Opinion ID: 1969179
Heading Depth: 1
Heading Rank: 3

Heading: The Case as to Parke, Davis

Text: As indicated earlier, the third party complaint against Parke, Davis asserted that it did so negligently and carelessly manufacture the said drug . . . as to properly [sic] warn, direct and/or instruct parties in interest of possible effect of the said product; also, that Parke, Davis did so carelessly and negligently fail to warn the plaintiffs, the defendant and other parties to this action of the dangerous effects of the said drug and did further fail to perform proper tests on the said drug and take the necessary precautions to avert the injuries complained of by the plaintiffs. There was no evidence of negligence in the manufacture of the drug or of failure to perform proper tests. Thus the complaint was based on an alleged negligent failure to warn the parties to the action of the dangerous effects of the drug. Parke, Davis contends that there was no competent evidence to support the verdict against it, and that therefore judgment n.o.v. should have been entered. In addition, it asserts various trial errors and errors in instructions to the jury which were sufficiently prejudicial as to warrant the granting of a new trial as to it. The argument in support of judgment n.o.v. is (1) that its warning relative to Chloromycetin was adequate as a matter of law, (2) that in any event its warning was, by Dr. Cucinotta's own testimony, adequate as to him, and (3) that although portions of Dr. Levin's testimony, if believed, would support a finding that he had not been properly warned, the evidence failed to show that the dosages of the drug administered by Dr. Levin were the effective cause of Mary Ann's death. While we agree that on the record nothing that Parke, Davis did or failed to do had a material influence on Dr. Cucinotta's prescription of the drug, we do not agree, as indicated heretofore, that there was insufficient showing that Dr. Levin's dosages could have contributed to Mary Ann's injuries and death. The question, therefore, narrows down to whether the warnings relative to the drug were adequate as to Dr. Levin. Here we think that on the basis of Dr. Levin's testimony there was enough evidence to take the case to the jury. There is no question that manufacturers of potentially dangerous drugs are held to a high degree of care. As this Court said in Henderson v. National Drug Company, 343 Pa. 601, 610, 23 A. 2d 743 (1942), . . . the public interest requires the holding of companies which make and sell drugs and medicine for use in the human body to a high degree of responsibility under both the criminal and civil law for any failure to exercise vigilance commensurate with the harm which would be likely to result from relaxing it. The Court went on to say, however, that this consideration did not justify the courts in lowering the standards of proof in cases of this kind. If we did so, the public interest would be ill served. Thus, neither the law of Pennsylvania, nor, so far as we are aware, the law of other states has imposed strict liability upon a drug manufacturer merely because of dangerous propensities of the product. Section 402A of the Restatement (Second) of Torts imposes strict liability on the seller of any product in a defective condition unreasonably dangerous to the user or consumer. This section has been adopted as the law of Pennsylvania. Webb v. Zern, 422 Pa. 424, 220 A. 2d 853 (1966). Comment h to the section makes it clear that a product, as to which adequate warning of danger involved in its use is required, sold without such warning is in a defective condition. Comment j states that in order to prevent the product from being unreasonably dangerous, the seller may be required to give directions or warning, on the container, as to its use. The comment continues: Where warning is given, the seller may reasonably assume that it will be read and heeded; and a product bearing such a warning, which is safe for use if it is followed, is not in defective condition nor is it unreasonably dangerous. The Restatement reaches the same conclusion as to a product which is incapable of being made safe for its intended use, such as new or experimental drugs, as to which, because of lack of time and opportunity for sufficient medical experience there can be no assurance of safety, but such experience as there is justifies the marketing and use of the drug notwithstanding a medically recognizable risk. The seller of such products, concludes this comment (Comment k ), again with the qualification that they are properly prepared and marketed and proper warning is given, where the situation calls for it, is not to be held to strict liability for unfortunate consequences attending their use, merely because he has undertaken to supply the public with an apparently useful and desirable product attended with a known but apparently reasonable risk. (Emphasis supplied.) Under the evidence, Chloromycetin was a drug in this category. [9] There is no question, and Parke, Davis does not contend, that it could properly be marketed without proper warning of its potentially dangerous side effects. Since the drug was available only upon prescription of a duly licensed physician, the warning required is not to the general public or to the patient, but to the prescribing doctor. See Stottlemire v. Cawood, 213 F. Supp. 897, 899 (D.C. 1963) (a case involving Chloromycetin). The question, therefore, in this case is whether the warning that was given to the prescribing doctors was proper and adequate. A corollary question is whether, if the printed warning was proper and adequate, it was in effect nullified by the representations of the so-called detail men. We think that whether or not the warnings on the cartons, labels and literature of Parke, Davis in use in the relevant years were adequate, and whether or not the printed words of warning were in effect cancelled out and rendered meaningless in the light of the sales effort made by the detail men, were questions properly for the jury. Action designed to stimulate the use of a potentially dangerous product must be considered in testing the adequacy of a warning as to when and how the product should not be used; if detail men are an effective means of selling a product and explaining its nature, a jury could find that they also afforded an effective medium of conveying a warning. Cf. Sterling Drug, Inc. v. Yarrow, 408 F. 2d 978, 993 (C.A. 8th Cir. 1969). Defendant Parke, Davis admits that Dr. Levin's testimony would support a finding that he had not been adequately warned by the detail men in 1960 and prior thereto as to the possible association of aplastic anemia with Chloromycetin. We agree, and the jury apparently did so find. We think there was no error in declining to enter judgment in favor of Parke, Davis. Parke, Davis asserts, further, that the proof at trial was at such substantial variance with the pleadings that either a judgment in its favor notwithstanding the verdict, or at least a new trial, is imperative. The first aspect of this contention has to do with Pennsylvania third party practice, and runs as follows: the original complaint against Ewing, the druggist, was a negligent filling of a prescription contrary to the instructions of the prescribing physician, Dr. Cucinotta; the third party complaint by Ewing against Parke, Davis stated, in effect, that he has was not properly warned about the drug; there was no allegation that Ewing was induced by Parke, Davis' actions to refill the prescription against the doctor's instructions; no evidence to this effect was offered, and indeed plaintiffs offered no proof in support of their complaint of negligence against Ewing; instead, they sought to prove the state of mind of the medical profession at large rather than any duty owed by Parke, Davis to Ewing or the appellees. In the first place, this argument overlooks the important fact that the third party complaint also asserts a failure adequately to warn the other additional defendants, the two doctors. In the second place, it reads too narrowly the Pennsylvania Rules of Civil Procedure relative to joinder of third parties. Rule 2252(a) permits joinder by a defendant of any person whether or not a party to the action who may be alone liable or liable over to him on the cause of action declared upon or jointly or severally liable thereon with him. (Emphasis ours.) Rule 2255 provides, in paragraph (d), that the plaintiff shall recover from an additional defendant found liable to him . . . as though such additional defendant had been joined as a defendant and duly served and the initial pleadings of the plaintiff had averred such liability. It is true that the cause of action declared upon by the plaintiff in this case was not the same as that set forth in the third party complaint: the negligent filling of a prescription by a druggist is not the same cause of action as the negligent failure by the drug manufacturer to give adequate warning to the druggist or the prescribing doctors. The same could be said in any third party situation. A's cause of action against B, for example, is not the same as A's cause of action against C, joined as alone liable, because a cause of action is by definition between particular named parties. It must be remembered that [t]he general plan of the joinder procedure is to adjudicate all rights growing out of a certain factual background. 3 Goodrich-Amram, Sec. 2255(d)-9, p. 107; see also the discussion at Sec. 2252(a)-5 and 6. The phrase cause of action declared upon as used in the rule may not be taken too literally. So long as the additional defendant's alleged liability is related to the original claim which plaintiff asserts against the original defendant, the third party complaint is within bounds. We think that is the case here: the asserted failure of the manufacturer of the drug to warn the prescribing doctors and the druggist of its dangers is sufficiently related to the plaintiff's original charge that the druggist negligently dispensed the drug to be within the ambit of third party procedure. Contrast Mallesky v. Stevens, 427 Pa. 352, 355, 235 A. 2d 154 (1967). The fact that at trial the plaintiffs concentrated their attack primarily on the third party defendants and hardly at all on the original defendant was not a variance as between pleadings and proof. As noted above, Pa. R.C.P. Rule 2255(d) in effect incorporates by reference in the original complaint the properly pleaded averments of third party liability contained in the third party complaint. The other aspect of Parke, Davis' argument as to variance is more difficult. As noted, the cause of action pleaded is negligent failure to warn the parties to the action (including particularly the two additional defendants who were prescribing physicians) of the dangerous effects of the drug. There was direct testimony on this subject, including both the printed warning and the promotional efforts of the detail men, by both doctors: Dr. Cucinotta stated, in effect, that he was adequately warned and understood the dangers and proper use of the drug, while Dr. Levin for his part indicated the contrary. Plaintiffs were allowed over objection to introduce, by expert witnesses, evidence directed to showing a failure to warn the medical profession. This consisted of the custom and practice of the manufacturer, Parke, Davis, in overpromoting its product, primarily through the use of detail men who minimized the dangers of the drug while emphasizing its effectiveness, wide acceptance and use, and lack of certain objectionable side effects associated with other drugs. The question is whether this evidence was properly admitted. While the question is close, we think the answer is in the affirmative in the setting of this case. The jury was not obliged to believe the oral, uncorroborated testimony of either doctor. The evidence of Parke, Davis' efforts in promoting the drug would tend to refute Dr. Cucinotta's testimony in the sense that he may have been influenced by the efforts, perhaps even unconsciously, to prescribe the drug (his memory was vague as to what transpired at visits of detail men to his office); and conversely, it would tend to corroborate and lend credence to Dr. Levin's testimony that he was so influenced. As a practical matter, it would have been difficult, if not impossible, to show how the promotional efforts of the manufacturer bore on the judgments of these codefendants without demonstrating that the efforts were directed to the entire class or group of which they were members: the advertisements and all the literature relative to Chloromycetin were directed to the medical profession; the printed warnings were directed to the medical profession; the detail men were engaged for the purpose of selling the drug by making calls upon the members of the medical profession. The approach of Parke, Davis to the medical profession in general was also relevant in another sense. The evidence indicated such a wide use of Chloromycetin as to suggest that it was not being limited to serious illnesses, and plaintiffs' experts so testified. On this basis the trial court instructed the jury that if it found that Parke, Davis was on notice that the drug was being used indiscriminately, and yet failed to try to restrict its use to proper situations, then the company could be found negligent. We think the charge was proper. When a required warning is retained unchanged in the face of being widely disregarded, and the supplier knows or has reason to know of such wide disregard, a jury may be permitted to find the warning insufficient. Were the evidence limited solely to the two doctors here involved, this approach to the warning problem would not be possible. But the focus must narrow, of course, from the general to the specific. There was adequate proof that the Chloromycetin ordered by one or both of the doctors in this case was the cause of death; a warning more explicit and more prominent given both by the written and the spoken word to those doctors might, so the jury could have found, have avoided the tragedy which occurred in this case. For similar holdings, see Sterling Drug v. Yarrow, supra ; Parke, Davis and Company v. Stromsodt, 411 F. 2d 1390, 1400 (C.A. 8th Cir. 1969), Tinnerholm v. Parke, Davis & Co., 285 F.S. 432, 451 (U.S.D.C., S.D.N.Y. 1968), Love v. Wolf, 226 Cal. App. 2d 378 (1964), Love v. Wolf, 249 Cal. App. 2d 822 (1967). We return to the assertion of variance. While the complaint could well have been more specific, no attempt was made by appellant to make it so, nor did it plead surprise. The case had been pending for several years before it came to trial, and a number of depositions had been taken. [10] The charge in the complaint, to repeat, was did fail to warn . . . of the dangerous effects of said drug . . . and to take the necessary precaution to avert the injuries complained of . . . These allegations put appellant sufficiently on notice as to what it had to meet; it was not misled to its prejudice. Nark v. Horton Motor Lines, Inc., 331 Pa. 550, 555, 1 A. 2d 655 (1938). See Butterfield v. Snellenburg, 231 Pa. 88, 79 Atl. 980 (1911). A final point must be considered as to Parke, Davis' motion for a new trial. Appellant contends that the trial court erred in admitting, over objection, evidence of a subsequent warning (employed in Chloromycetin packaging and literature after Doctors Cucinotta and Levin prescribed the drug for the minor plaintiff). Although precautions taken after the acts complained of are inadmissible for the purpose of proving antecedent negligence, Baran v. Reading Iron Co., 202 Pa. 274, 51 Atl. 979 (1902), such evidence is admissible if competent for any purpose and as long as it is so qualified by instructions to the jury. Hyndman v. Pa. Railroad Company, 396 Pa. 190, 152 A. 2d 251 (1959). In the latter case it was held that evidence of the type here in issue is admissible to show a caution which was not costly or burdensome to the defendant in relation to the risk or danger involved. Id. at p. 200. The charge in this case clearly instructed the jury that the subsequent warning was admitted for the limited purpose to show a caution which was not costly or burdensome to Parke, Davis in relation to the risk or danger involved. The jury was thrice instructed that the 1961 warning was not to be taken as evidence bearing on antecedent negligence. Parke, Davis nevertheless takes exception to the following portion of the charge: You may ask yourselves whether knowing that, whether having changed the warning in 1961 is the warning that they should have been fully aware of in 1960 and prior thereto [sic]. You may use that as evidence of the fact that they knew or should have known, and could have used that warning which they used in 1961 back in 1960, 1959, and 1958. In reviewing this instruction, we must look to the charge in its entirety to determine whether or not error was committed and whether that error was prejudicial. Mount v. Bulifant, 438 Pa. 265, 265 A. 2d 627 (1970). We are of the opinion that the charge, taken as a whole, adequately qualified the jury's consideration of this evidence, and cannot say that the quoted language, while it went too far, was prejudicial.