SB 3, authored by Senator Drozda, provides special protections for pharmacists who don’t feel like filling prescriptions based on the pharmacists’ subjective belief that the prescribed medication would be used to cause an abortion, destroy an “unborn” child, or assist a suicide.
By a vote of 22 to 26, the Senate rejected an amendment offered by Senator Simpson that would have specified that the legislation does not extend to contraceptive drugs and devices that have been approved by the federal Food and Drug Administration to prevent pregnancy.
In its current form, in some cases, the pharmacist might have to contact a physician to discuss the reason for the prescription, but I don’t see anything in the legislation that limits the pharmacists’ unfettered discretion to refuse to fill a prescription based on anything that may or may not be said by the physician during the discussion. Further, the pharmacist is granted immunity for his or her actions, and no sanction is permitted. A pharmacy is required to implement procedures to fill such a prescription in the face of recalcitrance by its employee-pharmacist; but the pharmacy is not allowed to discriminate in its employment practices based on the extra effort and expense necessitated by the pharmacist’s actions or refusal to act.
Update Lesley Stedman Weidenbener has an article on the proposed amendment. Apparently at the committee hearing, Sen. Drozda repeatedly said that the legislation wouldn’t apply to contraceptives. Then, once the bill was out of committee, he started backing away from that position. Sen. Simpson offered the amendment to make it clear that the bill didn’t apply to contraceptives and that, if Sen. Drozda meant what he said, it should be a slam dunk. Sen. Drozda said that such an amendment would have been more appropriate at the committee level and urged its rejection on the floor of the Senate. Well, perhaps Sen. Drozda, if you gave the committee accurate information; the issue could have been resolved in committee.
I’m anti-abortion but against this law. There’s way too many parts of Indiana where there is one pharmacy … and if that pharmacist doesn’t want to give you a drug you have a prescription for, well, you’re up a creek.
Sorry pharmacists – if you don’t like giving out abortion drugs, well, consider a different line of work.
The only way this law is close to fair is if the state pays all costs of raising any child that results from a pharmacists’ decision until age 18. Even then, of course, it isn’t …
I want to know when we’re going to say it’s okay for, say, a pharmacist who’s Jehovah Witness or some such to decide they aren’t going to give out cancer drugs because it must be God’s will for the patient to die of cancer. When the pharmacists get to make the decisions on who gets what meds instead of the doctors, we know we’re going to hell in a handbasket. How nice that Drozda is willing to carry the basket like Little Red Riding Hood off to meet the wolf.
Can someone with a medical background speak to the historical role of a pharmacist? Is it to just fill prescriptions properly, or is it to perform additional diagnosis past what a doctor does?
I did miss the following in the original post:
I’m marginally better with the bill if there was some timebound element to the above (say, 1 hour) but if you’re making people wait 24-48 hours for something, well, you are in effect preventing them from getting some emergency birth control in time.
Or that HIV/AIDS is a punishment from God and thworting it with medication is a sin.
Lovely.
Now, I agree this bill sure has a whiff of wingnuttery about it when it comes to the abortion/contraception issue. Early-term abortions are legal, as are contraceptives. I agree with the other posters that if a pharmacist isn’t comfortable prescribing something for a legal purpose, they probably shouldn’t be in that profession. Isn’t the issue more complicated though when it comes to suicide? Assisting suicide definitely isn’t legal, and like it or not, the “right to die” has not been found to exist. Could a pharmacist potentially face civil or criminal liability if he/she suspects a prescription could be used to commit suicide, but goes ahead & fills it anyway? Just wondering.
An interesting philosophical discussion to be sure. But the amendment before the Senate, and rejected by the Senate at the urging of the bill’s author, Sen. Drozda, was to make it clear that the bill didn’t apply to a pharmacist’s decision not to fill a prescription for legal contraception.
Pharmacists are not supposed to practice medicine. Yet they do, to some extent, every day. Sometimes it’s an annoyance, but often it is helpful, such as when a pharmacist calls to point out an obvious drug interaction that I missed, or to help me wade through all the second-choice drugs that might also work but would actually be covered by the patient’s insurance.
That having been said, any pharmacist who refuses to fill a prescription is, in fact, practicing medicine. That pharmacist is saying by their actions that that medicine is inappropriate in that particular case, not due to something he/she found on a physical exam or discussed in a medical history, but because the pharmacist read in an ancient text that contraception is bad. It’s no different really than if I erroneously recommended based on some ancient text that menstruating women should quarantine themselves until they have finished.
Don’t kid yourselves. This has nothing to do with abortion. It may be worded that way, but this legislator’s obvious lying and manipulation to not exclude contraceptives tells the tale. Abortofacients are rarely prescribed, but contraceptives are prescribed all the time. In all the media cases of this outlandish pharmacist behavior, it has ALWAYS been birth control pills or emergency contraception (morning-after pills, which are nothing more that differently-packaged oral contraceptives). I don’t recall one media-covered case that involved RU-486 or other such drugs.
The entire purpose of this legislation is to make it harder in some cases to get birth control pills. You know, because back before these women were having their “sex without consequences”, and we had prayer in schools, life was nothing but milk and honey.
If I get word that this is happening here, I will tell every patient I prescribe to that that location is not a full-service pharmacy and direct them to go elsewhere. I will also be calling the Attorney General to an annoying extent to report practicing medicine without a license.
Glenn–
This also has nothing to do with suicide. Pharmacists every day fill prescriptions that, if taken improperly, could result in suicide. Physician-assisted suicide is illegal anyway, and I have no doubt that a pharmacist can refuse or delay such a prescription in the same way that they now won’t fill prescriptions with obvious dosing errors on them.
The “suicide” language was put in to make it look like a reasonable bill–which it is not.
I don’t recall one media-covered case that involved RU-486 or other such drugs.
That’s because in the US RU-486 can only be dispensed by a physician. You couldn’t get it at a pharmacy, period.
Shelly–
Of course, RU-486 isn’t filled in pharmacies. You’re right.
So again… what “abortion causing” medications is this legislation being written about? They’re attempting to legislate for something that, as you pointed out, doesn’t happen anyway.
This legislation is about allowing pharmacists to restrict access to contraceptives (to include “morning after” pills) only. The suicide and abortion aspects are filler, the potential applications of the law to contraceptives are the meat.
T,
You’re absolutely correct. It’s about control and punishment, not abortion.
Assisted suicide… Well, I’ve just returned from Kansas where I set up hospice care for my aunt who’s dying from kidney failure. In the hospice “comfort care” medications was a vial of morphine sulfate to treat pain, oxygen hunger and spasms.
I suppose that this bill, if my aunt lived in Indiana, would allow the pharmacist to refuse to fill the morphine perscription on the basis that I or someone treating her might be tempted to give her an overdose to end her life.
I don’t think anyone’s looking at this from the pharmacist’s perspective…
The whole point behind this bill is NOT to allow pharmacists to push their moral or religious beliefs on patients, nor is it to let them be a moral judge. The point IS that pharmacists are (more often than not) liable when a patient dies or is injured by a drug the pharmacist gave them. This bill is about protecting the pharmacist. It’s NOT about controlling patients. The pharmacist’s license is on the line every time he/she makes a decision about whether or not it’s safe to dispense a medication to a patient.
With this bill in place, if a pharmacist knows that a patient is abusing his/her medication, that pharmacist can refuse to dispense it anymore. How many people in this country are on a script for pain pills and either abuse them or sell them? I worked at a pharmacy over the summer, and there were a handful of patients on pain or anxiety medication who the pharmacist KNEW were not taking the meds as directed. She knew that a couple of these people were flat-out overdosing on a regular basis, which was apparent when they continually tried to refill the prescription no more than two weeks after it had originally been filled (the scripts were written for a month’s worth of pills). The pharmacist knew that these patients were in danger, but there was nothing she could do about it. She just had to sit back and let them continue to kill themselves with a highly addictive drug. If this bill is passed into law, she can refuse to further dispense meds to these patients, and she can save herself from a future lawsuit if one of the patients dies from an overdose.
Like I said, this bill isn’t meant to restrict the use of medication, it’s just a preventative measure to keep pharmacist’s from having to pay for the mistakes their patients make by not taking medication safely. Think of it this way: say there’s a teenage girl who’s been on birth control, but somehow she skips a dose and gets pregnant. she goes into the pharmacy to get her next pack of birth control and plans on taking all 28 pills at once to induce an abortion. Because the pharmacist isn’t allowed to refuse to dispense it, he gives her the pills, and the girl takes them all that night. Then let’s say that the child is lost, and the girl’s parents find out. She tells them that the pharmacist let her have the birth control in complete knowledge of the fact that she was pregnant… and voila. The parents sue the pharmacist for killing the girl’s unborn child.
How does it make any sense to avoid passing this bill? It’s completely ridiculous to discount situations like that, since they are the VERY reason the bill was created in the first place. Which is worse, am ill-intentioned patient OD-ing because the pharmacist can’t stop them from getting those meds… or the pharmacist, in good conscience, denying a patient the pills to save his/her life? I think the former, but apparently I’m the only one who looks at it that way. I’m guessing that everyone here thinks it’s a person’s right to choose whether he wants to live or die. Well, that’s all good and well, but it’s not fair to pull that person’s pharmacist into it, making him/her risk losing a their license for a situation they couldn’t do anything about….
Oh, and for the record, retail pharmacies do carry the morning-after pill. Oddly enough (at least in the state of Indiana), the pharmacist is able to refuse to sell it.
If it’s about a pharmacists’ ability to stop a patient from taking a drug improperly, why in the world would the bill limit itself to those drugs that might be used for abortions or assisted suicides? Any number of drugs can be abused to the detriment of the patient — not necessarily because the drug is going to be used to commit suicide or cause an abortion.
If it’s really about pharmacist liability, put in an immunity clause for pharmacists who dispense drugs as prescribed.
One more thing… just because this bill gives pharmacists the ability to refuse to fill a script, it doesn’t mean that all pharmacists are suddenly going to just stop filling all scripts for birth control. Pharmacists aren’t stupid (if they were, they likely wouldn’t be allowed to manage thousands of dollars worth of medication). They realize that birth control is prescribed for a variety of reasons. The point of the bill is to allow a pharmacist to refuse to sell someone birth control if he/she knows outright that the patient will misuse them. The pharmacist I worked with is a very devout Christian, but she would never simply refuse to sell birth control just because she doesn’t believe in the use of contraceptives.
I find it funny that I keep hearing people talk about this like the bill will FORCE pharmacists to stop providing birth control and other medications. That is so not the case. Love it when people get bent out of shape about something they know very little about in the first place.
I agree with Doug. Why single out only certain drugs if this bill is really about protecting the pharmacist from liability? In your hypothesis involving the pregnant girl–how would the pharmacist know what the girl was going to do? Therefore, how could the pharmacist be liable?
Also, what if the pharmacist who refuses to dispense the medication is the owner of the pharmacy, not merely an employee? Does the pharmacy still have to implement procedures to fill the prescription?
As to the latter part, Pila, I think the bill requires that a pharmacy have procedures in place to ensure the prescription gets filled.
But, that might be of cold comfort in a place where the Wingnut Pharmacy is the only game in town and they make you come back three times over the course of five days to get your prescription filled.
Well, in the case of the pregnant girl, I said that if the pharmacist knew the girl was indeed with child, he should be allowed to refuse to dispense birth control to her. I don’t think a lot of people realize how careful a pharmacist has to be in giving out meds. There are so many drug interactions he/she has to take into account, and if the wrong move is made and the patient ends up sick or dead, the pharmacist is nearly always liable. Like I said, if the hypothetical girl’s parents were made to believe that the pharmacist gave her pills knowing that she was pregnant, they would have a case against that pharmacist, whether he/she wanted to give the girl the pills or not. According to the law, the pharmacist would have their head on a platter if something like that happened. Thus the introduction of this bill.
Deleted at request of commenter — Doug
It seems to me that the first step a pharmacist should take if he realizes a perscription is not being used properly is officially,for the record,immediately contact the doctor writing it,and laying out what he believes is happening.To wait for the doctor to contact the pharmacist would be reasonable wait time..Otherwise,a pharmacist should be liable for the consequences of not filling a legal perscription. A pharmacist saying the store is out of a drug when it is available is unprofessional and most likely would be a pattern that could be verified,than a one time occurence.
In France,by comparison,the pharmacist can diagnose,and sell perscription medecine on his authority as a pharmacist,but we do not have that system here.And when the underlying reason for not filling a perscription is a pharmacist’s personal religious conviction,then I think it’s one of those ‘tail wagging the dog’ issues.
I can tell you from experience that to wait for the doctor to contact the pharmacist is not “reasonable wait time.” I don’t know if you’re familiar with this, but some insurance companies require a prior authorization from the doctor for certain drugs before the prescription can be filled. It takes a couple days for a PA to be processed by the insurance company… but sometimes it takes up to a week for the doctor to fill the PA out in the first place. I don’t know what doctors are like outside of where I live, but the ones who practice around here are not as cooperative as you would think. They seem to thrive on avoiding problems from the pharmacy as much as possible. And to be honest, pharmacists know a lot more about medicine than most doctors do. (How wouldn’t they, when all they’re dealing with is medicine??) Anyway, my point is, things don’t run quit as smoothly and time-efficiently between doctors and pharmacists as everyone thinks. Go shadow a pharmacist for a day and see what I mean.
Sara Shannonhouse:
I cannot buy what you’re selling. Here’s the State Senate’s own summary of the bill:
This is not difficult language to understand.
* The protection against liability is for the refusal to dispense, not for the adverse consequences of drugs the pharmacist dispense.
* If the goal were protection of the patient against undesirable side effects, we would see broader wording to cover serious complications like seizures or liver damage.
This changes in this bill to IC 16 are nothing more than Bible-thumping wingnuttery, and for you to convince me otherwise, you’re going to have to show me a different bill.
Please conduct your evangelistic apologetics elsewhere.
Branden, I’m with you right up to that last sentence. I think it’s valuable for folks like Ms. Shannonhouse to put forward their perspective and even more valuable to read responding critiques.
Perhaps there is a third party out in the blogosphere reading this who will come across an argument similar to that of Ms. Shannonhouse. That person will be able to raise your argument in response.
We’re engineering memes here people!
Deleted at request of the commenter — Doug
If Sen. Drozda is pushing the bill and it has to do with abortions and assisted suicides, that’s at the very least a prima facie case for Bible-thumping wingnuttery.
I think the way pharmacists are looking at it though is that, if they don’t agree with the idea of abortion, they won’t have to essentially be an assistant to a patient inducing their own abortion. If a pharmacist knows (not thinks, but knows) that’s what the drug will be used for, he/she will be able to refuse to sell it to that patient. And with that removes the pharmacist’s liability for anything that happens to that patient if she does self-induce an abortion. That’s all I’m saying.
The legislation doesn’t require the pharmacist to know. It requires only belief.
Do you really believe that someone would go through 6 (sometimes more) years of school and all sorts of ethics and privacy training and whatnot, and then go into practice and decide to believe that every young girl getting birth control is going to use it for an abortion? I’m sorry, but it seems like everyone’s making assumptions based on the fact that they don’t want to lose their scripts for birth control. Think about this… my generation is starting to graduate from college and go into the workforce. That includes pharmacists. My generation is SO much different than our parents’. Do you honestly believe that pharmacists fresh out of school don’t understand everything that birth control is used for these days?
(I feel like I’m talking to a wall…)
Let’s try this another way. Where has there been a problem that this legislation would have prevented?
Sara,
You’re right that bill doesn’t explicitly mention God or Christian motivations for its text. But what political bloc is most strident about opposing the practices of abortion and euthanasia?
Has that political bloc been shown to have substantial influence over the Indiana General Assembly in the past? Does former Speaker Bosma’s conversion of the daily prayer into a platform for Christian sectarian exhortation constitute prior evidence for the influence of this bloc?
It’s not tricky to apply Occam’s Razor here.
Pharmacists’ professional training has little to do with this issue, as far as I can tell. There is the occasional (rare) scientist who embraces Intelligent Design and rejects evolution, for example. People are quite capable of compartmentalizing their minds and suppressing the inconsistencies between their beliefs.
Doug,
Sounds like a good argument against the voter ID law, too–it’s a shame that a “conservative” approach to legislation (“make no law before its time”) is not found to be politically expedient by self-described conservatives.
Seems to me this bill could actually put a pharmacist in an even *more* untenable position.
“You sold her birth control, WHEN YOU WEREN’T REQUIRED TO, and she used it to have an abortion… it’s *your* fault.”
If I were a pharmacist faced with this legal situation, I wouldn’t hand out birth control unless I was 100% sure it *wouldn’t* be used for abortions… which is, I think, where the authors are intending on going with this legislation.
Brenda:
Obviously I need to take lessons from you in getting down to brass tacks. :)
An excellent point. Liability flows from choice.
Sara: In your hypothetical, way up the thread you did not specify that the pharmacist knew that the girl was pregnant. I guess you meant that she was showing.
Also: I agree with Branden. Your interpretation that this bill would protect pharmacists from liability if birth control were misused does not seem to comport with the legislative summary. The summary says that the bill protects the pharmacist if he or she decides *not* to dispense medication if such medication or device would be used to cause an abortion, etc. The patient can’t sue the pharmacist, and the pharmacist’s employer cannot discipline him or her for refusing to dispense medications that would be used to cause an abortion, etc. How do you read that to mean that this bill protects a pharmacist from being sued if the drug is legally and properly dispensed and then misused?
If the real concern is protecting the pharmacist from liability, why not simply have a protection against liability for harmful consequences of *any* type that may flow from legal and proper dispensing of medications?
Brenda: Amen!
Sara: You said you feel as if you are talking to a wall. Well then, right back at ya. I have not read anything in your responses that actually addresses the questions and concerns that people here have raised.
Believe it or not, most of the people who post here are well-educated in various fields, including medicine and law. Some people actually have to parse statutes to make a living. Some of us don’t do that anymore–thank God. Nevertheless, we do understand that this bill is an attempt to pass a “pharmacist conscience” law. Nothing you have said changes that.
If we want to “protect” the pharmacist, why don’t we make a simpler bill? That may say a pharmacist will be liable for any issued prescriptive drugs even without the prescription. Or, pharmacists will not be liable if anything happens to the patient (say for example, over dosage) after the issuance of the prescriptive drug.