Prescription Drug Overdose Leads Court to Review Pharmacist’s Standard of Care

On March 13, 2008, Sarah Hollier visited Dr. Gregory Green for treatment of bronchitis. Dr. Green wrote Hollier a prescription, which she took to the Super One Pharmacy in Monroe to have filled. The pharmacist on duty, Katy Buntyn, was not familiar with the particular form of the drug that Dr. Green prescribed because it had been discontinued some four years prior. Buntyn directed her pharmacy technician to phone Dr. Green’s office for clarification on how to fill the order. Ultimately, after further confusion over the form of the drug and the dose, Buntyn mistakenly filled the prescription at a dosage which was at more than 2.5 times the “top end” dose indicated on the drug’s literature and eight times the dose intended by Dr. Green. When Hollier began taking the medication, she experienced high energy levels, sleeplessness, increased heart rate, and nausea.

Hollier’s husband, himself a pharmacist, recognized her symptoms and discovered the erroneous dose after inspecting the prescription bottle. The Holliers reported the problem to the pharmacy and, later, filed suit against the pharmacy and Buntyn. In Louisiana, pharmacists are not subject to the state’s Medical Malpractice Act, so the matter was heard in Monroe City Court on September 21, 2009. The trial court entered a judgment for Hollier and awarded her $7,500 in general damages and $827.08 for medical expenses. The defendants appealed, refuting liability.

The Second Circuit first reviewed the elements of general negligence, but then noted that a “pharmacist has a duty to fill a prescription correctly and to warn the patient or to notify the prescribing physician of an excessive dosage or of obvious inadequacies on the face of the prescription which create a substantial risk of harm to the patient.” Buntyn argued that she met this duty by calling Dr. Green’s office to inquire about the prescription. But the court disagreed that this action was sufficient to discharge her duty; instead, “the fact that the package insert lists the top end of an initial daily dosage of [the drug] at 9 mg should have aroused Ms. Buntyn’s suspicions that a 24 mg initial daily dosage was excessive.” At that point, reasoned the court, Buntyn “should have inquired further.” Thus, the court could not find that trial court committed manifest error in finding that Buntyn breached her duty to Hollier by supplying the extremely high dose of the drug, and affirmed the judgment.

The Hollier case makes clear that the law considers a patient’s health paramount. Even if some or all of the fault for an erroneous prescription can be traced back to the doctor, a pharmacist is still required to use independent judgment when filling a prescription. Circumstances such as a particularly high or low dose, a call for a drug that’s unrelated to the patient’s condition, or other irregularity should trigger the pharmacist to investigate further before dispensing the medication. The Hollier case suggests that simply confirming with the ordering doctor may not be sufficient when other common resources, such as the drug manufacturer’s package insert, suggest that the doctor’s orders are unsafe or inappropriate.