Pfizer, Inc. v. Jones, 781749

Decision Date26 November 1980
Docket NumberNo. 781749,781749
Citation272 S.E.2d 43,221 Va. 681
CourtVirginia Supreme Court
PartiesPFIZER, INC. v. Lottie M. JONES. Record

Rosewell Page, III, Richmond (Evan A. Burkholder; McGuire, Woods & Battle, Richmond, on briefs), for appellant.

Russell H. Roberts, Fredericksburg (Thomas E. Crosley, Jr.; Robert M. Haley; Roberts, Crosley, Haley & Ashby, Fredericksburg, on brief), for appellee.

Before I'ANSON, C. J., and CARRICO, HARRISON, COCHRAN, POFF, COMPTON and THOMPSON, JJ.

THOMPSON, Justice.

Pfizer, Inc. appeals from a $225,000 verdict and a $100,000 final judgment entered upon remittitur whereby it was found negligent in not adequately warning Lottie Jones's attending physician of the possible aftereffects of an injection of Vistaril IM prescribed for her.

On August 16, 1975, Lottie Jones was hospitalized in Fredericksburg by her physician, Dr. Richard H. Thompson, for treatment of cholecystitis (inflammation of the gallbladder). For the abdominal pain, fever and other symptoms she was experiencing, Dr. Thompson prescribed bed rest, intravenous fluids to maintain her hydration, antibiotics, and a series of four injections between August 17 and 21, combining Demerol and Vistaril IM. *

The first two and the fourth injections of the combination of Demerol and Vistaril IN were given without incident. However, immediately following the third injection into the right buttock, given on August 18 by the nurse on duty, Mrs. Jones complained of "very bad pain" in her hip. Ice packs were prescribed immediately. Dr. Thompson's initial examination of the hip the next morning revealed a reddish discoloration and hardening under the skin with blisters forming in a small area. Over a period of a week, the inflammation had spread to a very large area with raised blisters, a dark discoloration, and insensitivity to touch, which indicated to Dr. Thompson that necrosis, or death, of the tissue had occurred. Four debridements (operations to remove dead tissue) were performed on Mrs. Jones on September 4, 10, 16, and 23, and the wound was irrigated, washed out, and packed with gauze four times each day by the nursing staff. On October 9, skin was removed from Mrs. Jones's thigh, and a skin graft was performed on her hip. When released from the hospital on October 22, 1975, she had a large concave hole in her right hip. The fact that the subcutaneous injection of Vistaril IM caused the necrosis of the tissue was confirmed during the trial by expert medical testimony for both Mrs. Jones and Pfizer, Inc., the manufacturer of the drug Vistaril IM.

The insert accompanying the package of Vistaril IM contained these express directions: "Vistaril Hydroxyzine Hydrochloride Intramuscular Solution for Intramuscular Use Only"; "Hydroxyzine Hydrochloride intramuscular solution is intended only for intramuscular administration and should not, under any circumstances, be injected subcutaneously, intra-arterially or intravenously." (emphasis supplied); and "As with all intramuscular preparations, VISTARIL Intramuscular Solution should be injected well within the body of a relatively large muscle."

The main issue at trial was the sufficiency of the warnings contained in the package insert. Dr. Thompson and Dr. Peter R. Smith, testifying for Mrs. Jones, both admitted that they were familiar with the insert and knew that under no circumstances was Vistaril IM to be injected into the subcutaneous tissue, but asserted that the warning was inadequate because it did not warn of the potential risk of Vistaril IM coming into contact with subcutaneous tissue. Dr. Smith also testified that a special warning should appear on the insert to ensure that extra care be taken in the injection of obese patients. But Dr. Smith also acknowledged that "in working in a hospital ward ... you cannot warn about every drug and every possible complication."

In pretrial deposition excerpts admitted into evidence, Elizabeth Pronovost, the nurse who administered the controversial injection of Vistaril IM, stated that Mrs. Jones was a "very large woman" which would make injection deep within the muscle more difficult to accomplish, and that she had marked the target area of the hip before making the injection. She also stated that she was aware that Vistaril IM was an...

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