Can we be sued?

One of the main concerns expressed in the early days of citric provision was the worry that a drug service might be sued.

We have investigated this issue thoroughly, and have set out the position below. The bottom line is that our committment to quality and safety gives services the maximum possible protection from action in the civil courts, and successful action against a service using our sachets is virtually inconceivable.

In order to reassure practitioners and managers we have set out systematic explanation of why below.

The legal issue in terms of being sued for damages under civil law would come down to what is known in law as 'basic statutory rights', and the discharge of the service providers 'Duty of Care'. Both are described in full below.

A customer's basic statutory rights with regard to supplied products are that goods must be:

• Of satisfactory quality; and
• Free from defects

TOP

The citric acid we supply in sachets has been manufactured to British Pharmacopoeia (BP) standard – see our quality pages.

It is packaged in surroundings that comply with strict pharmaceutical industry standards of hygiene. The sachets are manufactured from a combination of paper and plastic laminates that keep the citric free from contamination by air and moisture.

Basic statutory rights also state that goods must be:

• fit for all the purposes for which goods of that kind are commonly supplied; and
• safe

Citric acid is not designed for injecting – the high levels of acidity can cause vein damage. It is normally manufactured and sold for the purposes of making jam, lemonade and for de-scaling kettles. Citric is supplied by needle exchange schemes because it is likely to be less harmful than injecting with other, more dangerous, acidifiers.

However, the basic statutory rights described above do not apply if the customer is aware that goods are not fit for the purpose the customer wanted them for.

Each sachet of citric acid we supply carries a clear health warning:

• Warning: injecting citric acid damages veins

TOP

We supply citric with handy wraps which protect the sachets from damage in peoples pockets and give give advice on the risks of injecting (including the risks of injecting citric). They make it clear that injectors are responsible for any damage caused to their veins.

Where possible this information should also be discussed with clients. The 'wraps' are an improvement on the leaflets that were approved for use by our barrister when citric sachets were launched, and represent additional clear evidence that we, and the services that dispense citric, are taking every possible step to ensure that clients are aware of the risks they are taking.

Your clients should also have received one of our free how much citric dvds/videos which further explain the risks and dangers and demonstrates a clear committment from us as manufacturers, and you as service providers to explaining risks in full to your clients.

A successful action for negligence would have to demonstrate that a duty of care had been breached (see below) and that any damage caused was due to the product supplied rather than another aspect of the injecting process.

Citric in single-use sachets is preferable to other, more dangerous, acidifiers. This fact and the clear warnings on the sachets, and on the free leaflets given away with each sachet, mean that it is very unlikely that there could be a successful claim against a drug service providing citric sachets, either under the Consumer Protection Act or for negligence

TOP

Duty of Care
All healthcare professionals and drug services owe a legal duty of care to their clients.

The question as to whether there has been a failure to exercise a duty of care is decided by considering whether or not, in the circumstances, the care was of an acceptable standard.

The measure for this is 'that care which would be given by a prudent and reasonable person'. The professional standing of the person providing the care is taken into account, and the care given is expected to be that of a reasonably competent person in that role.

Service users must give informed consent to their use of citric acid. To be able to give informed consent, service users must fully understand the pros and cons of using it.

Concerns about under-use of needle exchange services, and the possibility of the spread of viral infections via injecting paraphernalia, have led many drug services to consider the issue of access to citric acid.

Where citric is being supplied in centre-based needle exchanges, it would be good practice to record the giving of advice and a leaflet to the client. This record should be dated and signed by the worker.

Pharmacy syringe exchange packs with citric acid sachets should contain one of the leaflets supplied free with the sachets, and we also supply pre-paid postage cards for pharmacy exchanges for clients to order a free copy of the how much citric dvd.