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The Omnibus Reconciliation Act of 1990: Redefining Pharmacists’ Legal Responsibilities

Published online by Cambridge University Press:  24 February 2021

Steven W. Huang
Steven W. Huang*
Affiliation:
Quinn, Johnston, Henderson & Pretorius, Peoria, Illinois; 1995, University of Illinois at Urbana-Champaign; 1998, Tulane University School of Law
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Extract

Henry Fan, owner of T.I. Drugstores, one of the city's largest pharmacies, just walked into your office for legal advice. He sits down across from your desk and holds his head in his hands. With a worried look on his face, he tells you that his pharmacy has just been sued by one of its customers, Elaine Jones. A year ago, T.I. Drugstores received a prescription for Jones from Dr. Kenneth Brown for Bendectin, a prescription drug used for the treatment of nausea and vomiting during the early stages of pregnancy. After reviewing the prescription for errors, the pharmacist filled the prescription according to its directions and sold it to Jones.

Approximately eight months later, Jones gave birth to a baby girl with severe deformities as a result of the ingested Bendectin. Sadly, her child will never be able to sit or walk properly. Jones is suing T.I. Drugstores for negligently failing to advise her of the potential hazards associated with ingesting Bendectin. Additionally, Jones claims that T.I. Drugstores is strictly liable for failing to warn her of the fact that ingesting Bendectin causes birth defects in children.

Fan informs you that the pharmacist assumed that Brown had forewarned Jones of the risks associated with Bendectin. Outraged, Fan insists that neither his drugstore nor his pharmacist acted incorrectly. They simply did what they were supposed to do: fill the prescription according to its specifications.

Type
Articles
Information
American Journal of Law & Medicine , Volume 24 , Issue 4 , 1998 , pp. 417 - 442
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 1998

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References

1 See Gastineau, Richard Hight, Drug Therapy Counseling: Whose Duty to Warn?, 2 J. PHARMACY & L., 293, 294 (1993).Google Scholar

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 Green, Terance C., Licking, Sticking, Counting, and Pouring—Is That All Pharmacists Do?, 24 CREIGHTON L. REV. 1449, 1449 (1991).Google Scholar

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'l 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'l 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 A1.

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, Phartn Report: Why You Should Make Friends With a Pharmacist, PREVENTION, Oct. l, 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 Marchitelli, David J., Annotation, Liability of Pharmacist Who Accurately Fills Prescription for Harm Resulting to User, 44 A.L.R.5th 393, 393 (1996).Google Scholar

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 (Ill. 1987) (quoting RESTATEMENT (SECOND) OF TORTS § 402A (1965)).

46 See RESTATEMENT (SECOND) OF TORTS § 402A cmt. c (1965).

47 See Brushwood, David B., The Pharmacist's Drug Information Responsibility After McKee v. American Home Products, 48 FOOD & DRUG L.J. 377, 379 (1993).Google Scholar

48 See Holleran, Michael J., 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).Google Scholar

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 (ILL. 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 (Ill. 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 (Ill. App. Ct. 1993).

82 See Jones v. Irvin, 602 F. Supp. 399, 402 (S.D. Ill. 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 “[l]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 Rowe, Howard M., Patient Package Inserts: The Proper Prescription, 50 FOOD & DRUG L.J. 95, 95 (1995).Google Scholar

121 See Leesley v. West, 518 N.E.2d 758, 761 (Ill. 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 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 Brushwood, David B., The Professional Capabilities and Legal Responsibilities of Pharmacists: Should “Can” Imply “Ought”?, 44 DRAKE L. REV. 439, 443-44 (1996).Google Scholar

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 Owen, Jill Casson, The Pharmacist's Duty to Warn: Lasley v. Shrake's Country Club Pharmacy, 37 ARIZ. L. REV. 677, 688 (1995)Google Scholar.

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 West, John C. & Smith, David E., 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)Google Scholar; 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 Furrow, Barry R., 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)Google Scholar (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 Furnish, Tara L., Departing From The Traditional No Duty To Warn: A New Trend For Pharmacy Malpractice?, 21 AM. J. TRIAL ADVOC. 199, 201-02 (1997)Google Scholar.

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 longterm 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 Termini, Roseann B., 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)Google Scholar (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 Quick, Brenda Jones, The Cost of the Omnibus Budget Reconciliation Act of 1990, 2 J. PHARMACY & L. 145, 149 (1994)Google Scholar.

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 Laizure, Kathy Laughter, The Pharmacist's Duty To Warn When Dispensing Prescription Drugs: Recent Tennessee Developments, 22 U. MEM. L. REV. 517, 545 (1992).Google Scholar

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 Hotopp, Bill, Hook's SuperX, Inc. v. McLaughlin: Pharmacists’ Duty Toward Their Patients, 6 J. PHARMACY & L. 35, 43 (1998)Google Scholar; 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).