OPINION
Stephanie Yates experienced a stroke while using the ORTHO EVRA® birth control patch, and she now seeks to hold the designers and manufacturers of the patch liable. Yates appeals the district court’s award of summary judgment to defendants on all five of her claims. For the reasons set forth in this opinion, we affirm the district court’s judgment.
I.
A.
Yates brought suit against Ortho-McNeil-Janssen Pharmaceuticals, Inc., Alza Corporation, Johnson & Johnson
In the district court, Yates alleged five causes of action against defendants: (1) strict liability in tort — failure to warn; (2) strict liability in tort — manufacturing defect; (3) negligence; (4) breach of implied warranty; and (5) breach of express warranty. On April 7, 2014, the district court granted summary judgment as to Yates’s failure to warn claim. Yates v. Ortho-McNeil-Janssen Pharm., Inc., No. 3:09oe40023,
B.
Yates first visited OB/GYN Associates of Western New York on May 20, 2004, for her first gynecological appointment. Yates again visited OB/GYN Associates on November 3, 2004, when she was seventeen years old, because she was sexually active and was suffering from severe menstrual cramps. During the November 3, 2004 appointment, a licensed physician assistant — Jennifer Smith — counseled Yates about a variety of contraceptives, as well as the risks and benefits accompanying each product. Smith discussed the risks, benefits, and side effects of several methods of birth control, including oral contraceptives, Depo-Provera, NuvaRing, and ORTHO EVRA®. Smith testified that it would have been her usual practice to advise Yates that all these methods оf birth control carried risks, including breakthrough bleeding, moodiness, headaches, nausea, breast tenderness, blood clots, and stroke, and that the benefits included menstrual relief, and, obviously, birth control. Yates admits that she was counseled concerning the risk of a stroke and clotting associated with ORTHO EVRA®. At this time, Yates decided to try Depo-Provera, which requires injections at three-month intervals. Before this examination and consultation, Yates admittedly had never heard of ORTHO EVRA®.
Yates returned to OB/GYN Associates on March 3, 2005, because she wanted to discontinue the use of Depo-Provera due to weight gain. Yates did not want to take an oral contraceptive because she would have trouble remembering to take a pill every day. Yates elected to switch to the ORTHO EVRA® patch. Smith approved the change to ORTHO EVRA®, to begin on March 6, 2005. However, Yates was suffering from “constant heavy menses,” which is a common side effect of Depo-Provera and which delayed her switch to ORTHO EVRA®. DE 48-6, Smith Dep., Page ID 286. Yates again visited OB/ GYN Associates on March 18, 2005, March 29, 2015, and April 15, 2005. Smith testified that it wоuld have been her custom
Yates first used the ORTHO EVRA® patch on April 17, 2005, and she suffered a stroke on April 24, 2005, while she was still wearing her first weekly patch. One of Yates’s expert witnesses, Dr. Mary Elizabeth Roemholdt, a board-certified neurologist and neurophysiologist, opined that Yates’s “use of the Ortho-Evra patch was the contributing cause of her stroke.” DE 94-8, Roemholdt Aff., Page ID 4697.
Smith began working at OB/GYN Associates in 2001. As a physician assistant, Smith sees patients for routine checkups, gynecological problems, diagnosis, and treatmеnt, and she is authorized to prescribe medications. According to her deposition testimony, Smith prescribes medications based on her knowledge, training, and experience, as well as her assessment of the patient and her own clinical experience. Smith learns about the risks of medications that she prescribes from a variety of sources, including pharmaceutical sales representatives, medical journals, continuing medical education classes, and discussions with other doctors, physician assistants, and nurse practitioners in her office. Smith’s custom is to prescribe contraceptives that, in her independent medical judgment, will be safe and effective for the particular patient. With regard to ORTHO EVRA®, Smith knew that the warnings for the patch included increased risks of thromboembolism and stroke. Smith also acknowledges that she tells her patients that one of the risks of using ORTHO EVRA® is the risk of developing a blood clot or a thromboembolism. Smith further testified that she still prescribes ORTHO EVRA® for her patients.
C.
As with other hormonal contraceptives, ORTHO EVRA® prevents pregnancy by dеlivering higher and more consistent levels of estrogen and progestin than present in normal menstrual cycles. Strokes are a well-known potential side effect associated with hormonal contraceptives. The OR-THO EVRA® package insert in use at the time Yates used the patch contained information about the drug for prescribing physicians to review, and included the following warnings:
The use of combination hormonal contraceptives is associated with increased risks of several serious conditions including myocardial infarction, thrombo-embolism, stroke, hepatic neoplasia, and gallbladder disease, although the risk of serious morbidity or mortality is very small in healthy women without underlying risk factors. The risk of morbidity and mortality increases significantly in the presence of other underlying risk factors such as hypertension, hyperli-pidemias, obesity and diabetes.
Hormonal contraceptives have been shown to increase both the relative and attributable risks of cerebrovascular events (thrombotic and hemorrhagic strokes), although, in general, the risk isgreatest among older (>35 years), hypertensive women who also smoke. Hypertension was found to be a risk factor for both users and nonusers, for both types of strokes, and smoking interacted to increase the risk of stroke.
In a large study, the relative risk of thrombotic strokes has been shown to range from 3 for normal normotensive users to 14 for users with severe hypertension. The relative risk of hemorrhagic stroke is reported to be 1.2 for non-smokers who used hormonal contraceptives, 2.6 for smokers who did not use hormonal contraceptives, 7.6 for smokers who used hormonal contraceptives, 1.8 for normotensive. users and 25.7 for users with severe hypertension. The attributable risk is also greater in older women.
DE 48-8, Package Insert, Page ID 326-27.
The FDA requires that patient package inserts accompany each package of an estrogen drug product that the manufacturer or distributor intends to be dispensed to a patient. See 21 C.F.R. § 310.515. Accordingly, the patient package insert for OR-THO EVRA® included the following warning:
RISKS OF USING HORMONAL CONTRACEPTIVES, INCLUDING OR-THO EVRA®
2. Heart attacks and strokes
Hormonal contraceptives, including OR-THO EVRA®, may increase the risk of developing strokes (blockage or rupture of blood vessels in the brain) and angina pectoris and heart attacks (blockage of blood vessels in the heart). Any of these conditions can cause death or serious disability.
Smoking and the use of hormonal contraceptives including ORTHO EVRA® greatly increase the chances of developing and dying of heart disease. Smoking also greatly increases the possibility of suffering heart attacks and strokes.
DÉ 48-8, Package Insert, Page ID 330.
II.
Because this is a diversity case, we apply New York substantive law, Kepley v. Lanz,
“The Federal Rules of Civil Procedure are the rules of practice which apply to civil actions in the federal courts, regardless of whether jurisdiction is based on federal question or diversity оf citizenship.” Hayes v. Equitable Energy Res. Co.,
.We review the district court’s grant of summary judgment de novo. Laster v. City of Kalamazoo,
III.
A. Failure to Warn
The district court granted defendants’ motion for summary judgment on Yates’s strict liability failure to warn claim, holding that defendants provided adequate warnings to Yates’s prescribing medical provider regarding the risk of stroke associated with ORTHO EVRA®. Yates,
1.
To establish a claim against a drug manufacturer for failure to warn under New York law, “ ‘a plaintiff must demonstrate that the warning was inadequate and that the failure to adequately warn of the dangers of the drug was a proximate cause of his or her injuries.’ ” Krasnopol-sky v. Warner-Lambert Co.,
In this case, the “precise malady incurred” was a stroke, and the risk of stroke “was communicated in the prescribing information.” Defendants mentioned the risk of stroke associated with ORTHO EVRA® several times in the package inserts. The ORTHO EVRA® label specifically stated that “[t]he use of combination hormonal contraceptives is associated with increased risks of several serious condi
Yates cites Hollister v. Dayton Hudson Corp.,
Yates next cites DiBartolo v. Abbott Laboratories,
Yates further argues that the fact that the FDA subsequently required defendants to change ORTHO EVRA®’s warn-ihg regarding the risk of stroke is evidence of the insufficiency of the label in effect when she was prescribed ORTHO EVRA®. However, Yates cites no authority for the proposition that the subsequent improvement to a label, even a change that is required by the FDA, is probative evidence of the label’s previous failure to warn. Absent any such authority, we will not consider evidence of a subsequent improvement to a drug label as evidence of prior failure to warn, even in cases such as this in which the FDA mandated the change in labeling. See Fed.R.Evid. 407 (“When measures are taken that would have made an earlier injury or harm less likely to occur, evidence of the subsequent measures is not admissible to prove ... a need for a warning or instruction.”). As defendants contend, “Warnings can always be made ‘better,’ but ‘better’ is not the standard New York law requires — adequacy is. If the stroke warning was adequate to inform PA Smith when she prescribed ORTHO EVRA® to Plaintiff, then any subsequent updates made to that warning are not relevant.” Appellee Br. at 27. Quite simply, the ORTHO EVRA® warnings in effect when Yates was prescribed the patch adequately warned her prescribing medical provider — Smith—of the risk of stroke.
2.
Yates next argues that her case presents an exception to the learned intermediary doctrine, and that FDA regulations required defendants to warn her, as the consumer, directly regarding ORTHO EVRA®’s risks. Under New York law, there is an exception to the informed intermediary doctrine “where FDA regulations otherwise provide.” Lindsay,
In determining whether defendants had a duty to warn Yates directly of the known side effects and possible risks of ORTHO EVRA®, first, FDA regulations must provide otherwise. See id. Second, the exception to the informed intermediary doctrine will apply only if “an in-depth analysis of the benefits and risks to the individual of the [drug’s] administration appears to be unlikely.” See Samuels v. Am. Cyanamid Co.,
In this case, the applicable FDA rеgulations require that “each estrogen drug product restricted to prescription distribution, including products containing estrogens in fixed combinations with other drugs, shall be dispensed to patients with a
As to the second requirement, however, we find that Yates was counseled meaningfully by her prescribing medical provider, such that no exception to the informed intermediary doctrine applies here. The facts of this case clearly demonstrate that Smith adequately counseled Yates regarding her different birth control options. Smith was aware of several personal matters that affected Yates’s birth control selection, such as her apprehension about remembering to take an oral contraceptive daily. OB/GYN Associates is not a clinic designed to quickly process patients; rather, Smith testified that it is her custom to use her independent medical judgment when prеscribing birth control products to patients, and she specifically testified that she discussed the risks and benefits of several different forms of birth control with Yates. The mere fact that Smith gave Yates options and a voice in determining which method of birth control would best fit her needs and lifestyle does not remove Smith from her status as a learned intermediary. There may be cases in which a prescriber of birth control medication does not function as a learned intermediary, but this is not such a case.
B. Preemption
The district court concluded that, by virtue of the FDA’s approval of ORTHO EVRA®, Yates’s state law design defect claims are preempted under Mutual Pharm. Co. v. Bartlett, — U.S. -,
1.
The doctrine of conflict preemption has its roots in the Supremacy Clause, which states that federal law “shall be the supreme Law of the Land ... any thing in the Constitution or Laws of any State to the Contrary notwithstanding.” U.S. Const, art. VI, cl. 2. State-law claims can be preempted expressly in a federal statute or regulation, or impliedly, where congressional intent to preempt state law is inferred. Crosby v. Nat’l Foreign Trade Council,
“Impossibility pre-emption is a demanding defense.” Wyeth v. Levine,
As a general matter, plaintiffs injured by brand-name prescription drugs retain state-law tort remedies against the manufacturer of those drugs, provided it is not impossible for the drug manufacturer to comply with both state and federal law. See generally Levine,
The Supreme Court has provided guidance in three recent opinions on federal preemption in pharmaceutical products liability suits. In Levine, the plaintiff suffered an arm amputation following an injection of Phenergan, a drug that was administered to curb her nausea from a migraine headache.
Two years later, in PLIVA Inc. v. Mensing, the Supreme Court applied the impossibility preemption framework set forth in Levine and found that the plaintiffs state law claim was preempted. — U.S. -,
Another two years later, in Bartlett, the Supreme Court applied the Levine and Mensing preemption analyses to a generic design defect case. The plaintiff was given a generic form of the anti-inflammatory pain reliever sulindac, and as a result, she developed an acute case of toxic epidermal necrolysis. Bartlett,
2.
There is some disagreement between the parties about whether Yates pleaded design defect under strict liability or negligence theories. However, since New York law treats claims of design defect sounding in negligence as “functionally synonymous” to claims for design defect based on strict liability, we analyze the claims identically. Cavanagh v. Ford Motor Co., No. 13-cv-4584,
As an initial matter, the district court oversimplified the impossibility preemption analysis as stated in Levine, Mensing, and Bartlett. The district court seemingly concluded, and defendants encourage this reading on appeal, that the Bartlett Court’s finding of impossibility preemption extends to all design defect claims for both generic and brand-name drug manufacturers, based on the following sentence: “Once a drug — whether generic or brand-name — is approved, the manufacturer is prohibited from making any major changes to the ‘qualitativе or quantitative formulation of the drug product, including active ingredients, or in the specifications provided in the approved application.’ ”
Important to the preemption findings in Bartlett and Mensing is the fact that generic drug manufacturers are prohibited from making any unilateral changes to the drug’s composition or label, which is known as the “sameness” requirement. Bartlett,
Further, both the district court and defendants improperly rely on Amos,
3.
Applying the federal impossibility preemption analysis to this case, we must first determine what duties New York law placed on defendants in designing ORTHO EYRA®. See Bartlett,
(1) the utility of the product to the public as a whole and to the individual user; (2) the nature of the product — that is, the likelihood that it will cause injury; (3) the availability of a safer design; (4) the potential for designing and manufacturing the product so that it is safer but remains functional and reasonably priced; (5) the ability of the plaintiff to have avoided injury by careful use of the product; (6) the degree of awareness of the potential danger of the product which reasonably can be attributed to the plaintiff; and (7) the manufacturer’s ability to spread any cost related to improving the safety of the design.
Voss v. Black & Decker Mfg. Co.,
Second, we must determine whether federal law expressly prohibits defendants from complying with state law. Id. at 2476. Stated another way, we ask “whether this state-law duty makes compliance 'with any federal law impossible.” Sullivan,
Yates’s post-approval design defect claim is clearly preempted by federal law. FDA regulations provide that once a drug, whether generic or brand-name, is approved, the manufacturer is prohibited from making any major changes to the “qualitative or quantitative formulation of the drug product, including inactive ingredients, or in the specifications provided in the approved application.” 21 C.F.R. § 314.70(b)(2)(i). Moderate changes must be reported to the FDA “at least 30 days prior to distribution of the drug product made using the change.” Id. § 314.70(c) (emphasis added). Minor changes need only be reported in an annual report to the FDA. Id. § 314.70(d)(3). Although Yates asserts that to “reduc[e] the amount of estrogen from 0.75 mg/patch to 0.6 mg/ patch” “would be minimal,” we disagree. Appellant Br. at 45. Based on the plain meaning of the regulation, we are convinced that defendants could not have altered the dosage.of estrogen in ORTHO EVRA® without submission to the FDA and the agency’s “approval prior to distribution of the product made using the change.” See 21 C.F.R. § 314.70(b)(2)(i) (emphasis added). Among the enumerated “minor changes” that do not require prior notification to and/or approval from the FDA, are “[t]he deletion or reduction of an ingredient intended to affect only the color of the drug product” and “[a] change in the size and/or shape of a container containing the same number of dosage units.” 21 C.F.R. § 314.70(d)(2)(H), (iv). A “moderate change,” for example, is “[a] change in the contáiner closure system that does not affect the quality of the drug product.” We think it clear that changing the dosage level of the active ingredient of ORTHO EVRA® constitutes a “major change,” such that prior FDA approval is necessary. Id. § 314.70(b)(2)(i) (stating that “major changes” include “changes in the qualitative or quantitative formulation of the drug product) (emphasis added). Therefore, to the extent Yates argues that defendants should have altered the formulation of ORTHO EVRA® after the FDA had approved the patch, we find this claim clearly preempted. Quite simply, federal law prohibited defendants from decreasing
Yates also contends, however, that there is no federal law that would have prohibited defendants from designing a different drug in the first instance. Specifically, Yates asserts that “when defendants first decided how to configure Ortho Evra and before defendants ever obtained FDA approval to market the drug — no federal law prohibited defendants from adopting a safer design.” Appellant Br. at 38. Indeed, counsel for defendants has cited no federal law that restricts a brand-name drug manufacturer from designing a reasonably safe product prior to FDA approval. See Sullivan,
But Yates’s argument regarding defendants’ pre-approval duty is tоo attenuated. To imagine such a pre-approval duty exists, we would have to speculate that had defendants designed ORTHO EVRA® differently, the FDA would have approved the alternate design. Next, we would have to assume that Yates would have selected this method of birth control. Further yet, we would have to suppose that this alternate design would not have caused Yates to suffer a stroke. This is several steps too far. Even if New York law requires defendants to produce and market a different design, the ultimate availability to Yates is contingent upon whether the FDA would approve the alternate design in the first place. In Mensing, the plaintiffs argued that “if the Manufacturers had asked the FDA for help in changing the corresponding brand-name label, they might eventually have been able to accomplish under federal law what state law requires.”
The Manufacturers “freely concedе” that they could have asked the FDA for help. If they had done so, and if the FDA decided there was sufficient supporting information, and if the FDA undertook negotiations with the brand-name manufacturer, and if adequate label changes were decided on and implemented, then the Manufacturers would have started a Mouse Trap game that eventually led to a better label on generic metoclopramide.
Id. (internal citation omitted). In that case, the Supreme Court ultimately found
Yates cites Wimbush v. Wyeth,
Yates’s pre-approval claim fails for another reason. In Bartlett, the Supreme Court held that “[t]he [First Circuit] Court of Appeals’ solution — that [the manufacturer] should simply have pulled [the drug] from the market in order to comply with both state and federal law — is no solution.”
In sum, both Yates’s pre-approval and post-approval design defect claims are preempted by federal law.
C. Manufacturing Defect
As to Yates’s manufacturing defect claim, the district сourt held that “[t]here is no evidence that the Ortho Evra® patches which Ms. Yates received differed from either the manufacturing specifications for that product or from other identical units. Therefore, the Defendants are entitled to summary judgment as a matter
Under New York law, “[a] manufacturing defect claim is premised on the relevant product .being defective because it was not manufactured as designed.” Reed v. Pfizer, Inc.,
Yates contends that she has produced evidence that defendants used a “flawed manufacturing process to produce the drug” and that defendants had “major difficulties in scaling up the manufacture of Ortho Evra from clinical trials to commercial production.” Appellant Br. at 47-48. The only evidence that Yates produced on this matter comes from an affidavit from an expert witness. Dr. Susan Parisian, a board-certified physician and a former chief medical officer with the FDA, opined that defendants failed to adhere to good manufacturing practices for commercial production of ORTHO EVRA®. Dr. Parisian stated that defendants experienced difficulties in scaling up the manufacture of ORTHO EVRA® from clinical trials to commercial production, apparently as evidenced by inter-lot variability with respect to estrogen release rates. Dr; Parisian further asserted that “prior to commercial launch of April 2002, [defendants] had not developed robust manufacturing release specifications and process validations necessary to ensure consistent release of safe and effective commercial OR-THO EVRA.” DE 94-6, Parisian Aff., Page ID 4567 (emphasis added). Notably missing from Dr. Parisian’s affidavit, or from any other evidence produced by Yates, is support for the claim that there were manufacturing irregularities after the commercial launch of ORTHO EVRA®.
Defendants argue as follows:
Plaintiff cannot show that the product did not work as intended; ORTHO EVRA® did what it was prescribed to do — prevent her from becoming pregnant while using it. That she alleges that she experienced a known and warned-of side effect while using OR-THO EVRA® is not circumstantial evidence that the product did not perform as intended.
Appellee Br. at 51. We agree. If evidence of a known and warned-of side effect could be used as sufficient circumstantial evidence of a manufacturing defect, then every drug-user who suffered a known and warned-of side effect could state a claim for a manufacturing defect. Specifically, the fact that Dr. Roemholdt attributes Yates’s stroke to her use of the ORTHO EVRA® patch is not evidence of a manufacturing defect, since the ORTHO EVRA® label and package insert explicitly warned of the risk of stroke. Furthеr, Yates has produced no evidence, from Dr. Parisian or others, that any studies have revealed that the patches actually commercially produced and released to the public contained different estrogen amounts from
Drawing every reasonable inference in Yates’s favor, as required on summary judgment, her manufacturing defect claim must fail. There is no evidence, direct or circumstantial, that the ORTHO EVRA® patch used by Yates, or anyone else, differed from the FDA-approved design.
D. Negligence
The district court awarded summary judgment to defendants on Yates’s negligence claim on the basis that “[t]he courts of New York have held that state law claims of negligence, negligence per se, and breach of implied warranty are preempted when the article in question is regulated by federal law.” Yates,
E. Breach of Implied Warranty
The district court granted summary judgment to defendants on Yates’s claim for breach of the implied warranty of merchantability because it is preempted by federal law on the basis of Mitaro. Yates,
Under New York law, breach of the implied warranty of merchantability is a valid cause of action, separate and apart from strict liability in tort, though there is considerable overlap between them. See Denny,
Even if Mitaro does not stand for the proposition that once a design defect claim is preempted under federal law, other state law claims are preempted as well, Yates’s implied warranty claim fails on the merits. Because defendants adequately warned Yates’s prescribing medical provider of the risk of stroke, Yates has not proven her claim with respect to “a failure to provide adequate warnings.” See id. Further, Yates failed to produce any evidence on whether there was a manufacturing defect that affected commercial production of ORTHO EVRA®. See id.
F. Breach of Express Warranty
The district court granted summary judgment to defendants on Yates’s claim for breach of express warranty, because she “failed to perform any research regarding the Ortho Evra® patch because she trusted the medical advice she was given.” Yates,
To state a claim for breach of express warranty under New York law, the “plaintiff must allege that ‘there was an affirmation of fact or promise by the seller, the natural tendency of which was to induce the buyer to purchase and that the warranty was relied upon to the plaintiffs detriment.’ ” DiBartolo,
Yates contends that, even if she never received a representation from defendants to induce her to use ORTHO EVRA®, because New York does not require privity, her claim for breach of express warranty survives because “defendants falsely represented the level of estrogen in their product.” Appellant Br. at 54. Defendants respond that they made no direct, affirmative representation to Yates.
We conclude that the district court properly awarded summary judgment to defendants on Yates’s breach of express warranty claim. The record makes clear that defendants made no affirmation of fact or
CONCLUSION
For the reasons discussed above, we affirm the district court’s grant of summary judgment to defendants.
Notes
. In her Reply brief, Yates requests this court certify to the New York Court of Appeals the question of whether New York law recognizes an exception to the informed intermediary doctrine under these circumstances. Certification is inappropriate where a federal court "believes that it can resolve an issue of state law with available research materials already at hand, and makes the effort to do so.” Lehman Bros. v. Schein,
. In her Reply brief, Yates contends that "if this Court is unconvinced that New York recognizes a pre-approval duty to safely design prescription drugs,” that the following question be certified to the New York Court of Appeals: “Does New York recognize a drug manufacturer's duty to safely design a prescription drug before the FDA approves the drug for marketing?” Reply Br. at 22 n. 3. For the reasons stated in this opinion, such
. Yates further claims that her post-approval design defect claim parallels the federal Food, Drug, and Cosmetic Act ("FDCA”), and as such, is not preempted. Pursuant to the FDCA, manufacturers may not sell a drug that is "deemed to be misbranded” because it is "dangerous to health” when used in the dosage or manner called for in the drug's label.” See 21 U.S.C. § 352(j). The FDCA requires "new and scientifically significant information that was not before the FDA,” Bartlett,
