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Letters to the Editor
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Fitness to practise
Every right has its correlative duty
From Dr G. E. Appelbe, FRPharmS
I refer to the letters of Paul
Murphy (PJ, 23/30 December 2006, p768)
and Asta Prajapati (PJ, 13 January, p49). I am concerned that two pharmacists
can err in their comprehension of the Royal Pharmaceutical Society’s
Code of Ethics, professionalism generally and well known past legal decisions
which they should have learnt about at university. One error that needs
to be corrected relates to a pharmacist’s liability when dispensing
a prescription. The Society’s Code of Ethics, which the judge quoted
in his judgment, quite clearly states that “every prescription
must be professionally assessed by a pharmacist to determine its suitability
for the patient. Pharmacists must ensure that the patient receives sufficient
information and advice to enable the safe and effective use of the medicine.” The
Society’s view is that reflected in the Code of Ethics.
All pharmacists must know it is potentially dangerous suddenly to raise
or lower the dose of steroids. In the recent case the judge said: “The
most significant criticism of Mr G is that once he saw that the prescription
was for tablets of dexamethasone which were eight times the strength
of the tablets which had been dispensed on the seven previous occasions
on which Lloyds had dispensed prescriptions for dexamethasone for Mrs
Horton (as revealed by the computer records), it should have occurred
to him that this prescription was a mistake.”
The judge said that if the pharmacist had checked with the doctor, as
he should have done in accordance with the branch’s procedures
manual, which required the pharmacist to take responsibility for ensuring
that “the dose prescribed is safe for the patient”, the doctor’s
mistake would have been discovered and the subsequent injury and events
would not have occurred. The judge added that “these requirements
mirror pharmacists’ obligations under the common law”.
There is no question of the pharmacist being made a scapegoat. In negligence
both parties, doctor and pharmacist, made a mistake, and this led to
injury to the patient. In cases of this kind the liability is inevitably
joint, the doctor usually being primarily liable and the pharmacist secondarily
so. Apportioned liability is now an accepted principle in dispensing/negligence
cases.
The earlier major case to be heard by the High Court (Dwyer v Rodrick
and others [1982] — the Migril case) was similar to the existing
case in that the doctor made a mistake on the prescription and the potential
mistake was not queried by the pharmacist. In that case the judge in
making the award said “pharmacists … have to exercise an independent
judgment to ensure that the drug is apt for the patient as well as that
it conforms to the physician’s requirements”, and that the
pharmacist should have spotted the doctor’s error and queried the
prescription with the prescriber. The legal and professional responsibility
was highlighted and established by that case and was referred to in the
recent case.
Whether pharmacists like it or not the current case of Horton v Lloyds
Pharmacy Ltd (2006) confirms the earlier cases in common law as to the
accepted legal and professional duties and liability of a pharmacist.
Pharmacists consistently, and with good reason, press for recognition
as experts on medicines.
Every right has its correlative duty and pharmacists, as they achieve
greater recognition, must expect the law to require from them a higher
degree of skill.
As a consequence of that pharmacists may become more liable to actions
for professional negligence.
Gordon Appelbe
London
Duty of care
From Mr S. R. Potter, MRPharmS
I must comment on the letter from Asta
Prajapati (PJ, 13 January, p49)
regarding the recent Lloydspharmacy legal case.
I believe that the judge was right in asserting that the pharmacist should
have confirmed the intention behind the gross increase in dose prescribed
(rather than specifically the dose itself) with the prescriber or the
patient before dispensing.
Mr Prajapati asserts that the pharmacist involved was “unlucky”.
I am afraid that I believe that this case was less about bad luck and
more about poor judgement. Pharmacists are health care professionals
and have a duty of care to their patients. Part of being recognised as
a professional is the obligation to be fully accountable for our actions.
Stephen Potter
Birmingham
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The
Pharmaceutical Journal