, there is not nearly as much background information available as would be available if it were a case decided by a court of appeals where the panel of judges hearing the case would have written an opinion. Such an appellate court opinion typically supplies details about the facts and history of the case, as well as the rationale used by the judges for their decision. Here, the jury reached a decision for which it was not required to provide a written rationale.

First, it is important to emphasize that such a wrongful death action filed by surviving relatives is based on the allegation that the negligent act of the defendant caused the death, and the surviving parties are entitled to recover legal damages as a result. This legal doctrine is based on the reasoning that the survivors have themselves been damaged by no longer having the deceased person in their lives.

Next, the role of the jury in apportioning blame cannot be overemphasized. In this case, the jurors clearly concluded that the acts of the pharmacist and employer were far and away the principal causes of the death.

Finally, a take-away message?dealing with computer-generated alert messages is something practitioners do multiple times per day, using their professional knowledge and judgment and taking into account information from a variety of sources to make an assessment. Whereas it certainly is possible to be lulled into a routine when dealing with such matters, it is important to bear in mind that these computer prompts are in place for a reason?to protect the patient. They bring into focus issues for professional decision making by the pharmacist. Following through by discussing the relevant information with the patient is an important professional responsibility.