Who would be at fault? Doctor or pharmacist?

[Dr Trek 1]

Here is somewhat of a legal question simply because I have always been curious about this.

Let's say that a physician prescribes a patient a medication. The patient goes to his pharmacy and gets the medication, takes it, has some type of reaction to it and dies. Let's say that there is no way the physician or the pharmacist could have predicted this reaction. Who is at fault?

For another scenario, let's say that the doctor writes a prescription for a patient which interacts with a medication the patient is currently on but does not tell the doctor about. The patient then gets this medication filled at a brand new pharmacy that does not have his or her prescription history. The patient takes the medication and dies. Now who is at fault?

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[Squad51]

Here is somewhat of a legal question simply because I have always been curious about this.

Let's say that a physician prescribes a patient a medication. The patient goes to his pharmacy and gets the medication, takes it, has some type of reaction to it and dies. Let's say that there is no way the physician or the pharmacist could have predicted this reaction. Who is at fault?

No one, but that won't stop the suits. If "there (was) no way the physician or the pharmacist could have predicited this reaction" then there really is no tort. The plantiff is the case would have to argue that either or both should reasonably have foreseen the outcome.

For another scenario, let's say that the doctor writes a prescription for a patient which interacts with a medication the patient is currently on but does not tell the doctor about. The patient then gets this medication filled at a brand new pharmacy that does not have his or her prescription history. The patient takes the medication and dies. Now who is at fault?

This is a bit stickier. Both the physician and pharmacist should have asked the patient about other prescriptions they were taking. If they both document such a conversation, and the patient still denied taking anything else (this has happened with viagra and nitrates!) then neither is technically at fault. But, again, the plantiff would still likely sue and argue (perhaps) that either or both should have asked specifically about the medication the patient was taking and explained that if they were taking this particular medication and the new one together, they might die. This is the type of questioning I have seen done in the ED before NTG is given ("now Mr. X, before I give this nitro, are you sure you haven't taken Viagra, Cialsis, or Levitra in the past week? If you have and I give this, you might die...)

 

[Dr Trek 1]

Thank you for your reply.

I have another scenario.

Let's say that both the doctor and pharmacist miss the possible complication, then who is at fault? Or is the liability split 50/50?

 

[toofache32]

Why does it have to be someone's fault? Somehow in the USA we have gotten into a "there HAS to be someone to blame" mentality.

In situation #1...adverse reactions are possibilities with ALL drugs...including advil and oxygen. There isn't always a way to predict when it will happen. As long as the benefits outway the risks of the medication.

In situation #2...it's THE PATIENT'S fault if they were asked what meds they were taking and didn't tell the doctor everything. The same goes for when patients deny using cocaine before going under general anesthesia when in fact they used it last night.

In situation #3...I'm not sure what you're getting at. "Complications" can come in the form of adverse outcome within the standard of care, or they can be due to negligence, etc. It's usually the former although many patients assume the doctor was negligent just because something bad happened.

 

[MacGyver]

Both the physician and pharmacist should have asked the patient about other prescriptions they were taking. If they both document such a conversation, and the patient still denied taking anything else (this has happened with viagra and nitrates!) then neither is technically at fault. But, again, the plantiff would still likely sue and argue (perhaps) that either or both should have asked specifically about the medication the patient was taking and explained that if they were taking this particular medication and the new one together, they might die. This is the type of questioning I have seen done in the ED before NTG is given ("now Mr. X, before I give this nitro, are you sure you haven't taken Viagra, Cialsis, or Levitra in the past week? If you have and I give this, you might die...)

i hope you agree thats an absolutely ridiculous standard to hold doctors to. If docs are really expected to ask specifically about every possible drug interaction, the simplest patient visit would get lengthened by at least triple, it not more.

this reminds me of presurgical consent discussions. lawyers argue that you ahve to discuss EVERY SINGLE POSSIBLE SURGICAL COMPLICATION. For a typical surgery, that list of complications runs at least 20-25 items, if not more. Discussing 20-25 possible complications for surgery would take AT LEAST 2 hours. Remember the lawyers wont let you off the hook if you just give out a one line blurb about each complication, they would insist that to get informed consent you have to have a detailed conversation about each and every one of them.

Its absolutely ridiculous. I'm starting to favor socialized medicine if we can be employees of hte federal government and get shielded and get individual immunity from lawsuits.

 

[sdn1977]

Here is somewhat of a legal question simply because I have always been curious about this.

Let's say that a physician prescribes a patient a medication. The patient goes to his pharmacy and gets the medication, takes it, has some type of reaction to it and dies. Let's say that there is no way the physician or the pharmacist could have predicted this reaction. Who is at fault?

For another scenario, let's say that the doctor writes a prescription for a patient which interacts with a medication the patient is currently on but does not tell the doctor about. The patient then gets this medication filled at a brand new pharmacy that does not have his or her prescription history. The patient takes the medication and dies. Now who is at fault?

Dr Trek - I'm a pharmacist, so I'll try to give some perspective. These questions, though, don't have simple answers.

Your first question - pt takes medication, suffers from a heretofore unknown reaction, dies - not an unheard of scenario, but very rare. First...the most liable party would be the drug manufacturer. An example of this is the Zomax (zomepirac) case in the 1980's - this was an NSAID which in post-marketing was found to cause a high incidence of immunologic reactions which resulted in death of a signficant # of pts. The manufacturer was sued, but also named were the prescribers & dispensing pharmacists. Ultimately, no prescribers nor pharmacists were held liable, because their actions (the prescribing, dispensing & post-traumatic treatment) were all within reasonable expectations of their practices. Unless they did not do what they should do anytime a pt suffers a drug reaction, they are not held liable for what they cannot expect to happen.

Your second question - pt goes to prescriber, doesn't tell complete history, goes to new pharmacy, takes medication & dies - well, except for the dying part, probably happens multiple times in a day. This is called Dr shopping for prescription drugs. Its not always controlled drugs. Again...the "reasonable man" standard of care is - what would a reasonable person who occupies the role of provider be expected to provide in terms of care. A complete history, insofar as the pt is willing to give it, good clinical judgement, proper instruction & accessibility for follow-up.

This doesn't mean prescribers and pharmacists are named in lawsuits - we are all the time. However, we often get dropped from a case if during the discovery part of the process, no negligence is found.

 

[sdn1977]

Thank you for your reply.

I have another scenario.

Let's say that both the doctor and pharmacist miss the possible complication, then who is at fault? Or is the liability split 50/50?

No - liability is determined by which party carries the greater fault. It is rarely 50/50. It would be an unusual case in which both the prescriber and pharmacist were both negligent. It has occurred - there have been some hallmark cases of oncology drugs prescribed to children in which the physician prescribed a dose which was far larger than any child should receive and the pharmacist didn't catch the error. In that case - yes, each party shared liability, but I can't recall if it was 50/50 exactly. I'd have to look it up again.

 

[ShyRem]

these kinds of questions and this kind of thinking is EXACTLY why medical malpractice is outrageous. Whatever happened to "ACCIDENT" and "UNFORESEEN OUTCOME"?? Have we become such a litigious society that someone HAS to be at fault all the time?? Have we become unable to say "it's my fault" (for not being forthcoming and truthful) or "sometimes stuff happens for no apparent reason"??