A DIFFERENT TWIST ON CORRESPONDING RESPONSIBILITY

The biggest hot button legal issue in community pharmacy practice today is that of the “corresponding responsibility” of the pharmacist when vetting controlled substances prescriptions.  We all know what happens when pharmacists fill large numbers of prescriptions for controlled substances not issued for legitimate medical uses.  However, in my consulting practice, I sometimes get questions from pharmacists who are worried that they might be in big trouble if they reject a controlled substance prescription that later turns out to be legitimate.  Not to worry and here’s why…

 

In a recent case in Northern Virginia, Davis v. Wal-Mart Stores East, a U.S. District Judge dismissed a series of claims against Wal-Mart and one of its pharmacists, Brenda Greer.  In this case, a former government contractor with a security clearance, Eve Davis, was receiving Adderall® for attention deficit/hyperactivity disorder (ADHD).  Because Ms. Davis did not have insurance, her prescribing physician, Dr. Syed Ahmed, would provide her with two one-month prescriptions for the drug at each office visit in order to hold down her cost of office visits.  As was Ms. Davis’s custom and practice, she would fill these prescriptions a few days apart, although at no time did she exceed the frequency of one prescription per month.

 

One day in October, 2013, Ms. Davis dropped off two prescriptions at a Wal-Mart pharmacy in Northern Virginia.  Pharmacist Greer queried the state’s Prescription Monitoring Program (PMP) to assist her in validating the prescription.  To her surprise, she noticed that Ms. Davis had just filled an identical prescription for Adderall® just four days earlier.  In fact, the pharmacist noted a similar pattern going back 6 months and elected to contact the physician to verify that he knew what was going on but the physician was not available.  In the meantime, her pharmacy technician contacted Ms. Davis and left a voice message that she would be unable to fill the prescription for 48 hours.  However, for inexplicable reason, pharmacist Greer then contacted the Sheriff’s Office and apparently told a dispatcher that she had a patient “…turning in prescriptions with the same date on it for the same medicine at two pharmacies…”.  She apparently also told the dispatcher that the prescription was a fake and a duplicate and the signature looked “funny”. Why she would handle the situation in such an extreme fashion no one knows.  When Ms. Davis returned to the pharmacy to pick up her prescription, she was met by a Sheriff’s deputy, handcuffed, and taken to a room in the store to be interviewed.  Davis was subsequently arrested and jailed with a charge of attempting to purchase a controlled substance by fraud.

The physician called the pharmacist back the following Monday and told her that the prescriptions were valid.  Rather than contact the Sheriff’s office, she held on to that information for two weeks before giving it to the prosecutor.  Ms. Davis was denied bond and spent 16 days in jail.  She claimed she suffered from amphetamine withdrawal  and subsequently attempted suicide.  When all the facts came to light, the charges against Ms. Davis were dropped and she was released from jail.  Unfortunately, she lost her security clearance and all the government contracts she was working on.  As one can imagine, lawsuits would be filed against anyone and everyone who participated in this misadventure.

Interestingly, the lawsuit against pharmacist Greer and Wal-Mart was dismissed by the Federal District Judge Henry Hudson without prejudice.  In his decision, Judge Hudson said that “…one may certainly question the wisdom or prudence of Greer’s decisions throughout this incident but the allegations do not plausibly amount to negligence…”.  He went on to say that “…the fact that the prescription was not in compliance with federal regulations (there should have been a notation on the prescription when the second prescription could be filled), coupled with the PMP information, was enough to give Greer legitimate reason to question this prescription and be concerned…”.  In addition, Virginia’s “safe harbor” law allowed her to to bring in law enforcement without retaliation by the subject.

Takeaway Points

None of this should have ever happened.  Despite the court’s ruling that she had been within her rights to do what she did, Pharmacist Greer certainly did not need to go to these extremes when a couple of brief phone calls could have resolved everything.  However, if one looks past the over-the-top behavior of Pharmacist Greer, the fact remains that she was fulfilling her “corresponding responsibility” in vetting this controlled substance prescription.  Hopefully pharmacists reading this will recognize that using even a modicum of common sense and following the letter and spirit of the law are not mutually exclusive.