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Pharmacist liability.

The various legal theories under which pharmacists may be found liable are reviewed. The pivotal element in determining pharmacist malpractice is the study that was owed to the patient. A pharmacist's principal duties to the patient are to dispense the correct drug and to label it correctly; failure to fulfill either of these responsibilities had led to successful claims of malpractice. There have been only a few cases in which the court ruled that the pharmacist had a duty to warn the patient about a potential adverse drug effect or interaction. However, as the role of the pharmacist expands, more courts may begin to find pharmacists liable for failing to warn the patient under specific circumstances. Pharmacists have a heightened duty to warn the patient about potential problems associated with nonprescription drugs that they recommend. A pharmacist may escape liability if there was a lack of proximate cause. Similarly, the defenses of contributory or comparative negligence and voluntary assumption of risk are based on some conduct by the plaintiff that negates or modifies the pharmacist's negligence. Statutes of limitation can also exclude liability. Courts have not found pharmacists liable under strict liability theories. A breach of warranty claim has rarely been successful. Pharmacists could be found liable for negligent selection of therapeutic alternatives but probably not for injuries allegedly caused by correctly selected equivalent agents. Although no cases have been reported, pharmacists could be subjected to negligence-based liability for nondistributive pharmaceutical services. As pharmacists assume more responsibilities, pharmacist malpractice law will expand.

Duty to Warn↗

The advanced practice nurse and changing perspectives on physical restraint.

Regulatory changes concerning the use of physical restraints in nursing homes have stimulated an examination of restraint use practices in other care settings. Caregivers are receiving mixed messages about appropriate restraint use in the hospital. Legal decisions are ambiguous in terms of the nurse's liability for restraint decisions, and the use of restraints may create a conflict between respecting patient autonomy and acting in the patient's best interest. Recent research does not support the belief that restraint use prevents patient injuries, but continues to document the untoward effects of restraints. Restraint reduction efforts have been successful in nursing homes, and many strategies can be adapted in acute care. As the movement to integrated systems of care places increased emphasis on continuity of services across settings and improved client outcomes, restraint practice is one area where interinstitutional collaboration and coordination must occur. The advanced practice nurse is in a key role to facilitate continuity of restraint reduction efforts.

Continuity of Patient Care↗

Malpractice and avascular necrosis: legal outcomes.

Every physician, but particularly specialists, have reason to be concerned about medical legal issues. Avascular necrosis has been established as a possible serious complication of steroid treatment in inflammatory bowel disease. Two specific Canadian cases illustrating the sequence of medical history, time, expert testimony and legal outcomes are presented. Awards plus costs in the order of $1 million or more were the result of these legal proceedings. The courts stated the major factors in finding liability against doctors were the failure to show the patient had been fully informed of treatment options. There was considerable weight given to expert testimony and the patient recollection of events to support their contentions. Adequate contemporaneous record keeping was absent to contradict evidence of the patients. The judges in both illustrative examples leaned heavily on Supreme Court of Canada guidelines whereby the patient must be informed at all stages of the medical process.

Adult↗

Telemedicine: the invisible legal barriers to the health care of the future.

Telemedicine has the potential to transform the world of health care just as the Internet transformed the world of commerce. Ms. Daly examines two legal obstacles to expanding the use of telemedicine: licensure and liability. She defines telemedicine and discusses its common applications and significant benefits. Licensure laws and liability rules result in formidable barriers to the expanded use of telemedicine, while also failing to provide sufficient protection for consumers. Ms. Daly argues that for the benefits of telemedicine to reach those most in need, mutual recognition of licensing laws coupled with a universal standard of care is necessary.

Cost Savings↗