Cedar River Clinics, a women's health and abortion provider with facilities in Renton, Tacoma, and Yakima, filed a complaint with the Washington State Department of Health this week alleging three instances where pharmacists raising moral objections refused to fill prescriptions for Cedar River clients. The complaint includes one incident at the Swedish Medical Center outpatient pharmacy in Seattle. According to the complaint, someone at the Swedish pharmacy said she was "morally unable" to fill a Cedar River patient's prescription for abortion-related antibiotics. Cedar River's complaint quotes its Renton clinic manager's May 17, 2005, e-mail account: "Today, one of our clients asked us to call in her prescription... to Swedish outpatient pharmacy. [We] called the prescription in... and spoke with an efficient staff person who took down the prescription. A few minutes later, this pharmacy person called us back and told us she had found out who we were and she morally was unable to fill the prescription." (Cedar River thinks their client eventually got her prescription filled.)
Cedar River's complaint, dated April 10, summarizes: "In each of the situations, we believe the pharmacist displayed behavior that was biased, unprofessional, and unethical. We are concerned that this type of poor treatment may be becoming a trend."
The complaint also includes an incident from November 2005 in Yakima, in which a pharmacist at a Safeway reportedly refused to fill a Cedar River patient's prescription for pregnancy-related vitamins. The pharmacist reportedly asked the customer why she had gone to Cedar River Clinics and then told the patient she "didn't need them if she wasn't pregnant."
Next week, the Washington State Board of Pharmacy (WSBP) will begin deliberating on rules that will determine whether pharmacists can cite "conscientious, moral, or religious reasons" in refusing to fill prescriptions for drugs like Plan B, the well-known emergency contraception pill. The board hopes to have rules in place as early as this summer.
The seven-member board, appointed by the governor, issues pharmacist licenses and regulates pharmacists statewide. Obviously, if the board allows individual pharmacists to withhold medication on moral grounds, it will have implications beyond a woman's access to things like Plan B, antibiotics, or vitamins. For example, self-righteous pharmacists could prevent a woman from getting birth control pills if she couldn't supply a marriage license; prevent a recovering alcoholic from getting Antabuse; or stop someone from getting an AIDS cocktail.
The issue of a pharmacist's responsibility to dispense prescriptions that clash with his or her moral beliefs has become a cause for the religious right and dissident pharmacists who want to play by their own rules at the expense of health-care customers who want legal prescriptions filled.
Women's rights advocates, like Northwest Women's Law Center (NWLC) and Planned Parenthood Network of Washington, object to any rules that would prevent women from accessing medication—rules they refer to as "Refusal Clauses." (Those who support allowing individual pharmacists to refuse to fill prescriptions refer to such rules as "Conscience Clauses.")
"Pharmacists should not be able to elevate their personal beliefs over the needs of the patient," says Amy Luftig, deputy director of public policy at Planned Parenthood Network of Washington. Luftig offered several anecdotes of refusal stories—including one of a young couple seeking emergency contraception in the Central District who were lectured by the pharmacist about sex—but says most women are too embarrassed or stigmatized to go public with a complaint like the one Cedar River filed on behalf of its clients. (Indeed, until this week, pharmacy board director Steven Saxe says, the board had not received any complaints.) Luftig says Planned Parenthood is now posting signs in its clinics asking people for their refusal stories.
Sara Ainsworth of the NWLC says refusing to fill birth control prescriptions for women is illegal. She cites a 1992 Washington statute that explicitly protects a woman's right to both abortion and birth control. "If a pharmacist denies contraception to women, his or her actions, per state law, are discriminatory and unlawful," Ainsworth says.
Ainsworth acknowledges that employers are legally required to accommodate an employee's religious beliefs, but she says federal and state law are clear: Employers can require employees to meet a "bona fide occupational qualification." "If you're a pharmacist," she says, "It's your job to dispense drugs if there are no problems like drug interactions."
However, the Alliance Defense Fund, a Christian group based in Arizona that was cofounded by Focus on the Family's James Dobson, has jumped into the debate. In a March 10 letter to the WSBP, the group argued: "The right of conscience is a fundamental right recognized in the Washington Constitution. No citizen can be forced to yield that right when he or she enters the profession of his choice."
"That is not an accurate description of the law," Ainsworth says. "The state can enact laws that restrict some religious expression and practice if there's a compelling reason to do so—like in the interest of public health to make sure all people get their prescriptions filled in a timely manner."
However, one point that does spook Ainsworth is this: the 1992 pro-choice law included a "conscience" clause: "No person or private facility may be required by law or contract in any circumstances to participate in the performance of an abortion if such a person or private medical facility objects to doing so." Obviously, dispensing birth control medication isn't tantamount to performing an abortion, but the fact that there is precedent for a conscience or refusal clause gives conservatives hope.
The final voice on the issue could be Governor Christine Gregoire's. Earlier this year, Gregoire sent a letter to the board making her position clear. "It is inappropriate for pharmacies or pharmacists to interfere with [the] established patient-doctor relationship by granting or denying prescriptions based on their personal objections."
However, to the chagrin of some activists, Gregoire has not backed up her letter by using the bully pulpit to frame this as a make-or-break question for the board members.
The Washington State Pharmacy Association (WSPA), a nonprofit umbrella organization that has over 2,000 pharmacist members, sent its recommendations to the board in late January. Prioritizing a pharmacist's right to "act in accord with his or her moral, ethical, or religious principles, which may include conscientious objection to performing certain pharmaceutical care services," the association recommended "the reasonable accommodation of a pharmacist's conscientious objection." To that end, the WSPA's solution seems to be: Allowing pharmacists to direct customers to other pharmacies.
Cedar River Clinics Executive Director Beverly Whipple says she filed the complaint with the board to "let them know there are problems." She adds: "If they give the stamp of approval to refusals, the problem will get immensely bigger."
Swedish Medical Center's pharmacy did not return calls.