Dr Phil Hammond, broadcaster and sessional GP in Bristol

Doctors and pharmacists need to work in partnership
 

Should pharmacies be held liable for dispensing drugs that doctors have legally, but ill-advisedly, prescribed? There have been many occasions when a helpful pharmacist has queried one of my prescriptions and nipped a potential disaster in the bud, and there are plenty of examples of doctors being sued for bad prescribing. But a case going through the US courts at the moment seeks to make pharmacists accept some of the legal responsibility for the side-effects of drug misuse, particularly when they have been given prior warning.

Back in 2003, the Nevada controlled-substance task force sent letters to 14 pharmacies in Las Vegas warning that Patricia Copening, a doctor’s receptionist, might be abusing drugs after they counted up her yearly dispensation of 4500 prescription-only painkillers. A year later, still under the influence of these drugs, she climbed into a grey Dodge Durango, veered onto U.S. 95 and was seen weaving erratically in and out of three-lane traffic. She then ploughed into a 21-year-old delivery driver who was repairing a flat tyre, killing him and injuring another man who was helping him.1

When the police arrived, Ms Copening struggled to keep her balance while walking barefoot in a straight line and couldn’t remember the name of one of her two children. A blood test detected hydrocodone, and she was charged with reckless driving. She served 9 months and the doctor who issued most of her prescriptions had his license revoked. But after the task-force letters came to light, lawyers representing the victims’ families added seven pharmacy-chain owners and one independent drug store to the law suit.1

In 1994, the Supreme Court in Indiana ruled that a pharmacy had a legal duty to stop issuing painkillers to a patient who was filing prescriptions ‘faster than would normally be appropriate’. In the Nevada case, the pharmacies’ lawyers argued that it was not illegal to dispense a legal prescription that was properly filled in, and the county court judge dismissed the pharmacies from the law suit stating that the controlled-substance task force issued a warning without specifying what action should be taken. Therefore, none of the pharmacies had a legal obligation to turn Ms Copening away or to protect the public from the consequences of her actions.1

However, the families have now appealed to the state Supreme Court and a final judgement is expected soon.1 Whichever way it goes, it seems that the more information healthcare professionals collect, the more likely we are to be held accountable for not making appropriate use of it. We now have sophisticated computer programmes examining our prescribing habits in great detail, but do we always take notice when the screen flashes ‘this patient is apparently over using this drug’?

As patients live longer and end up on more and more drugs, it’s vital that we work in partnership with pharmacists to spot avoidable harm and follow our actions through together. I met a pharmacist recently who took great pride in the medication review he performed for one of his patients, only for that pride to turn to rage as it transpired the GP had just ripped it up and carried on as normal.

There are dozens of drugs that affect our ability to drive; painkillers and benzodiazepines particularly can impair judgement as much as a few pints of strong lager. But I’m not sure I always remember to warn patients about the dangers and I’m grateful for any pharmacist acting as a safety net. And if a pharmacist couldn’t contact me and declined to dispense one of my prescriptions for safety reasons, I’d be thankful. Remember, we’re all in this together.

Dr Phil’s new book Sex, sleep, or scrabble? Seriously funny answers to life’s quirkiest questions is out now.

  1. Merrick A. Case spurs pharmacies’ fears of lawsuits over drug abuse. Wall Street Journal 2009; October 29: 18–19. Available at: wsj.com/article/SB125668736789811845.htmlG