## Facts

- Meyer Proctor, who had serious eye problems, was treated by ophthalmologist Michael J. Davis, M.D., using Depo‑Medrol, a corticosteroid manufactured by The Upjohn Company.
- Depo‑Medrol was approved for certain uses but was widely used by ophthalmologists in an off‑label periocular manner (injection around the eye) to treat inflammatory ocular conditions.
- Dr. Davis had previously administered periocular Depo‑Medrol injections to Proctor with some success.
- On November 7, 1983, while intending a periocular injection to Proctor’s left eye, Dr. Davis inadvertently inserted the needle intraocularly and injected Depo‑Medrol into the eye.
- Proctor suffered severe injury and ultimately lost the left eye.
- Evidence showed Upjohn knew physicians used Depo‑Medrol periocularly and had encouraged that practice for years.
- Evidence also showed Upjohn had notice of at least three prior incidents in which accidental intraocular Depo‑Medrol injection caused serious vision loss, but did not warn that the drug was toxic to intraocular structures and difficult to remove once injected into the globe.
- The Proctors sued Dr. Davis for medical malpractice and Upjohn for product liability based on failure to warn; Marjorie Proctor asserted derivative damages.

## Issues

1. Whether a drug manufacturer had a duty to warn physicians of catastrophic injury from accidental intraocular injection when the drug was foreseeably used periocularly off‑label and the manufacturer had knowledge of prior similar injuries.
2. Whether the learned‑intermediary doctrine or alleged common knowledge within the ophthalmology community defeated failure‑to‑warn liability or causation.
3. Whether the verdict exonerating the physician could be reconciled with a finding that the manufacturer’s failure to warn proximately caused the injury.
4. Whether punitive damages were supported by evidence of conscious disregard for safety and, as remitted, were permissible.

## Decision

- The judgment for Dr. Davis was affirmed; the jury’s defense verdict on malpractice stood.
- The judgment against Upjohn was affirmed as to failure‑to‑warn liability.
- The court held the jury could find Upjohn had a duty to warn physicians about the known risk of severe ocular injury from accidental intraocular injection in the setting of foreseeable periocular use.
- The court held the learned‑intermediary doctrine did not bar liability and that the adequacy and effect of warnings were factual questions supported by the record.
- The court upheld submission of punitive damages against Upjohn and sustained a substantial punitive award as remitted by the trial court.

## Legal Principles

- A prescription drug manufacturer must warn prescribing physicians of known, serious risks that are reasonably foreseeable, including risks arising in foreseeable off‑label uses known to and encouraged by the manufacturer.
- A risk is not “too remote” when prior similar incidents show the harm has materialized and the manufacturer has actual notice of the danger.
- Under the learned‑intermediary doctrine, the duty to warn runs to physicians; it does not immunize the manufacturer when the warning to physicians is inadequate and a proper warning could have altered medical choices or precautions.
- A defense verdict for a physician and a plaintiff’s verdict for a manufacturer are not necessarily inconsistent; a jury may find no breach of the medical standard of care yet still find that inadequate manufacturer warnings contributed to the harm by withholding material risk information.
- Punitive damages may be awarded against a manufacturer when evidence supports wilful and wanton misconduct or reckless disregard for safety, such as knowingly failing to communicate a severe, preventable risk.

## Conclusion

The appellate court affirmed the physician’s exoneration but held the manufacturer liable for failing to warn physicians of a known, catastrophic risk tied to foreseeable periocular use of Depo‑Medrol, and it upheld punitive damages based on evidence that the manufacturer knowingly withheld critical safety information despite prior similar injuries.


Proctor v. Davis, 291 Ill. App. 3d 265, 682 N.E.2d 1203 (Ill. App. Ct. 1997)