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Docket No. 90482-Agenda 20-September 2001.

HEIDI HAPPEL et al., Appellees, v. WAL-MART STORES, INC., d/b/a Wal-Mart Pharmacy, Appellant.

Opinion filed March 21, 2002.

JUSTICE McMORROW delivered the opinion of the court:

The central issue in this appeal is whether a pharmacy has aduty to warn about a known drug contraindication⁽¹⁾ where thepharmacy is aware of a customer's drug allergies and knows thatthe medication prescribed by the customer's physician iscontraindicated for a person with those allergies. Plaintiff HeidiHappel, who is allergic to aspirin, ibuprofen, and acetaminophen,experienced a severe reaction after taking Toradol, a pain relieverprescribed by her physician, Dr. Zbigniew T. Lorenc. Toradolshould not be taken by persons who are allergic to aspirin andother nonsteroidal anti-inflammatory drugs (NSAIDs). Heidi andher husband, plaintiff Kent Happel, subsequently brought anegligence action against Dr. Lorenc and Wal-Mart Stores, Inc.,whose pharmacy in McHenry, Illinois, filled the prescription.Plaintiffs settled with Dr. Lorenc, and the trial court granted Wal-Mart's motion for summary judgment. The appellate courtreversed (316 Ill. App. 3d 621), and we granted Wal-Mart'spetition for leave to appeal. 177 Ill. 2d R. 315. For the reasons setforth below, we affirm the judgment of the appellate court.

BACKGROUND

On August 4, 1993, Heidi called Dr. Lorenc's officecomplaining of severe menstrual cramps. She sought a moreeffective pain reliever, and Dr. Lorenc prescribed Toradol. Hisoffice telephoned the prescription to the Wal-Mart pharmacy inMcHenry, Illinois. Dr. Lorenc had been treating Heidi sinceDecember 1992, and he knew of her drug allergies. However, hestated in his deposition that on August 4, 1993, he did not knowthat Toradol was contraindicated for patients with allergies toaspirin. If he had known this, he would not have prescribedToradol for Heidi.

Prior to August 4, 1993, Heidi had been to the Wal-Martpharmacy in McHenry about six times to have other prescriptionsfilled. Each time she went, pharmacy workers asked her if she hadany drug allergies, and each time she told them she was allergic toaspirin, acetaminophen, and ibuprofen. Wal-Mart pharmacymanager Steven Odes testified in his deposition that in August1993, it was the pharmacy's policy and procedure to ask customersabout their known allergies prior to dispensing medication. Thepurpose of this practice, Odes said, was to alert the pharmacist toany drug interactions or allergies. Both Odes and Florence Bowser,another of defendant's pharmacists, testified that Heidi's allergyinformation was in the pharmacy's computer system and availableto pharmacists on August 4, 1993, when Heidi's Toradolprescription was filled.

Bowser testified in her deposition that she was working at theWal-Mart pharmacy on August 4, 1993, but she believed that Odeswas also on duty that day. Bowser took the call from Dr. Lorenc'soffice and wrote down the Toradol prescription, but she did notremember actually filling the prescription. She said she had "nomemory of the entire incident." Odes stated that he did not workat the pharmacy on August 4, 1993, and that Bowser was the onlypharmacist on duty and therefore she filled the prescription. Odesalso stated that Bowser would have had available to her theinformation that Toradol should not be given to patients withallergies to aspirin or other NSAIDs. According to Odes, Bowser"would know if there was a contraindication." Bowser indicatedthat she was aware that Toradol was contraindicated for personswho were sensitive to aspirin and ibuprofen.

If the Toradol information was in the pharmacy's computer,a "drug interaction" warning would have flashed across the screen,halting the prescription process for customers such as Heidi forwhom Toradol was contraindicated. At that point, the pharmacistwas to call the physician and notify him of the contraindication.Bowser did not remember calling Dr. Lorenc about Heidi'sprescription, nor did she remember seeing any documentationindicating that she made such a call.

If, after being notified of a contraindication, a physicianwanted the prescription filled anyway, the pharmacist would haveto override the computer system by entering a special code. Odestestified that in order for Heidi's Toradol prescription to have beenfilled on August 4, 1993, Bowser would have had to override thesystem. He agreed that in such circumstances, to override thecomputer and fill the prescription without first contacting thephysician would be a deviation from the standard of careapplicable to pharmacists. Bowser testified that a pharmacist isrequired to know a customer's drug allergies andcontraindications.

Once Heidi learned on August 4, 1993, that the prescriptionhad been called in to the Wal-Mart pharmacy, she telephoned herhusband, Kent, at work, and asked him to pick it up. Prior to thisdate, neither she nor Kent had ever heard of Toradol, which is anNSAID, as is aspirin. Kent went to the pharmacy to pick up theprescription, but before it was filled, a pharmacy worker asked himabout Heidi's drug allergies. Kent informed the worker that Heidiwas allergic to aspirin, ibuprofen, and acetaminophen.

There were directions on the bottle that Heidi received fromthe pharmacy, but there was no warning about contraindications.Heidi took the first dose of Toradol at about 4 p.m. on August 4,and within 40 minutes she began to experience respiratoryproblems including a tightness in her chest. She began a breathingtreatment with a nebulizer, and called the pharmacy to ask if shecould be having a reaction to Toradol. Her call was disconnected.She called again, and was told that there should be no drugreaction problem. Heidi then called a friend who was a pharmacistand was aware of her allergies. He told her to begin a nebulizertreatment if she had not already done so, and to go to theemergency room if her condition worsened. She went to theemergency room, and was found to be experiencing anaphylacticshock.⁽²⁾ Heidi testified in her deposition that, as a result of takingToradol, she subsequently experienced more frequent asthmaattacks, as well as seizures and a worsening of her multiplesclerosis.

On September 30, 1994, plaintiffs filed a negligence actionagainst Dr. Lorenc and Wal-Mart. On March 8, 1999, Wal-Martfiled a motion for summary judgment, and on March 15, 1999,plaintiffs settled with Dr. Lorenc and dismissed him from theircomplaint. Plaintiffs then moved to amend their complaint to addpunitive damages claims. The trial court denied this request aswell as Wal-Mart's motion for summary judgment. Plaintiffs filedan amended motion seeking to add punitive damages claims totheir complaint.

Defendant Wal-Mart filed a motion to reconsider the denialof summary judgment, arguing that there was no legal duty for itto warn, and it did not voluntarily assume such a duty. OnSeptember 17, 1999, the trial court granted summary judgment infavor of defendant and denied plaintiffs' motion to amend theircomplaint. On appeal, the appellate court reversed the granting ofsummary judgment, concluding that defendant Wal-Mart owedplaintiffs a duty to warn. 316 Ill. App. 3d 621. However, the courtmade it clear that this duty was a narrow one:

"[U]nder the circumstances here, where defendant knewof Heidi's allergies, where defendant knew that Toradolwas contraindicated for a person with Heidi's allergies,and where defendant knew that injury or death wassubstantially certain to result, defendant had anaffirmative duty to disclose, either to Dr. Lorenc or toHeidi, the information that Heidi should not takeToradol." 316 Ill. App. 3d at 629.

The appellate court also affirmed the trial court's denial ofplaintiffs' motion to amend their complaint.

ANALYSIS

After granting Wal-Mart's petition for leave to appeal (177 Ill.2d R. 315), we granted leave to the National Association of ChainDrug Stores to file an amicus curiae brief supporting defendant'sarguments. We also granted leave for the National Association ofBoards of Pharmacy (NABP) to file an amicus curiae briefsupporting plaintiffs' arguments. Thereafter, Wal-Mart filed amotion before this court seeking to strike the NABP's brief forincluding materials outside the record. See Zurich Insurance Co.v. Raymark Industries, Inc., 118 Ill. 2d 23 (1987); Jenkins v. Wu,102 Ill. 2d 468 (1984). We ordered the motion taken with the case.We note that Wal-Mart had by motion objected to the samematerials before the appellate court. That court denied the motion.Having reviewed the NABP's brief, we find, similar to theappellate court, that the materials provided by the NABP arerelevant to standards of practice and care, and that such matterswere raised in pleadings and depositions in this case. We thereforedeny Wal-Mart's motion to strike the NABP's brief.

This matter is before this court on Wal-Mart's motion forsummary judgment. In cases involving motions for summaryjudgment, we conduct a de novo review of the evidence in therecord. Espinoza v. Elgin, Joliet & Eastern Ry. Co., 165 Ill. 2d107, 113 (1995). The purpose of a summary judgment proceedingis not to try an issue of fact, but to determine whether any genuineissue of material fact exists. Frye v. Medicare-Glaser Corp., 153Ill. 2d 26, 31 (1992); Housh v. Swanson, 203 Ill. App. 3d 377, 381(1990). It is "a drastic means of disposing of litigation" (Espinoza,165 Ill. 2d at 113) and therefore should be granted only when "thepleadings, depositions, and admissions on file, together with theaffidavits, if any, show that there is no genuine issue as to anymaterial fact and that the moving party is entitled to a judgment asa matter of law" (735 ILCS 5/2-1005(c) (West 2000)). Forpurposes of summary judgment, we construe the facts strictlyagainst the moving party and in the light most favorable to thenonmoving party. Espinoza, 165 Ill. 2d at 113; Frye, 153 Ill. 2d at31.

As noted, the central issue before us concerns the existence ofa duty, i.e., whether defendant and plaintiffs stood in such arelationship to each other that the law imposed upon defendant anobligation of reasonable conduct for the benefit of plaintiffs. Kirkv. Michael Reese Hospital & Medical Center, 117 Ill. 2d 507, 525(1987); Ward v. K mart Corp., 136 Ill. 2d 132, 140 (1990). " ' "Aduty to warn exists where there is unequal knowledge, actual orconstructive [of a dangerous condition], and the defendant[,]possessed of such knowledge, knows or should know that harmmight or could occur if no warning is given." ' " [Citation.]Schellenberg v. Winnetka Park District, 231 Ill. App. 3d 46, 52(1992), quoting Pitler v. Michael Reese Hospital, 92 Ill. App. 3d739, 745 (1980), quoting Kirby v. General Paving Co., 86 Ill. App.2d 453, 457 (1967). "Whether a duty exists in a particular case isa question of law to be determined by the court." Ward, 136 Ill. 2dat 140; Kirk, 117 Ill. 2d at 525.

In determining whether a duty exists, courts look to certainrelevant factors. These include: (1) the reasonable foreseeabilitythat the defendant's conduct may injure another, (2) the likelihoodof an injury occurring, (3) the magnitude of the burden of guardingagainst such injury, and (4) the consequences of placing thatburden on the defendant. Ward, 136 Ill. 2d at 140-41; Kirk, 117 Ill.2d at 525-26; Colonial Inn Motor Lodge, Inc. v. Gay, 288 Ill. App.3d 32, 40 (1997).

It is undisputed that, at the time Heidi's prescription was filledon August 4, 1993, Wal-Mart was aware not only of Heidi's drugallergies, but also that the drug prescribed by Dr. Lorenc, Toradol,was contraindicated for persons such as Heidi who are allergic toaspirin. Given this superior knowledge on the part of Wal-Mart,and particularly given the nature of the knowledge, i.e., thatToradol was contraindicated, it was reasonably foreseeable that afailure to convey this knowledge might result in injury to Heidi.Both the likelihood and the reasonable foreseeability of injury herewere great. These factors thus favor the imposition of a duty onWal-Mart.

The burden on defendant of imposing this duty is minimal.All that is required is that the pharmacist telephone the physicianand inform him or her of the contraindication. Alternatively, thepharmacist could provide the same information to the patient.Since this burden of warning about a contraindication is extremelysmall, this factor also favors the imposition of a duty here.

Next, we consider the consequences of imposing a duty towarn on defendant. As is discussed more fully below, defendantis not being asked to learn the customer's condition, nor isdefendant being required to render a medical judgment or interjectitself into the doctor-patient relationship. Instead, Wal-Mart needonly pass along to the customer or the physician the informationit already possesses about the contraindication for this specificcustomer. Such a practice apparently was already being followedat the Wal-Mart pharmacy in McHenry. Bowser testified in herdeposition that prior to August 1993 she had had occasion "once,twice a month" to notify a physician about a patient's drugallergies. In these circumstances, the recognition of a duty to warnwould simply require Wal-Mart to continue with a practice it wasalready engaged in.

Wal-Mart contends that imposing a duty to warn here wouldhave a "chilling effect" on pharmacies and their customers.According to Wal-Mart, because the duty to warn is premised onthe pharmacy's knowledge of a customer's allergies, theimposition of such a duty may discourage pharmacies fromgathering information about customers' allergies in the firstinstance. In order to avoid this duty, pharmacies will no longerrequest allergy information or record it in their computers. Thusthe pharmacy's customers will be deprived of potentiallybeneficial warnings. Therefore, Wal-Mart contends, no dutyshould be recognized. We disagree.

The consequence of accepting Wal-Mart's "chilling effect"argument would be to sanction the status quo, where pharmaciessolicit allergy information from their customers but are under noobligation to follow through with a warning, even where thepharmacy knows that the drug being prescribed is contraindicatedfor the individual customer. The difficulty with this approach isthat the status quo is unacceptable. By asking customers abouttheir drug allergies, the pharmacy is engendering reliance in thecustomer that the pharmacy will take steps to ensure that thecustomer does not receive a drug to which the customer is allergic.There can be no other reason for a pharmacy's seeking thisinformation regarding drug allergies. Where the pharmacy fails towarn the customer, then the customer is placed at risk of seriousinjury or death.

We do not disapprove of pharmacies' collecting allergyinformation and recording it in their computers. However, if apharmacy chooses to engage in such a practice, it must also warnof known contraindications. The alternative, as noted, would placethe customer at serious risk. We therefore conclude that anynegative consequences of recognizing a duty to warn here are faroutweighed by the substantial reasons favoring such a duty.Accordingly, this factor also supports the imposition of a duty onWal-Mart.

We think that, given the circumstances in this case, Wal-Marthad a duty to warn and that this duty is encompassed within thepharmacist's duty of ordinary care. See Eldridge v. Eli Lilly & Co.,138 Ill. App. 3d 124, 126 (1985) ("A pharmacist owes a duty ofordinary care in practicing his profession, but such care requiresthe highest degree of prudence, thoughtfulness and diligence, andit is proportioned to the danger involved"). As noted, Wal-Martwas aware not only of Heidi's drug allergies, but also that Toradolwas contraindicated for persons with such allergies. Acontraindication is a serious limitation on a drug's use, necessarilyimplying grave consequences if it is ignored. As one court hasnoted, a contraindication refers to "a circumstance under which thedrug must never be given." Hand v. Krakowski, 89 A.D.2d 650,651, 453 N.Y.S.2d 121, 123 (1982), cited with approval in McKeev. American Home Products Corp., 113 Wash. 2d 701, 715, 782P.2d 1045, 1053 (1989). Taking into account the potentially severeconsequences of a failure to warn in this case, we conclude thatimposing on Wal-Mart a duty to warn is clearly proportionate to"the danger involved." Eldridge, 138 Ill. App. 3d at 126.

Notwithstanding the foregoing, Wal-Mart argues that theappellate court below erred in finding that Wal-Mart had a duty towarn Heidi or Dr. Lorenc about the Toradol contraindication. Wal-Mart contends that because Illinois has adopted the learnedintermediary doctrine, under which the prescribing physician hasthe primary responsibility to warn of drug interactions and side-effects, pharmacies in Illinois have no such duty. According toWal-Mart, "[t]he learned intermediary doctrine exemptspharmacists and pharmacies from giving warnings to patients."Accordingly, Wal-Mart contends that, absent any duty to warn onWal-Mart's part, the trial court was correct in granting summaryjudgment in defendant's favor, and the appellate court's reversalof this judgment was in error. We disagree.

In support of its argument, Wal-Mart relies upon severalIllinois cases, including Kirk v. Michael Reese Hospital & MedicalCenter, 117 Ill. 2d 507 (1987), wherein this court adopted thelearned intermediary doctrine. In Kirk, the plaintiff was injuredwhile riding as a passenger in a car driven by Daniel McCarthy,who had been a psychiatric patient at the defendant hospital.Certain prescription drugs were given to McCarthy on the day hewas discharged from the hospital. On that same day, McCarthyconsumed an alcoholic beverage. Later in the day, the car he wasdriving hit a tree, injuring the plaintiff. In his complaint, whichnamed as defendants the hospital, the prescribing physicians, themanufacturers of the prescription drugs, and McCarthy, theplaintiff alleged, inter alia, that the hospital negligently failed toadequately warn McCarthy that the prescribed drugs woulddiminish his physical and mental abilities. The trial courtdismissed the counts against most of the defendants, but theappellate court reversed and remanded the dismissed counts fortrial.

In reversing the appellate court and affirming the trial court'sdecision, this court relied in part upon the learned intermediarydoctrine. Under this rule, "manufacturers of prescription drugshave a duty to warn prescribing physicians of the drugs' knowndangerous propensities, and the physicians, in turn, using theirmedical judgment, have a duty to convey the warnings to theirpatients." Kirk, 117 Ill. 2d at 517. The underlying rationale of thelearned intermediary doctrine is that, with regard to prescriptiondrugs, which are likely to be complex medicines, it is theprescribing physician who knows both the propensities of the drugand the susceptibilities of his patient, and who therefore is in thebest position to prescribe a particular drug for the patient.Accordingly, while drug manufacturers must warn the ultimatepurchasers about the dangers inherent in patent drugs sold over thecounter, the manufacturer need not warn the individual consumerabout the dangers of prescription drugs. In selling these drugs, themanufacturer is required to warn only the prescribing physician,who then acts as a " ' "learned intermediary" ' " between themanufacturer and the consumer. Kirk, 117 Ill. 2d at 518, quotingStone v. Smith, Kline & French Laboratories, 731 F.2d 1575, 1580(11th Cir. 1984), quoting Reyes v. Wyeth Laboratories, 498 F.2d1264, 1276 (5th Cir. 1974).

Based on this doctrine, the court in Kirk held that thedefendant drug manufacturers had no duty to warn patientsdirectly. The court came to the same conclusion with regard to thedefendant hospital:

"The extent of warnings to patients concerningprescription drugs, as we have previously noted, is withinthe discretion of the physician. As such, the allegednegligent acts specified in the complaint are matterswithin the duty of care owed by the treating physician,rather than the hospital." Kirk, 117 Ill. 2d at 524.

While the hospital might appear to have been acting in therole of a pharmacy, the court in Kirk did not directly address thequestion of whether the learned intermediary doctrine applied topharmacies.⁽³⁾ However, in the following year that question wasaddressed by our appellate court. In Leesley v. West, 165 Ill. App.3d 135 (1988), a decision also relied upon by Wal-Mart, thesecond district appellate court applied the learned intermediarydoctrine to pharmacists, and held that the defendant pharmacy hadno duty to pass on to a customer relevant warnings given to it bythe manufacturer of a prescription drug. The plaintiff in Leesleysued for damages resulting from severe gastrointestinal bleedingcaused by the prescription drug Feldene. In her complaint, theplaintiff alleged, inter alia, that both the drug manufacturer andthe pharmacy that filled the prescription failed to warn her directlyabout the potential hazards of the drug, including gastrointestinalbleeding, which is a known but infrequent side effect of Feldene.

The court in Leesley held that, based in part on the learnedintermediary doctrine, neither the manufacturer nor the pharmacyhad a duty to warn the customer directly of the potential sideeffects of Feldene. With regard to the pharmacy, the courtexplained that the foreseeability of injury to an individualconsumer "varies greatly depending on the medical history andcondition of the individual-facts which we cannot reasonablyexpect the pharmacist to know." Leesley, 165 Ill. App. 3d at 142.The court in Leesley also noted that it would be "veryburdensome" to require the pharmacy to convey to its customersthe warnings it received from the manufacturer. Such arequirement might very well mean that pharmacists "must bear theadditional costs of reproducing the material they receive." Leesley,165 Ill. App. 3d at 142.

Other cases relied upon by Wal-Mart include Eldridge v. EliLilly & Co., 138 Ill. App. 3d 124 (1985), and Fakhouri v. Taylor,248 Ill. App. 3d 328 (1993), both of which address the question ofwhether a pharmacist has a duty to warn that drugs are beingprescribed in excessive quantities. In each case, the court pointedto the learned intermediary doctrine in concluding that no suchduty exists.

Relying on the foregoing and similar cases, Wal-Martcontends that the learned intermediary doctrine precludes theimposition of a duty to warn here. We disagree. Given theparticular facts in the instant case, we conclude that this case isoutside the purview of the learned intermediary doctrine.

As noted, the rationale underlying the learned intermediarydoctrine is that because the prescribing physician has knowledgeof the drugs he is prescribing and, more importantly, knowledgeof his patient's medical history, it is the physician who is in thebest position to prescribe drugs and monitor their use. Thusmanufacturers of these drugs should not be required to warnindividual patients of the dangers inherent in their use. That is theproper province of the prescribing physician, not the drugmanufacturer, who has a duty only to warn the physician.

It is this rationale which underlies the reasons cited by thecourts in Leesley, Eldridge and Fakhouri in explaining whypharmacists should not have a duty to warn a patient or physicianof the adverse side effects of prescription drugs. Imposing such aduty, the court in Eldridge noted, "would require the pharmacistto learn the customer's condition and monitor his drug usage. Toaccomplish this, the pharmacist would have to interject himselfinto the doctor-patient relationship and practice medicine withouta license." Eldridge, 138 Ill. App. 3d at 127. Similarly, the courtin Fakhouri asserted that "[d]etermining which medication is to beutilized in any given case requires an individualized medicaljudgment, which, in our opinion, only the patient's physician canprovide." Fakhouri, 248 Ill. App. 3d at 332. The court noted thatit is the physician who presumably knows the patient's currentcondition as well as his complete medical history. Therefore, thecourt in Fakhouri explained, "[t]o impose a duty to warn on thepharmacist would be to place the pharmacist in the middle of thedoctor-patient relationship, without the physician's knowledge ofthe patient." (Emphasis in original.) Fakhouri, 248 Ill. App. 3d at332-33. Along these same lines, the court in Leesley noted that apharmacist cannot reasonably be expected to know the medicalhistory and condition of the individual consumer, and thereforeshould not have a duty to warn individual consumers.

These reasons for not imposing a duty to warn on pharmacistsdo not apply in the instant case. Here, Wal-Mart was aware notonly of Heidi's drug allergies, but also that Toradol wascontraindicated for persons such as Heidi with allergies to aspirin.Imposing a duty to warn of this contraindication would not requirethe pharmacist to "learn the customer's condition and monitor hisdrug usage." Eldridge, 138 Ill. App. 3d at 127. On the contrary,Wal-Mart already had the knowledge it needed in order to give aneffective warning, and this warning required Wal-Mart only tonotify Dr. Lorenc or Heidi of the Toradol contraindication, not tomonitor Heidi's drug usage.⁽⁴⁾ Further, imposing a duty to warnhere would not have intruded Wal-Mart into the doctor-patientrelationship, forcing it to "practice medicine without a license."Eldridge, 138 Ill. App. 3d at 127. We agree with the appellatecourt below that "[t]his is not a case in which the plaintiff isasking the pharmacist to exercise any modicum of medicaljudgment or to interject himself into the doctor-patientrelationship." 316 Ill. App. 3d at 627-28.

The situation here differs from that in Fakhouri and Eldridge,where imposing the duty that the plaintiff sought would haverequired the pharmacist to warn that drugs were being prescribedin excessive quantities. As the court in Eldridge aptly noted, "[a]prescription which is excessive for one patient may be entirelyreasonable for the treatment of another." Eldridge, 138 Ill. App. 3dat 127. Hence, imposing upon a pharmacist a duty to warn in sucha situation might arguably require him to make a medicaljudgment. Here, the pharmacist was faced not with a prescriptionfor a quantity in excess of normal use, but rather with a simplecontraindication, which, as noted, means that the drug should notbe given. See Hand v. Krakowski, 89 A.D.2d 650, 651, 453N.Y.S.2d 121, 123 (1982); Webster's Third New InternationalDictionary 495 (1993). It requires no medical judgment simply tonotify a physician or a patient of such a contraindication.

Contrary to Wal-Mart's contentions, the scope of theprotection provided to pharmacists by the learned intermediarydoctrine is limited, particularly in situations such as the instantcase where a pharmacy has knowledge that a prescribedmedication is contraindicated for a specific customer. With theexception of the appellate decision below in the case at bar, wehave found no Illinois decisions addressing the question of apharmacist's duty to warn in these circumstances. However, courtsin other jurisdictions have addressed either this or similar issues.We find the decision in Morgan v. Wal-Mart Stores, Inc., 30S.W.3d 455 (Tex. Ct. App. 2000), particularly instructive withregard to the limitations of the learned intermediary doctrine insituations similar to the case at bar.

The plaintiffs in Morgan sued Wal-Mart Stores, Inc., allegingthat their son's death in August 1993 resulted from an adversereaction to Desipramine, a prescription drug sold by a Wal-Martpharmacist. The plaintiffs alleged that Wal-Mart was negligent infailing to properly warn of the hazards and harms associated withthe use of Desipramine. The jury agreed, finding that Wal-Mart'sfailure to warn was negligent, and that this failure was a proximatecause of the son's death. On appeal, Wal-Mart argued, as it doeshere, that its pharmacists had no duty to warn of the potentialdangers of Desipramine because that duty rested with theprescribing physician.

The appellate court in Morgan reversed the trial court,concluding that pharmacists have no generalized duty to warn ofpotential adverse reactions to prescription drugs. However, inreaching this conclusion, the court made clear the limitations in itsholding. It noted specifically that the plaintiffs had not alleged thatWal-Mart possessed any special knowledge of their son's medicalhistory that would have imposed upon Wal-Mart a duty to warn.In addition, the plaintiffs did not contend "that Wal-Mart was orshould have been aware of any contraindications." Morgan, 30S.W.3d at 467. The court in Morgan pointed to decisions in otherjurisdictions where a duty was imposed on pharmacists "beyondaccurately filing [sic] prescriptions *** based on the presence ofadditional factors, such as known contraindications, that wouldalert a reasonably prudent pharmacist to a potential problem."(Emphasis added.) Morgan, 30 S.W.3d at 466.

The court acknowledged that Wal-Mart might have beenliable if there had been "neglect in the face of information onwhich a reasonably prudent pharmacist would have acted."Morgan, 30 S.W.3d at 467. In the absence of such information,however, there was no liability. Hence, the court's carefullyworded holding in Morgan:

"[I]n light of the learned intermediary doctrine, which wefind applicable to the relationship among physician,patient, and pharmacist, we hold that pharmacists have nogeneralized duty to warn patients of potential adversereactions to prescription drugs absent some specialcircumstances not present here." (Emphasis added.)Morgan, 30 S.W.3d at 469.

In the instant case, by contrast, such "special circumstances"were present. It is undisputed that Wal-Mart had "specialknowledge" of Heidi's medical history, i.e., her drug allergies. Inaddition, Wal-Mart knew that Toradol was contraindicated forpersons such as Heidi with allergies to aspirin and other NSAIDs.In such limited circumstances, a narrow duty to warn clearlyexists. See McKee v. American Home Products Corp., 113 Wash.2d 701, 715, 782 P.2d 1045, 1053 (1989) (agreeing that"pharmacists should have a duty to be alert for patent errors in aprescription, [including] *** known contraindications *** and totake corrective measures" (emphasis omitted)).

For the reasons set forth above, we hold that a narrow duty towarn exists where, as in the instant case, a pharmacy has patient-specific information about drug allergies, and knows that the drugbeing prescribed is contraindicated for the individual patient. Insuch instances, a pharmacy has a duty to warn either theprescribing physician or the patient of the potential danger.

Because of our disposition on the duty of the pharmacy, weneed not address Wal-Mart's argument that it engaged in novoluntary undertaking to warn, and therefore did not remove itselffrom the protection of the learned intermediary doctrine. SeeKasin v. Osco Drug, Inc., 312 Ill. App. 3d 823, 827 (2000)(concluding that under Frye v. Medicare-Glaser Corp., 153 Ill. 2d26 (1992), the learned intermediary doctrine no longer appliesonce a pharmacist voluntarily undertakes to warn a consumer of adrug's dangerous propensities). The duty we impose here isbeyond the scope of the learned intermediary doctrine. Thus it isirrelevant whether Wal-Mart removed itself from the protection ofthis rule. The learned intermediary doctrine is simply notimplicated by the circumstances in this case.

CONCLUSION

Because we have concluded that Wal-Mart owed a narrowduty to warn in this case, there remains a genuine issue of materialfact as to whether Wal-Mart breached this duty, and if so, whetherthis breach proximately caused Heidi's injuries. Summaryjudgment therefore was improper. Accordingly, we affirm thejudgment of the appellate court below, which reversed the trialcourt's granting of summary judgment and remanded the cause forfurther proceedings.

Affirmed.

1. ¹The term "contraindication" is defined as "an indication, symptom,or condition that makes inadvisable a particular treatment or procedure."Webster's Third New International Dictionary 495 (1993).

2. ²"Anaphylactic" is derived from the term "anaphylaxis," which isdefined as "hypersensitivity (as to foreign proteins or drugs) ***manifested in man in acute serum sickness and in severe or fatalreactions to second or later administrations of certain drugs." Webster'sThird New International Dictionary 78 (1993). In her deposition,Florence Bowser defined "anaphylactic shock" as follows: "It means theinternal organs can swell, breathing passages can swell and the personcan die."

3. ³The court in Kirk did state in dictum that "negligence claims againstpharmacists for failure to warn concerning overconsumption of drugshave been dismissed primarily because the manufacturers' warningsabout prescription drugs are to be given to the physicians, who then hadthe duty to warn the patients." Kirk, 117 Ill. 2d at 526.

4. ⁴We note that the Pharmacy Practice Act of 1987 (225 ILCS 85/1 etseq. (West 2000)) defines "Pharmaceutical care" as including "the actof monitoring drug use." 225 ILCS 85/3(t) (West 2000). The narrowduty we impose here would not require the pharmacist to conduct suchmonitoring.