docs(issues): re-grade #322 to P1 — the two Warfarin records are complementarily incomplete

[BigSimmo]

Summary

One queued update request re-grading #322 P2 → P1 and correcting its central claim. Traced against the data and the resolution code, not inferred from the row's prose.

• The row's claim is factually wrong, and it understates the defect. #322 says the two records carry "three interaction rows each with ZERO in common". They are not zero in common: row 0 (Pharmacokinetic — CYP2C9 inhibitors: amiodarone, fluconazole, metronidazole, cotrimoxazole) and row 2 (Dietary — vitamin K) are substantively shared.
• The actual defect is complementary incompleteness, and it lands on psychiatric drugs.

	warfarin-vka	warfarin-anticoagulant
CYP2C9 inhibitors (CRITICAL)	✅	✅
Dietary vitamin K (HIGH)	✅	✅
CYP2C9 inducers — carbamazepine, St John's Wort (CRITICAL)	✅	❌
NSAIDs / Aspirin / SSRIs — 12 counterparties, 6 of them SSRIs (HIGH)	❌	✅

Neither record is complete alone, and each omits a psychiatrically central interaction the other holds.

• There is no union — resolution is strictly per-slug. src/lib/medication-interactions.ts:207 and :241 read INDEX.bySlug[slug], and INDEX.names maps slug → display name, not name → slugs. So which record a clinician opens determines what they see, and both display as "Warfarin" with nothing distinguishing them.
• Consequence for this app's actual user. A psychiatrist checking warfarin against sertraline sees the bleeding warning only if they happened to open warfarin-anticoagulant, and sees nothing if they opened warfarin-vka. Checking warfarin against carbamazepine is the exact mirror. That is the reason for P1: it is not a duplicate-data hygiene issue, it is a silently incomplete answer on a narrow-therapeutic-index anticoagulant.
• Secondary artefact recorded for the same pass: each record lists the other as a counterparty (warfarin-vka row-0 counterparties include warfarin-anticoagulant), so the duplicate is being treated as a drug that interacts with itself.

Scope is stated explicitly in the row. This establishes the structural inconsistency only. Whether either record's interaction content is clinically correct is not assessed here and is not an agent's call. Merging is flagged as the obvious candidate precisely because the two sets are complementary — but that remains a clinician's decision, and the row says so and forbids patching the catalogue automatically.

The row is also grouped with #318 as the clinical-content cluster: both are unvalidated medication-interaction surfaces in a prescribing tool.

Verification

• npm run verify:pr-local

- completed: check:runtime, check:installed-lock-parity, format:changed, sitemap:check,
  docs:check-index, docs:check-inventory, docs:check-scripts, docs:check-links,
  check:branch-review-ledger, check:outstanding-issues, check:ledger-write-discipline
- failed: (none)
- not reached: (none)

Evidence came from reading data/medication-interaction-index.json (both bySlug entries in full) and src/lib/medication-interactions.ts. No provider access, no writes, no catalogue data changed by this PR.

UI verification not run: no UI, routing, styling, or browser-behaviour change in this diff.

Risk and rollout

• Risk: Low as a diff — one JSON request file under docs/outstanding-issues-inbox/. No application source, no catalogue data, no schema. The canonical ledger is untouched until a reconcile applies it. The subject is high-risk, which is the point of the re-grade.
• Rollback: git revert the single commit, or delete the request file before reconciliation. A re-grade is also trivially reversible via another --pri update.
• Provider or production effects: None.

Clinical Governance Preflight

Not applicable as a checklist — classifyPullRequestFiles returns clinicalRisk: false, operationalRisk: false, ragRanking: false, ui: false for docs/outstanding-issues-inbox/**, and this diff changes no ingestion, answer-generation, ranking, source-rendering, document-access or privacy code. It describes a clinical-content defect rather than touching one. The governance work this row calls for — a clinician deciding between merge, delete and relabel, then confirming the merged interaction set is complete — is deliberately left to the owner and is recorded as such.

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