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Rx2013
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Negligence
unintentional act that causes harm
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Purpose of negligens and malpractice laws
compensate victim and deter careless and irresponsible acts
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Elements of negligence
- duty
- breach of duty
- causation
- damages
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Plantiff must prove
all 4 elements with a preponderance of evidence
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Duty for pharmacists
requires degree of care that a reasonable prudent pharmacist would use under similar condition
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Pharmacists held to error free standard for
mechanical type acts (not requiring professional judgement)
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Nonjudgemental error in filling
- breach of duty per law
- expert witnesses not generally required
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Actual cause
plaintiff must prove negligence was substantial factor in the harm caused
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proximate cause
extent to which the defendant should be held liable for the conduct
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Actual damages
- loss of income
- medical expenses
- pain and suffering
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Punitive damages
- awarded for willful or reckless negligence
- considered punishment
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contributory negligence
common law rule completely barring recovery
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Comparative negligence
- statutory
- requires court base judgement award on relative negligence of each party
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limitations of defense to negligence
- claim must be within a specified period of time
- discovery rule defers time until injury is discovered
- statute or repose limits discovery period time
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Responsible for the negligence of employes
employer
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Purpose of vicarious liablility rule
cause employers to hire and train competent emloyees
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plaintiff may sue
employer and or employee
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Pharmacy practice has changed
from processing rx accurately to improving pt outcomes
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Pharmaceutical care model
- patient oriented
- not physician oriented
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traditional position of court reguarding pharmacist legal duty to warn pt
- pharmacist has no legal duty
- pharmacist duty is to accurately dispense rx as written
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Duty of a pharmacist to provide expanded patient services based on 3 factors
- relationship
- foreseeablility
- public policy
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relationship
- pharmacist patient relationship is independent
- patient relies on pharmacist because of knowlege
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Foreseeability
pharmacist only expected to warn of foreseeable risk
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social policy
- prevent drug abuse
- reinforce physician patient relationship
- decrease health care costs
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courts found pharmacists have no general duty to warn absent "special circumstances" which include
- special instructions by mfg to warn
- contraindications
- special knowlege by pharmacist of patient's condition
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A pharmacist will be held liable when
it voluntarily assumes a funtion that it was under no legal obligation to assume and a patient relies on that function to his/her detriment
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companies should maintain and develop
appropriate systems for order processing and to detect errors before a patient is harmed
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failure of a business to develop systems in spite of numerous errors could result in
punitive damages for recklessness or conscious disreguard for safety of pt
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Failures of quality casing error and human harm may lead to
board disciplinary action
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the goal of risk management is to
reduce the incidence of errors thus protecting patients
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effective risk managemnt systems requires development of
quality systems
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Risk of corporate negligence requires companies to develop quality improvement plans and use them which requires companies to:
- maintain policies and procedures related to erros
- implement incident reporting system where errors are documented, investigated and acted on
- periodically evaulate employees
- continually asses and improve quality of system
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Pharmacist as risk manager
- pharmacist should tell pt error was made
- adequate documentation
- application of general risk management rules to error
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Malpractice insurance
- individual insurance even if covered by employer
- exclude intentional violations
- needs to cover compounding, blood testing, immunizations, initiation or adjusting therapy pursuant to collaborative practice.
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