Tuesday, October 12, 2004
Prescription for Trouble? 
by Lenka Reznicek [permalink] 
If find this story from nearby Madison, WI disturbing both in itself and as part of the larger discussion of new proposed 'conscience laws' that would excuse medical professionals' refusal to treat patients or provide certain services based on personal moral beliefs.
From the Dunn County News: On a summer Saturday in 2002, relief pharmacist Neil Noesen, 30, of Barron was flying solo behind the pharmacy counter at the Menomonie Kmart. It would be the first -- and only -- time the independent contractor would be called upon to fill in for vacationing staff.

When a University of Wisconsin-Stout student [recently identified in other accounts as Amanda Phiede] came into the store on July 6 to have her prescription for an oral contraceptive refilled, Noesen asked her if she was using it for birth control purposes. Affirming that she was, he refused to fill the prescription, saying that it was against his religious beliefs to do so. The young woman asked where she could go to get her prescription filled, only to be told that he could not give her that information.

What Noesen also didn't tell her was that the state's Pharmacy Examining Board recognizes a pharmacist's right to refuse a prescription. And, indeed, he had a verbal agreement with managing pharmacist, Ken Jorandby, about his beliefs and was told that other pharmacists on duty would fill them later.

But customers have rights, too, under the Wisconsin Administrative Code, to have their prescriptions transferred to another pharmacy. Later in the day, the woman attempted to obtain her refill from the Wal-Mart Pharmacy. When the pharmacist called Kmart to transfer the prescription, Noesen refused to do so, again citing his religious beliefs.

Following the incident, the Stout student filed a complaint against Noesen with the Wisconsin Department of Regulation and Licensing (DRL). The complaint was filed on Sept. 10, 2002 and later amended in March 2004 to reflect that charges of unprofessional conduct are not concerned with the fact that Noesen did not dispense the contraceptives. Rather, it is because he allegedly refused both to transfer the prescription to another pharmacy and to return the original prescription to the customer.
Noesen's hearing is expected to conclude today. From CNN:
The state Department of Regulation and Licensing accuses Noesen of unprofessional conduct for not transferring Phiede's prescription. "The additional risk of pregnancy should not have been imposed on her by someone else," said John Zwieg, a lawyer for the department. Noesen's attorney, Krystal Williams-Oby, said Noesen broke no laws. She described him as a devout Roman Catholic and said any punishment would violate his constitutional right to religious expression.
When Noesen made the choice to become a pharmacist by profession, surely he knew many of the prescriptions he would be asked to fill would be for contraceptive drugs and devices. While I personally think pharmacists should do their job by filling all prescriptions legal in their state or jurisdiction, I understand the reasons for his conscientious objection. It appears he had reached an agreement with his supervisor to have another K-Mart pharmacist fill out prescriptions he felt unable to process, so why Noesen chose not to tell Phiede about her option to come back later is unclear.

That said, it's one thing if Noesen categorically refused to fill any prescriptions for contraception (or the contraceptive or morning-after Pills) regardless of the customer. It's another thing altogether if he makes the choice because he thinks a particular customer, in his opinion, should not be using a certain product for other than medical or safety reasons. The CNN article details that Noesen specifically asked Phiede if the prescription was to be used for contraception, as there are other non-birth control medical indications for the Pill's use, such as treatment of severe acne and dysmenorrhea. When she replied "yes," it was at that point that Noesen refused to fill the prescription.

I think the most objectionable and troubling part was that only did Noesen refuse to transfer Phiede's prescription to the Wal-Mart she'd chosen or refer her to another pharmacy, but he refused to return the original back to her. By holding her prescription "hostage," Noesen effectively attempted to keep Phiede from taking the prescription elsewhere to be filled - which seems to imply he wanted to influence her choice to use contraception, her choice to engage in sexual activity, or make pregnancy more likely if she chose to have sex.

This action goes far beyond personal objection to dispensing a type of drug and constitutes invasive interference in this woman's intimate personal affairs. It's nothing less than a forcible imposition of beliefs on a customer, which I think is not only unprofessional but borders on the criminally or civilly actionable. At the very least, I feel it's justifiable cause to revoke or suspend Noesen's pharmacy license.

The Guttmacher Report, "Conscience Makes a Comeback in the Age of Managed Care"
Planned Parenthood of New York on Conscience Clauses
Madison, WI Capital Times Online edition
Barron [WI] News Shield
Drug Topics from Feb 23rd, 2004

Update: from Drug Topics -
"The pharmacist has no right to impose his or her moral beliefs on the general public," wrote Gregory Bluhm, R.Ph., Channahon, Ill. "If you wish to practice pharmacy in such a manner, the public should be alerted in advance. Should we all be permitted to pick and choose on our own which therapies should be withheld? If you present yourself as a pharmacist at a public venue, you have a duty to fill all legal prescriptions. You do not have a forum to impose your morality upon the general public."

Noesen declined to comment on the advice of his attorney, Krystal Oby of Kingdom Legal Services in Madison. He is facing an administrative law hearing on May 4 stemming from charges filed by the Wisconsin board of pharmacy.

Refusing to fill a "proper, legitimate prescription is poor patient care at best," said Wesley Schieman, R.Ph., of Sandusky, Mich. "To not honor a transfer request nor even return the prescription as the pharmacist did is unprofessional and inexcusable. The pharmacy is not a pulpit."

Arlene Cayer, who works at Northwest Community Hospital in Arlington Heights, Ill., also deplored Noesen's failure to perform what she sees as his professional duty. She suggested that if a pharmacist has a religious objection to dispensing oral contraceptives, the public should be warned in advance. "It never ceases to amaze me the lengths men will go to in order to control the sexual lives of women," she added.

Noesen, who asked the patient why she wanted the oral contraceptives, has no right to know, said Sue Bliss, an Oregon pharmacist who authors Drug Topics' Eye on Ethics column. The woman may have different religious beliefs or had medical reasons for preventing pregnancy, such as a serious genetic illness. "Her decision in a compassionate, democratic, and, above all, religiously free country like ours is her own decision," she said.