Cvs Pharmacy v. Hon. bostwick/tucson Medical ( 2021 )


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  •                              IN THE
    SUPREME COURT OF THE STATE OF ARIZONA
    CVS PHARMACY, INC., AND CVS ARIZONA, L.L.C.,
    Petitioners,
    v.
    THE H ONORABLE JANET C. BOSTWICK, JUDGE OF THE SUPERIOR COURT OF
    THE STATE OF ARIZONA, IN AND FOR THE COUNTY OF PIMA,
    Respondent Judge,
    and
    TUCSON MEDICAL CENTER,
    Real Party in Interest.
    No. CV-20-0120-PR
    Filed September 1, 2021
    Appeal from the Superior Court in Pima County
    The Honorable Janet C. Bostwick, Judge
    No. C20184991
    REVERSED AND REMANDED
    Order of the Court of Appeals, Division Two
    No. CA-SA 2020-0012
    Filed April 14, 2020
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    COUNSEL:
    Andrew M. Federhar, Jessica A. Gale, Spencer Fane LLP, Phoenix, and
    Conor B. O’Croinin (argued), Zuckerman Spaeder LLP, Baltimore, MD,
    Attorneys for CVS Pharmacy, Inc. and CVS Arizona, L.L.C.
    Ronald Jay Cohen, Daniel G. Dowd (argued), Betsy J. Lamm, Lauren M.
    LaPrade, Cohen Dowd Quigley, P.C., Phoenix; Lance Oliver, Motley Rice
    LLC, Mount Pleasant, SC; Steven C. Mitchell, Samuel F. Mitchell, Mitchell
    & Speights, L.L.C, Scottsdale, Attorneys for Tucson Medical Center
    Jeffrey C. Warren, Amanda Heitz, David T. Lundmark, Claudia C. Ionescu,
    Charles M. Seby, Bowman and Brooke LLP, Phoenix, Attorneys for Amicus
    Curiae Arizona Association of Defense Counsel
    Troy P. Foster, Megan Weides, The Foster Group, PLLC, Phoenix; Chad
    Golder, Esq. Washington, DC, Attorneys for Amici Curiae American
    Hospital Association, Federation of American Hospitals and America’s
    Essential Hospitals
    Eric M. Fraser, Hayleigh S. Crawford, Osborn Maledon, P.A., Phoenix,
    Attorneys for Amici Curiae Kingman Hospital, Inc., Arizona Spine and
    Joint Hospital LLC, Bullhead City Hospital Corporation, Carondelet St.
    Joseph’s Hospital, Holy Cross Hospital, Inc., Hospital Development of West
    Phoenix, Inc., Northwest Hospital, LLC, Oasis Hospital, Oro Valley
    Hospital, LLC, Orthopedic and Surgical Specialty Company, LLC, St.
    Mary’s Hospital of Tucson, VHS Acquisition Subsidiary Number 1, Inc.,
    VHS of Arrowhead, Inc., and Yuma Regional Medical Center
    Timothy A. Nelson, The Nelson Law Group, PLLC, Phoenix, Attorney for
    Amicus Curiae Arizona Hospital and Healthcare Association
    Daniel J. O’Connor, Jr., Richard R. Reed, Jr., O’Connor & Dyet, P.C., Tempe;
    A. Joshua Podoll and Danielle Sochaczevski, Williams & Connolly LLP,
    Washington, DC, Attorney for Amicus Curiae Cardinal Health, Inc.
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    John J. Kastner, Jr., Rachel B. Weil, Steven J. Boranian, Jennings, Strouss &
    Salmon, P.L.C., Tucson, Attorney for Amicus Curiae AmerisourceBergen
    Drug Corporation
    David L. Abney, Ahwatukee Legal Office, P.C., Phoenix, Attorney for
    Amicus Curiae Arizona Association for Justice/Arizona Trial Lawyers
    Association
    Bradley J. Johnston, Levi T. Claridge, The Cavanagh Law Firm, Phoenix;
    Charles C. Lifland, Sina S. Aria, O’Melveny & Myers LLP, Los Angeles, CA;
    Steve Brody, O’Melveny & Myers LLP, Washington, DC; Todd Jackson,
    Jean Roof, Jackson & Oden, P.C. Tucson; André H. Merrett, Thorpe Shwer,
    P.C., Phoenix, John D. Lombardo, Jake R. Miller, Arnold & Porter, Los
    Angeles, CA; Richard M. Amoroso, Gregory A. Davis, Squire Patton Boggs
    (US) LLP, Phoenix; Brent A. Hawkins, Morgan, Lewis & Bockius LLP, San
    Francisco, CA; Brian M. Ercole, Morgan, Lewis & Bockius LLP, Miami,
    Florida, Attorneys for Amicus Curiae Pharmaceutical Manufacturers
    ________________
    JUSTICE BOLICK authored the opinion of the Court, in which CHIEF
    JUSTICE BRUTINEL, VICE CHIEF JUSTICE TIMMER, and JUSTICES
    LOPEZ, BEENE, and PELANDER (Retired) * joined. **
    _______________
    * Justice William G. Montgomery has recused himself from this case.
    Pursuant to article 6, section 3 of the Arizona Constitution, the Honorable
    Justice John Pelander (Ret.), was designated to sit in this matter.
    **Although Justice Andrew W. Gould (Ret.) participated in the oral
    argument in this case, he retired before issuance of this opinion and did not
    take part in its drafting.
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    JUSTICE BOLICK, opinion of the Court:
    ¶1            This case concerns whether a hospital may directly recover
    from a third party the costs of uncompensated medical care provided to
    patients whose need for treatment the third party allegedly caused, and
    whether a pharmacy that self-distributes prescription opioids to its
    affiliated pharmacies owes a duty to a hospital that incurs costs to treat
    opioid-addicted patients. We hold that the exclusive right for a hospital to
    recover from a third-party tortfeasor is through the medical lien statutes
    and that a pharmacy does not owe a duty to a hospital under the facts
    alleged here.
    I.     BACKGROUND
    ¶2            CVS Health Corporation operates centers that distribute
    prescription drugs to CVS-branded retail pharmacies, which in turn sell
    those medications to individual patients. Tucson Medical Center (“TMC”)
    is a nonprofit community hospital serving residents throughout southern
    Arizona.
    ¶3            In October 2018, TMC filed a complaint alleging a broad
    “conspiracy” among drug manufacturers, distributors, and marketers (the
    “Marketing and Distributor Defendants”) to establish a “network to
    promote the use of opioids” by making “misrepresentations and omissions
    regarding the appropriate uses, risks, and safety of opioids, to increase
    sales, revenue, and profit from their opioid products.” In short, TMC
    alleged the Marketing and Distributor Defendants created a false narrative
    of opioid-friendly messaging, fueling the national opioid epidemic.
    ¶4            In July 2019, TMC filed its First Amended Complaint (the
    “Complaint”), adding CVS Health Corporation; CVS Pharmacy, Inc.; CVS
    Arizona, LLC; and specific CVS Pharmacies (collectively, “CVS”) as
    defendants. TMC’s Complaint alleged that CVS, together with the
    Marketing and Distributor Defendants, “extract billions of dollars of
    revenue from the addicted American public while hospitals sustain tens of
    millions of dollars of losses caused as a result of the reasonably foreseeable
    consequences of the prescription opioid addiction epidemic.” The
    Complaint also alleged that CVS “failed to exercise due care in dispensing,
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    and instead dispensed far more opioids into Arizona communities than
    were needed for licit use.” With respect to the individual CVS Pharmacies,
    the Complaint alleged that each such store has a duty to establish policies
    and procedures to avoid filling prescriptions indicative of abuse, to train
    their employees on these policies and procedures, and to report potential
    diversion of opioids—which occurs when individuals obtain prescription
    opioids for nonmedical purposes—to the appropriate authorities.
    ¶5            The Complaint alleged that all defendants, including CVS,
    were liable for negligence, wanton negligence, negligence per se, negligent
    distribution, nuisance, and unjust enrichment (respectively, Counts 3, 4, 5,
    7, 8, and 9). TMC alleged hospitals within the state incur “millions of
    dollars in damages for the costs of uncompensated care,” and that TMC
    suffered additional damages by incurring operating expenses, including
    “additional training, additional security. . . . [and] special programs over
    and above their ordinary hospital services” due to caring for opioid-
    addicted patients. Unlike the hospitals in Ansley v. Banner Health Network,
    TMC does not seek damages for Medicaid patients. See 
    248 Ariz. 143
    , 153
    ¶ 45 (2020) (holding that the lien statutes cannot allow hospitals to recover
    the costs of medical care beyond the amounts provided by Medicaid).
    ¶6            CVS moved to dismiss the Complaint, arguing, as relevant
    here, that: (1) Arizona’s medical lien statutes, specifically, A.R.S.
    § 33-934(A), precluded all TMC’s claims against it; and (2) CVS “did not
    owe a duty to protect plaintiff from the harm alleged in the complaint.”
    CVS also claimed TMC failed to state a legally cognizable claim against it
    for nuisance or unjust enrichment. 1
    ¶7             The trial court denied CVS’s motion to dismiss, permitting all
    claims against CVS to proceed. The court determined that TMC asserted a
    direct claim for damages, which included claims for uncompensated
    patient bills, and that it must take TMC’s factual assertion of direct loss as
    1 The parties discuss TMC’s public nuisance claim in their briefs; however,
    we did not accept review on that issue and decline to address it here. See
    Bennett v. Napolitano, 
    206 Ariz. 520
    , 525 ¶ 21 (2003). The unjust enrichment
    claim is also not before us.
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    true. The court further found that “[s]tatutes and case law provide a
    potential public policy basis for a CVS duty to [TMC],” that public policy
    favors “regulating and preventing harm from opioids, whether distributed
    or dispensed improperly under the law,” and that TMC “would arguably
    be in a class of persons protected” by the statutes.
    ¶8           CVS filed a petition for special action in the court of appeals,
    which declined jurisdiction. Judge Brearcliffe dissented, stating the court
    should accept jurisdiction and grant relief to CVS.
    ¶9             We granted review because application of the Arizona
    medical lien statutes, A.R.S. §§ 33-931 to -936, and whether a pharmacy
    owes a duty to a hospital for the distribution of opioids to third parties,
    present issues of statewide importance. We have jurisdiction under article
    6, section 5(3) of the Arizona Constitution.
    II.    DISCUSSION
    ¶10             The only issue presently before us is whether the trial court
    should have dismissed the negligence claims against CVS. Dismissal is
    appropriate under Arizona Rule of Civil Procedure 12(b)(6) if, “as a matter
    of law . . . plaintiffs would not be entitled to relief under any interpretation
    of the facts susceptible of proof.” Fid. Sec. Life Ins. Co. v. Ariz. Dep’t of Ins.,
    
    191 Ariz. 222
    , 224 ¶ 4 (1998). Because questions of law are reviewed de
    novo, we review dismissal under Rule 12(b)(6) de novo. Coleman v. City of
    Mesa, 
    230 Ariz. 352
    , 356 ¶ 8 (2012).
    ¶11           Our analysis in this case is informed by both federal and state
    law. Federal law regulates the dispensing of pharmacological drugs and
    addresses the opioid epidemic. State law generally governs the obligations
    flowing from one person or entity to another with respect to injury claims
    and remedies for damages. See generally In re Nat’l Prescription Opiate Litig.,
    
    452 F. Supp. 3d 745
     (N.D. Ohio 2020) (applying federal statutes and Florida
    tort law in consolidated opioid cases in multidistrict federal litigation).
    Here, TMC alleges that by various acts of negligence, the CVS defendants
    inflicted economic harm on the hospital both in the form of uncompensated
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    care it was required to provide to opioid-addicted patients, and for
    additional expenses it incurred as a result of the opioid epidemic. We refer
    to the first type of economic damages as “indirect” or “derivative” because
    they are occasioned by the alleged inadequate compensation for patient
    care, and the second type as “direct” because they are costs directly
    incurred by TMC.
    ¶12            CVS argues that TMC’s claims for indirect damages are
    foreclosed by Arizona’s medical lien statutes, and that the negligence
    claims for direct damages fail because CVS lacks a requisite duty as a matter
    of law. We address each argument in turn.
    A. Arizona’s Medical Lien Statutes
    ¶13            TMC asserts it has been harmed by CVS’s improper
    distribution of opioids, which fueled the opioid epidemic and foreseeably
    caused damages for the costs of uncompensated care to treat opioid-
    addicted patients. Although TMC contends the harm it suffered is direct,
    TMC’s negligence-based claim for uncompensated patient care is actually
    based, at most, on CVS’s infliction of harm on opioid-addicted patients,
    rather than infliction of harm directly on TMC.                    Cf. In re
    Tobacco/Governmental Health Care Costs Litig., 
    83 F. Supp. 2d 125
    , 126 (D.D.C.
    1999) (dismissing the Republic of Guatemala’s claims to recover citizens’
    health care costs because the alleged injury was derivative of the citizens’
    injuries). Therefore, TMC’s direct claim against CVS results from an
    indirect, derivative injury—the personal injuries to patients that resulted in
    increased hospital treatment expenses. In essence, TMC seeks to stand in
    the shoes of its patients to recover for the uncompensated care.
    ¶14            Arizona’s medical lien statutes, §§ 33-931 to -936, authorize
    hospitals to impose a lien against “all claims of liability or indemnity . . . for
    damages accruing to the person to whom the [hospital’s] services are
    rendered . . . on account of the injuries that gave rise to the claims and that
    required the services.” § 33-931(A). The medical lien statutes, accordingly,
    govern claims for indirect damages and “extend to health care providers a
    remedy not available under the common law—the ability to enforce a lien
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    against those liable to the patient for damages in order to secure the
    providers’ customary charges for care and treatment of an injured person.”
    Premier Physicians Grp., PLLC v. Navarro, 
    240 Ariz. 193
    , 195 ¶ 7 (2016)
    (quoting Blankenbaker v. Jonovich, 
    205 Ariz. 383
    , 388 ¶ 22 (2003)). “The lien
    shall be for the claimant’s customary charges for care and treatment or
    transportation of an injured person.” § 33-931(A).
    ¶15             Arizona, however, prohibits assignment of personal injury
    claims. See Allstate Ins. Co. v. Druke, 
    118 Ariz. 301
    , 303–04 (1978); State Farm
    Fire & Cas. Co. v. Knapp, 
    107 Ariz. 184
    , 185 (1971). And TMC cannot
    circumvent this rule by asserting a direct claim for uncompensated care
    against a third party it contends caused personal injuries to its patients. See
    United Food & Com. Workers Unions, Emps. Health & Welfare Fund v. Philip
    Morris, Inc., 
    223 F.3d 1271
    , 1274 (11th Cir. 2000) (“The usual common law
    rule is that a health-care provider has no direct cause of action in tort against
    one who injures the provider’s beneficiary, imposing increased costs upon
    the provider.”). To do so would create an end-run around the no-
    assignment principle. See Allstate, 
    118 Ariz. at 304
     (in rejecting assignment
    of claims, the Court remarked that “[w]hatever the form, whatever the
    label, whatever the theory, the result is the same”). Not insignificantly, it
    would also deprive patients of the ability to successfully assert claims
    against CVS.
    ¶16            Barred from pursuing a negligence claim against CVS to
    recover indirect damages, TMC is limited to suing the patient or perfecting
    and collecting on a statutory lien. The remedy provided by the medical lien
    statutes is exclusive because those statutes “create[] a right and also
    provide[] a complete and valid remedy for the right created.” See
    Blankenbaker, 
    205 Ariz. at
    387 ¶ 18 (quoting Valley Drive-In Theatre Corp. v.
    Superior Court, 
    79 Ariz. 396
    , 400 (1955)). Absent coverage by the medical
    lien statutes, a hospital may not assert a claim against a third party for
    uncompensated patient care. In sum, TMC’s claims for uncompensated
    care provided for patients’ injuries are barred. But because the lien statutes
    do not displace TMC’s claims for direct damages, we next address whether
    TMC can maintain its negligence claims to recover such damages. See
    § 33-931(C) (“The lien entitlements authorized by subsection A of this
    section and the assignment authorized by subsection B of this section are
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
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    applicable to all customary charges by hospitals or ambulances of political
    subdivisions.” (emphasis added)).
    B. Duty
    ¶17         TMC’s negligence claims for direct damages similarly fail
    because CVS does not owe a duty to TMC under the facts alleged.
    ¶18           “To establish a defendant’s liability for a negligence claim, a
    plaintiff must prove: (1) a duty requiring the defendant to conform to a
    certain standard of care; (2) breach of that standard; (3) a causal connection
    between the breach and the resulting injury; and (4) actual damages.”
    Quiroz v. ALCOA Inc., 
    243 Ariz. 560
    , 563–64 ¶ 7 (2018). We determine
    whether a legal duty exists without considering the case-specific facts
    concerning breach and causation. 
    Id.
     at 564 ¶ 7.
    ¶19            In Quiroz, we outlined Arizona’s duty framework. First, duty
    is not presumed, and the plaintiff has the burden of establishing its
    existence. 
    Id.
     at 563 ¶ 2. Second, foreseeability is not a factor in determining
    duty. 
    Id.
     (citing Gipson v. Kasey, 
    214 Ariz. 141
    , 144 ¶ 15 (2007)). Third, duty
    is based on common law special relationships or relationships created by
    public policy. 
    Id.
     Finally, the sources for identifying public policy are state
    and federal statutes and the common law. 
    Id.
    ¶20           “[S]pecial relationships [are] recognized by the common law,
    contracts, or ‘conduct undertaken by the defendant.’” 
    Id.
     at 565 ¶ 14
    (quoting Gipson, 214 Ariz. at 145 ¶¶18–19). As a threshold matter here, CVS
    does not have a special relationship with TMC. In such circumstances,
    absent clearly expressed public policy, we do not find a duty flowing from
    one to the other.
    ¶21           “[W]e exercise great restraint in declaring public policy,”
    which is ordinarily the prerogative of the legislative bodies. Id. at 566 ¶ 19.
    “Public policy creating a duty is based on our state and federal statutes and
    the common law . . . [,] specifically, case law and Restatement sections
    consistent with Arizona law.” Id. at 565 ¶ 15, 567 ¶ 20. Statutes “create a
    duty when a plaintiff ‘is within the class of persons to be protected by the
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
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    statute and the harm that occurred . . . is the risk that the statute sought to
    protect against.’” Id. at 565 ¶ 15 (quoting Gipson, 214 Ariz. at 146 ¶ 26).
    ¶22           TMC contends that CVS’s duty derives from public policy.
    Specifically, it argues that federal and state statutes, including the
    Controlled Substances Act (“CSA”) (
    21 U.S.C. § 801
     et seq.), the Arizona
    Uniform Controlled Substances Act (“AUCSA”) (A.R.S. § 36-2501 et seq.),
    and the Arizona Opioid Epidemic Act (“AOEA”) (S.B. 1001, 53rd Leg., 1st
    Spec. Sess. (Ariz. 2018)), establish that CVS owed a duty of care to TMC.
    However, there is no legally cognizable duty, public policy-based or
    otherwise, that would allow TMC to assert a negligence claim against CVS.
    ¶23           Public policy does not establish a duty from CVS to TMC.
    TMC relies on statutes prohibiting the distribution of prescription drugs,
    such as the CSA and AUCSA, to establish a public policy-based duty to
    hospitals. 2 But the class protected by those statutes is prescription-drug
    users, not hospitals. The CSA and AUCSA, for example, were enacted to
    combat drug abuse and control the traffic of controlled substances. See
    Reed-Kaliher v. Hoggatt, 
    237 Ariz. 119
    , 124 ¶ 22 (2015) (“The manifest
    purpose of the CSA was ‘to conquer drug abuse and to control the
    legitimate and illegitimate traffic in controlled substances.’” (quoting
    Gonzales v. Raich, 
    545 U.S. 1
    , 12 (2005))); Unif. Controlled Substances Act
    prefatory note (Unif. L. Comm’n 1994). The CSA (and the AUCSA by
    extension) protect “individual members of the public from falling victim to
    drug misuse and abuse.” See In re Nat’l Prescription Opiate Litig., 452 F.
    Supp. 3d at 788. Indeed, TMC acknowledges that the CSA’s and AUCSA’s
    overall objective is to protect against addiction, overdose, and death as a
    result of drug abuse. But TMC is a hospital. And a hospital cannot suffer
    from addiction, overdose, and death, and thus does not fall within the class
    of persons meant to be protected. See Gipson, 214 Ariz. at 146 ¶¶ 25–26; In
    2TMC further relies on Kromko v. Arizona Board of Regents, 
    149 Ariz. 319
    , 321
    (1986), to find a duty based on public policy. However, Kromko does not
    discuss duty. Although Kromko supports the proposition that a public or
    nonprofit hospital serves a public purpose, this conclusion was regarding
    the Gift Clause in article 9, section 7 of the Arizona Constitution. 
    149 Ariz. at 321
    .
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
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    re Nat’l Prescription Opiate Litig., 452 F. Supp. 3d at 788 (“West Boca, a
    hospital system, is not an ‘individual member of the public’ that could fall
    victim to drug misuse and abuse. West Boca is not an intended beneficiary
    of the CSA.”). Nor is the economic harm here of the type that the CSA and
    AUCSA are intended to protect against. See In re Nat’l Prescription Opiate
    Litig., 452 F. Supp. 3d at 788; H.B. 2157, 34th Leg., 1st Reg. Sess. (Ariz. 1979)
    (adopting the AUCSA); Unif. Controlled Substances Act prefatory note
    (Unif. L. Comm’n 1994).
    ¶24            For the same reasons, TMC’s reliance on the AOEA is
    misplaced. The AOEA is intended to help Arizona address the opioid crisis
    and prescription-drug users affected by it. See S.B. 1001, 53rd Leg., 1st Spec.
    Sess. (Ariz. 2018); Ariz. State Senate Fact Sheet for S.B. 1001, 53rd Leg., 1st
    Spec. Sess. (Jan. 26, 2018). The AOEA contains provisions affecting
    hospitals, such as: establishing requirements for prescribing, administering,
    and dispensing schedule II opioids; adding criminal penalties for
    violations; and requiring hospitals that offer substance abuse treatment to
    adhere to reporting requirements and to refer overdose patients to behavior
    health service providers. See A.R.S. §§ 13-2310; 36-109, -407, -2525, -2606.
    However, notwithstanding the AOEA’s impact on hospitals, it did not
    create a duty flowing from pharmacies to hospitals.
    ¶25           TMC next argues that the medical lien statutes support a
    public policy-based duty from CVS to TMC. As the trial court recognized,
    the medical lien statutes demonstrate “a public policy in favor of seeking to
    compensate a hospital that’s providing medical care for a party who cannot
    pay in the community.” However, the medical lien statutes do not regulate
    conduct, as would be necessary to establish a duty. See Lips v. Scottsdale
    Healthcare Corp., 
    224 Ariz. 266
    , 268 ¶ 10 (2010). “Generally, a cause of action
    for negligence arises from a duty, a determination that a person is required
    to conform to a particular standard of conduct.” Id.; Gipson, 214 Ariz. at 143
    ¶ 10. These statutes do not attempt to regulate conduct in any way but
    instead provide an avenue for hospitals to recoup customary patient
    charges. See, e.g., Gipson, 214 Ariz. at 147 ¶ 32 (finding a duty of care based
    on statutes prohibiting distribution of prescription drugs); Estate of
    Hernandez v. Ariz. Bd. of Regents, 
    177 Ariz. 244
    , 255–56 (1994) (finding a duty
    of care based on laws prohibiting furnishing alcohol to minors). The
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    medical lien statutes cannot be used by TMC to establish a public policy-
    based duty from a pharmacy to a hospital.
    ¶26            TMC also seeks support from 42 U.S.C. § 1395dd(a) and (b),
    which requires hospitals to provide necessary medical screening and
    stabilizing treatment to patients suffering emergency medical conditions.
    But that requirement does not establish a duty between a pharmacy and
    hospital. Although that requirement arguably places a hospital at risk of
    incurring additional expenses, any claim to recoup such expenses belongs
    to the hospital to assert against the patient. It does not provide a right to
    assert claims against third parties, such as pharmacies.
    ¶27           Finally, TMC’s pursuit of economic damages is precluded
    because TMC cannot recover for purely economic harm absent some
    “special reason” justifying finding a duty to avoid economic harm. See Lips,
    224 Ariz. at 268 ¶¶ 10–11. This Court has recognized a duty based on
    purely economic loss only in a limited number of circumstances, such as in
    “particular professional and business relationships.” See id. at ¶¶ 11–12
    (stating that “[c]ourts have not recognized a general duty to exercise
    reasonable care for the purely economic well-being of others” in order to
    “avoid imposing onerous and possibly indeterminate liability on
    defendants”). And TMC cites no cases allowing a negligence claim against
    a third party for purely economic loss.
    ¶28            Here, no “special reason” exists to impose a duty on CVS to
    avoid economic harm to TMC. TMC urges us to recognize an exception for
    the “closed system” in the pharmaceutical industry that is designed to
    protect against improper distribution and prescription-drug abuse, but we
    are not empowered to create such an exception absent a clear public policy
    directive, nor can we fathom the applicability and limits of such an inchoate
    doctrine based upon the arguments presented.
    ¶29           We recognize the tremendous costs imposed by the opioid
    crisis on society generally, and hospitals specifically. Jennifer Bresnick,
    Hospitals Face Higher Costs, More ED Visits from Opioid Abuse, Health IT
    Analytics (Dec. 21, 2016), https://healthitanalytics.com/news/hospitals-
    face-higher-costs-more-ed-visits-from-opioid-abuse. The human costs are
    CVS PHARMACY, INC . V. H ON. BOSTWICK/TUCSON MEDICAL CENTER
    Opinion of the Court
    tragic. However, it is for Congress and the legislature, not the courts, to
    create methods to alleviate those costs. Arizona law neither imposes nor
    supports the imposition of a duty from pharmacies to hospitals under the
    facts of this action.
    III.         CONCLUSION
    ¶30          For the foregoing reasons, we reverse the trial court’s ruling
    denying CVS’s motion to dismiss TMC’s negligence claims (Counts 3, 4, 5,
    and 7). We remand the case to the trial court to dismiss the negligence-
    based claims and for further proceedings on the remaining public nuisance
    and unjust enrichment claims.