Opinion ID: 2395066
Heading Depth: 1
Heading Rank: 4

Heading: Portland Prescription Shop The Pharmacy

Text: Portland Prescription Shop takes the position that it owed no duty to a non-customer user of an unavoidably dangerous prescription drug dispensed by it and, further, that it fulfilled the only duty owed its customer, to fill the prescription according to the physician's order. If the only duty owed by the pharmacy was to fill the prescription correctly, there would be no duty owed to a non-customer because, obviously, the pharmacy would have no higher duty to a non-customer than to a customer. But, as stated previously, the law imposes upon all persons the duty to use reasonable care under the circumstances. Supra at 428. Pharmacists have a duty to exercise the standard of care required of the pharmacy profession in the same or similar communities. Dooley v. Everett, 805 S.W.2d 380, 385 (Tenn. Ct. App. 1990). The Court of Appeals in Dooley properly rejected the defense of learned intermediary where the pharmacist failed to warn a customer of the danger of one prescription drug interacting with another drug prescribed by the same physician. The court held that whether the duty to discover and warn customers of potential drug interactions is included within the general scope of the duties a Tennessee pharmacist owes to its customers was a disputed, material fact and reversed a summary judgment for the pharmacist. Id. at 385, 386. The court in Dooley found that the statutory definition of the practice of pharmacy was helpful in determining the duty owed by a member of the profession. The court referred to T.C.A. § 63-10-101(d) and (e)(6), which are as follows: (d) The practice of pharmacy in this state is declared a professional practice affecting the public health, safety and welfare and is subject to regulation and control in the public interest and concern that the practice of pharmacy, as defined in this chapter, merit and receive the confidence of the public and that only qualified persons be permitted to practice pharmacy in this state. (e) As used in this chapter: ..... (6) Practice of pharmacy means the practice of that profession concerned with the art and science of preparing, compounding and dispensing of drugs and devices, whether dispensed on the prescription of a medical practitioner or legally dispensed or sold directly to the ultimate consumer, and includes the proper and safe storage and distribution of drugs, the maintenance of proper records therefor, and the responsibility of relating information as required concerning such drugs and medicines and their therapeutic values and uses in the treatment and prevention of disease. (Emphasis added.) The court further found in Dooley : The pharmacist is a professional who has a duty to his customer to exercise the standard of care required by the pharmacy profession in the same or similar communities as the community in which he practices his profession. Dooley v. Everett, 805 S.W.2d at 385. Similarly, pharmacists themselves have recognized: The increased complexity of pharmacotherapeutics and the accompanying adverse reactions to drugs and interactions between drugs have resulted in an expanded role for pharmacists as drug therapy counselors. A pharmacist's formal education stresses patient counseling as an integral role in health care. Leadership within the profession advocates continued expansion into new areas of patient education. A trend toward patient-oriented clinical pharmacy practice, which was opposed initially by many pharmacists, now appears to have firmly taken hold. Brushwood, The Informed Intermediary Doctrine and the Pharmacist's Duty to Warn, 4 J.Legal Med. 349, 351 (1983). The plaintiffs introduced proof concerning the practice and custom of other pharmacies with regard to dispensing Micronase. Another pharmacy in Portland Prescription Shop's trade area provides its customers with the following precautions concerning the drug: If any of the information in this leaflet causes you special concern or if you want more information about your medicine or its use, check with your doctor, nurse or pharmacist. REMEMBER, KEEP THIS AND ALL OTHER MEDICINES OUT OF THE REACH OF CHILDREN AND NEVER SHARE YOUR MEDICATION WITH OTHERS. The leaflet also warns customers to be on the lookout for hypoglycemia, describes hypoglycemia's symptoms, and informs the customer of steps to take should the symptoms appear. Pursuant to the authority of T.C.A. § 63-10-102, the Board of Pharmacy of the State of Tennessee has promulgated certain rules and standards of practice. These rules provide: A pharmacist should, on dispensing a new prescription, explain to the patient or the patient's agent the directions for the use and a warning of all effects of the medication or device that are significant and/or potentially harmful. This communication should be performed in such a manner that will assure the proper use of the medication or device prescribed. 7 Tenn. Comp. R. & Regs. 1140-3-.03(13) (1991). Although the rules and standards of practice promulgated by the Board of Pharmacy do not necessarily establish the duty of care owed by the pharmacy in this case, they are relevant to the issue and may provide guidance in determining if there is a duty of care under the circumstances. Cf. Lazy Seven Coal Sales v. Stone & Hinds, 813 S.W.2d 400, 405 (Tenn. 1991). In this case, the pharmacy had been advised by the manufacturer of the potential dangers of Micronase. Supra at 429-430. It knew of the manufacturer's urging that the patient and the patient's family members be advised of the symptoms and dangers of complications that might arise from the use of Micronase. The prescription given by Dr. Simonton to the pharmacy did not include a warning to be placed on the label. The pharmacy took no action to alert the physician to the need for a warning and provided no warning itself. The pharmacy acceded to its customer's request that the drug be dispensed in a bottle without a child-proof safety cap without giving any warning of the dangers posed by Micronase. The record shows that the duty owed Richards was greater than merely filling the physician's prescription correctly. As indicated by the evidence in the record, Micronase posed a danger to Richards even if taken according to the physician's order. The pharmacy's customer was not aware of that danger because she had not been advised by either the physician, who prescribed the unavoidably unsafe drug, or the pharmacy which dispensed the drug. A significant factor affecting the pharmacy's duty was the knowledge that no warning had been given by the physician. Under these circumstances, it was reasonably foreseeable that Richards was at risk of injury. Consequently, the pharmacy, as well as the physician, owed her the duty to warn. The issue now is whether the duty to warn extended to the plaintiff in this case. Because of the significance of foreseeability in the law's imposition of duty, and because the dangers posed in this case by Micronase were equally foreseeable to the physician and the pharmacist, the discussion of the duty owed by the physician, supra at 433, is relevant, in principle, to the duty owed by the pharmacy. For the reasons discussed above, the plaintiff has failed to show that the injury was reasonably foreseeable. Consequently, the duty to warn of the danger posed by the drug did not extend to the plaintiff, and the pharmacy is entitled to summary judgment. The judgment of the Court of Appeals granting summary judgment to each of the defendants is affirmed. Costs are taxed to the plaintiffs. ANDERSON, C.J., and DROWOTA, O'BRIEN and BIRCH, JJ., concur.