Age-Old Problem: Quinine or Quinidine?

Issue of the Case:

In this month?s case, a court was asked whether a plaintiff who received quinidine instead of quinine should have her case dismissed for failure to provide expert testimony.

Facts of the Case:

Suffering from nighttime leg cramps, the plaintiff consulted her physician, who prescribed quinine sulfate. The prescription was taken to a Mississippi pharmacy, where the defendant pharmacist mistakenly dispensed quinidine.

The pharmacy denied that it had dispensed the wrong drug even though the label on the prescription vial stated that the contents were quinidine. The pharmacist refused to appear for any depositions, and he further refused to admit that he had dispensed quinidine. Both he and the pharmacy, however, admitted that the prescription container had been mislabeled as ?quinidine sulfate.?

The plaintiff did not notice the difference in the drug names. She took the wrong medication for about 2 weeks, and then she began suffering severe stomach cramps. She was admitted to the hospital with a diagnosis of acute gastritis. During her hospitalization, the dispensing error was discovered. The plaintiff?s blood levels showed that she had consumed toxic amounts of quinidine.

The Court?s Ruling:

The case bounced back and forth because of the plaintiff?s failure to provide any expert witnesses. The trial court, after 3 years of motions, dismissed the action. The plaintiff appealed. A Mississippi appellate court ruled that the trial court was wrong. Summary judgment for the defendants was not justified because the only real issue was whether the pharmacist had misfilled the prescription. There was ample evidence of negligence, without any expert testimony, to allow the case to proceed. The case was reinstated.

The Court?s Reasoning:

The trial court granted the defendant?s motion for summary judgment because the plaintiff ?failed to properly designate expert witnesses.? Yet, the appellate court found that the plaintiff had, in fact, identified 2 pharmacists from the School of Pharmacy who would testify for her. She did not, however, provide a summary of the grounds for each expert?s opinion, nor did she state the subject matter on which they were expected to testify.

The defendants argued that dismissal was proper because the plaintiff could not prevail unless she was able to show by expert testimony that the pharmacist was negligent in filling her prescription. They reasoned that, because the plaintiff did not answer their pretrial query regarding the opinion that her experts would give, she would not be successful at trial and the case should be dismissed. The plaintiff countered that she could not outline the basis for her experts? opinions because the dispensing pharmacist was uncooperative and refused to give any deposition.

The Court of Appeals noted that the medical records showed, without contradiction, that the plaintiff had a high serum quinidine level upon admission to the hospital. The hospital records also indicated that the plaintiff?s acute gastritis was quinidine-induced. Furthermore, the pharmacist acknowledged that the prescription had been written for quinine but that he had mislabeled the container. The court concluded that, given this evidence, the case did not require expert testimony to prove that a dispensing error is negligence. Thus, there was a genuine issue of fact and the case should proceed to trial. The trial court decision was overturned.

The appellate court went on to chastise the plaintiff for failure to provide the information requested by the defendants. In sending the case back to the trial court, it asked the judge to impose whatever sanctions she determined appropriate for the plaintiff?s actions. Moreover, the trial judge was asked to consider the role that the pharmacy and the pharmacist had in frustrating or thwarting the plaintiff?s desire to take depositions.

Larry M. Simonsmeier is Emeritus Professor of Pharmacy Law at Washington State University College of Pharmacy.