A twist on the old pharmacist story

January 20, 2007

For a while, it seemed as if we’d hear new reports about a pharmacist refusing to fill a prescription on religious grounds every week. It led to a flood of publicity, bills in Congress, and new laws at the state level. This week, there was a similar controversy in Ohio, but this one had a twist.

As long-time readers know, I’ve never fully understood why this is even a story. Pharmacists, by virtue of their professional responsibilities, agree to fill prescriptions. Doctors prescribe a remedy, a patient seeks that remedy, a pharmacist provides the remedy. It’s a pretty simple system.

If a pharmacist realizes that he or she may be called on to perform tasks with which they’re uncomfortable, this person has a choice: do the job or find a different job in which these moral quandaries won’t be an issue. In other words, if you don’t like filling prescriptions, don’t become a pharmacist.

So, what happened this week? A pharmacist refused to give a customer emergency contraception that didn’t even need a prescription.

A woman has complained to the governor and an abortion rights group about Wal-Mart workers who wouldn’t give her morning-after contraceptive pills that don’t require a prescription.

Tashina Byrd, 23, of Springfield, said the pharmacist “shook his head and laughed” when a pharmacy attendant asked this month about giving the woman and her boyfriend Plan B. The hormone pills can help prevent pregnancy if taken within 72 hours of unprotected sex.

The attendant told Byrd and her boyfriend, Brian O’Neill, 37, of Columbus, that the store stocked Plan B but nobody would give it to them…. Byrd wrote Gov. Ted Strickland and contacted NARAL Pro-Choice America and Wal-Mart Watch, an activist group that seeks to change the retailer’s practices.

Now, as it turns out, Byrd got the medication from another pharmacy 45 miles away, but that’s not really the point.

The FDA approved Plan B emergency contraception for over-the-counter sales to adults. This Wal-Mart had the medication in stock and there was a customer who wanted to buy it. What’s the argument here?

Brent Beams, the pharmacist, told the Dispatch that he denied the couple’s request for the contraceptive pills because he believes “in preserving life, and I do not believe in ending life, and life begins at conception.”

After the pharmacist turned them down, the couple asked for a store manager who “came over and said, ‘The pharmacist has the law on his side,'” O’Neill said.

Really? An adult paying customer is denied access to a legal medication and the law is on the pharmacist’s side? I don’t think so.

“There’s a duty to dispense … without delay, without any kind of harassment,” said Nancy Keenan, NARAL president.

Wal-Mart is investigating. With any luck, the company will tell Brent Beams that it’s time to find a new job.

You just can’t give fundies even a small amount of power. It’s sad that the punishment in this case might merely be losing a job at Wal-mart. Maybe people in the health-care system will have to sign oaths that they will do their job to eliminate any misunderstanding. 45 miles is a long long way for some people.

  • Damn straight Wal*Fart will investigate this violation of their first commandement: Thou shalt not harm the bottom line.

    I bet if Catholics who in drug stores refused to ring out customers buying condoms this crap would stop.

  • Pharmacists who refuse legal to dispense legal birth control should be held liable for child support if the result of their intervention is a child.
    This is not a passive act. It’s an active intervention to produce a desired result – a birth. As it’s the last deliberate act in a chain of events, I have no problem assigning responsibility.
    I suspect most of them would quickly forget their ‘deeply held convictions’ if the cost of them were 18 years of monthly child support payments per incident.

  • Fight fire with fire: any gun control advocates out there should get jobs at Wal-Mart and request to work at the sporting goods counter. The rest is up to you.

  • Plan B does its thing before conception by preventing ovulation.

    Huh! I thought it kept a fertilized egg from attaching to the uterus. So it would only be effective if a female were about to ovulate? Thanks.

    However, this nonsense began when pharmacists started refusing to fill prescriptions for traditional oral contraceptives because some believe it might cause spontaneous abortion of a fertilized egg. So we aren’t dealing with people who are fact friendly.

  • As eye-rollingly insane as this is, it seem to be typical for that area. Doesn’t anybody remember this from Kevin Drum’s blog last fall? Makes me glad that I don’t live in the Buckeyed state.

    On a slightly different note, I can’t imagine that the Walmart bean counters in Arkansas could be too happy to know that products for which they have presumably spent money to stock in their stores are sitting idly on the shelf because some lowly EMPLOYEE refuses to do his job and just sell them.

  • To roll with the #3 and #4 meme (which I love!), how about getting tee-totalers to work at liquor stores and see how well that works out?

    Or fiscally responsible politicians (I know, an oxymoron, but still) not giving money to evangelists because they believe in the Constitution?

    Yeah, that would go over real well……

  • So it would only be effective if a female were about to ovulate?

    Yes indeedy, that is true. Reproductive endocrinologists give large quantities of progesterone (albeit a different progesterone than levonorgestrel) to women who have just been given an embryo during IVF in an attempt to get that little sucker to implant in the uterus. Normally, implantation takes place about 8-10 days after conception. In IVF, the embryo just gets placed loose in the uterus through a catheter threaded through the cervix.

    Prior to ovulation there is a delicate little dance taking place between the ovary of the month and the pituitary gland. A big whack of estrogen or progesterone (or, probably, testosterone — but that would some unintended consequences) screws up the back and forth communication between the two and ends the cycle prematurely. See Wikipedia for more info.

    After ovulation, the ovary starts to produce progesterone to mature the lining of the uterus so that a potential embryo can implant (not to prevent the thing from implanting!!!). Giving additional progesterone in the form of Plan B is like spitting into the ocean and has no effect on post-ovulatory implantation.

    This stuff is very well understood and it just makes me crazy when pharmacists misrepresent it. It’s somewhat more tolerable when Rev. Jim Bob lies about Plan B in his post-snake handling sermon, but pharmacists are supposed to have had some sort of training in biology and science.

  • I remember when I was a kid, I was watching Phil Donohue and he was talking to some racists. He had a number of episodes like that, but around the mid 80’s I remember one member of the panel was a young white woman who was a nurse and a racist. I think a member of the audience or Phil himself asked how her racisim affects her job. There were black people in her city and black patients at the hospital.

    She said that she did her job with a black person as she would a white person, despite her personal distaste for black people. Its her job as a nurse to treat patients in her care and her personal views had nothing to do with it. To paraphrase, rather closely, she said that if she wasn’t going to treat every patient that came through the door then she shouldn’t be a nurse.

    Now on a personal note, I’m sure her distaste for a black person might affect how well she does her job: how much enthusiasm and going beyond the call of duty or what have you that she would be willing to do. However, I find it interesting that this white racist nurse has more professional integrity than others.

  • “Pharmacists who refuse legal to dispense legal birth control should be held liable for child support if the result of their intervention is a child.
    This is not a passive act. It’s an active intervention to produce a desired result – a birth. As it’s the last deliberate act in a chain of events, I have no problem assigning responsibility.
    I suspect most of them would quickly forget their ‘deeply held convictions’ if the cost of them were 18 years of monthly child support payments per incident.”

    This, right here, is one of the best idea’s I’ve ever heard. If I had any clue how I’d seriously propose this be made law.

  • I’m a progressive who happens to be a tax accountant. I can just imagine what my clients would say if I neglected to take legitimate tax deductions on their returns because I believe in government and want to do my bit to fund government programs I believe in. That’s a total breach of the ethical obligations of my profession. Lawyers can’t roll over in defending their clients because they believe that the other guy has right on his side. Waitresses can’t refuse to serve someone because they don’t support his views. Pharmacists have a duty to fill prescriptions, and if they are uncomfortable with that, then find another job.

  • “Now, as it turns out, Byrd got the medication from another pharmacy 45 miles away, but that’s not really the point.”

    Um, yes, it is the point, or at least a major point. Not everyone is in a position to drive 45 miles to obtain legal medications. But I think the oddest part of all is that the store even stocked it if they refuse to sell it. No retail store is legally required to carry any particular item, even pharmaceutical items, correct? And if the pharmacist or any person can legally decline, that doesn’t prohibit the manager (who likely had to approve stocking the item) from selling it himself.

  • Well, if some phundy pharmacist told my girlfriend, while I was standing there next to her, that he had Plan B but refused to sell it to her, there would be a mess behind the counter worse than Xenia Ohio after the tornado hit that Ohio town, primarily from the pharmacist’s head knocking over each shelf as I eliminated those shelves that did not have Plan B on them with his head.

  • Stories such as this make my blood boil.

    But, I do like the idea of a gun control advocate taking over a Wal Mart sporting goods departments – even more than the fabled Vegan at the Philly cheese steak sandwich counter.

  • Wal-Mart corporate policy, as it relates to Plan B, is that if a particular pharmacist finds him/herself unable to sell the product for moral reasons, they are to refer the customer to another pharmacist, pharmacy assistant, or sales associate.

    The pharmacist, therefore, violated corporate policy—as did the store manager. They both need to be sent packing.

    Ohio’s Pharmacy Association claims to have no policy relating to this, either—but it is the State that holds the authority to issue licensure. If a particular job carries with it a particular responsibility, then the State Licencing Agency and the State Board of Employment, on the basis of the job’s licensing-specific requirements, may find that the pharmacist-in-question is guilty of job abandonment.

    Also—if the State allows one individual to promote their unique religious beliefs upon another individual, to the intent of impeding the rights of that other individual, then the State is guilty of promoting a unique religious belief—clearly a violation of the First Amendment….

  • We have the same crap going on here in Washington State. I’d be willing to bet that a man could walk in and fill his Viagra prescription and buy out the condom supply with nary an eyebrow raised. But let the woman this guy is nailing walk in and ask for the pill, and all hell breaks loose. These fundies don’t even follow their own so-called logic. Not only are they completely sexist, they’re stupid as well.

  • Seems like every time I go to Wal-Fart and load up a big ol’ cart full of plastic crap and ice cream, I forget my wallet at home, so I have to leave the damn cart and go home to get my wallet. Then I forget to go back.

    It’s the damndest thing.

  • As a retired RN( graduated from a Roman Catholic Nursing school), it was not my choice to chose who to care for. I took care of ALL patients completely the same. I had no right to impose my beliefs on my patients at all and I feel that the pharmacists should be brought up on charges with the licensing board if they fail to fill all prescriptions and dispense any and all over the counter medications that are legal in the state they practice in. Who are they to decide people’s lives??? I am so fed up with those who decide to impose their beliefs on others….complain to the state boards and make them disipline these pharmacists. As RN’s we are charged with following all MD orders that are legal and so are they.

  • I think most of the commenters are missing the point here:

    If Plan B is to be available ‘over the counter,’ why did this Wal-Mart patron even need to ask the pharmacist for it?

    Over-the-counter by definition (despite its literal translation) means that something can be purchased freely, without the need for anyone’s say so. Think anti-dandruff shampoo, antimicrobial creams, sunscreens, etc.

    So why wasn’t Plan B physically placed in a location that would obviate the need to ask the pharmacist in the first place? Is there an internal policy at Wal-Mart that says, in effect, ‘Plan B, while OTC, must be requested of the pharmacist by the customer,’ or similar? That alone seems to be against the law if true.

  • “So why wasn’t Plan B physically placed in a location that would obviate the need to ask the pharmacist in the first place? Is there an internal policy at Wal-Mart that says, in effect, ‘Plan B, while OTC, must be requested of the pharmacist by the customer,’ or similar? That alone seems to be against the law if true.”

    It’s only available to those over 18, I believe. Like cigarettes I suppose…

  • What Dustin said re: Behind the counter OTCs.

    In addition, a lot of allergy/cold meds are technically OTC but because of the Great Meth Scare you have to go through a lot of hassle to buy it. I’ve noticed many retailers keep an odd collection of items things behind the counter. Some places keep the smoking cessation products behind the counter (right next to the smokes, hmmm). But those are expensive so I guess it makes sense. However, a local grocery store keeps the baby formula at the customer service register and I always forget to ask why.

  • The worst part about this is the craven state legislators trying to pass laws protecting a pharmacist’s self-proclaimed right to interfere in the relationship between a patient and her doctor.

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