Evolving responsibilities 
in pharmacy


On the Docket

The professional role of pharmacists has expanded significantly in recent years. This advance in practice responsibilities has been evidenced in many ways, including judicial views of pharmacists. Judicial views often mirror public perceptions, and they can serve as a litmus test for what society expects of a group of persons who have been granted licensure to practice the pharmacy profession in service to the public.


A recent judicial opinion from Florida significantly reflects expanded responsibilities for pharmacists. The opinion was released almost 30 years to the day after a contrary opinion from Illinois, which expressed a far narrower view of pharmacist responsibilities. These two differing judicial opinions are bookends that reveal the hard work and dedication of pharmacists who have deliberately and dramatically advanced our profession over the intervening three decades.


Page out of history


In the 1985 case, a patient sued both her physician and her pharmacy. The patient alleged that her physician had “over-medicated” her with “massive amounts” of ethchlorvynol. She alleged that her pharmacy had negligently “failed to take any action whatsoever to notify the plaintiff or her physician” of the potential problems presented by this medication as it was prescribed. 


The court dismissed the lawsuit, holding that “a pharmacist has no duty to warn the customer or notify the physician that the drug is being prescribed in dangerous amounts, that the customer is being over medicated, or that the various drugs in their prescribed quantities could cause adverse reactions to the customer.” 


According to the court, a pharmacist’s responsibility was limited to technical accuracy in order processing, and at that time there was no legal duty to anticipate any harm that could occur from the use of an accurately dispensed medication. There is no record of this dismissal being appealed. The 1985 ruling was cited in many subsequent cases as authority for the position that a pharmacist has no legal duty to provide consultation even if a patient is at risk of serious harm from a prescribed medication.


Contemporary view


In the 2015 case, a woman sued a pharmacy that had allegedly dispensed hydrocodone/acetaminophen, oxycodone/acetaminophen, and alprazolam to her deceased husband. The plaintiff alleged that the pharmacy had dispensed these medications “without question, even though the prescriptions were issued too closely in time and days before [her husband] should have exhausted the preceding prescription.” The trial court dismissed the case, and the plaintiff appealed.


On appeal, the court held that “a pharmacist’s duty to use due and proper care in filling a prescription extends beyond simply following the prescribing physician’s directions.” The court noted that “the prescriptions at issue here are alleged to be unreasonable on their face because they were written in a quantity, frequency, dosage, or combination that a reasonable pharmacist would either have checked with the prescribing doctor or warned the patient.” Dismissal of the case against the pharmacy was reversed.


Analysis


The ruling in the 1985 case was stunning. At that time, a pharmacist could escape legal liability to a patient, even if the pharmacist could have prevented harm to the patient, as long as prescribed medications were dispensed accurately by following doctor’s orders. The 2015 case is a firm repudiation of that approach. Pharmacists now must consider the best interests of patients and provide consultation to patients and/or prescribers if prescribed medications pose preventable risks for patients.


The evolution toward this new legal standard has been gradual, but it has been steady and clear. It is a standard that calls for conversation and collaboration. It is a standard that focuses on outcomes for patients, rather than on processes for pharmacists.



Based on: Jones v Irvin, 602 F.Supp. 399 (SD Ill, February 15, 1985); Oleckna v Daytona Discount Pharmacy, 2015 Fla.App. LEXIS 1561 (February 6, 2015)