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Hayward v. Jack's Pharmacy Incorporated6/15/2005
w and evaluate the order for such things as rational therapy contraindications, reasonable dose, over utilization and abuse and misuse." This duty was identified by Jack Botts in his deposition.
Lott explained that the regulations applied to all retail pharmacies doing businesses with nursing homes:
he standard of care in St. Maries, Idaho, for the provision of pharmaceuticals to nursing home patients is the same whether in St. Maries, Boise, Spokane or Coeur d'Alene. The similarity in the standard of care is primarily because of the pervasive regulation of nursing homes by the United States government including their interpretive guidelines.
Lott said the regulations imposed on Jack's Pharmacy a duty to monitor the usage of drugs prescribed:
Marvin Wheeler stated to me in 1999 that the regulations for nursing homes applied to all retail pharmacies doing business with nursing homes. Those regulations including the I.A.P.A. require contracts with unit dose pharmacies. Jack's Pharmacy was providing daily medication to Valley Vista Care Center which was distributed in a unit dose fashion. Therefore, these regulations applied to Jack's Pharmacy and its dispensing pharmacists.
Lott said also:
The pharmacist must have an adequate system in place to identify that drugs are delivered and billed correctly along with documentation of unused doses. The extensive errors I reviewed in this case, including notes indicating medications were dispensed on the non-existent dates of November 31, 1994 and April 31, 1994, fell below the minimum standard of care.
Lott concluded, based on his review of the information and guidelines, that Jack's Pharmacy should have contacted Dr. Thurston about the March 18, 1994 prescription and failing to do so "resulted in the chemical restraint and may have contributed to the physical decline of Delbert Lewis Hayward."
Based on the testimony recited above, we conclude that Lott satisfied the competency test. He reviewed the depositions of Botts and Brown, two St. Maries pharmacists, which indicated (1) the "start low, go slow" utilization standard of Haldol, and (2) the duty to alert the physician where it appears that a large or excessive dose has been prescribed. He confirmed with Wheeler that the standard of care imposed by state and federal regulations did apply to all pharmacies dispensing pharmaceuticals to nursing facilities and that the standard was the same, whether the dispensing occurred in St. Maries, Spokane, Coeur d'Alene, or Boise. The testimony recited above also leads us to conclude that there is a question of fact on whether the standard was breached.
Having concluded that Lott was competent to testify, and that there was evidence the standard of care was breached, one additional point is worth discussing briefly. Jack's Pharmacy argued that if Hayward prevailed, the resultant rule would require Jack's Pharmacy to actually visit the nursing home and review the particular patient's records. Nothing in the evidence suggests so and nothing in our holding today should be construed to require this. We hold only that Lott was competent to testify as to the standard of care and its breach.
VI. CONCLUSION
Dr. Luxenberg's testimony about the standard of care applicable to a medical director treating a patient in a nursing facility was admissible and the district court erred in drawing the distinction between Dr. Thurston's roles as medical director and physician.
As for Jack's Pharmacy, Dr. Lott adequately familiarized himself with the local standard of care applicable to Jack's Pharmacy. While there is disagreement about what th
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