Court hears amputee's case on limits of drug suits

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Posted on 3rd November 2008 by Gordon Johnson in Uncategorized

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Date: 11/3/2008

By MARK SHERMAN
Associated Press Writer

WASHINGTON (AP) — The Bush administration and a drug maker urged the Supreme Court on Monday to throw out a multimillion dollar verdict to a Vermont musician who lost her arm because of a botched injection to relieve nausea.

The case is being watched closely by the pharmaceutical industry and consumer groups because of its potential for broad limits on lawsuits by people, such as Diana Levine, who were harmed by prescription drugs.

But the justices seemed more likely on Monday to be headed toward a narrow ruling that might be confined to the facts of Levine’s case.

A Vermont jury awarded Levine $6.7 million after the improper injection of Phenergan, an anti-nausea drug made by Wyeth Pharmaceuticals, caused gangrene that led to the amputation of her right arm.

The jury agreed with Levine that Wyeth should have included a stronger warning about the risks of a method of intravenous injection known as IV push.

But lawyers for Wyeth and the government said Levine’s case should have been thrown out of court because Phenergan has been approved by the federal Food and Drug Administration and its label adequately warned about its risks. FDA approval serves as a shield against liability lawsuits under state law in such cases, they said.

“The labeling plainly comprehended and warned about the specific risks of IV administration,” Seth Waxman, representing Wyeth, told the justices.

In recent years, the administration and business groups have aggressively pushed limits on lawsuits through the doctrine of pre-emption — asserting the primacy of federal regulation over rules that might differ from state to state.

But Justice Samuel Alito, among others, had a more basic question for Waxman.

“How could the FDA have concluded that IV push was safe and effective,” Alito asked, given that Phenergan is not a lifesaving drug and gangrene can result from improper administration?

Justice Ruth Bader Ginsburg chimed in, “How could the benefit outweigh the substantial risk?”

Waxman responded that testimony in this case was clear that there are circumstances in which IV push is “medically warranted.”

David Frederick, representing Levine, argued that Wyeth never made clear to the FDA how dangerous IV push could be. He noted that Pfizer, Inc., stopped making IV push an acceptable method of injecting its anti-nausea drug after two amputations were reported.

A ruling probably will not come before early next year.

Copyright 2008 The Associated Press.

Amputee awaits high court, wants musical glow back

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Posted on 30th October 2008 by Gordon Johnson in Uncategorized

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Date: 10/30/2008

By DAVE GRAM
Associated Press Writer

MARSHFIELD, Vt. (AP) _ When Diana Levine turned 63 recently, her daughter made her a birthday card, drawing on Greek mythology with an illustration of Diana the Huntress, her bow string drawn taut, an arrow ready to fly.

But the arm pulling at the bowstring was amputated below the elbow — just like Diana Levine’s — and the target was labeled the “Wyeth monster.”

That’s Wyeth as in Wyeth Pharmaceuticals, the company Levine blames for a botched injection of the Wyeth-made drug Phenergan that led doctors to amputate her right arm in 2000.

Levine, once a professional guitar player and pianist, now plays with one hand and sings. “It’s about getting my glow back,” she said recently as she was awaiting a hearing Monday before the U.S. Supreme Court, where Wyeth is appealing a $6.7 million verdict in her favor.

The outcome of Levine’s case could have major ramifications for drug makers and consumers. The court is expected to decide whether people can sue under state law — or are pre-empted from doing so — for harm caused by a drug approved by the federal Food and Drug Administration.

Levine said the drug makers “are using my case … to get through this doctrine that will say that if it is FDA-approved, then we are not accountable, because FDA said it’s OK. … Mr. Pharmaceutical Company is not responsible and is not liable and doesn’t have to help the person who just lost her arm, or her life.”

Levine, who suffered from migraine headaches, had a particularly bad episode in the spring of 2000. A friend drove her from her dirt road farmhouse-turned-music studio in Marshfield, Vt. to a clinic in neighboring Plainfield.

She was given drugs for the pain and, to combat nausea, an intramuscular injection of Phenergan, a drug that has been around for 50 years.

When Levine complained that she still felt nauseous, the clinic suggested an “IV-push” of Phenergan. This delivered a high volume of the drug very quickly to her right arm, not the slow flow that could have been delivered by an IV drip.

The second injection accidentally punctured an artery, prompting gangrene to set in. After several weeks of deterioration, her arm was amputated.

Levine recalls first seeing what remained of her arm after surgery. “I was horrified and shocked and about as sad as I ever have been in my life,” she said.

She reached an out-of-court settlement with the clinic and sued Wyeth, contending that the label on the Phenergan she was given should have more clearly warned about the danger of giving the drug IV-push.

Combatting an upset stomach with a method that can end up causing limb loss is “an unfathomable benefit-risk ratio,” Levine said. With two other methods for injecting Phenergan, “there’s no earthly reason for this third option (IV-push) to even be made available,” she said.

Wyeth and the FDA say that when a drug like Phenergan has a federally approved label, its manufacturer is immune from lawsuits in state court. Wyeth maintains its label clearly describes the risks of Phenergan, and that it was not only approved but mandated by the FDA. “Wyeth could not change Phenergan’s labeling to comply with Vermont law without violating federal law,” it said in court papers.

Consumer groups are mounting a vigorous campaign against that position, saying federal regulation should represent the floor, not the ceiling, of a drug company’s responsibility.

“What a trial lawyer reasonably could fear in this case is that in one fell swoop, the U.S. Supreme Court would eliminate the right of an injured person to recover from a drug company in the case of a dangerous drug that caused their injury,” said Fordham University law professor Benjamin Zipursky, a product liability expert.

The court could effectively “eliminate all pharmaceutical company liability in this one case,” Zipursky said.

Bert Rein, a lawyer for Wyeth, said that concern was overblown. “Some of the hysteria being whipped up is really unjustified,” he said. “We believe the court will rule on the specific facts of the case,” rather than so broadly as to affect most liability claims.

That was not what Wyeth argued when urging the Supreme Court to take the case.

In its appeal to the court, Wyeth said the justices should act to prevent erroneous rulings in “tens of thousands of individual claims and potentially millions of class action claims” that are pending in state and federal courts.

While the legal war continues, Levine wages a more personal struggle. Sometimes it’s just to roll her left sleeve up or down, file papers, wash dishes or mow the lawn.

“If you were to put your hand in your pocket for a day and not use it, you would pretty much come to the conclusion that there’s nothing that’s a one-handed activity,” she said.

Mostly, the struggle is to continue a life in which songwriting was her gift and the guitar and piano were the tools of her trade.

“My identity was seriously damaged. Not just the musical one, but the physical. I mean, I had lost my glow, the glow was gone,” Levine said, recalling her recent performance with a group of women singers. “That’s what it’s about, it’s about getting my glow back.”

Levine has had more than a little help from her friends.

“She’s determined not to let this setback destroy her music,” said singer-songwriter Jon Gailmor, who had collaborated with Levine and her late husband in performances and on recordings. “It’s probably given her some new material, made her stronger even. She’s an amazing person.”

Quoting a musician friend, Levine calls the right hand the “joyous hand” — the one that gets to strum or pick the guitar, finding the rhythm, while the left searches the neck for the right note or chord. On keyboards, the right hand most often finds the improvisational riffs while the left lays down the underlying rhythm and chord changes.

Levine has no joyous hand now.

A piano and guitar player since childhood, she studied chemistry and psychology at the University of Vermont. Levine, who performed under the name Diana Winn, married a blues guitarist David “Crow” Levine, playing bass alongside of him in the Re-Bops, a band that gained a regional following in the 1980s.

Her husband died in 1993, leaving Levine and the couple’s daughter, Jessamine, now 25.

Now, she’s less concerned with the legal arguments than with making music and sharing it, especially with children.

She pays the bills using her monthly disability check from Social Security, Re-Bob Records sales — though she says she’s unable to keep up the business as well as she used to — and assistance from her family. “I have help from home. Nobody’s going to let me be out in the cold.”

Levine sat one recent afternoon at her
piano, accompanied by Jessamine on guitar, working out a new tune she hoped to send to actor Dennis Quaid, who is waging a drug labeling fight of his own after his infant twins were given a dose of the blood-thinnerHeparin — 1,000 times what was called for.

The twins’ birthday is in November, and Levine was writing a song for them.

Plunking out chords with her left hand, Levine asked Jessamine, “What do we go to there? Do you like G? Or should it be D-minor?”

And then she sang a song fragment:

“It’s the twinses’ birthday, celebrate times two. It’s the twinses’ birthday, if you only knew. There’s been some hard times they’ve both been through …”

Copyright 2008 The Associated Press.

Report: FDA officials opposed drug suit policy

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Posted on 30th October 2008 by Gordon Johnson in Uncategorized

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Date: 10/29/2008

By KEVIN FREKING
Associated Press Writer

WASHINGTON (AP) _ Top scientists and career employees at the Food and Drug Administration opposed agency regulations that weaken consumers’ ability to sue drug makers, congressional investigators said Wednesday.

At issue is language in a drug-labeling rule from 2006 that effectively limits when people can sue in state court over injury claims involving medications. The FDA contends federal regulations prevail when there is a conflict with state law. This concept is called pre-emption.

Internal agency documents showed that career officials opposed this approach, according to a report released by Rep. Henry Waxman, chairman of the House Oversight and Government Reform Committee. In the past, the agency had viewed private suits as an additional layer of protection against unsafe drugs, the report said.

“Much of the argument for why we are proposing to invoke pre-emption seems to be based on a false assumption that the FDA-approved labeling is fully accurate and up-to-date in a real time basis,” the report quoted Dr. John Jenkins, who oversees FDA’s new drug reviews, as saying. “We know that such an assumption is false.”

Patients injured by drugs have won suits against drug manufacturers for failing to warn against certain dangers.

In a case to be argued before the Supreme Court on Monday, a Vermont woman sued Wyeth after she lost her right arm below the elbow following a high-volume injection of the drug Phenergan. The injection accidentally punctured an artery, prompting gangrene to set in. Levine argued that the company had a duty to warn consumers that such injections could have devastating consequences. The state courts agreed, awarding her nearly $7 million.

Wyeth appealed, saying it was protected from such suits. It argued a state court cannot overrule the FDA’s judgment on label warnings.

FDA scientists had weighed the risks and benefits of Phenergan, used to treat nausea and allergies, when it approved the prescribing literature, or label, as a guide for doctors. The FDA was aware of risks associated with injecting some forms of Phenergan, but the label did not specifically warn about the technique used with Levine.

The FDA said in its 2006 rule and in a 2008 rule that state suits could encourage drug makers to propose unnecessary labeling. Such labeling could result in scientifically unsubstantiated warnings and less use of beneficial treatments.

Waxman’s staff obtained documents rejecting that warning. Jane Axelrad, an associate director for policy at the agency, wrote: “We rarely find ourselves in situations where sponsors want to disclose more risk information than we think is necessary,” she said. “To the contrary, we usually find ourselves dealing with situations where sponsors want to minimize the risk information.”

FDA officials said the agency encourages robust debate on public policy, so some dissension can be expected.

“As in any organization, there is rarely unanimity of opinion,” said spokeswoman Rita Chappelle.

In the end, the agency determined that finalizing the rules were the appropriate action.

“It was appropriate because FDA is the public health agency charged by Congress with the responsibility to ensure that drugs and certain medical devices are safe and effective and that the labeling adequately informs users of the risks and benefits of the product,” Chappelle said. “In addition, the agency is uniquely qualified to make such important and complex judgments.”

Public Citizen, the consumer advocacy group, said the Bush administration had pushed pre-emption clauses in a wide array of regulations.

“This effort to prevent injured citizens from using the courts and holding negligent companies’ accountable must be stopped,” said Brian Wolfman, director of Public Citizen’s litigation group.

The report said the FDA has yet to provide a complete set of documents that would show communications between the White House and the agency, but some documents suggested the agency and the White House would not go forward with a rule on labeling until the pre-emption changes were included.

___

On the Net:

House Oversight and Government Reform Committee: http://oversight.house.gov


Copyright 2008 The Associated Press.