On The Docket
David B. Brushwood, BSPharm, JD
The standard of care in a medical malpractice lawsuit is usually established through expert witness testimony by clinicians who have extensive experience in the same specialty (or subspecialty) field as the defendant. It is generally considered unfair to the defendant, and potentially confusing to the jury, if a witness whose background and experience differs from that of the defendant is allowed to testify that the defendant failed to meet the applicable standard of care.
Several recent legal cases have considered whether a pharmacist may testify as an expert on the standard of care in a malpractice case against a physician. Most such cases have addressed the argument that a pharmacist lacks sufficient knowledge and skill to testify as to a physician’s clinical care. These cases have gone both ways.
A recent malpractice lawsuit raises the contrary issue of whether an experienced pharmacist might be too well qualified to testify on the appropriateness of drug therapy when the defendant is a physician whose specialty is not in the area of drug therapy that led to the alleged malpractice.
Background
The patient whose care was the subject of this recent lawsuit had a complex medical history. He was transported to a local hospital with complaints of abdominal pain. He was administered 1 mg of hydromorphone intravenously. The pain was not alleviated, so the patient was given another 1 mg dose of hydromorphone.
The patient was transferred to a larger hospital due to his worsening renal function. A nephrologist at the larger hospital ordered 2 mg of hydromorphone to be administered intravenously every 4 hours as needed. The patient was administered this dose of hydromorphone three more times over the next 12 hours. The patient died, allegedly as the result of an overdose of hydromorphone.
The patient’s estate sued the nephrologist for negligence in failing to monitor the patient’s condition and reduce the dose of hydromorphone. A jury returned a verdict in favor of the plaintiff and the nephrologist appealed.
Rationale
On appeal, the nephrologist argued that the court should not have allowed expert testimony from a pharmacist, who the nephrologist argued “was not qualified to offer an opinion concerning the clinical aspects” of the patient’s care, because the issues in the case were “outside the scope of [the pharmacist’s] knowledge, expertise, and training as a pharmacist.”
The appellate court noted that the witness was “a retired clinical pharmacist who consulted with physicians and is knowledgeable about how drugs affect the body.”
The pharmacist had testified that the patient’s medical records showed “that his oxygen levels were on a downward trend, which was absolutely an indicator that [the patient] had too much hydromorphone in his system.”
The pharmacist testified that the 2-mg dose was too high for an opioid naive patient, contradicting the nephrologist’s assertion that the patient was opioid tolerant based on the two administrations of 1 mg of hydromorphone at the local hospital.
The appellate court concluded that the challenged opinions offered by the pharmacist “fall within the purview of his knowledge and experience, particularly concerning how drugs affect the body and how to monitor for drug-related side effects.”
The verdict against the nephrologist was affirmed.
Discussion
Courts have begun to accept pharmacists as qualified expert witnesses in physician malpractice lawsuits. This is gratifying to some pharmacists who have long sought equal footing with physicians in regard to clinical pharmacotherapy expertise. They have argued that it is unfair to disqualify a pharmacist from expert testimony based simply on the different academic degree.
Perhaps the time has come to consider the possibility that it is unfair to physicians for an expert on drug therapy to testify on the standard of care when the physician has not been trained in this specialty area. Is it realistic to expect a nephrologist to dose pain medication as well as an experienced clinical pharmacist?