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Failure to Warn of Risk is Pharmacy Error, Says Nevada Supreme Court

An elderly Nevada woman suffered a severe allergic reaction to the sulfa-based drug she was prescribed. She was taken to the emergency room the next day and was diagnosed with toxic epidermal necrosis, a type of chemical burn in which the top layer of skin peels off large areas of the body. She died soon thereafter with burns covering 40 to 50 percent of her body.

The woman's medical record included a note that she had a possible sulfa drug allergy. Her doctor had asked about it, but the woman had downplayed it and asked for the prescription. The doctor did not run any tests to determine if the allergy was true or prescribe an alternative drug that was not sulfa-based. (A medical malpractice claim had already been settled with the prescribing doctor.)

When the elderly woman's caregiver went to pick up her prescription at a Walgreen's pharmacy, the pharmacy employee told her about the possible sulfa drug allergy. The employee called the patient, who said she had taken a similar drug in the past, and the pharmacist overrode the flag in the computer system and filled the prescription.

Walgreens argued that because the pharmacist had filled the prescription with the correct medication and dosage, they had fulfilled their duty. A District Court Judge agreed, saying that unless there was an error with the prescription or that it would be obviously fatal, the pharmacist's duty was limited to filling the prescription as written.

The Nevada Supreme Court disagreed. The justices said that pharmacists can be held liable for patient injuries if the pharmacist had knowledge of customer-specific risks. The fact that the patient's pharmacy record showed a possible allergy proved just such knowledge.

A representative for the Nevada Pharmacists Association said that best practices among pharmacists is to contact the doctor whenever a patient medical record notes an allergy. That did not occur in this case.

The wrongful death claim has now been sent back to a lower court to be heard again.

Source: AP via Nevada Appeal, "Justices: Pharmacists must tell of risks," by Sandra Chereb, November 24, 2011.

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