CHAINS and BUSINESS

Rite Aid ordered to pay patient $250,000

A Baltimore County Circuit Court in Towson, Md., has ordered Rite Aid Corp. to pay $250,000 to Ellen Gray. The 42-year-old plaintiff contended that she became disabled in October 2000 after following incorrect advice printed in an information pamphlet that was enclosed with a prescription for doxycycline for the treatment of Lyme disease. The pamphlet instructed her to take milk with her medication, according to her lawyer, Loyd Byron Hopkins of Frederick, Md. Hopkins contended that milk and calcium products decreased the absorption of the drug and its ability to treat his client's Lyme disease symptoms.

A spokeswoman for Rite Aid said that the company did not have a comment on the lawsuit.

"Rite Aid got tagged with a liability verdict on breach of express warranty, which was based on the chain pamphlet that says, 'Count on us for the Rite advice. Everything you need to know about this medication is in writing in this pamphlet.' That was clearly false, based on evidence that the defense and the plaintiff produced at trial," explained Hopkins. "Rite Aid was using information from First DataBank but First DataBank was getting their information on doxycycline from Pfizer based on Pfizer's Vibramycin," he told Drug Topics. "Rite Aid did not sell Pfizer's Vibramycin to Mrs. Gray; they sold her Watson Pharmaceuticals' doxycycline."

Watson Pharmaceuticals had sent Rite Aid a pamphlet with instructions for the chain to provide patients with very specific information, Hopkins said. The Watson pamphlet stated that all patients using doxycycline should be advised that milk, dairy, or calcium products decrease the absorption of doxycycline. "Usually this decrease is not significant was the language," noted Hopkins, "but there was a clear warning that milk, dairy, and other calcium products bind the doxycycline and prevent its absorption. Rite Aid completely omitted those two sentences and just blindly advised patients to take the doxycyline with milk, giving them no warning whatsoever that if doxycycline is taken with milk, its absorption can be reduced by up to 20%." In most circumstances, that reduction might not be a big deal, he added, but with Lyme disease, you have to wear the organism down, and you need sufficient doxycycline in your system to do that.

From Oct. 26 to Nov. 8, according to Hopkins, while Mrs. Gray was taking doxycycline, she drank milk and ate dairy products, including ice cream, cheese sandwiches, and macaroni and cheese. "She followed the pamphlet's advice to the letter and got worse instead of better. Normally when you take doxycycline for Lyme disease, you see a turnaround within two to three days—and, in more resistant cases, within a week," he said.

Hopkins said that on Nov. 8, 2000, Gray spoke to her brother, David Levy, a urologist, who later testified at the trial. Having had experience prescribing doxycycline, as soon as Levy heard she was eating macaroni and cheese, he told her to stop taking milk and dairy products. So she abstained from these foods, and two days later her fever broke and her excruciating pain started to abate. Rite Aid claimed the milk didn't make a difference, but when Gray stopped taking the drug with the milk, the doxycycline responded as everybody expected it to. "That was an inescapable fact," said Hopkins. She was, however, left with persistent symptoms of Lyme disease.

Hopkins said that Gray, who had her prescription filled at the Rite Aid pharmacy in Ticonium, Md., spoke with three pharmacists who worked there. "At the time, all three agreed the pamphlet was wrong and needed to be changed," he said. At the trial, two of the pharmacists claimed they never had a conversation with Mrs. Gray and that they had never worked together. The third pharmacist acknowledged having a conversation with Gray, but didn't remember the specifics of the discussion. Hopkins said that a few months before cross examining the third pharmacist, he had done a deposition in which she admitted that if Rite Aid had permitted her to, she would have changed the pamphlet and taken out the reference that recommended the medication to be taken with milk, because she believes milk decreases the absorption of doxycycline.

"Rite Aid made a horrendous mistake, and if they were responsible, they would do something about it. They would change the pamphlet and provide the warnings that Watson instructed them to provide to all patients. There's no excuse," said Hopkins. "If the manufacturer who sells you the drug tells you to give all patients this advice, there's an important reason for that. The fact that Rite Aid knew milk decreases the absorption of doxycycline by 20% and didn't think that was something the consumer had the right to know is equally egregious," Hopkins charged.

The case is expected to go before the Court of Appeals. Post-trial motions will be heard in August.

Sandra Levy

 

Sandra Levy. Rite Aid ordered to pay patient $250,000. Drug Topics Jul. 7, 2003;147:69.