Opinion ID: 2331217
Heading Depth: 1
Heading Rank: 6

Heading: duty to third parties in prescribing medication

Text: We next consider the plaintiff's argument that Dr. Magee owed a duty of care to the Burroughses (as members of the motoring public) in making his decision to prescribe the two drugs to Mr. Hostetler. The plaintiff asserts that a balancing of the factors summarized above in the context of the duty to warn leads to the conclusion that Dr. Magee also owed a duty to consider the risks to third parties when prescribing the medications to Mr. Hostetler. The plaintiff argues that the office note dated August 8, 1995 (in which Dr. Magee's colleague stated his concern that Hostetler was abusing Soma while driving a truck) establishes that there was a foreseeable probability of the harm that occurred in this case. As we discussed above, we agree with Mrs. Burroughs on this point. The office note written by Dr. Magee's colleague clearly refutes any argument that it was not foreseeable that Mr. Hostetler might be involved in an accident. The implicit but plain meaning of that note is that Mr. Hostetler posed a danger to himself and/or others by continuing to driv[e] a rig on the highways across the country while taking Soma. However, as discussed above, the answer to the question of whether the harm or injury was foreseeable is not dispositive in determining the existence of a legal duty. Both Dr. Magee and the TMA argue that policy reasons outweigh any other factors that might support a finding that a physician owes a duty to third parties in making prescription decisions. In holding that Dr. Magee did not owe the Burroughses a duty of care in making his decision to prescribe the two drugs to Mr. Hostetler, the Court of Appeals relied upon Webb v. Jarvis, 575 N.E.2d 992 (Ind.1991). In Webb , the defendant physician prescribed anabolic steroids to a patient. The plaintiff alleged that the steroids caused the patient to turn into a toxic psychotic who was unable to control his rages and that the patient, during such a rage, shot and injured the plaintiff. The plaintiff sued the physician, alleging that he was negligent in over-prescribing anabolic steroids to the patient. The plaintiff urged the court to find an affirmative duty on the part of a physician to administer medical treatment to a patient in such a way as to take into account possible harm to unidentifiable third persons. Id. at 995. The Indiana Supreme Court declined to find that the physician owed the non-patient plaintiff a duty of care. One basis for the Court's holding was its consideration of public policy. As the Court stated: A physician's first loyalty must be to his patient. Imposing a duty on a physician to predict a patient's behavioral reaction to medication and to identify possible plaintiffs would cause a divided loyalty. Were we to impose a duty on a physician to consider the risk of harm to third persons before prescribing medication to a patient, we would be forcing the physician to weigh the welfare of unknown persons against the welfare of his patient. Such an imposition is unacceptable. The physician has the duty to his patient to decide when and what medication to prescribe the patient, and to inform the patient regarding the risks and benefits of a particular drug therapy. He should fulfill that duty without fear of being exposed to liability to unknown, unidentified third persons. Id. at 997. The Hawaii Supreme Court expressed similar concerns in McKenzie : Prescribing decisions must take into account complicated issues concerning the potential benefits and risks to individual patients. Moreover, although we do not believe that doctors would altogether stop prescribing beneficial medications to their patients because of the risk of liability to third parties, an expansion of such liability would certainly discourage some prescriptionsparticularly, as amicus curiae HMA points out, the prescription of psychiatric medications that necessarily have behavioral effects. The social utility of these medications is enormous, and we do not want to discourage their use. The risk of tort liability to individual patients should be enough to discourage negligent prescribing decisions. As discussed infra, the risk of injury to non-patient third parties can be readily addressed through the more narrow question of whether there is a duty to warn patients against driving while under the influence of the medication. Moreover, controversially but realistically, physicians and patients must consider factors such as cost, cost-effectiveness, and availability of insurance coverage in prescribing decisions. Insurers likewise must consider treatment effectiveness and cost in determining which treatments to pay for and which medications to include on hospital and clinic formularies.... Health care policy decisions require a complicated array of considerations by a variety of private and public decision makers, which include physicians, other professionals, regulators, employers, patients, and other health care consumer representatives who have a stake in such decisions. We believe that these policy decisions are better left to the aforementioned stake-holders than to judges and juries, at least with respect to non-patient third parties injured in automobile accidents. Similarly, individual treatment decisions are best left to patients and their physicians. [D]octors should not be asked to weigh notions of liability in their already complex universe of patient care. [ Lester v. Hall, 126 N.M. 404, 970 P.2d 590, 593 (1998)] (internal quotation marks omitted). Accordingly, considering the social utility of medications, the multitude of issues that already must be considered in prescribing decisions, the reality that existing tort law which is applicable to the individual patient should be sufficient to discourage negligent prescribing decisions, and the fact that imposing a duty to warn may readily reduce the risk to third parties, we discern no logical, sound, or compelling reasons, under the present circumstances, to introduce into the already complex universe of patient care the additional risk of tort liability to non-patient third parties injured in automobile accidents. McKenzie, 47 P.3d at 1214-15. As stated earlier, Tennessee courts, like the Indiana and Hawaii courts, must consider public policy in determining the existence or non-existence of a duty. We find the Indiana and Hawaii courts' respective discussions of public policy to be persuasive as they relate to the facts of the pending case. The public policy considerations stated in Webb and in McKenzie are relevant to several of the factors we consider in resolving duty issues. First, the importance or social value of the activity engaged in by defendant is substantial. Second, the public policy considerations are relevant to the factor concerning the feasibility of alternative, safer conduct and the relative costs and burdens associated with that conduct; the relative usefulness of the safer conduct; and the relative safety of the alternative conduct. In the context of making prescription decisions for individual patients (as opposed to warning a patient of adverse affects of a prescription), alternative, safer conduct is not so feasible. Moreover, the relative costs and burdens of any such alternative conduct could be high. As the Indiana and Hawaii courts pointed out, imposing a duty on a physician to consider third parties when making prescribing decisions could compromise the physician's care of individual patients. Balancing the various factors we consider in determining duty issues, we hold that Dr. Magee did not owe a legal duty to the Burroughses in deciding to prescribe the two medications to Mr. Hostetler.