Lead Opinion
Appellant/cross-appellee Wayne E. Walker (Walker) appeals from the order of the state court granting summary judgment to appellee Jack Eckerd Corporation (Eckerd’s). Cross-appellant Alan A. Karp, M.D. (Dr. Karp) cross-appeals from the order denying his motion for summary judgment.
This appeal arises from a malpractice action by Walker against Dr. Karp who prescribed a drug, Blephamide, that allegedly injured Walker, and against the pharmacy which dispensed the drug. A package insert issued to pharmacies with the drug warned that prolonged use could result in glaucoma. Dr. Karp, who was then duly licensed to practice medicine in Georgia, twice prescribed Blephamide for Walker. Walker asserts that both of Dr. Karp’s prescriptions were “PRN” prescriptions. A “PRN” prescription can be refilled as needed over a lengthy time period, usually not over one year. Dr. Karp denies that he issued either prescription as “PRN,” or otherwise refillable. Nevertheless, appellant made averments of fact in his complaint that both the first and second prescriptions, which Dr. Karp telephoned to Eckerd’s, were “PRN.” Eckerd’s dispensed this drug under one of the prescription numbers fifteen times to Walker in less than one year. Walker subsequently was diagnosed with glaucoma, which allegedly was caused by excessive Blephamide prescribed by Dr. Karp and dispensed by Eckerd’s. Held:
Case No. A93A0691 (Main Appeal)
1. The trial court, citing Reynolds v. Estate of R. J. Reynolds,
Appellant’s contention that this pleading did not constitute an admission in judicio because it was merely an expression of opinion is
A question rеmains whether an admission in judicio results when conflicting evidence appears elsewhere in the record as to the fact allegedly admitted in the pleadings. Admissions in judicio can be considered in the disposition of summary judgment cases. See generally Reynolds, supra; Four Square Constr. Co. v. Jellico Coal &c. Co.,
In Summerlot v. Crain-Daly Volkswagen,
In Space Leasing Assoc. v. Atlantic &c. Systems,
It appears that merely because conflicting evidence may exist as to a given issue of fact, this will not prevent per se a party from making an admission in judicio in his pleadings as to that fact. However, if the trial court admits that conflicting evidence, and either the court (e.g., when ruling on a motion for summary judgment) or the jury (when reaching its verdict) considers the conflicting evidence on the
The case аt bar is factually distinguishable from the above-cited cases; likewise, it is distinguishable from Smith v. Doe,
In this case, the trial court expressly held in its order that “plaintiff [was] bound by the allegation contained in his complaint, which was admitted by the answer.” Inherent in this ruling, as further evidenced by the accompanying citation to Reynolds, supra, is the trial court’s election not to allow appellant to withdraw the admission in judicio made in his complaint of the fact that Karp twice telephoned a “PRN” prescription to Eckerd’s drugstore, as averred in the complaint. Clearly, the trial court did not dispose of the issue of “PRN” prescriptions on the merits. Accordingly, the trial court did not abuse its discretion in entering this finding and treating the admission in judicio as conclusive. Reynolds, supra.
2. Appellant asserts the trial court erred in holding that there was no breach of a legally recognized duty on the part of Eckerd’s either in failing to warn or in failing to refuse to refill the prеscriptions. (By virtue of the admission in judicio in appellant’s pleadings it has been conclusively established that the prescriptions were tele
Neither party has cited and we are not aware of any Georgia statutory authority expressly imposing a duty to warn or to refuse to fill prescriptions upon pharmacists who are provided with manufacturers’ literature warning of potential adverse effects if certain drug dosages are exceeded. Compare OCGA § 16-13-73. In fact, OCGA § 26-3-8 (b) specifically excepts certain prescription drugs from various statutory labeling and warning requirements. However, both parties have well-identified the two conflicting lines of authority pertaining to the common-law duty of pharmacists regarding the warning of patients and the refusal to fill prescriptions; the strengths and weaknesses оf each position have been ably argued by counsel for both sides. It appears to be a matter of first impression for this court as to the scope of a pharmacist’s duty, at the present time in this state, in the dispensing of prescriptions.
Appellant, citing Docken v. CIBA-GEIGY,
However, in view of OCGA Title 26, Chapters 3 and 4, the need for preserving, without interference of third parties, a trusted physician-patient relationship, the fact that patients have different reactions to and tolerances for drugs coupled with the fact that the severity of a patient’s condition may warrant a different level of risk acceptance, which factors are best monitored and evaluated by doc
In adopting this view, we are aware that effective January 1, 1993, the Georgia State Board of Pharmacy imposed certain new drug review and patient counseling rules on pharmacists. Rules of Ga. State Board of Pharmacy, § 480-31-.01. However, this does not alter the legislature’s intent prior to these rules to except certain prescription drugs from various labeling and warning requirements. OCGA § 26-3-8 (b). Nor will we here decide whether these rules of the State Board of Pharmacy are mandated by federal law or are in conflict with OCGA § 26-3-8 (b). Suffice it to say that this case is not intended to serve as controlling precedent for cases involving pharmacists’ duties arising after January 1, 1993.
We do not here address a situation where a druggist has improperly compounded a drug, filled a legitimate prescription with a different drug than prescribed, or allowed a drug to become infected with some adulterating foreign substance during the course of preparing and filling the prescription. Compare Pysz, supra at 562 (2) and Gar-side, supra at IV; Ramirez, supra at 88 (4) with Ullman, supra at 956
3. In view of the above, the trial court did not err in granting appellee’s motion for partial summary judgment. See generally Lau’s Corp. v. Haskins,
Case No. A93A0692
Cross-appellant Karp asserts the trial court erred in denying his motion for summary judgment as there is no genuine issue of fact whether a physician-patient relationship exists between him and appellant. Cross-appellant argues that both of the prescriptions were placed by phone merely as an “accommodation” to cross-appellee, who initially was married to Karр’s mother-in-law, and not as a result of an existing physician-patient relationship. Karp did not bill crossappellee for his services.
In this state “there can be no liability for malpractice in the absence of physician-patient relationship.” Peace v. Weisman,
Generally, it is a question of fact for the jury whether there exists a physician-patient relationship; however, a case may be disposed of by summary judgment where the facts are shown by such clear, palpable, and undisputed evidence that the jury could reasonably draw but one conclusion. Cf. Southern Trust Ins. Co. v. Braner,
Judgment affirmed.
Dissenting Opinion
dissenting.
I agree with the majority that, under the common law, a pharmacist has no duty to warn a patient about all possible adverse effects incident to the use of properly prescribed medications.
In my opinion this limited duty best serves the patient, the doctor and the pharmacist. Although the pharmacist owes a duty to the patient beyond just accurately filling the prescribed medication, the pharmacist is not unduly interjected into the physician-patient relationship. On the other hand, the pharmacist is required to question a prescription which is erroneous оr which is irregular on its face, thereby protecting the patient and the physician from physician errors which the patient could not detect but which would be readily apparent to a properly trained pharmacist.
Applying this limited duty to the facts of this case, a material question of fact remains for jury resolution concerning whether dispensing the drug Blephamide “PRN” constitutes such a patent or obvious error that the pharmacist should have contacted the prеscribing physician before repeatedly dispensing the medication. The package insert for Blephamide contains the following warning: “Prolonged use may result in glaucoma, with damage to the optic nerve, defects in visual acuity and fields of visions, and in posterior subcapsular cataract formation. Prolonged use may suppress the host response and thus increase the hazard of secondary ocular infection. ... If these products are used for 10 days or longer, intraocular pressure should be routinely monitored....” I would therefore reverse the trial court’s grant of appellee Eckerd’s motion for partial summary judgment.
I am authorized to state that Presiding Judge McMurray and Judge Blackburn join in this dissent.
Notes
As the majority notes, this case does not address the issue of the duty of a pharmacist after January 1, 1993, when new drug review and patient counseling rules adopted by the Georgia State Board of Pharmacy become effective.
