R.Ph.s' refusal to dispense sparks media flurry

A Chicago pharmacist's refusal to dispense the morning-after pill and the Wisconsin pharmacy board's discipline of a pharmacist who refused to transfer a script for birth control pills have triggered a flurry of media attention on pharmacy.

Newspaper and nationally syndicated columnists have all weighed in on the issue. At least a dozen states have legislation to bring pharmacists under the protection of the conscience-clause umbrella, but legislators in three states have bills to make pharmacies fill all legal prescriptions. Not to be outdone, the U.S. Congress has gotten into the act with two bills that would require pharmacies to dispense all scripts while allowing pharmacists to opt out.

The refusal to dispense has become a political football that has nothing to do with the pharmacist's role; instead, it's being promoted as the next front line in the contraception wars, according to Susan Winckler, R.Ph., VP-policy and communications and staff counsel, American Pharmacists Association. "We have a few unfortunate incidents where pharmacists did obstruct access," she said. "That's what generates the attention, because that should not have occurred," she added.

There is some concern that the proposed federal legislation may encroach on the powers of state pharmacy boards, said Kristina Lunner, APhA's director of federal government affairs. "We know better than to predict Congress, and it's a little too early to say whether the legislation has legs," she added. "The proponents of the bills have gotten their political wish because it's in the media. They don't need a legislative win to draw the type of attention they're getting."

As the media attention intensifies, some state pharmacy boards are feeling the heat from consumers and legislators complaining about R.Ph.s who refuse to dispense, said Carmen Catizone, executive director, National Association of Boards of Pharmacy. He added that most pharmacy boards support APhA's opt-out position.

"There's a lot of public outrage that a pharmacist would interfere," said Catizone. "There's pressure put on the boards of pharmacy by the most vocal critics, asking why the boards aren't taking action against those pharmacists. The boards are caught in the middle. And the proposed federal legislation is interference with state regulatory matters that just makes things more complicated."

The general tenor of editorials, commentary, and letters to the editor has been against pharmacists, who are chided for trying to impose themselves between the patient and the physician. Some contend that objecting pharmacists should consider another line of work, while others put them down as workers who merely take pills out of big bottles and put them into little bottles.

Such commentary and media coverage doesn't have APhA squeezing all those lemons to make lemonade, but it does present an opportunity to project a positive message, according to Winckler. "We can explain in public forums that pharmacists do much more than process a lawful prescription," she said. "People don't understand what pharmacists do because a pharmacist's clinical evaluation takes place without touching the patient. We have to seize the platform to inform people."

The current national kerfuffle over refusal to dispense is a good time for pharmacists to think about their own beliefs and standards, advised Lunner. "They need to do a self-evaluation," she said. "They need to know what their personal limits are and what the accommodations are before they're presented with a script."