Judicial Expansion of DUR

Article excerpt

From a recent Alabama Supreme Court opinion came this statement: "We believe that a prescription from an oncologist that a pharmacist believes to call for a heart medication used by cardiologists to treat arrhythmias or serious heart ailments should cause [the R.Ph.] grave concern and necessarily prompt further inquiry. The extreme unusualness of a prescription from a cancer specialist supposedly calling for a dangerous heart medication, combined with the alleged illegibility of the prescription, is sufficient evidence of a reckless disregard of the safety of others to create a jury question as to whether [the R.Ph.] acted wantonly. A jury could infer that [the R.Ph.'s] actions under those circumstances rose to the level of a conscious disregard for the safety of [the patient]."

The lawsuit, which gave rise to the above statement, was brought by a patient alleging that a pharmacist negligently and "wantonly" misfilled the patient's prescription. The court established that the pharmacist entered information from a prescription for tamoxifen into the computer as Tambocor, and, as a result of the incorrect entry, dispensed the wrong drug on three occasions. The pharmacist knew the prescriber was an oncologist, and although the pharmacist recognized the obvious potential problem, the pharmacist did not intervene with the oncologist. The pharmacy admitted to negligently misfilling the Rx but disputed the "wantonness" allegation. In Alabama, wantonness is defined as "reckless or conscious disregard of the rights and safety of others." Based on the full facts, the jury found the existence of wantonness.

The issue of whether an Rx is appropriate in light of the licensure and nature of practice of the prescriber is not new. For example, all R.Ph.s would surely question a dentist's prescription for an oral contraceptive. But not all examples are this clear, as the above lawsuit demonstrates.

Through talking with pharmacists about the Alabama lawsuit, it is clear that specialists prescribe, with some degree of regularity, drug products that are not directly related to the specialty. However, this alone does not necessarily make the prescription inappropriate to the extent that the R.Ph. should refuse to dispense the prescription. On the other hand, and in light of the Alabama Supreme Court opinion, pharmacists presented such Rxs must inquire with the prescriber to determine the justification for such an Rx. …