Bills Target Pharmacists Who Say ‘No’

With drugstores now a battleground in the war over reproductive rights, California lawmakers today will consider whether to create the nation’s first law requiring pharmacists to fill emergency contraception prescriptions and other medications even if they find them immoral.

Two Democratic bills pending in the Legislature would require druggists to dispense all lawful drugs. Both proposals would allow California’s 25,000 pharmacists to demur only if the store could ensure that the prescription would be filled by another without excessive inconvenience to the patient.

The push in Sacramento comes after four more states -- Arkansas, Georgia, Mississippi and South Dakota -- gave pharmacists the right to refuse to fill orders about which they have moral qualms.

Reproductive-rights groups are pressing lawmakers elsewhere, including Missouri, New Jersey and West Virginia, to establish professional-duty laws for pharmacists. On Friday, Illinois Gov. Rod Blagojevich issued a 150-day emergency order that would require pharmacists to fill contraceptive prescriptions, after a Chicago druggist refused to dispense birth-control pills.

“These bills, no one’s ever tried anything like them before,” said Elizabeth Nash, who follows state legislation for the Alan Guttmacher Institute, a nonprofit group in Washington, D.C., that does research on sexual and reproductive health. “By their very nature, they are untested. We don’t know how the implementation would work.”

Pharmacies were pulled into the fight over reproductive rights after the approval of the morning-after pill, which blocks a fertilized egg from implantation in the uterus. In 2002, California became the first state to allow pharmacists to write and fill prescriptions for emergency contraception pills. Objectors consider the medication a type of abortion.

“The Legislature has spoken on the right for women to have access to emergency contraception,” said Sen. Deborah Ortiz (D-Sacramento), author of SB 644. Under her bill, violators could face discipline by the state licensing board. It is backed by a coalition of women’s groups, including NARAL Pro-Choice California and Planned Parenthood Affiliates of California.

“We’re simply trying to ensure that consumers -- women -- are not abandoned and that they’ll have timely access to the medication,” Ortiz said.

But the California Pharmacists Assn. has raised concerns about Ortiz’s bill as well as AB 21, written by Assemblyman Lloyd Levine (D-Van Nuys). His bill, which the Assembly Health Committee will consider today, would allow the attorney general to act against resistant pharmacists.

The association wants Ortiz’s bill rewritten to apply not just to pharmacists but to all medical professionals who dispense drugs. It objects to the authorization of punishment in Levine’s legislation.

Under both bills, objecting pharmacists must have previously notified their employers of their specific objections in writing. Even then, they must fill the prescription if they cannot find another pharmacist who can do so promptly.

Charlie Green, who owns two pharmacies in Stockton and refuses to dispense emergency contraception prescriptions, said over the years that he has referred customers to other pharmacies or Planned Parenthood clinics and that it “has not been a problem.” He objects to state legislation that would require pharmacists to provide the drugs.

“Being a Catholic and a man of conscience, I have a difficult time with anything that could be interpreted at all as terminating a pregnancy,” Green said. “My feeling is, if I choose not to do that, I still have an obligation to my patients to seek out the best healthcare they need.”

The California Board of Pharmacy said it had received no complaints about pharmacists refusing to fill such prescriptions.

Karen Romano, a West Los Angeles mother, said that last November, a pharmacist at her drugstore balked at filling a prescription for Misoprostol, to soften the cervix, until he knew what it would be used for.

Romano’s doctor had prescribed it to prepare her for a dilation and curettage procedure to remove the tissue of a fetus that she had miscarried but had not discharged, she said.

The pharmacist gave her the medication after learning that it was not for an abortion. But he told Romano that he would not have provided it if that had been the purpose. She took the prescription elsewhere.

“I was just stunned,” Romano said. “We really wanted this baby. In addition to going through this sort of anguish, to go through this at the pharmacist was just awful. It felt so invasive and so wrong. How could he do this?”

She declined to name the drugstore, saying that it was a national chain which, after she complained, said the pharmacist was not following company policy and acted to prevent future occurrences. Romano plans to testify today in support of Levine’s bill.

“The job of a pharmacist is to fill a prescription, not to be a doctor, not to be a moral advisor,” Levine said. Pharmacies could become more politicized if federal regulators allow the sale of the Plan B morning-after pill, which does not require a prescription.

The legalization of assisted suicide, which Oregon has already done and Levine is proposing this year in another bill, could add another category of drugs that some pharmacists could find repugnant.

“This goes well beyond pharmacists and contraception,” said Adam Sonfield, a public policy associate at the Guttmacher Institute.

“You can be thinking of a certain type of antibiotic if it could be used for a sexually transmitted disease, or Ritalin for a child,” he said. “You could imagine pain medication for end-of-life care. In the future, there could be all sorts of things coming out of stem-cell research.”