The omnibus reconciliation act of 1990: Redefining pharmacists' legal responsibilities

American Journal of Law and Medicine

Volumn 24, Issue 4, 1998, Pages 417-442

  Huang, Steven W ^a  

^a UNIVERSITY OF ILLINOIS AT URBANA CHAMPAIGN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; JOB PERFORMANCE; LAW; LEGAL LIABILITY; PHARMACIST; PHARMACY;

DRUG ABUSE; GOVERNMENT REGULATION; LEGAL APPROACH; LEGAL OBLIGATIONS; NEGLIGENCE; OMNIBUS BUDGET RECONCILIATION ACT (OBRA) 1990; PROFESSIONAL PATIENT RELATIONSHIP; RISKS AND BENEFITS; STANDARDS; TECHNICAL EXPERTISE; UNITED STATES;

DISCLOSURE; DRUG LABELING; DUTY TO WARN; GOVERNMENT REGULATION; HUMANS; INFORMED CONSENT; JOB DESCRIPTION; LIABILITY, LEGAL; MEDICATION ERRORS; PATIENT EDUCATION; PHARMACEUTICAL PREPARATIONS; PHARMACISTS; PROFESSIONAL ROLE; RISK ASSESSMENT; SOCIAL RESPONSIBILITY; UNITED STATES;

EID: 0032421861     PISSN: 00988588     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (357)

1. See Richard Hight Gastineau, Drug Therapy Counseling: Whose Duty to Warn?, 2 J. PHARMACY & L., 293, 294 (1993).
2. See Changes at the Pharmacy Offer Diagnostic Opportunity, GENESIS REP., May 1, 1997, available in 1997 WL 11413157 [hereinafter Changes at the Pharmacy].
3. Wendy Bounds, Rx for Disaster, GOOD HOUSEKEEPING, Oct. 1997, at 100.
4. See id.
5. See Terance C. Green, Licking, Sticking, Counting, and Pouring - Is That All Pharmacists Do?, 24 CREIGHTON L. REV. 1449, 1449 (1991).
6. See id.
7. See Changes at the Pharmacy, supra note 2.
8. See id.
9. See id. Although definitions vary from state to state, retail community pharmacies include: (a) those stores shops, offices or other places where medical drugs are compounded, dispensed or sold and (b) where prescriptions are filled or dispensed on an outpatient basis. See Federgo Discount Ctr. v. Department of Prof'1 Regulation, Bd. of Pharmacy, 452 So. 2d 1063, 1064 (Fla. Dist. Ct. App. 1984).
10. See Green, supra note 5, at 1449.
11. In most jurisdictions, chain drug stores refer to those retail pharmacies that typically supply themselves from their own warehouses. See Barr Lab. v. Abbot Lab., 978 F.2d 98, 103 (3d Cir. 1992).
12. See Changes at the Pharmacy, note 2. Once again, although definitions vary from state to state, independent community drug stores refer to those pharmacies that are not part of a group of affiliated pharmacy facilities which are under some type of direct or indirect common ownership. See Albertson's, Inc. v. Department of Prof'1 Regulation, 681 So. 2d 708, 709 (Fla. 1996).
13. See Changes at the Pharmacy, note 2.
14. See Peter Eisler, Study: Many Elderly Given Wrong Drugs, USA TODAY, Nov. 17, 1997, at Al.
15. See id.
16. Id.
17. Id.
18. See id.
19. See Andrea Rock, Prescription for Trouble, MONEY, Apr. 1, 1998, at 114, 116.
20. See Rick Chillot, Pharm Report: Why You Should Make Friends With a Pharmacist, PREVENTION, Oct. 1, 1997, at 35.
21. See id.
22. See Green, supra note 5, at 1449.
23. See id.
24. See id.
25. See Bounds, supra note 3, at 100.
26. David J. Marchitelli, Annotation, Liability of Pharmacist Who Accurately Fills Prescription for Harm Resulting to User, 44 A.L.R.5th 393, 393 (1996).
27. See Rock, supra note 19, at 116.
28. See Bounds, supra note 3, at 154.
29. See id.
30. See id.
31. See id.
32. See id.
33. See id.
34. See id.
35. See id.
36. See id.
37. See id.
38. See id.
39. See Rock, supra note 19, at 119.
40. See id.
41. See id.
42. See id. State legislatures in Florida and Arizona are considering such action. See id.
43. See id.
44. Marchitelli, supra note 26, at 393.
45. See Kirk v. Michael Reese Hosp. & Med. Ctr., 513 N.E.2d 387, 391 (I11. 1987) (quoting RESTATEMENT (SECOND) OF TORTS § 402A (1965)).
46. See RESTATEMENT (SECOND) OF TORTS § 402A cmt. c (1965).
47. See David B. Brushwood, The Pharmacist's Drug Information Responsibility After McKee v. American Home Products, 48 FOOD & DRUG L.J. 377, 379 (1993).
48. See Michael J. Holleran, The Pharmaceutical Access and Prudent Purchasing Act of 1990: Federal Law Shifts the Duty to Warn From the Physician to the Pharmacist, 26 AKRON L. REV. 77, 92 (1992).
49. RESTATEMENT (SECOND) OF TORTS § 402A cmt. k (1965) (first emphasis added).
50. 710 P.2d 247 (Cal. 1985).
51. Doctors used to prescribe Stilbestrol as a safeguard against miscarriages. See id.
52. See id. at 249.
53. See id. Clear cell adenocarcinoma is a type a kidney cancer. See PHYSICIANS DESKTOP MEDICAL DICTIONARY 276 (1st ed. 1995).
54. See Murphy, 710 P.2d at 249.
55. See id. at 250.
56. Id. at 251.
57. See id.
58. See id.
59. Id. at 250.
60. See id. at 253.
61. See id.
62. See id.
63. See id.
64. See Holleran, supra note 48, at 92.
65. See id. at 93.
66. See Ramirez v. Richardson-Merrell, Inc., 628 F. Supp. 85, 87 (E.D. Pa. 1986).
67. See id.
68. See Holleran, supra note 48, at 90.
69. See id. (suggesting that before a pharmacist may be held liable on a negligence claim, evidence must demonstrate that he owed a duty of care and that he breached that duty).
70. See id. at 84.
71. See Marchitelli, supra note 26, at 393.
72. See Kirk v. Michael Reese Hosp. & Med. Ctr., 513 N.E.2d 387, 392 (I11. 1987).
73. See id.
74. See id.
75. See Green, supra note 5, at 1459; Leibowitz v. Ortho Pharm. Corp., 307 A.2d 449, 457-58 (Pa. Super. Ct. 1973).
76. See Green, supra note 5, at 1460.
77. See Eldridge v. Eli Lilly & Co., 485 N.E.2d 551, 553 (I11. App. Ct. 1985).
78. Id.
79. Walker v. Jack Eckerd Corp., 434 S.E.2d 63, 68 (Ga. Ct. App. 1993).
80. See Green, supra note 5, at 1458-59.
81. See Fakhouri v. Taylor, 618 N.E.2d 518, 520 (I11. App. Ct. 1993).
82. See Jones v. Irvin, 602 F. Supp. 399, 402 (S.D. I11. 1985).
83. See Green, supra note 5, at 1459.
84. See Jones, 602 F. Supp. at 401-02 (surveying court cases supporting the proposition that pharmacists have no duty to warn).
85. See Fakhouri, 618 N.E.2d at 520.
86. See id.
87. See McKee v. American Home Products Corp., 782 P.2d 1045, 1051 (Wash. 1989).
88. Jones, 602 F. Supp. at 402.
89. See McKee, 782 P.2d at 1051.
90. See Green, supra note 5, at 1461.
91. Stebbins v. Concord Wrigley Drugs, Inc., 416 N.W.2d 381, 388 (Mich. Ct. App. 1987).
92. See Pysz v. Henry's Drug Store, 457 So. 2d 561, 562 (Fla. Dist. Ct. App. 1984).
93. See id.
94. 476 N.E.2d 881 (Ind. Ct. App. 1985).
95. See id. at 882. Physicians prescribe Valium to manage anxiety disorders or to provide shortterm relief from anxiety symptoms. See PHYSICIAN'S DESK REFERENCE 2182 (50th ed. 1996).
96. Syncope is defined as "[1]oss of consciousness and postural tone caused by diminished cerebral blood flow." STEDMAN'S MEDICAL DICTIONARY 1720 (26th ed. 1995).
97. See Ingram, 476 N.E.2d at 883.
98. See id.
99. See id. at 882.
100. See id. at 886.
101. See id. at 886-87.
102. See id. at 887.
103. See id. at 886-87.
104. See id. at 887.
105. See id.
106. See id.
107. See id.
108. See id.
109. See McKee v. American Home Products Corp., 782 P.2d 1045, 1054 (Wash. 1989) (citing 21 C.F.R. §§ 201.100(d), 201.56-.57).
110. See id.
111. See Laws v. Johnson, 799 S.W.2d 249, 251 (Tenn. Ct. App. 1990).
112. See id.
113. See id.
114. See Green, supra note 5, at 1463 (noting applicable Food and Drug Administration regulations).
115. See 21 C.F.R. § 310.501 (1998).
116. See 21 C.F.R. § 310.502 (1998).
117. See 21 C.F.R. § 201.305 (1998).
118. See 21 C.F.R. § 310.515 (1998).
119. See 21 C.F.R. § 310.516 (1998).
120. See Howard M. Rowe, Patient Package Inserts: The Proper Prescription, 50 FOOD & DRUG L.J. 95, 95 (1995).
121. See Leesley v. West, 518 N.E.2d 758, 761 (I11. App. Ct. 1988); Nichols v. Central Merchandise, Inc., 817 P.2d 1131, 1132-33 (Kan. Ct. App. 1991); Laws v. Johnson, 799 S.W.2d 249, 254-55 (Tenn. Ct. App. 1990); McKee v. American Home Products Corp., 782 P.2d 1045, 1055-56 (Wash. 1989).
122. 782 P.2d 1045 (Wash. 1989).
123. See id. at 1047. Physicians typically prescribe Plegine for weight control purposes. See id. at 1046
124. See id. at 1047.
125. See id.
126. See id. at 1046.
127. Id.
128. See id. at 1054.
129. See id.
130. See id.
131. See id. at 1055.
132. See id.
133. See id.
134. See id.
135. See id. at 1054.
136. See id. at 1055.
137. 137 See id.
138. See id.
139. Id.
140. See id.
141. See id.
142. See id. at 1055-56.
143. See Gastineau, supra note 1, at 305.
144. 827 F. Supp. 1522 (D. Nev. 1993).
145. See id. at 1524.
146. See id.
147. See id. at 1524-25.
148. Id.
149. See id. at 1525.
150. See id.
151. See id.
152. See id. Heredia v. Johnson is a district court opinion that is not binding in the Ninth Circuit. It exists only as persuasive authority.
153. See id. (finding that a pharmacist has a minimum duty to fill prescriptions as prescribed and to label them properly); Gassan v. East Jefferson Gen. Hosp., 628 So. 2d 256, 258 (La. Ct. App. 1993) (holding that a pharmacist has a duty to fill a prescription correctly); Baker v. Arbor Drugs, Inc., 544 N.W.2d 727, 730 (Mich. Ct. App. 1996) (concluding that a pharmacist owes the customer a duty to fill a prescription properly).
154. See Johnson v. Walgreen Co., 675 So. 2d 1036, 1037 (Fla. Dist. Ct. App. 1996).
155. See David B. Brushwood, The Professional Capabilities and Legal Responsibilities of Pharmacists: Should "Can" Imply "Ought "?, 44 DRAKE L. REV. 439, 443-44 (1996).
156. See id. at 444.
157. Id.
158. See id.
159. See Tombari v. Conners, 82 A. 640, 642 (Conn. 1912) (concerning a pharmacy clerk's incorrect mixture of a drug); Troppi v. Scarf, 187 N.W.2d 511, 513 (Mich. Ct. App. 1971) (involving parents who had an unwanted child after a pharmacist negligently filled a prescription for birth control pills); French Drug Co., Inc. v. Jones, 367 So. 2d 431, 433 (Miss. 1978) (involving a pharmacist who filled a prescription with the wrong drug); Hoar v. Rasmusen, 282 N.W. 652, 654 (Wis. 1938) (concerning a druggist who provided a substitute medication in lieu of the prescribed drug without inquiring whether the customer was allergic to the substitute).
160. See Burke v. Bean, 363 S.W.2d 366, 368 (Tex. App. 1962).
161. See Brown v. Marshall, 11 N.W. 392, 395 (Mich. 1882), cited with approval in Troppi, 187 N.W.2d at 513.
162. See Troppi, 187 N.W.2d at 513.
163. Burke, 363 S.W.2d at 368.
164. See French Drug Co., Inc., 367 So. 2d at 434.
165. See Nichols v. Central Merchandise, Inc., 817 P.2d 1131, 1133 (Kan. Ct. App. 1991).
166. Gassen v. East Jefferson Gen. Hosp., 628 So. 2d 256, 258 (La. Ct. App. 1993) (quoting Riff v. Morgan Pharmacy, 508 A.2d 1247, 1251 (Pa. Super. Ct. 1986)).
167. Id. (quoting People's Serv. Drug Stores v. Somerville, 158 A. 12 (Md. 1932)).
168. See id.
169. See McKee v. American Home Products Corp., 782 P.2d 1045, 1053 (Wash. 1989).
170. See Riff v. Morgan Pharmacy, 508 A.2d 1247, 1253 (Pa. Super. Ct. 1986).
171. See Green, supra note 5, at 1460-61.
172. See People's Serv. Drug Stores v. Somerville, 158 A. 12, 13 (Md. 1932).
173. Id.
174. 508 A.2d 1247 (Pa. Super. Ct. 1986).
175. See id. at 1249-50.
176. See id. at 1249.
177. See id. at 1250.
178. See id. at 1249.
179. See id.
180. See id. at 1247.
181. See id. at 1248.
182. See id. at 1251.
183. See id.
184. See id. at 1251-52.
185. id. at 1253.
186. See id. at 1252.
187. See id. at 1253.
188. Id.
189. See id.
190. See id. at 1254.
191. See, e.g., Lasley v. Shrake's Country Club Pharmacy, Inc., 880 P.2d 1129, 1134 (Ariz. Ct. App. 1994) (reversing lower court's summary judgment in favor of the defendant pharmacist because a pharmacist may have a duty of care to caution patients when drugs have addictive qualities); Baker v. Arbor Drugs, 544 N.W.2d 727, 731 (Mich. Ct. App. 1996) (reversing summary judgment in favor of the defendant pharmacist because the defendant may have voluntarily assumed a duty of care to customers).
192. See supra Part III.B.2.
193. See Jill Casson Owen, The Pharmacist's Duty to Warn: Lasley v. Shrake's Country Club Pharmacy, 37 ARIZ. L. REV. 677, 688 (1995).
194. See Green, supra note 5, at 1464.
195. See id.
196. See id. at 1465.
197. See id.
198. See id.
199. 36 P.2d 962 (Kan. 1934).
200. See id.
201. See id.
202. See id.
203. See id.
204. See id.
205. See id.
206. See id.
207. See id.
208. See id. at 963.
209. See id.
210. See id. at 962.
211. Id. at 964.
212. See id.
213. See id.
214. See Ferguson v. Williams, 399 S.E.2d 389, 393 (N.C. Ct. App. 1991).
215. See Eldridge v. Eli Lilly & Co. 485 N.E.2d 551, 554-55 (Ill. App. Ct. 1985).
216. See Ferguson v. Williams, 374 S.E.2d 438, 440 (N.C. Ct. App. 1988).
217. See id. Contraindication is defined as "something (as a symptom or condition) that makes a particular treatment or procedure inadvisable." See MERRIAM WEBSTER'S MEDICAL DESK DICTIONARY 162 (1996).
218. See Hand v. Krakowski, 89 A.D.2d 650, 651 (N.Y. App. Div. 1982).
219. See id. at 651.
220. Psychotropic drugs are those "capable of affecting the mind, emotions, and behavior." STEDMAN'S MEDICAL DICTIONARY 1461 (26th ed. 1995).
221. See Hand, 89 A.D.2d at 651.
222. Pancreatitis is the "[i]nflammation of the pancreas." STEDMAN'S MEDICAL DICTIONARY 1286 (26th ed. 1995).
223. See Hand, 89 A.D.2d at 650. Cirrhosis is the "widespread disruption of normal liver structure by fibrosis and the formation of regenerative nodules that is caused by ... chronic progressive conditions affecting the liver . . . ." MERRIAM WEBSTER'S MEDICAL DESK DICTIONARY 143 (1996).
224. See Hand, 89 A.D.2d at 651.
225. See id. at 650.
226. See id. at 651.
227. See id.
228. See id.
229. See id.
230. See id.
231. See supra Part III.C.
232. Pub. L. No. 101-508, 104 Stat. 1388 (1990). Section 4401 of the Omnibus Budget Reconciliation Act of 1990 ("OBRA 1990") mandates that pharmacists become more involved in various aspects of their patients' drug treatment. See John C. West & David E. Smith, A Prescription for Liability The Pharmacy Mandate of the Budget Reconciliation Act of 1990 and Its Impact Upon Pharmacists ' Common Law Duties, 2 J. PHARMACY & L. 127, 127 (1994); see also infra notes 240-259 and accompanying text (describing OBRA's drug utilization review (DUR) program). This mandate was originally proposed in the 101st Congress as the Pharmaceutical Access and Prudent Purchasing Act. See S. 2605, 101st Cong. § 1 (1989).
233. See Holleran, supra note 48, at 79; see also Barry R. Furrow, Enterprise Liability for Bad Outcomes from Drug Therapy: The Doctor, the Hospital, the Pharmacy, and the Drug Firm, 44 DRAKE L. REV. 377, 407 (1996) (noting that under OBRA 1990, pharmacists have a duty to warn customers of the drug's adverse effects and to become more involved in the patients' drug treatment).
234. See infra notes 248-258 and accompanying text.
235. See Holleran, supra note 48, at 78.
236. See Owen, supra note 193, at 689; see also West & Smith, supra note 232, at 130 (describing components of the prospective DUR program and what minimum information must be provided by pharmacists to their customers).
237. See 42 U.S.C. § 1396r-8 (1994).
238. See Holleran, supra note 48, at 79 (arguing that once pharmacists are held to a higher standard of care, it will be "inappropriate [and] unconscionable ... to hold pharmacists to a lower standard of care when dealing with non-Medicaid patients").
239. See Owen, supra note 193, at 690. Over 40 states have extended OBRA 1990's regulations to cover all prescriptions. See id. n. 144. Jurisdictions that have not extended OBRA 1990's coverage include Colorado, Connecticut, Hawaii, Minnesota, Puerto Rico, South Carolina and Wyoming. See id.
240. See 42 U.S.C. § 1396r-8(g)(1)(A) (1994); West & Smith, supra note 232, at 129.
241. 42 U.S.C. § 1396r-8(g)(2)(A)(i).
242. See 42 U.S.C. § 1396r-8(g)(2) (providing standards for the DUR programs).
243. See 42 U.S.C. § 1396r-8(g)(2)(A)(i).
244. See West & Smith, supra note 232, at 138 (noting that some commentators consider the "statutory and administrative specifications under OBRA as merely a codification of good pharmacy practice").
245. See 42 U.S.C. § 1396r-8(g)(1)(A).
246. See supra Part III.B.
247. See 42 U.S.C. § 1396r-8(g)(2)(A)(ii). But see infra note 259 (providing that pharmacists will not be held liable for failing to provide counseling to their customers when the customer declines consultation).
248. 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(II).
249. 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(II)(bb); see also Gastineau, supra note 1, at 295 (describing pharmacists' heightened responsibilities under OBRA 1990's DUR program); West & Smith, supra note 232, at 130 (explaining the new duties imposed on pharmacists, which include patient counseling and record keeping).
250. See 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(I) (providing that "[t]he pharmacist must offer to discuss with each individual receiving benefits under this subchapter or caregiver of such individual . . . who presents a prescription, matters which in the exercise of the pharmacist's professional judgment ... the [pharmacist] deems significant. . . .").
251. It is important to note that the counseling standards provided in OBRA 1990 represent the minimum duties that pharmacists must assume under each state's DUR program. See 42 U.S.C. § 1396r-8(g)(2)(A)(ii).
252. See 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(I)(cc).
253. See id.
254. see 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(I)(dd).
255. See id.
256. See id.
257. see 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(I)(ee), (ff), (gg).
258. See 42 U.S.C. § 1396r-8(g)(2)(A)(ii)(I)(hh).
259. See 42 U.S.C. § 1396r-8(g)(2)(A)(ii) (stating that "[n]othing in this clause shall be construed as requiring a pharmacist to provide consultation when an individual receiving benefits under this subchapter or caregiver of such individual refuses such consultation").
260. See Tara L. Furnish, Departing From The Traditional No Duty To Warn: A New Trend For Pharmacy Malpractice?, 21 AM. J. TRIAL ADVOC. 199, 201-02 (1997).
261. See id. These states include Arizona, Indiana, Louisiana, Nevada, New York and Tennessee. See id. at 202
262. 642 N.E.2d 514 (Ind. 1994).
263. See id. at 516.
264. See id.
265. See id.
266. See id.
267. See id.
268. See id.
269. See id.
270. See id.
271. See id.
272. See id.
273. See id. at 521.
274. See id. at 517-18.
275. See id. at 517.
276. See id.
277. See id. at 518.
278. Id. (quoting IND. CODE § 25-26-13-16 (1993)) (emphasis added).
279. See id.
280. See id. at 519; see also Lasley v. Shrake's Country Club Pharmacy, 880 P.2d 1129, 1134 (Ariz. Ct. App. 1994) (holding that a pharmacist has the duty to warn customers of the addictive nature and dangers of prolonged use of prescription drugs).
281. See McLaughlin, 642 N.E.2d at 519.
282. See id.
283. See id.
284. See id. at 521.
285. 890 S.W.2d 425 (Tenn. 1994).
286. See id. at 427.
287. See id.
288. see id. Hypoglycemia is defined as "[a]n abnormally small concentration of glucose in the circulating blood. STEDMAN'S MEDICAL DICTIONARY 836 (26th ed. 1995).
289. See Pittman, 890 S.W.2d at 427.
290. See id.
291. See id.
292. See id. at 435.
293. See id.
294. See id. at 427.
295. See id.
296. See id. at 434.
297. See id. at 435.
298. Id. (emphasis added).
299. See id.
300. See id. (holding that the pharmacy could have reasonably foreseen that Richards, the plaintiff's grandmother and defendant's customer, was at risk of injury; therefore, the pharmacy had a duty to warn her).
301. See id.; accord Walker v. Jack Eckerd Corp., 434 S.E.2d 63, 69 (Ga. Ct. App. 1993) (court determined that a pharmacist did not have a duty to warn a patient about the adverse effects of long-term use of eye drops, but explained that the decision would not be controlling precedent for cases involving allegations occurring after January 1, 1993, the date in which Georgia's OBRA regulations took effect).
302. See Roseann B. Termini, The Pharmacist Duty to Warn Revisited: The Changing Role of Pharmacy in Health Care and the Resultant Impact on the Obligation of a Pharmacist to Warn, 24 OHIO N.U. L. REV. 551, 560-61 (1998) (commenting that Pittman 's refusal to extend pharmacists' duty to warn a nonpatient third party hinged on the foreseeability test).
303. See Furnish, supra note 260, at 199.
304. See Shelly Ward, The Pharmacist's Duty to Warn, ATLA EXCHANGE Q., Oct. 1997, at 4.
305. See Owen, supra note 193, at 690.
306. See. e.g., id.
307. See id.
308. See id. n.145.
309. See id at 690.
310. See id. n.146.
311. See id. at 690.
312. See id. n.146. These jurisdictions are Alaska, Arizona, Colorado, Maryland, Massachusetts, Missouri and Puerto Rico. See id.
313. See supra notes 285-302 and accompanying text (discussing Pittman).
314. See, e.g., Furnish, supra note 260, at 201. The jurisdictions include Georgia, Florida, Illinois, Kansas, Michigan, Missouri, Pennsylvania and Washington. See id.
315. See Linda A. Johnson, At Rutgers, A Doctoral Degree in Pharmacy Will Be The Norm, THE RECORD, NORTHERN NEW JERSEY, Oct. 14, 1997, at A3, available in WL 6905277.
316. See id.
317. See id.
318. See Green, supra note 5, at 1468.
319. See id.
320. See id.
321. See Brenda Jones Quick, The Cost of the Omnibus Budget Reconciliation Act of 1990, 2 J. PHARMACY & L. 145, 149 (1994).
322. See id.
323. See id. at 150; Green, supra note 5, at 1468.
324. See Quick, supra note 321, at 150.
325. See id.
326. See Green, supra note 5, at 1468.
327. See id.
328. See id.
329. See Training: Pharmacy Requirements Demand Commitment, DETROIT NEWS, Apr. 28, 1997, at F6.
330. See Johnson, supra note 315, at A03.
331. See id.
332. See Trends & Timelines Pharmacy Schools: Moving to Six-Year Programs, AM. POL. NETWORK, Dec. 18, 1997, at 17 [hereinafter Trends & Timelines].
333. See Green, supra note 5, at 1476.
334. See Trends & Timelines, supra note 332, at 17.
335. See Rock, supra note 19, at 117.
336. See Kathy Laughter Laizure, The Pharmacist 's Duty To Warn When Dispensing Prescription Drugs: Recent Tennessee Developments, 22 U. MEM. L. REV. 517, 545 (1992).
337. See Rock, supra note 19, at 117.
338. See Laizure, supra note 336, at 545.
339. See Rock, supra note 19, at 117.
340. See id.
341. See id.
342. See id.
343. See Laizure, supra note 336, at 545.
344. See Bill Hotopp, Hook 's SuperX, Inc. v. McLaughlin: Pharmacists ' Duty Toward Their Patients, 6 J. PHARMACY & L. 35, 43 (1998); see also Ramirez v. Richardson-Merrell, Inc., 628 F. Supp. 85, 88 (E.D. Pa. 1986) (holding that because a physician is generally more familiar than a pharmacist with a patient's condition, imposing a duty to warn on the pharmacist would do more harm than good and would interfere with the physician-patient relationship); Lasley v. Shrake's Country Club Pharmacy, Inc., 890 P.2d 1129, 1133 (Ariz. Ct. App. 1994) (same).
345. See Owen, supra note 193, at 696-97.
346. See id. at 697.
347. See id.
348. See id. at 697-99 (explaining that pharmacists generally have significantly more drug training than do physicians and that computer technology is often available to pharmacists to supplement that training).
349. See id. at 699.
350. See Laizure, supra note 336, at 547.
351. See id.
352. See Riff v. Morgan Pharmacy, 508 A.2d 1247, 1253 (Pa. Super. Ct. 1986).
353. See discussion supra Part III (discussing the plaintiffs' tort cases against pharmacists).
354. See Holleran, supra note 48, at 84-85.
355. See 42 U.S.C. § 1396r-8(g)(2)(A) (1994).
356. See id. § 1396r-8(g)(1)(A).
357. See generally Holleran, supra note 48, at 94-96 (discussing OBRA's impact on claims against pharmacists).