Pharmacist responsibilities do not extend to therapists

On the docket

In a recent federal case from Nevada, allegations against a marriage and family therapist were dismissed based on the judge’s ruling that expanded responsibilities for pharmacists to not apply to a therapist.

Background

A patient was prescribed the sedative zolpidem and allegedly “suffered complications from the drug, which ultimately resulted in his death.” Surviving members of his family sued the drug manufacturer and the patient’s therapist. The family alleged that the therapist knew the patient was taking zolpidem, knew he was having suicidal ideations, and therefore had a duty to warn the patient of the drug’s potential mental and emotional adverse effects.

The plaintiffs argued that the therapist was essentially in the same position as a pharmacist who knows of a potential problem with a patient’s drug therapy, and that the therapist should have the same legal responsibility as a pharmacist. Specifically, the plaintiffs contended that the therapist had been “instructed, taught, and tested on medication side effects” and that because of the therapist’s specific knowledge of the patient and general knowledge of medications, she had a duty to warn the patient—a duty she had not fulfilled.

Rationale

In evaluating this claim, the federal judge first referred to the general rule that it is the prescribing physician who has the responsibility to warn patients of potential adverse effects. The court then described what it called the “pharmacist exception” to the general rule. Under this exception, pharmacists “have a duty to warn of prescription drug side effects in circumstances where they have knowledge of a customer-specific risk—such as a known allergy or harmful interaction with another prescription.” The court explained that this exception “creates a safety net, of sorts, for patients by imposing a duty to warn on pharmacists when, because of their expertise in pharmacology and their customer-specific knowledge in relation to that expertise, a pharmacist’s knowledge of the patient’s situation is superior to that of the treating physician.”

The judge refused to extend the pharmacist exception to therapists, reasoning that to do so would be contrary to the public policy underlying both the general rule and the exception. The court said, “although a licensed Marriage and Family Therapist may have some general knowledge of certain side effects of certain prescription drugs, which may aid her in counseling patients, her knowledge is not nearly to the level of specialty held by a pharmacist.” The court also said, “imposing a duty to warn could require therapists, with limited knowledge of the patient’s entire medical situation, to interject themselves into the doctor–patient relationship.”

The judge ruled that the pharmacist exception could not be applied to marriage and family therapists.

Discussion

This solid and sensible judicial ruling, as complimentary toward pharmacists as it may be, raises some challenging questions about the factors that trigger a pharmacist’s responsibility to patients beyond accuracy in order processing. According to the judge’s rationale, the pharmacist’s expanded responsibility is based on knowledge of drugs and of patients. There must be more to it than that, however. The relationship between pharmacists and patients, including the commitment pharmacists have made to patient care and the expectations patients have of pharmacists, likely provides a richer foundation for distinguishing the roles of pharmacists and therapists. Knowledge is necessary, but it is not sufficient as the basis of expanded responsibilities.

Therapists, trained in psychology, do have knowledge of psychoactive drugs. Some of them practice in settings where their recommendations for the use of such drugs are generally accepted by practitioners licensed to prescribe them. Their counseling activities provide them with knowledge of patients’ mental and emotional status. Moreover, the judge’s concern that therapists lack “knowledge of the patient’s entire medical situation” would apply to pharmacists as well. Therefore, there must be something more than knowledge that expands professional duties arising out of the pharmacist exception from which therapists are excluded.

Pharmacists have committed not only to the acquisition of knowledge but also to the use of knowledge in the care of patients and promotion of good outcomes. Patients expect that pharmacists will provide this expertise along with drug products. It is the relationship characterized by pharmacist commitment and patient expectation that justifies the pharmacist’s exception from the general rule of physician responsibility.

Based on: Kwasniewski v Sanofi-Aventis, 2012 U.S.Dist LEXIS 178038 (December 17, 2012).