| INDUSTRY WATCH : Legal Decision |
A recent Oregon Supreme Court decision has expanded the potential liability exposure of physicians and pharmacists who prescribe or dispense controlled substances. The case, Stone v. Witt, arose from a fatal accident caused by a driver who was impaired by prescribed medications. The court’s ruling allows third-party claims—made by people who were never patients of the providers involved—to proceed under an ordinary negligence standard. For prescribers in Oregon, the decision represents a meaningful shift in the legal landscape.
Background: The Case and the Ruling
In this case, a patient with a history of substance abuse was prescribed controlled substances by several providers, which then were filled at a pharmacy. She subsequently drove while impaired and struck and killed a cyclist. The cyclist’s estate filed suit against the prescribing physicians and the pharmacy, even though these parties had no direct relationship with the victim.
The trial court dismissed the claims on the grounds that there was no legal basis for third-party liability. The Oregon Supreme Court subsequently reversed that decision. Its reasoning: Oregon tort law does not limit liability to parties in a direct relationship. If conduct unreasonably creates a foreseeable risk of harm, the party responsible for that conduct can be held liable to anyone harmed as a result—not just to patients.
The court drew a parallel to “dram shop liability,” in which a bar can be held responsible for serving alcohol to a visibly impaired patron who subsequently causes an accident. The analogy has limits—patients typically don’t present as visibly impaired at medical appointments—but the court’s point was about foreseeability, not observable intoxication. The question for prescribers becomes: did you know, or should you have known, that this patient posed a risk to others?
What Changed—and What Didn’t
Jeff Street, who has defended healthcare providers in Oregon and Washington for 40 years, notes that the ruling clarifies something that was always present in Oregon tort law. “What it’s saying to healthcare providers is, if you didn’t understand this already, all of you are always potentially liable for ordinary negligence, and you can’t stand behind duty as your shield,” he says.
Street draws a comparison to Tarasoff, the 1976 California case in which a psychiatrist was found liable for failing to warn a third party about a patient’s violent threats. Oregon has been moving in this direction for some time, Street says. Stone v. Witt removes any remaining ambiguity.
It is important to note what the ruling does not do. Stone v. Witt came out of a motion to dismiss—the earliest stage of litigation. The court did not find the physicians or pharmacy liable. It held that the plaintiff’s claims could proceed to trial. The case returns to the trial court, where evidence will be gathered, experts will testify, and liability will ultimately be determined on the facts.
Practicing within the standard of care remains the primary defense. Appropriate prescribing decisions, thorough documentation, use of the prescription drug monitoring program, and consistent patient monitoring should support a strong defense if a claim arises.
Claims and Defense Implications
From a claims perspective, the ruling introduces several practical complications, says Kari Adams, Senior Vice President, Claims for Physicians Insurance. First, the volume of potential claims increases when third parties—people who have no relation to the patient—can bring suit. Even defensible claims carry court costs.
Second, cases may involve a co-defendant dynamic in which the prescribing physician and the patient who caused the harm are both named defendants. “That patient might say, ‘He should have known I was misusing drugs. I wasn’t in my right mind. I was addicted,’” Adams notes. “Now we have to build a defense that, no, this patient was misusing the drugs, and we weren’t aware of that.” Coordinating defense strategy in that context requires careful attention.
A Note on Legislative Remedy
Justice Garrett’s concurring opinion is worth noting, says Street. Garrett agreed with the legal analysis, but recognized its potential chilling effect on prescribing. He concluded: “For those reasons, I agree with today’s decision, although it need not be the last word.”
The concurrence suggests the court is aware that the ruling creates practical difficulties for prescribers, while indicating that addressing those difficulties falls outside the judicial role. If the medical community believes the current standard creates unworkable liability exposure, the appropriate avenue for remedy is the state legislature.
Practical Considerations for Physicians Insurance Members
For members who prescribe controlled substances in Oregon, the Stone v. Witt decision is a reminder that liability exposure can extend beyond the patient relationship. A few practical steps are worth reviewing:
• Document prescribing decisions thoroughly, including the clinical rationale for continuing or modifying a controlled-substance prescription.
• Use Oregon’s Prescription Drug Monitoring Program consistently, and document those queries.
• When patient behavior raises concern about misuse, document those observations and the steps taken in response.
• Consult with risk management or legal counsel if you have questions about a specific patient situation.
As of this writing, Stone v. Witt is set to go to trial in Deschutes County, Oregon.
Members with questions about how this ruling may affect their practice or coverage are encouraged to contact Physicians Insurance directly.
Additional Resources (Members Only) on phyins.com
• Controlled Substances: Chronic Pain Management (CME)
• Evidence-Based Approaches to Pain Control (CME)
• Opioids and Chronic Pain Management (CME)
• Outpatient Opioid Misuse: Risk Identification and Stratification (CME)
• The Opioid Epidemic: Implications for Healthcare (CME)