The act of prescribing a medication is a clinical decision that carries its own standard of care, separate from the physical delivery of that medication to the patient. Under Georgia common law, the prescribing physician has a duty to exercise the degree of care and skill that a reasonably competent peer in the same specialty would apply when selecting, dosing, and monitoring pharmaceutical therapy. This discussion is limited to the prescribing decision and the oversight of drug interactions. The physical act of administering medication, which is governed by the nursing standard of care, is a distinct subject addressed elsewhere.
Drug Interaction Risks
Modern pharmaceutical therapy frequently involves multiple concurrent medications, and the potential for harmful drug interactions is an inherent feature of complex treatment regimens. A drug interaction occurs when the effect of one medication is altered by the presence of another, producing an outcome that neither drug would produce alone. These interactions can amplify a drug’s effect to dangerous levels, neutralize its therapeutic benefit, or generate an entirely new adverse reaction.
The prescribing physician’s duty encompasses awareness of known interaction risks for the medications being prescribed. This does not require encyclopedic recall of every conceivable combination. It does require that the physician evaluate the patient’s current medication regimen before adding a new prescription and exercise reasonable diligence in identifying interactions that are well-established in the medical and pharmacological literature. A prescribing decision that ignores a widely recognized contraindication between two drugs the patient is actively taking represents a departure from the standard of care.
The analysis becomes more complex when the interaction involves medications prescribed by different providers. A patient may be receiving prescriptions from a primary care physician, a specialist, and a hospital-based provider simultaneously. Each prescribing physician has a duty to inquire about the patient’s full medication profile before adding to it. The failure to ask what other medications a patient is taking, when that information is reasonably obtainable, can itself constitute a breach of the prescribing standard.
Prescribing Despite Known Patient Allergy
A distinct category of prescribing error occurs when a physician orders a medication to which the patient has a documented allergy. The physician’s duty at the prescribing stage is to review the patient’s allergy history before selecting a drug. If the patient’s chart documents a known allergy to a specific medication or drug class, prescribing that drug or a related agent without clinical justification and appropriate safeguards represents a failure at the point of the prescribing decision itself.
This prescribing-stage duty is separate from the administering professional’s verification duty at the point of delivery. Even though the nurse has an independent obligation to check for allergy conflicts before administration, that downstream checkpoint does not relieve the prescribing physician of the initial obligation to avoid ordering a known allergen. The two duties operate in sequence, not as substitutes for each other.
When a physician prescribes a medication despite a documented allergy, and the patient experiences an allergic reaction, the prescribing decision becomes the focus of the malpractice analysis. The question is whether a reasonably competent physician would have reviewed the patient’s allergy history, identified the conflict, and selected an alternative medication.
EMR Alert Systems and Their Role
Electronic medical record systems have introduced automated drug-interaction and allergy alerts that flag potential conflicts at the point of prescribing. When a physician enters a prescription order, the EMR system may generate a warning if the prescribed drug interacts with another active medication or matches a documented allergy.
These alert systems occupy an increasingly significant role in the prescribing-error landscape. From a general framework perspective, the existence of an automated alert that a physician overrides or dismisses can become relevant evidence in a malpractice analysis. If the system flagged a known contraindication and the physician proceeded to prescribe the medication without documented clinical justification for overriding the alert, that sequence may support an allegation of breach.
However, the legal analysis does not begin and end with the alert. Alert fatigue, where the volume of automated warnings desensitizes providers and leads to routine override behavior, is a recognized phenomenon in clinical practice. The standard of care is still defined by what a reasonably competent peer would do, not by whether every system-generated alert was followed. The alert is one piece of evidence within a broader inquiry into the physician’s prescribing methodology and decision-making process.
The Physician’s Prescribing Duty
At its core, the prescribing duty requires the physician to make an informed, patient-specific medication decision. This encompasses evaluating the patient’s diagnosis, selecting a medication appropriate for that diagnosis, choosing a dose suitable for the patient’s weight, age, organ function, and other individual variables, and monitoring the patient’s response to the prescribed therapy. Each of these steps must be performed with the degree of care and skill expected of a competent peer.
Consider a scenario where a physician prescribes two medications for a patient without reviewing the patient’s active medication list. The two drugs have a well-documented contraindication that is recognized in standard pharmacological references and would be flagged by most electronic prescribing systems. The patient takes both medications as prescribed and experiences an adverse reaction consistent with the known interaction between the two drugs. The claim would allege that a competent prescribing physician would have reviewed the patient’s medication profile, identified the contraindication, and either selected an alternative drug or implemented appropriate monitoring safeguards.
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Disclaimer
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