Drug Topics - December 12, 2008 - (Page 46)

Continuing Education IMPLICATIONS FOR PHARMACY PRACTICE adopted in Massachusetts, does not eliminate a pharmacist’s duty to warn a particular customer of the potentially adverse interaction of two drugs which the pharmacist knows the customer is taking.” The Brienze case illustrates how one state court has determined, under speciﬁc circumstances, that the pharmacist’s legal responsibility extends beyond accurately dispensing prescription medications to include a duty to warn. Although the facts of the Brienze case are very similar to the Walker case, Brienze involves two drugs that were ﬁlled within days, not months, of each other. However, like Walker, Brienze also fails to provide further clariﬁcation, outside the speciﬁc facts of the case, as to what would constitute “knowledge” on behalf of the pharmacist or what type of potential interaction would impose a legal duty upon the pharmacist to warn the patient. For example, under Brienze, when would the pharmacist no longer be responsible for knowing the other drugs the patient is taking? Would the court have made the same analysis and decision in Brienze if the theophylline prescription had been ﬁlled six months before the ciproﬂoxacin was ﬁlled, as occurred in Walker? Discussion When it comes to potentially harmful interactions between prescription medications, one hopes that most pharmacists follow on a daily basis the practices suggested by the court in Brienze and the dissenting judge in Walker. By reviewing patient pharmacy records, inquiring when necessary, and alerting the patient and/or prescriber, the pharmacist provides a safety net in situations where there is potential for harmful drug interactions. However, in light of the fact that the Walker case found the pharmacist had no legal duty under the circumstances, but the Brienze case found otherwise, how should these cases be interpreted and applied to future similar circumstances for pharmacists? From a legal perspective, what time frame would be reasonable for a pharmacist to monitor a patient’s drug use for potentially harmful interactions or to ask whether the patient is still taking other medications? What types of interactions or side effects would require an intervention or warning by the pharmacist? In light of the uncertainty of these questions and because numerous courts are moving toward accepting the principle that pharmacists have a duty to warn under certain circumstances, pharmacists should consider the importance of warning patients in those instances where courts have determined pharmacists have a legal duty to warn. Duty to warn: Recommendations There is a body of published case law from the state courts that have addressed the issue of whether a pharmacist has a legal duty to warn. Although there are legal inconsistencies between the states, the cases can guide determination of how the profession should approach the duty-to-warn matter. Regarding a pharmacist’s duty to warn, practicing pharmacists should consider the following recommendations: Pharmacists should realize that the duty-to-warn standard varies from jurisdiction to jurisdiction. While one state may consider pharmacists to have a duty to warn, other states may not. Also, the circumstances that may require a pharmacist to warn may vary from state to state. Pharmacists should be aware of the circumstances in which they could be held to have a duty to warn. Although the courts have been slow to apply the duty-to-warn standard to pharmacists, this standard is becoming more widely accepted. While most cases hold that pharmacists do not have a general duty to warn patients about potential side effects, state courts continue to ﬁnd that pharmacists may have a duty to warn under speciﬁc circumstances. Pharmacists should not rely on simply a “counting, pouring, licking, and sticking” standard as a shield from civil liability. Although accuracy is still an essential function for pharmacists, courts are continuously recognizing that pharmacists have additional legal duties. Pharmacists should comply with federal and state requirements that may have an impact upon their duty to warn. With the advent of federal and state legislation, including OBRA ’90, pharmacists are expected to check for drug interactions, correct dosing, and drug-disease contraindications, among other things. Failure to meet these obligations may result in legal liability. Pharmacists should act on potential contraindications or adverse reactions. When a potential contraindication or adverse reaction is foreseeable on the part of the pharmacist, the pharmacist may be found negligent if he/she fails to take proper action. Pharmacists should ensure that, when they advertise or voluntarily undertake a duty to check for drug interactions, this responsibility is met. Failure to perform this service may lead to pharmacist liability. Pharmacists should always provide patients with available or regulated written drug information. However, simply providing patient information sheets does not shield the pharmacist from potential liability. Pharmacists should always consult the patient’s physician when a question arises. Although some courts have held that this practice has the potential to interfere with the physicianpatient relationship, failure to follow it could result in pharmacist liability for patient harm. Pharmacists should always counsel patients and answer any questions they might have. Summary Although most courts have yet to hold that pharmacists have a duty to warn their patients, practice standards are changing. Owing to their increased knowledge and responsibility in practice, pharmacists will be held to a higher legal standard, a standard that will eventually include a duty to warn. Pharmacists should not rely on inconsistent legal standards to determine their level of professional practice; rather, they should provide these services to all patients. W W W.D R U GTO P I C S .C O M 46 DRUG TOPICS D E C . 15, 2008 http://WWW.DRUGTOPICS.COM

Table of Contents Feed for the Digital Edition of Drug Topics - December 12, 2008

Drug Topics - December 12, 2008 Contents Up Front Up Front In Depth Letters Health-System Edition Cover Story: Controlled Substance Disposal a Growing Problem for Hospitals Pharmacists Hope for Speedy Approvals Deaths from C. Difficile Increasing PharmMD Teams with HealthSpring RX Care Commentary Ohio Hospital Automates Pharmacy The Business Outlook for 2009 OTC The Pharmacist's Duty to Warn: Implications for Pharmacy Practice New Products Viewpoint

Drug Topics - December 12, 2008

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