About the Author
Joseph L. Fink III, JD, DSc (Hon), BSPharm, FAPhA, is emeritus professor of pharmacy law and policy and former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.
Publication
Article
Had the pharmacy established safe opioid prescribing policies?
Issue of the Case
During his senior year of high school, a football player injured his shoulder and required surgery for a torn rotator cuff. He later died from a drug overdose, leading his family to file a lawsuit against the pharmacy that provided postsurgical opioid medications.
The Facts of the Case
The injury occurred during the fall of 2009. During the 2 months following the injury, the young man received prescriptions for a total of 260 opioid tablets, all of which were dispensed at the defendant pharmacy. He died in 2017 from abuse of oxycodone and fentanyl among other medications, and his family filed a lawsuit claiming that the original opioid dispensing launched his opioid use disorder. He had entered rehabilitation programs 5 times between 2009 and 2017.
Joseph L. Fink III, JD, DSc (Hon), BSPharm, FAPhA, is emeritus professor of pharmacy law and policy and former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.
The lawsuit, filed in the name of the young man’s estate, advanced arguments alleging negligence and wrongful death, among other claims. A central issue was whether the pharmacy chain had established and implemented proper policies to address such prescribing and dispensing practices. Specific arguments focused on whether the pharmacy had a “Good Faith Practices Policy” that was followed, which would include contacting the prescriber, an oral consultation with the patient, and warnings about duplicative therapy.
The defendant pharmacy chain filed a motion requesting that the judge issue a summary judgment in its favor. The pharmacy chain advanced several arguments to support this motion, including that the lawsuit was filed too late and that the attorneys for the estate could not demonstrate that the prescriptions were the proximate cause of the injury or untimely death of the young man. The trial court judge granted that motion, and the estate (parents) appealed.
The Court’s Reasoning
A 3-judge panel at the state court of appeals reversed the decision of the trial court judge, thereby reinstating the lawsuit. The panel reviewed the information and concluded the attorneys for the estate had indeed presented sufficient evidence to support a factual dispute regarding the man’s cause of death. An affidavit from a medical specialist in addiction, pain, and emergency medicine had been presented during the proceedings at the trial court level. The trial court judge erred when he disregarded that submission, thereby undercutting the fact that there was in fact a genuine dispute regarding 1 or more material facts.
The court of appeals concluded that there were reasonable disputes regarding the facts. Did the pharmacy’s alleged over-dispensing instigate the chain of events that caused the young man’s addiction? Were the opioids a suitable choice or needed at all to manage his pain? Did the pharmacy staff contact the prescriber for clarification? And was the amount of opioids dispensed appropriate under the circumstances?
The court of appeals reversed the decision of the trial court, granting summary judgment in favor of the pharmacy chain and remanding the matter for further proceedings at the trial court level. The court stated that it was easy “to see how the trial court misconstrued the facts regarding causation in this case. To be sure, the period between the dispensing of the drugs to the decedent’s overdose is significant. However, addiction is a ‘long-term, chronic, and relapsing disease’ that is complex to assess in this context.” The 3-judge appellate panel concluded that issues of fact did exist as to whether the pharmacy’s actions played a pivotal or instigating role in the death of the young man, a decision to be made by members of a jury following a full trial.