Opinion ID: 2395066
Heading Depth: 1
Heading Rank: 3

Heading: Dr Simonton The Prescribing Physician

Text: The premise on which the learned intermediary doctrine is based failed in this case. The justification for relieving manufacturers of prescription drugs of the duty imposed generally upon manufacturers is that: Prescription drugs are likely to be complex medicines, esoteric in formula and varied in effect. As a medical expert, the prescribing physician can take into account the propensities of the drug, as well as the susceptibilities of his patient. His is the task of weighing the benefits of any medication against its potential dangers. The choice he makes is an informed one, an individualized medical judgment bottomed on a knowledge of both patient and palliative. Stone v. Smith, Kline & French Laboratories, 731 F.2d at 1579-1589 (quoting Reyes v. Wyeth Laboratories, 498 F.2d at 1276) (emphasis added). In this case, Dr. Simonton gave no warning; consequently, neither his patient nor any member of his patient's family got the benefit of his knowledge and judgment regarding the dangers of Micronase. Dr. Simonton acknowledges that had his patient, Pittman's grandmother, experienced a complication as the result of dangers of which she was not advised, the physician's liability would be clear beyond dispute. He insists, however, that he owed no legal duty to any person other than his patient. The physician-patient relationship is an essential element of a cause of action for medical malpractice, but not for common law negligence. The law imposes upon all persons the duty to use reasonable care under the circumstances. Physicians are not exempt from this duty to non-patients even though the act or omission was committed while engaged in the practice of medicine. Of course, a duty of care is dependent upon foreseeability, as previously discussed. See supra at 428. In two cases decided by this Court, the physician-defendant has been held liable for damages to a non-patient caused by the physician's common law negligence. In Wharton Transport Corp. v. Bridges, 606 S.W.2d 521, 526 (Tenn. 1980), the Court held that the physician was liable to a non-patient who was injured as the result of a truck driver's negligence, where the physician was negligent in performing a physical examination of the truck driver and in certifying his fitness to the employer. In Bradshaw v. Daniel, 854 S.W.2d 865 (Tenn. 1993), the Court responded to the same contention made by the physician-defendant in this case: The defendant contends that the absence of a physician-patient relationship negates the existence of a duty in this case. While it is true that a physician-patient relationship is necessary to the maintenance of a medical malpractice action, it is not necessary for the maintenance of an action based on negligence, and this Court has specifically recognized that a physician may owe a duty to a non-patient third party for injuries caused by the physician's negligence, if the injuries suffered and the manner in which they occurred were reasonably foreseeable. Id. at 870. In Bradshaw, the Court reviewed cases from other jurisdictions in which the court held that the physician is under a duty to exercise reasonable care to protect non-patients from dangers emanating from the patient's illness, the most common being the danger of becoming infected with a contagious disease. The Court quoted with approval the following decisions: [I]n [ Hofmann v. Blackmon, 241 So.2d 752 (Fla. Dist. Ct. App. 1970) cert. denied 245 So.2d 257 (Fla. 1971)], an action was brought against a physician by a child who had contracted tuberculosis as a result of the physician's negligent failure to diagnose the disease in his patient, the child's father. Reversing a summary judgment for the physician, the Florida District Court of Appeals held that a physician owes a duty to a minor child who is a member of the immediate family and living with a patient suffering from a contagious disease to inform those charged with the minor's well being of the nature of the contagious disease and the precautionary steps to be taken to prevent the child from contracting such disease and that the duty is not negated by the physician negligently failing to become aware of the presence of such a contagious disease. 241 So.2d at 753. Likewise, in [ Shepard v. Redford Community Hosp., 151 Mich. App. 242, 390 N.W.2d 239 (1986) appeal denied 431 Mich. 872, 430 N.W.2d 458 (1988)], a wrongful death action was filed by the mother of a child who was infected and died of spinal meningitis after the physician failed to diagnose the disease in his patient, the mother. Again, reversing a summary judgment in favor of the defendant on the issue of legal duty, the Michigan Court of Appeals stated that the defendant had a physician-patient relationship with plaintiff. This was a special relationship with the one who allegedly infected Eric, leading to his death... . Because defendant had a special relationship with plaintiff we conclude that defendant owed a duty of reasonable care to Eric. As plaintiff's son and a member of her household, Eric was a foreseeable potential victim of defendant's conduct. 390 N.W.2d at 241. Finally in [ Wojcik v. Aluminum Co. of America, 18 Misc.2d 740, 183 N.Y.S.2d 351 (1959)], an action was brought by a woman who was infected with tuberculosis against the physician who discovered her husband had the disease, but did not inform her. The New York court held that the physician owed a duty to warn his patient's wife of the risks associated with contracting the disease and stated that one who by reason of his professional relations is placed in a position where it becomes his duty to exercise ordinary care to protect others from injury or danger is liable in damages to those injured by reason of his failure to do so. 183 N.Y.S.2d at 358 (citations omitted). Bradshaw v. Daniel, 854 S.W.2d at 871-72. However, the instrumentality which caused the plaintiff's death in Bradshaw was not a contagious disease, but Rocky Mountain Spotted Fever, a disease which cannot be transmitted from one person to another but is contracted by humans through the bite of a tick. Persons occupying the premises where the disease was contracted are at risk because of the clustering characteristic of the infected ticks. The issue in Bradshaw was: [W]hether a physician has an affirmative duty to warn a patient's family member about the symptoms and risks of exposure to Rocky Mountain Spotted Fever, a noncontagious disease. Id. at 870. The Court held: We, therefore, conclude that the existence of the physician-patient relationship is sufficient to impose upon a physician an affirmative duty to warn identifiable third persons in the patient's immediate family against foreseeable risks emanating from a patient's illness. Accordingly, we hold that under the factual circumstances of this case, viewing the evidence in a light most favorable to the plaintiff, the defendant physician had a duty to warn his patient's wife of the risk to her of contracting Rocky Mountain Spotted Fever, when he knew, or in the exercise of reasonable care, should have known, that his patient was suffering from the disease. Id. at 872-73. These prior decisions require the conclusion that, in the practice of medicine, Dr. Simonton's duty is not limited, as a matter of law, to his patients. The question now is whether Pittman is included among those non-patients to whom the physician owed a duty, or as stated in Bradshaw, whether the injuries suffered by Pittman, and the manner in which they occurred, were reasonably foreseeable. Id. at 870. The record establishes that the drug prescribed is exceedingly harmful to most persons not suffering from the condition for which it was prescribed. The package inserts delivered to Dr. Simonton by The Upjohn Company and the entry in the Physician's Desk Reference with which he was familiar, contained the following: The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members. (Emphasis added.) The issue being tested on this motion for summary judgment is the likelihood that an adult house guest of Dr. Simonton's patient would take the drug accidentally. If a reasonable person could foresee the probability of this occurrence, the law imposes a duty of reasonable care, care commensurate with the risk. Such reasonable care must be given meaning in relation to all relevant circumstances; the degree of foreseeability needed to establish a duty of care decreases in proportion to the magnitude of the foreseeable harm. As the gravity of the possible harm increases, the apparent likelihood of its occurrence need be correspondingly less to generate a duty of precaution. W. Page Keeton, et al., Prosser and Keeton on the Law of Torts, § 31, at 171 (5th ed. 1984). The probability of harm, and thus the danger, that Micronase poses to persons other than those for whom it is prescribed is, according to the record, great. Consequently, the likelihood of its being ingested from a person other than the patient becomes the significant factor for consideration. The relevant circumstances of this case do not support the plaintiff's insistence that he was among those persons likely to be harmed, and, therefore, entitled to legal protection at the hands of the defendant [physician]. Lindsey, 689 S.W.2d at 859. Those persons identified in Upjohn's literature to whom a warning regarding the properties and dangers of Micronase should be given were the patient and responsible family members. Arguably, Pittman was a responsible member of the patient's family. However, responsible family members were included, not for their benefit but for the protection of the patient, to enable those persons caring for the patient to recognize the symptoms of hypoglycemia, which may render the patient unconscious, and take the prescribed emergency action. The Upjohn warning, which has been found to be sufficient under the circumstances of this case, [1] does not recognize a duty to the plaintiff. The court in Bradshaw found the duty to warn extended to identifiable third persons in the patient's immediate family. However, in Bradshaw the infected ticks posed an active, hidden danger to all persons on the premises. The ticks sought out their victims and no action was required by the patient or the potential victim to accomplish the injury. In the case before the court, the danger was benign. The Micronase did not constitute any danger to Pittman so long as it remained in its container. The warning required by the holding in Bradshaw does not recognize a duty to the plaintiff in this case. The Court of Appeals properly found, that an adult house guest will reach high upon a refrigerator, take down a bottle of prescription medication clearly belonging to someone else, and ingest several of the pills therein without the knowledge and permission of the owner of the prescription medication is not reasonably foreseeable. The plaintiff has failed to show that the injury was a reasonably foreseeable probability, not just a remote possibility... . Doe v. Linder, 845 S.W.2d at 178. Consequently, the physician's duty to warn did not extend to the plaintiff, and the physician is entitled to summary judgment.