Title: Happel v. Wal-Mart Stores, Inc.

State: illinois

Issuer: Illinois Supreme Court

Document:

Docket No. 90482-Agenda 20-September 2001.
HEIDI HAPPEL et al., Appellees, v. WAL-MART STORES, 								INC., d/b/a Wal-Mart Pharmacy, Appellant.
Opinion filed March 21, 2002.
	 
	JUSTICE McMORROW delivered the opinion of the court:
	The central issue in this appeal is whether a pharmacy has a
duty to warn about a known drug contraindication(1) where the
pharmacy is aware of a customer's drug allergies and knows that
the medication prescribed by the customer's physician is
contraindicated for a person with those allergies. Plaintiff Heidi
Happel, who is allergic to aspirin, ibuprofen, and acetaminophen,
experienced a severe reaction after taking Toradol, a pain reliever
prescribed by her physician, Dr. Zbigniew T. Lorenc. Toradol
should not be taken by persons who are allergic to aspirin and
other nonsteroidal anti-inflammatory drugs (NSAIDs). Heidi and
her husband, plaintiff Kent Happel, subsequently brought a
negligence action against Dr. Lorenc and Wal-Mart Stores, Inc.,
whose pharmacy in McHenry, Illinois, filled the prescription.
Plaintiffs settled with Dr. Lorenc, and the trial court granted Wal-Mart's motion for summary judgment. The appellate court
reversed (316 Ill. App. 3d 621), and we granted Wal-Mart's
petition for leave to appeal. 177 Ill. 2d R. 315. For the reasons set
forth below, we affirm the judgment of the appellate court.
BACKGROUND
	On August 4, 1993, Heidi called Dr. Lorenc's office
complaining of severe menstrual cramps. She sought a more
effective pain reliever, and Dr. Lorenc prescribed Toradol. His
office telephoned the prescription to the Wal-Mart pharmacy in
McHenry, Illinois. Dr. Lorenc had been treating Heidi since
December 1992, and he knew of her drug allergies. However, he
stated in his deposition that on August 4, 1993, he did not know
that Toradol was contraindicated for patients with allergies to
aspirin. If he had known this, he would not have prescribed
Toradol for Heidi.
	Prior to August 4, 1993, Heidi had been to the Wal-Mart
pharmacy in McHenry about six times to have other prescriptions
filled. Each time she went, pharmacy workers asked her if she had
any drug allergies, and each time she told them she was allergic to
aspirin, acetaminophen, and ibuprofen. Wal-Mart pharmacy
manager Steven Odes testified in his deposition that in August
1993, it was the pharmacy's policy and procedure to ask customers
about their known allergies prior to dispensing medication. The
purpose of this practice, Odes said, was to alert the pharmacist to
any drug interactions or allergies. Both Odes and Florence Bowser,
another of defendant's pharmacists, testified that Heidi's allergy
information was in the pharmacy's computer system and available
to pharmacists on August 4, 1993, when Heidi's Toradol
prescription was filled.
	Bowser testified in her deposition that she was working at the
Wal-Mart pharmacy on August 4, 1993, but she believed that Odes
was also on duty that day. Bowser took the call from Dr. Lorenc's
office and wrote down the Toradol prescription, but she did not
remember actually filling the prescription. She said she had "no
memory of the entire incident." Odes stated that he did not work
at the pharmacy on August 4, 1993, and that Bowser was the only
pharmacist on duty and therefore she filled the prescription. Odes
also stated that Bowser would have had available to her the
information that Toradol should not be given to patients with
allergies to aspirin or other NSAIDs. According to Odes, Bowser
"would know if there was a contraindication." Bowser indicated
that she was aware that Toradol was contraindicated for persons
who were sensitive to aspirin and ibuprofen.
	If the Toradol information was in the pharmacy's computer,
a "drug interaction" warning would have flashed across the screen,
halting the prescription process for customers such as Heidi for
whom Toradol was contraindicated. At that point, the pharmacist
was to call the physician and notify him of the contraindication.
Bowser did not remember calling Dr. Lorenc about Heidi's
prescription, nor did she remember seeing any documentation
indicating that she made such a call.
	If, after being notified of a contraindication, a physician
wanted the prescription filled anyway, the pharmacist would have
to override the computer system by entering a special code. Odes
testified that in order for Heidi's Toradol prescription to have been
filled on August 4, 1993, Bowser would have had to override the
system. He agreed that in such circumstances, to override the
computer and fill the prescription without first contacting the
physician would be a deviation from the standard of care
applicable to pharmacists. Bowser testified that a pharmacist is
required to know a customer's drug allergies and
contraindications.
	Once Heidi learned on August 4, 1993, that the prescription
had been called in to the Wal-Mart pharmacy, she telephoned her
husband, Kent, at work, and asked him to pick it up. Prior to this
date, neither she nor Kent had ever heard of Toradol, which is an
NSAID, as is aspirin. Kent went to the pharmacy to pick up the
prescription, but before it was filled, a pharmacy worker asked him
about Heidi's drug allergies. Kent informed the worker that Heidi
was allergic to aspirin, ibuprofen, and acetaminophen.
	There were directions on the bottle that Heidi received from
the pharmacy, but there was no warning about contraindications.
Heidi took the first dose of Toradol at about 4 p.m. on August 4,
and within 40 minutes she began to experience respiratory
problems including a tightness in her chest. She began a breathing
treatment with a nebulizer, and called the pharmacy to ask if she
could be having a reaction to Toradol. Her call was disconnected.
She called again, and was told that there should be no drug
reaction problem. Heidi then called a friend who was a pharmacist
and was aware of her allergies. He told her to begin a nebulizer
treatment if she had not already done so, and to go to the
emergency room if her condition worsened. She went to the
emergency room, and was found to be experiencing anaphylactic
shock.(2) Heidi testified in her deposition that, as a result of taking
Toradol, she subsequently experienced more frequent asthma
attacks, as well as seizures and a worsening of her multiple
sclerosis.
	On September 30, 1994, plaintiffs filed a negligence action
against Dr. Lorenc and Wal-Mart. On March 8, 1999, Wal-Mart
filed a motion for summary judgment, and on March 15, 1999,
plaintiffs settled with Dr. Lorenc and dismissed him from their
complaint. Plaintiffs then moved to amend their complaint to add
punitive damages claims. The trial court denied this request as
well as Wal-Mart's motion for summary judgment. Plaintiffs filed
an amended motion seeking to add punitive damages claims to
their complaint.
	Defendant Wal-Mart filed a motion to reconsider the denial
of summary judgment, arguing that there was no legal duty for it
to warn, and it did not voluntarily assume such a duty. On
September 17, 1999, the trial court granted summary judgment in
favor of defendant and denied plaintiffs' motion to amend their
complaint. On appeal, the appellate court reversed the granting of
summary judgment, concluding that defendant Wal-Mart owed
plaintiffs a duty to warn. 316 Ill. App. 3d 621. However, the court
made it clear that this duty was a narrow one:
		"[U]nder the circumstances here, where defendant knew
of Heidi's allergies, where defendant knew that Toradol
was contraindicated for a person with Heidi's allergies,
and where defendant knew that injury or death was
substantially certain to result, defendant had an
affirmative duty to disclose, either to Dr. Lorenc or to
Heidi, the information that Heidi should not take
Toradol." 316 Ill. App. 3d at 629.
The appellate court also affirmed the trial court's denial of
plaintiffs' motion to amend their complaint.
ANALYSIS
	After granting Wal-Mart's petition for leave to appeal (177 Ill.
2d R. 315), we granted leave to the National Association of Chain
Drug Stores to file an amicus curiae brief supporting defendant's
arguments. We also granted leave for the National Association of
Boards of Pharmacy (NABP) to file an amicus curiae brief
supporting plaintiffs' arguments. Thereafter, Wal-Mart filed a
motion before this court seeking to strike the NABP's brief for
including materials outside the record. See Zurich Insurance Co.
v. Raymark Industries, Inc., 118 Ill. 2d 23 (1987); Jenkins v. Wu,
102 Ill. 2d 468 (1984). We ordered the motion taken with the case.
We note that Wal-Mart had by motion objected to the same
materials before the appellate court. That court denied the motion.
Having reviewed the NABP's brief, we find, similar to the
appellate court, that the materials provided by the NABP are
relevant to standards of practice and care, and that such matters
were raised in pleadings and depositions in this case. We therefore
deny Wal-Mart's motion to strike the NABP's brief.
	This matter is before this court on Wal-Mart's motion for
summary judgment. In cases involving motions for summary
judgment, we conduct a de novo review of the evidence in the
record. Espinoza v. Elgin, Joliet & Eastern Ry. Co., 165 Ill. 2d 107, 113 (1995). The purpose of a summary judgment proceeding
is not to try an issue of fact, but to determine whether any genuine
issue of material fact exists. Frye v. Medicare-Glaser Corp., 153 Ill. 2d 26, 31 (1992); Housh v. Swanson, 203 Ill. App. 3d 377, 381
(1990). It is "a drastic means of disposing of litigation" (Espinoza,
165 Ill. 2d at 113) and therefore should be granted only when "the
pleadings, depositions, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment as
a matter of law" (735 ILCS 5/2-1005(c) (West 2000)). For
purposes of summary judgment, we construe the facts strictly
against the moving party and in the light most favorable to the
nonmoving party. Espinoza, 165 Ill. 2d  at 113; Frye, 153 Ill. 2d  at
31.
	As noted, the central issue before us concerns the existence of
a duty, i.e., whether defendant and plaintiffs stood in such a
relationship to each other that the law imposed upon defendant an
obligation of reasonable conduct for the benefit of plaintiffs. Kirk
v. Michael Reese Hospital & Medical Center, 117 Ill. 2d 507, 525
(1987); Ward v. K mart Corp., 136 Ill. 2d 132, 140 (1990). " ' "A
duty to warn exists where there is unequal knowledge, actual or
constructive [of a dangerous condition], and the defendant[,]
possessed of such knowledge, knows or should know that harm
might or could occur if no warning is given." ' " [Citation.]
Schellenberg v. Winnetka Park District, 231 Ill. App. 3d 46, 52
(1992), quoting Pitler v. Michael Reese Hospital, 92 Ill. App. 3d
739, 745 (1980), quoting Kirby v. General Paving Co., 86 Ill. App.
2d 453, 457 (1967). "Whether a duty exists in a particular case is
a question of law to be determined by the court." Ward, 136 Ill. 2d 
at 140; Kirk, 117 Ill. 2d  at 525.
	In determining whether a duty exists, courts look to certain
relevant factors. These include: (1) the reasonable foreseeability
that the defendant's conduct may injure another, (2) the likelihood
of an injury occurring, (3) the magnitude of the burden of guarding
against such injury, and (4) the consequences of placing that
burden on the defendant. Ward, 136 Ill. 2d at 140-41; Kirk, 117 Ill.
2d at 525-26; Colonial Inn Motor Lodge, Inc. v. Gay, 288 Ill. App.
3d 32, 40 (1997).
	It is undisputed that, at the time Heidi's prescription was filled
on August 4, 1993, Wal-Mart was aware not only of Heidi's drug
allergies, but also that the drug prescribed by Dr. Lorenc, Toradol,
was contraindicated for persons such as Heidi who are allergic to
aspirin. Given this superior knowledge on the part of Wal-Mart,
and particularly given the nature of the knowledge, i.e., that
Toradol was contraindicated, it was reasonably foreseeable that a
failure to convey this knowledge might result in injury to Heidi.
Both the likelihood and the reasonable foreseeability of injury here
were great. These factors thus favor the imposition of a duty on
Wal-Mart.
	The burden on defendant of imposing this duty is minimal.
All that is required is that the pharmacist telephone the physician
and inform him or her of the contraindication. Alternatively, the
pharmacist could provide the same information to the patient.
Since this burden of warning about a contraindication is extremely
small, this factor also favors the imposition of a duty here.
	Next, we consider the consequences of imposing a duty to
warn on defendant. As is discussed more fully below, defendant
is not being asked to learn the customer's condition, nor is
defendant being required to render a medical judgment or interject
itself into the doctor-patient relationship. Instead, Wal-Mart need
only pass along to the customer or the physician the information
it already possesses about the contraindication for this specific
customer. Such a practice apparently was already being followed
at the Wal-Mart pharmacy in McHenry. Bowser testified in her
deposition that prior to August 1993 she had had occasion "once,
twice a month" to notify a physician about a patient's drug
allergies. In these circumstances, the recognition of a duty to warn
would simply require Wal-Mart to continue with a practice it was
already engaged in.
	Wal-Mart contends that imposing a duty to warn here would
have a "chilling effect" on pharmacies and their customers.
According to Wal-Mart, because the duty to warn is premised on
the pharmacy's knowledge of a customer's allergies, the
imposition of such a duty may discourage pharmacies from
gathering information about customers' allergies in the first
instance. In order to avoid this duty, pharmacies will no longer
request allergy information or record it in their computers. Thus
the pharmacy's customers will be deprived of potentially
beneficial warnings. Therefore, Wal-Mart contends, no duty
should be recognized. We disagree.
	The consequence of accepting Wal-Mart's "chilling effect"
argument would be to sanction the status quo, where pharmacies
solicit allergy information from their customers but are under no
obligation to follow through with a warning, even where the
pharmacy knows that the drug being prescribed is contraindicated
for the individual customer. The difficulty with this approach is
that the status quo is unacceptable. By asking customers about
their drug allergies, the pharmacy is engendering reliance in the
customer that the pharmacy will take steps to ensure that the
customer does not receive a drug to which the customer is allergic.
There can be no other reason for a pharmacy's seeking this
information regarding drug allergies. Where the pharmacy fails to
warn the customer, then the customer is placed at risk of serious
injury or death.
	We do not disapprove of pharmacies' collecting allergy
information and recording it in their computers. However, if a
pharmacy chooses to engage in such a practice, it must also warn
of known contraindications. The alternative, as noted, would place
the customer at serious risk. We therefore conclude that any
negative consequences of recognizing a duty to warn here are far
outweighed by the substantial reasons favoring such a duty.
Accordingly, this factor also supports the imposition of a duty on
Wal-Mart.
	We think that, given the circumstances in this case, Wal-Mart
had a duty to warn and that this duty is encompassed within the
pharmacist's duty of ordinary care. See Eldridge v. Eli Lilly & Co.,
138 Ill. App. 3d 124, 126 (1985) ("A pharmacist owes a duty of
ordinary care in practicing his profession, but such care requires
the highest degree of prudence, thoughtfulness and diligence, and
it is proportioned to the danger involved"). As noted, Wal-Mart
was aware not only of Heidi's drug allergies, but also that Toradol
was contraindicated for persons with such allergies. A
contraindication is a serious limitation on a drug's use, necessarily
implying grave consequences if it is ignored. As one court has
noted, a contraindication refers to "a circumstance under which the
drug must never be given." Hand v. Krakowski, 89 A.D.2d 650,
651, 453 N.Y.S.2d 121, 123 (1982), cited with approval in McKee
v. American Home Products Corp., 113 Wash. 2d 701, 715, 782 P.2d 1045, 1053 (1989). Taking into account the potentially severe
consequences of a failure to warn in this case, we conclude that
imposing on Wal-Mart a duty to warn is clearly proportionate to
"the danger involved." Eldridge, 138 Ill. App. 3d at 126.
	Notwithstanding the foregoing, Wal-Mart argues that the
appellate court below erred in finding that Wal-Mart had a duty to
warn Heidi or Dr. Lorenc about the Toradol contraindication. Wal-Mart contends that because Illinois has adopted the learned
intermediary doctrine, under which the prescribing physician has
the primary responsibility to warn of drug interactions and side-effects, pharmacies in Illinois have no such duty. According to
Wal-Mart, "[t]he learned intermediary doctrine exempts
pharmacists and pharmacies from giving warnings to patients."
Accordingly, Wal-Mart contends that, absent any duty to warn on
Wal-Mart's part, the trial court was correct in granting summary
judgment in defendant's favor, and the appellate court's reversal
of this judgment was in error. We disagree.
	In support of its argument, Wal-Mart relies upon several
Illinois cases, including Kirk v. Michael Reese Hospital & Medical
Center, 117 Ill. 2d 507 (1987), wherein this court adopted the
learned intermediary doctrine. In Kirk, the plaintiff was injured
while riding as a passenger in a car driven by Daniel McCarthy,
who had been a psychiatric patient at the defendant hospital.
Certain prescription drugs were given to McCarthy on the day he
was discharged from the hospital. On that same day, McCarthy
consumed an alcoholic beverage. Later in the day, the car he was
driving hit a tree, injuring the plaintiff. In his complaint, which
named as defendants the hospital, the prescribing physicians, the
manufacturers of the prescription drugs, and McCarthy, the
plaintiff alleged, inter alia, that the hospital negligently failed to
adequately warn McCarthy that the prescribed drugs would
diminish his physical and mental abilities. The trial court
dismissed the counts against most of the defendants, but the
appellate court reversed and remanded the dismissed counts for
trial.
	In reversing the appellate court and affirming the trial court's
decision, this court relied in part upon the learned intermediary
doctrine. Under this rule, "manufacturers of prescription drugs
have a duty to warn prescribing physicians of the drugs' known
dangerous propensities, and the physicians, in turn, using their
medical judgment, have a duty to convey the warnings to their
patients." Kirk, 117 Ill. 2d  at 517. The underlying rationale of the
learned intermediary doctrine is that, with regard to prescription
drugs, which are likely to be complex medicines, it is the
prescribing physician who knows both the propensities of the drug
and the susceptibilities of his patient, and who therefore is in the
best position to prescribe a particular drug for the patient.
Accordingly, while drug manufacturers must warn the ultimate
purchasers about the dangers inherent in patent drugs sold over the
counter, the manufacturer need not warn the individual consumer
about the dangers of prescription drugs. In selling these drugs, the
manufacturer is required to warn only the prescribing physician,
who then acts as a " ' "learned intermediary" ' " between the
manufacturer and the consumer. Kirk, 117 Ill. 2d  at 518, quoting
Stone v. Smith, Kline & French Laboratories, 731 F.2d 1575, 1580
(11th Cir. 1984), quoting Reyes v. Wyeth Laboratories, 498 F.2d 1264, 1276 (5th Cir. 1974).
	Based on this doctrine, the court in Kirk held that the
defendant drug manufacturers had no duty to warn patients
directly. The court came to the same conclusion with regard to the
defendant hospital:
		"The extent of warnings to patients concerning
prescription drugs, as we have previously noted, is within
the discretion of the physician. As such, the alleged
negligent acts specified in the complaint are matters
within the duty of care owed by the treating physician,
rather than the hospital." Kirk, 117 Ill. 2d  at 524.
	While the hospital might appear to have been acting in the
role of a pharmacy, the court in Kirk did not directly address the
question of whether the learned intermediary doctrine applied to
pharmacies.(3) However, in the following year that question was
addressed by our appellate court. In Leesley v. West, 165 Ill. App.
3d 135 (1988), a decision also relied upon by Wal-Mart, the
second district appellate court applied the learned intermediary
doctrine to pharmacists, and held that the defendant pharmacy had
no duty to pass on to a customer relevant warnings given to it by
the manufacturer of a prescription drug. The plaintiff in Leesley
sued for damages resulting from severe gastrointestinal bleeding
caused by the prescription drug Feldene. In her complaint, the
plaintiff alleged, inter alia, that both the drug manufacturer and
the pharmacy that filled the prescription failed to warn her directly
about the potential hazards of the drug, including gastrointestinal
bleeding, which is a known but infrequent side effect of Feldene.
	The court in Leesley held that, based in part on the learned
intermediary doctrine, neither the manufacturer nor the pharmacy
had a duty to warn the customer directly of the potential side
effects of Feldene. With regard to the pharmacy, the court
explained that the foreseeability of injury to an individual
consumer "varies greatly depending on the medical history and
condition of the individual-facts which we cannot reasonably
expect the pharmacist to know." Leesley, 165 Ill. App. 3d at 142.
The court in Leesley also noted that it would be "very
burdensome" to require the pharmacy to convey to its customers
the warnings it received from the manufacturer. Such a
requirement might very well mean that pharmacists "must bear the
additional costs of reproducing the material they receive." Leesley,
165 Ill. App. 3d at 142.
	Other cases relied upon by Wal-Mart include Eldridge v. Eli
Lilly & Co., 138 Ill. App. 3d 124 (1985), and Fakhouri v. Taylor,
248 Ill. App. 3d 328 (1993), both of which address the question of
whether a pharmacist has a duty to warn that drugs are being
prescribed in excessive quantities. In each case, the court pointed
to the learned intermediary doctrine in concluding that no such
duty exists.
	Relying on the foregoing and similar cases, Wal-Mart
contends that the learned intermediary doctrine precludes the
imposition of a duty to warn here. We disagree. Given the
particular facts in the instant case, we conclude that this case is
outside the purview of the learned intermediary doctrine.
	As noted, the rationale underlying the learned intermediary
doctrine is that because the prescribing physician has knowledge
of the drugs he is prescribing and, more importantly, knowledge
of his patient's medical history, it is the physician who is in the
best position to prescribe drugs and monitor their use. Thus
manufacturers of these drugs should not be required to warn
individual patients of the dangers inherent in their use. That is the
proper province of the prescribing physician, not the drug
manufacturer, who has a duty only to warn the physician.
	It is this rationale which underlies the reasons cited by the
courts in Leesley, Eldridge and Fakhouri in explaining why
pharmacists should not have a duty to warn a patient or physician
of the adverse side effects of prescription drugs. Imposing such a
duty, the court in Eldridge noted, "would require the pharmacist
to learn the customer's condition and monitor his drug usage. To
accomplish this, the pharmacist would have to interject himself
into the doctor-patient relationship and practice medicine without
a license." Eldridge, 138 Ill. App. 3d at 127. Similarly, the court
in Fakhouri asserted that "[d]etermining which medication is to be
utilized in any given case requires an individualized medical
judgment, which, in our opinion, only the patient's physician can
provide." Fakhouri, 248 Ill. App. 3d at 332. The court noted that
it is the physician who presumably knows the patient's current
condition as well as his complete medical history. Therefore, the
court in Fakhouri explained, "[t]o impose a duty to warn on the
pharmacist would be to place the pharmacist in the middle of the
doctor-patient relationship, without the physician's knowledge of
the patient." (Emphasis in original.) Fakhouri, 248 Ill. App. 3d at
332-33. Along these same lines, the court in Leesley noted that a
pharmacist cannot reasonably be expected to know the medical
history and condition of the individual consumer, and therefore
should not have a duty to warn individual consumers.
	These reasons for not imposing a duty to warn on pharmacists
do not apply in the instant case. Here, Wal-Mart was aware not
only of Heidi's drug allergies, but also that Toradol was
contraindicated for persons such as Heidi with allergies to aspirin.
Imposing a duty to warn of this contraindication would not require
the pharmacist to "learn the customer's condition and monitor his
drug usage." Eldridge, 138 Ill. App. 3d at 127. On the contrary,
Wal-Mart already had the knowledge it needed in order to give an
effective warning, and this warning required Wal-Mart only to
notify Dr. Lorenc or Heidi of the Toradol contraindication, not to
monitor Heidi's drug usage.(4) Further, imposing a duty to warn
here would not have intruded Wal-Mart into the doctor-patient
relationship, forcing it to "practice medicine without a license."
Eldridge, 138 Ill. App. 3d at 127. We agree with the appellate
court below that "[t]his is not a case in which the plaintiff is
asking the pharmacist to exercise any modicum of medical
judgment or to interject himself into the doctor-patient
relationship." 316 Ill. App. 3d at 627-28.
	The situation here differs from that in Fakhouri and Eldridge,
where imposing the duty that the plaintiff sought would have
required the pharmacist to warn that drugs were being prescribed
in excessive quantities. As the court in Eldridge aptly noted, "[a]
prescription which is excessive for one patient may be entirely
reasonable for the treatment of another." Eldridge, 138 Ill. App. 3d
at 127. Hence, imposing upon a pharmacist a duty to warn in such
a situation might arguably require him to make a medical
judgment. Here, the pharmacist was faced not with a prescription
for a quantity in excess of normal use, but rather with a simple
contraindication, which, as noted, means that the drug should not
be given. See Hand v. Krakowski, 89 A.D.2d 650, 651, 453 N.Y.S.2d 121, 123 (1982); Webster's Third New International
Dictionary 495 (1993). It requires no medical judgment simply to
notify a physician or a patient of such a contraindication.
	Contrary to Wal-Mart's contentions, the scope of the
protection provided to pharmacists by the learned intermediary
doctrine is limited, particularly in situations such as the instant
case where a pharmacy has knowledge that a prescribed
medication is contraindicated for a specific customer. With the
exception of the appellate decision below in the case at bar, we
have found no Illinois decisions addressing the question of a
pharmacist's duty to warn in these circumstances. However, courts
in other jurisdictions have addressed either this or similar issues.
We find the decision in Morgan v. Wal-Mart Stores, Inc., 30 S.W.3d 455 (Tex. Ct. App. 2000), particularly instructive with
regard to the limitations of the learned intermediary doctrine in
situations similar to the case at bar.
	The plaintiffs in Morgan sued Wal-Mart Stores, Inc., alleging
that their son's death in August 1993 resulted from an adverse
reaction to Desipramine, a prescription drug sold by a Wal-Mart
pharmacist. The plaintiffs alleged that Wal-Mart was negligent in
failing to properly warn of the hazards and harms associated with
the use of Desipramine. The jury agreed, finding that Wal-Mart's
failure to warn was negligent, and that this failure was a proximate
cause of the son's death. On appeal, Wal-Mart argued, as it does
here, that its pharmacists had no duty to warn of the potential
dangers of Desipramine because that duty rested with the
prescribing physician.
	The appellate court in Morgan reversed the trial court,
concluding that pharmacists have no generalized duty to warn of
potential adverse reactions to prescription drugs. However, in
reaching this conclusion, the court made clear the limitations in its
holding. It noted specifically that the plaintiffs had not alleged that
Wal-Mart possessed any special knowledge of their son's medical
history that would have imposed upon Wal-Mart a duty to warn.
In addition, the plaintiffs did not contend "that Wal-Mart was or
should have been aware of any contraindications." Morgan, 30 S.W.3d  at 467. The court in Morgan pointed to decisions in other
jurisdictions where a duty was imposed on pharmacists "beyond
accurately filing [sic] prescriptions *** based on the presence of
additional factors, such as known contraindications, that would
alert a reasonably prudent pharmacist to a potential problem."
(Emphasis added.) Morgan, 30 S.W.3d  at 466.
	The court acknowledged that Wal-Mart might have been
liable if there had been "neglect in the face of information on
which a reasonably prudent pharmacist would have acted."
Morgan, 30 S.W.3d  at 467. In the absence of such information,
however, there was no liability. Hence, the court's carefully
worded holding in Morgan:
		"[I]n light of the learned intermediary doctrine, which we
find applicable to the relationship among physician,
patient, and pharmacist, we hold that pharmacists have no
generalized duty to warn patients of potential adverse
reactions to prescription drugs absent some special
circumstances not present here." (Emphasis added.)
Morgan, 30 S.W.3d  at 469.
	In the instant case, by contrast, such "special circumstances"
were present. It is undisputed that Wal-Mart had "special
knowledge" of Heidi's medical history, i.e., her drug allergies. In
addition, Wal-Mart knew that Toradol was contraindicated for
persons such as Heidi with allergies to aspirin and other NSAIDs.
In such limited circumstances, a narrow duty to warn clearly
exists. See McKee v. American Home Products Corp., 113 Wash. 2d 701, 715, 782 P.2d 1045, 1053 (1989) (agreeing that
"pharmacists should have a duty to be alert for patent errors in a
prescription, [including] *** known contraindications *** and to
take corrective measures" (emphasis omitted)).
	For the reasons set forth above, we hold that a narrow duty to
warn exists where, as in the instant case, a pharmacy has patient-specific information about drug allergies, and knows that the drug
being prescribed is contraindicated for the individual patient. In
such instances, a pharmacy has a duty to warn either the
prescribing physician or the patient of the potential danger.
	Because of our disposition on the duty of the pharmacy, we
need not address Wal-Mart's argument that it engaged in no
voluntary undertaking to warn, and therefore did not remove itself
from the protection of the learned intermediary doctrine. See
Kasin v. Osco Drug, Inc., 312 Ill. App. 3d 823, 827 (2000)
(concluding that under Frye v. Medicare-Glaser Corp., 153 Ill. 2d 26 (1992), the learned intermediary doctrine no longer applies
once a pharmacist voluntarily undertakes to warn a consumer of a
drug's dangerous propensities). The duty we impose here is
beyond the scope of the learned intermediary doctrine. Thus it is
irrelevant whether Wal-Mart removed itself from the protection of
this rule. The learned intermediary doctrine is simply not
implicated by the circumstances in this case.
CONCLUSION
	Because we have concluded that Wal-Mart owed a narrow
duty to warn in this case, there remains a genuine issue of material
fact as to whether Wal-Mart breached this duty, and if so, whether
this breach proximately caused Heidi's injuries. Summary
judgment therefore was improper. Accordingly, we affirm the
judgment of the appellate court below, which reversed the trial
court's granting of summary judgment and remanded the cause for
further proceedings.
	Affirmed.
1.      1The term "contraindication" is defined as "an indication, symptom,
or condition that makes inadvisable a particular treatment or procedure."
Webster's Third New International Dictionary 495 (1993). 

2.      2"Anaphylactic" is derived from the term "anaphylaxis," which is
defined as "hypersensitivity (as to foreign proteins or drugs) ***
manifested in man in acute serum sickness and in severe or fatal
reactions to second or later administrations of certain drugs." Webster's
Third New International Dictionary 78 (1993). In her deposition,
Florence Bowser defined "anaphylactic shock" as follows: "It means the
internal organs can swell, breathing passages can swell and the person
can die." 

3.      3The court in Kirk did state in dictum that "negligence claims against
pharmacists for failure to warn concerning overconsumption of drugs
have been dismissed primarily because the manufacturers' warnings
about prescription drugs are to be given to the physicians, who then had
the duty to warn the patients." Kirk, 117 Ill. 2d  at 526. 

4.      4We note that the Pharmacy Practice Act of 1987 (225 ILCS 85/1 et
seq. (West 2000)) defines "Pharmaceutical care" as including "the act
of monitoring drug use." 225 ILCS 85/3(t) (West 2000). The narrow
duty we impose here would not require the pharmacist to conduct such
monitoring.