tag:blogger.com,1999:blog-7476621888383604834.post2708877343440515873..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: Good Ethics/Bad Law in MassachusettsJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-7476621888383604834.post-14429766014250854692008-10-21T19:07:00.000-04:002008-10-21T19:07:00.000-04:00To Jim Sabin..you know I think I will!! hahaDonna ...To Jim Sabin..you know I think I will!! haha<BR/>Donna AAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-38499395775918720512008-10-21T07:53:00.000-04:002008-10-21T07:53:00.000-04:00Hi Donna -I'd say - go for it. The worst that coul...Hi Donna -<BR/><BR/>I'd say - go for it. The worst that could happen is that you get no response. But the Obama campaign has been inclusive, and let's hope and expect the Obama/Biden administration to be the same!<BR/><BR/>Best<BR/><BR/>JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-14262328831715471912008-10-15T20:08:00.000-04:002008-10-15T20:08:00.000-04:00Thanks for the note.I have a crazy notion of conta...Thanks for the note.<BR/>I have a crazy notion of contacting Obama and proposing to be part of his healthcare rebuilding. What can be more important and more of an incremental part of the greatly needed change in healthcare in this country!! What do you think? hahaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-64907652683517037852008-09-13T08:27:00.000-04:002008-09-13T08:27:00.000-04:00Hi ClinkShrink -FYI, some years back I co-taught a...Hi ClinkShrink -<BR/><BR/>FYI, some years back I co-taught an elective in "ethics and law in outpatient psychiatry" several times at the Harvard Longwood Psychiatry program. Patricia Illingworth, my co-teacher(a lawyer/philosopher), and I found that case law was very engaging for the residents, and for us. Garamella, Jaffee v Redmond, Joyce Brown (or Billie Boggs), Meinhard v Salmon (about professionalism, not psychiatry per se) and Wickline were all of great interest. <BR/><BR/>Best<BR/><BR/>JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-42376755148837186562008-09-13T07:36:00.000-04:002008-09-13T07:36:00.000-04:00I read your comment on our blog about the Coombes ...I read your comment on our blog about the Coombes vs Florio case and I just had to stop by and thank you for your contribution. My co-bloggers don't have the fascination for case law that I have, but I've been waiting for someone like you to chime in. Thanks so much. I'm adding that case to our fellowship's journal club when we get to the Tarasoff issues.<BR/><BR/>Thanks for reading Shrink Rap.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-7629223942526509132008-09-07T00:00:00.000-04:002008-09-07T00:00:00.000-04:00For now....I have time only to strongly concur. I ...For now....I have time only to strongly concur. I add that there are some grey lines in medicine and dispensing of pharmaceuticals. Pardon me , more soon.<BR/>D<BR/>CincinnatiAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-62130526829943661262007-12-17T14:10:00.000-05:002007-12-17T14:10:00.000-05:00Hi Jim,I agree with your assessment of "bad law, g...Hi Jim,<BR/><BR/>I agree with your assessment of "bad law, good ethics" 100%. What I found fascinating about this case is the absence of the role of the pharmacist, and, through further research, the legal precedents for this exclusion.<BR/> In reading the court’s decision in Cottam v. CVS (referenced in the Florio decision), I was amazed to find out how little legal responsibility rests upon the pharmacist in regards to consulting patients as to the potentially harmful side effects of the medication(s) being dispensed. Here’s what’s fascinating: through a legal precedent called the “learned intermediary doctrine”, pharmacies are essentially absolved of the duty to warn their customers about a medication’s potentially negative side effects. It essentially designates the prescribing physician as, in essence, the ‘retailer’ of the medication, not the pharmacy. This doctrine is applied to the Florio case through reference to McKee v. American Home Prods. Corp, in which the decision was reached that “the reasons for applying the learned intermediary doctrine to drug manufacturers apply with equal force to pharmacies. In both instances, the physician is in a better position to decide the information that is most pertinent to each particular patient because the physician has superior knowledge of the patient's medical history and unique condition.” <BR/>This is, frankly, not true. From my experiences working in a pharmacy, I can attest that by virtue of customer records, a pharmacist and their staff are at least as, and in my opinion, much more likely to have a more complete prescription history of a given patient than said patient’s physician. This is simply because of the fact that physicians, through no fault of their own, lack the networking capabilities readily available to pharmacists. Patients receiving prescriptions from Drs. X, Y, and Z do not necessarily inform the different physicians of the various other medications they are prescribed. Granted, there is an inherent oneness on the individual to present this information to physician, but nowhere can I find it stated that a patient’s failure to do so relieves the physician of responsibility or liability.<BR/>Here’s where it gets further complicated: A pharmacy IS legally responsible, and holds liability for failure to warn against the interactions of two or more medications against each other (Lasley v. Shrake's Country Club Pharmacy). All major pharmacies have computer systems that automatically flag harmful interactions, but they can only draw from prescriptions filled within the same chain, sometimes only within the same store. Insurance companies have access to all medications billed to them, regardless of prescribing physician or pharmacy chain, but they cannot account for prescriptions run through for “cash,” not billed to a 3rd party. <BR/>The question is who, then, is ultimately responsible for the coordination of a patients care in regards to medication? I believe this responsibility must rest with the pharmacist. The case laid forth for the establishment of the “learned intermediary doctrine” ignores the fact that a physician may not be aware or in possession of a patient’s full medical history, including current medications. Whereas the point of liability legislation is to defer said liability from the individual to a professional caretaker, the individual must therefore be excused from the responsibility of accuracy. Where it would be unrealistic to then expect a physician to present every possible medical scenario, including side effects, to a patient upon dispensing every new prescription, it is totally plausible that a pharmacy counsel the customer time a medication is dispensed. <BR/>Currently, the law states that a pharmacist, or staff representative, must make the offer to counsel every time a prescription is dispensed. Customers sign a ‘consultation log’ affirming that such an offer was made, and either waived or accepted. These logs are kept as record to accordance with the law. <BR/>Why then, if it is the physician, and not the pharmacy, that bears liability, do patients not sign such a log that attests to their counsel, or waving of counsel, from the prescribing physician? The only case I can see that begins to explain this is Morgan v Wal-Mart – Texas- in which the courts decided that if presented with all of the potential warnings accompanying every prescription at the point of purchase, the patient/customer may choose not to fill the prescription. I disagree with this assertion, and would argue that it is the inherent duty of any retailer to explain any and all potential side effects of the products it dispenses. I would further contend that the retailer of prescription medications is the pharmacy and it’s staff, not the physician – as defined by the “learned intermediary doctrine” – due to the increased likelihood that a pharmacist is in possession of a greater amount of relevant historical information, and therefore in a better position to advise the patient of any side effects.<BR/>To borrow your phrase, Jim, I see this as No Ethics/ Bad Law.Anonymousnoreply@blogger.com