Woman Loses Suit Against Hospira Shortage

In April 2011, Jennifer Lacognata was diagnosed with vitamin A deficiency and subsequently prescribed an injectable drug called Aquasol A that is made by Hospira. Shortly afterwards, though, she was unable to obtain the medicine because Hospira was experiencing manufacturing problems (

back story). And so, Lacognata filed a lawsuit claiming the drugmaker breached a responsibility to supply its patients with a needed medicine.

The lawsuit was the latest attempt to hold drugmakers accountable for ongoing product shortages that have allegedly caused numerous individuals harm. Last year, a half dozen people who suffer from Fabry disease filed a lawsuit against Genzyme for ongoing shortages of the Fabrazyme treatment (look here). In March, an Idaho woman filed a wrongful-death lawsuit that maintained the Fabrazyme shortage led to the death of her husband (see this).

The lawsuits were filed amid an unprecedented number of shortages over the past two years of numerous medications needed for treating different cancers and attention deficit disorder, among other ailments (here is the latest list). The problem has prompted probes of gray markets (see here); cries that drugmakers should be fined for not reporting looming shortages (read this) and complaints that the FDA is contributing to the mess with overzealous enforcement (back story).

There has also been mounting frustration among patients, some of whom worry about reports that shortages have led to increased deaths (look here) and fear they will meet a similar fate. As for Lacognata, she is now blind in one eye due to vitamin A deficiency, as noted in her lawsuit (which you can read here). Last week, though, a federal court judge in Florida denied her gambit and tossed the suit.

In his order, US District Court Judge James Moody Jr. shot down all of her arguments. For instance, he wrote that "there is no authority that supports (her) argument that a drug manufacturer, like Hospira, has a duty to continue supplying a patient with a drug that it knows the patient relies upon for his or her medical health." And he disagreed that Hospira was negligent for failing to stockpile adequate reserves and because its representatives assured Lacognata the shortage would end, but in fact, later did not.

Moody, however, wasn't buying. Lacognata alleges that Hospira patient reps told her that Aquasol A would be backordered until September 2011, but "this hardly amounts to a promise with definite terms. (She) does not allege that she changed her position to her detriment based on the representation. For example, (Lacognata) does not allege that she gave up the opportunity to utilize other treatment options in reliance on Hospira’s alleged promise... Under these circumstances, no set of facts could establish such a claim" (here is the order).

"We are disappointed with the decision," says her attorney, Allen Black, who also represents several Fabrazyme patients who sued not only Genzyme, but also the FDA, the US Department of Health and Human Services and the National Institutes of Health. That lawsuit argues that patient rights were violated because the federal government failed to take adequate enforcement actions against such drugmakers and allow for alternative means to protect supplies (read here).

"But I will keep fighting for Jennifer and the other patients. I am surprised that the court will not even let these drug shortage victims through the door of the court...," he says. "We always anticipated that this case would likely be appealed either by us, or Hospira, so we are not out of the game. At least we have an opinion now and are able to take the next steps to help the victims."

gavel pic thx to walknboston on flickr

16 Comments

Jul 11, 2012 - 10:05am
There is no contractual relationship between the patient and provider that obligates the provider to provide a specific product at a specific time in a specific dose. Any first year law student would know this.
Jul 11, 2012 - 2:38pm
OII, so as not to mislead folks, the claimed basis for relief included a request for equitable action under the quasi-contract theory promissory estoppel (resulting in damages from detrimental reliance) not a claim under contract theory for breach of an express contract (resulting in damages from the breach).
Jul 11, 2012 - 2:50pm
Allen, there are about 200 drugs in short supply, many life saving cancer drugs. Say that a patient is "promised" six cycles of chemotherapy but an unforeseen manufacturing problem cuts off the supply after three. Under your theory who is the negligent party, the drug company, the hospital or the oncologist. Personally if I were an oncologist these days I would make sure that every informed consent my patient signed contained a Force Majeure clause to protect me in such situations
Jul 11, 2012 - 3:36pm
OII, I think your proposed hypothetical is best understood in the context of how our society views promises that are made to others.

Here is a good quote concerning the role of promises in society: "Few moral judgments are more intuitively obvious and more widely shared than that promises ought to be kept. For this reason promises and related phenomena, such as vows, oaths, pledges, contracts, treaties and agreements more generally are important elements of justice and the law, and, at least in the Social Contract tradition, of the political order as well." see Standford Encyclopedia of Philosophy at plato.stanford.edu/entries/promises/

Jul 11, 2012 - 5:24pm
Allen,

Vows, oaths pledges, and agreements are generally verbal statements and the reality of their longevity is up to the truthfulness and morals of the individuals taking part. Contracts and treaties, however, are generally signed and witnessed, and as such, would be legally binding. Unless a contract is signed between a patient and the provider, you have no case, and are in fact just another lawyer (aka-a detriment to self-responsibility in our society) who is trying to make a living off of entities that you see as having deep pockets. Maybe you would stop this foolishness if you had to pay the court costs for these lame cases. Maybe I should sue you for being annoying.

Jul 11, 2012 - 7:11pm
While you obviously cannot do this with most drugs that are on shortage, in this case, the injectable drug is a vitamin A derivative. Does anyone know if a compounding pharmacy that does sterile injectables can compound something equivilant or something similar that can be used as a substitute?
Jul 11, 2012 - 8:00pm
This is the feel-good story of the year: a grifter and her ambulance chaser thwarted! A beautiful thing. I question the Viamin A deficiency. That is unheard of in the US. Being a fat-soluble vitamin slowly eliminated from the body, it is extremely unlikely that the grifter-plaintiff had a deficiency. If she had short bowel syndrome or other condition that could cause malabsorption of Vitamin A, the grifter would likely be on parenteral nutrition, obviating the need for Aquasol. As a clinician having practiced in a nutrition/malaborption clinic, I can tell you that Vit A toxiicity is far more common than deficiency--in the US. Hey grifter--don't despair: there is a class action against Linked in that I'm sure can join. Loser.
Jul 11, 2012 - 8:13pm
Xavier is correct. Standard legal contracts have sections known as "Representations and Warrants". Using my chemotherapy example, unless it is specifically "repped and warranted" that chemotherapy would be available for the full six cycles the patient would have no basis to sue. Moreover, the manufacurer would be on solid legal grounds to invoke Force Majeure if an unforseen problem halted production.

I just signed a promissory note to pay interest on a particular loan. There were no handshake agreements, implied promises or social contracts. The only thing that mattered, as David Mamet would say was "getting them to sign on the line that is dotted" (from the play Glengarry Glen Ross).

Jul 11, 2012 - 8:17pm
Anne, since Vitamin A is a fat soluble vitamin special manufacturing techniques are required to make it compatible with an aqueous solution for injection. This can't be done in a compounding lab. I'm also assuming those techniques are patent protected, further preventing copounding. Otherwise we would have seen a generic by now.
Jul 11, 2012 - 8:23pm
Kerry, I have to disagree with your statement on Vitamin A deficiency. While natural defiency of Vitamin A is rare, it is common in conditions that cause malabsorption syndrome such as gluten intolerance, chronic pancreatitis, and others. Sabiston's textbook of Surgery lists 60 causes in a single table alone.

Until we know the patient's history we should not question the validty of the diagnosis.

Jul 11, 2012 - 8:33pm
Kerry, you must not have gone to an American Medical School. Aquasol is administered as an thrice weekly intramuscular injection on an outpatient basis. TPN is administered through a central venous line in a hospital setting. Putting a patient on TPN who may not need it just for the purpose of getting some Vitamin A on board would be like hitting a fly with a bazooka. Frankly, given the risks inherent in TPN it would be malpractice IMO.

I suggest you lower the deductible on your malpratice insurance.

Jul 11, 2012 - 8:37pm
BTW, one of my Physiology Professors from Vanderbilt holds the patent on Intralipid. So I do know what the hell I'm talking about.
Jul 11, 2012 - 9:12pm
Ok...clinician I can see with my one eye why YOU did not make it through med school and become a full fledged doctor. Before you start spouting off about the statistics of Vitamin A deficiency here in the US you should walk a mile in my shoes.
Jul 12, 2012 - 7:54am
Jennifer, I'm not sure which clinician you are referring to, but on behalf of Kerry and I we both sincerely hope that you don't develop blindness in your other eye from Vitamin A deficiency so that you will be able to continue to hurl your missives at those on these boards who likely have many more years of postgraduate training and experience than you.
Jul 12, 2012 - 8:19pm
OII, I'm so disappointed: you are usually the one person on this blog who is a voice of reason (besides myself, of course). I assure you that I understand the nuances of TPN and Aquasol (not that I didn't find your dosing instructions helpful). I am quite aware of the risks and financial burden associated w/ TPN. However, if this woman was truly losing her vision due to vitamin A deficiency, do you not think she would have gotten a few liters of TPN solution with MVI? The benefit would have outweighed the risk. Moreover, assuming she could only absorb 10% of fat soluble vitamins, a supra-therapeutic dose of vitamin A could have been given p.o. and staved off a deficient state. Given the unlikelihood that she was only able to absorb 10% of fat, she would likely be on permanent TPN anyway-and this discussion would be moot.

Jennifer, assuming you actually do have partial blindness, I'm sorry for your impairment but I refuse to believe it's due to vitamin A deficiency, and that Hospira is in any way culpable. Obviously a judge agrees with my position. I'm curious as to why your husband joined the suit. A cynical person could get the impression that this was a money-making scheme. This is purely speculation and opinion, but I suspect this isn't your first lawsuit.

Lastly, I regret that you find my academic pedigree wanting. However, I'm educated enough to reognize an idiotic lawsuit when I see it. All in my opinion, of course.

Oct 21, 2012 - 11:43am
Kerry_Zaputz, I have Vitamin A deficiency and, where I have not suffered total blindness as of yet, I have had long bouts of total night blindness. I received the Aquasol A, Hospira injections in 2004 which required me to get 18 injections in the hip, one each day for 18 consecutive days. Trust me when I say no one fakes Vitamin A deficiency.

Note to all: I have now been successful in using compounded synthetic Vitamin A injection in lieu of those from the mfg of the Aquasol A, Hospira. I live in California and it took some doing to find a compounding facility to fill my need.