Medical Malpractice - Learned-Intermediary Doctrine - Nail v. Publix Super Markets, Inc.
In Nail v. Publix Super Markets, Inc., [Ms. 1091740, May 13, 2011] __ So. 3d __(Ala. 2011), the Alabama Supreme Court held that a claim against a pharmacy for failure to inform a customer of a change in dosage of a dangerous drug is not barred by the learned-intermediary doctrine. In Nail, a pharmacist at Publix Pharmacy failed to inform the plaintiff that her dosage of the blood-thinner Coumadin had been changed from 1 mg to 5 mg. Thus, the patient continued to take the drug five times a day (as she had done with the fifteen previous 1 mg prescriptions). As a result, the plaintiff suffered Coumadin toxicity and an epidural hematoma of the cervical spinal cord, which required surgery. After determining that a genuine issue of material fact was present as to whether the plaintiff received counseling with respect to the change in dosage and determining that the trial court's granting of the defendant's motion for summary judgment was in error, the Court examined whether the plaintiff's claims were barred by the learned-intermediary doctrine. The Court acknowledged that "[u]nder the learned-intermediary doctrine, the pharmacist does not have a duty to warn customers of the hazardous side effects either orally or by way of the manufacturer's package insert. We have also applied the learned-intermediary doctrine to bar a pharmacy's liability where a pharmacist gave a physician incomplete dosing information" (citations omitted). However, the Court distinguished those holdings from the present case, explaining that "[n]otifying a customer that there has been a change in prescription strength does not infringe upon the physician-patient relationship. Accordingly, we cannot say that the learned-intermediary doctrine bars [the plaintiff's] claim against Publix." Justice Murdock dissented, arguing that "discussing information of this nature with a patient is part and parcel of the task assigned . . .to the physician, i.e., discussing the propriety of and risk associated with taking a given prescription. Where the prescription written by a physician is normal on its face, the duty imposed by law on the pharmacist is to accurately fill that prescription and to notify the customer of any potential interactions between the prescribed drug and other drugs being supplied by the pharmacist to the customer."