Can this really happen?

[kidmel45]

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Can a pharmacist refuse to fill a perscription if they don't believe in the therapy? A patient at my mentors office ran into a pharmacist at a national chain (that begins with a W...) who refused to fill a depo-provera script because the pharmacist did not believe in abortion!!

Any thoughts? Not so much on abortion, but the fact that a pharmacist can refuse to fill a script.

 

[Winged Scapula]

Will move this to the Pharmacy Forum as I assume the denizens there will have more information on this interesting topic...

 

[Modnar]

Originally posted by kidmel45
Can a pharmacist refuse to fill a perscription if they don't believe in the therapy? A patient at my mentors office ran into a pharmacist at a national chain (that begins with a W...) who refused to fill a depo-provera script because the pharmacist did not believe in abortion!!

Any thoughts? Not so much on abortion, but the fact that a pharmacist can refuse to fill a script.

Are you sure it was Depo Provera? My understanding is that one actually has to visit a doctor to get a Depo injection, rather than giving it to oneself.

If it was indeed Depo, the pharmacist was a) out of line and b) misinformed. Hormonal contraception's main function is to prevent one from ovulating in the first place and thicken the cervical mucus, making it more difficult for sperm to get through.

 

[baggywrinkle]

Originally posted by kidmel45
Can a pharmacist refuse to fill a perscription if they don't believe in the therapy? A patient at my mentors office ran into a pharmacist at a national chain (that begins with a W...) who refused to fill a depo-provera script because the pharmacist did not believe in abortion!!

Any thoughts? Not so much on abortion, but the fact that a pharmacist can refuse to fill a script.

Indeed, a pharmacist may refuse and has an obligation if he/she has reason to believe that the therapy will cause harm. The tricky phrase here is "cause harm" and is open to interpretation. That is why they call it professional judgement. A pharmacists duty to exercise professional judgement to protect the patient(s) has been upheld recently by court decision in California when an RPh refused to dispense an abortifactant to terminate a pregnancy citing religious values.

A better example is a clearly dangerous prescription written for strychnine in copious quantity to be consumed all at once.
The pharmacist would be considered negligent for failure to intervene by refusing to fill.

That is why there are real people behind the counter rather than vending machines.

 

[TCB]

This law is called "Pharmacist Conscience Law".

 

[lord999]

As far as I've been trained, so long as a pharmacist has a reason, s/he can refuse to fill any Rx, including therapeutically correct medications.

For instance, we had a dentist write for Plan B with signa Use ut. dict. We called him back with the refusal to fill for obvious reasons. He argued that as an unrestricted practitioner, he could write for what he wanted. We said that was true, but only in his reasonable "scope of practice" which emergency contraception is not normally a dentists' function.

Question:
Can a pharmacist blanket refuse to fill a prescription (as in say "I'm too busy, go somewhere else")? I know we turn away questionable C-II's with "I don't have this in stock." There are some pharmacists that say that we do not need a reason to deny fill.

On that DepoProvera, I sincerely hope that the pharmacist wasn't incompetent enough to deny the script on those grounds. Depo-Provera is definitely not an emergency contraceptive method.

 

[Caverject]

If anything, I could imagine an RX being refused for Preven, the morning after pill, but no way would Depo be an abortion shot. Im sure there has to be some miscommunication along the line.

 

[Modnar]

Originally posted by baggywrinkle
A pharmacists duty to exercise professional judgement to protect the patient(s) has been upheld recently by court decision in California when an RPh refused to dispense an abortifactant to terminate a pregnancy citing religious values.

However, the pharmacist does not know why the patient was prescribed the abortifacient. Perhaps the doctor believes that it would be detrimental to the patient's health - or even fatal - for her to carry a child. The pharmacist would be out of line by refusing to fill the prescription without even asking the doctor for an explanation.

It's also important to point out that not all patients are fortunate enough to live in large cities where there are a number of different pharmacy chains in town. If you live in the middle of nowhere and Wag's is the only game in town, what are you going to do if they won't fill your prescription?

 

[lord999]

At least in AZ, pharmacists have the right to refuse without a reason to dispense emergency contraception that is a clearly an abortifacient.


Therein lies a problem.

Who's to say what you are using Mircette for if the signa is Use ut. dict? Could it be 1 t po qd? Or could it be take 2 tabs today, and 2 tabs 12 h from start? There are pharmacists who will refuse to fill contraceptives without a definite signa for that reason.

Is this reasonable practice? I don't know, but I respect the right of a pharmacist to answer satisfactorially any and all lingering doubts that a prescription that falls under his/her care is safe and efficacious and falls within the guidelines of rational therapy. I also respect, trust, and hope that the physician will act in the patient's best interests when the prescriptions are written. It's a conflict of interest sometimes.

I settled the question for myself this way. When I take the oath, I cease to be just another citizen. I'll be a pharmacist forever, and that may mean doing things that I as a person do not condone. I chose a profession, meaning I have agreed to place the interests of the public above my own, and therefore, I will act accordingly to the social mores of my profession.

 

[kidmel45]

Thanks for all the info. This is a pretty interesting topic. Can the pharmacist be fired for letting his/her religious beliefs interfere with the job they are licensed to do?

Yes, it was depoprovera This doctor's office has the pt get it filled at the pharmacy and bring it back to the office to get the shot (not sure why).

 

[Homunculus]

as long as the Rx is legitimate, and within the course and scope of professional practice for the physician, isn't the pharmacist obligated to fill it? If there is a gross mistake, such as dosage, drug interaction, allergy, etc, they are required to not fill it, but how can a pharmacist judge the legitimacy of the treatment decided on? The simple fact that the physician (within his scope of practice) wrote a script in itself makes it legitimate, and as such the pharmacist should fill it regardless of whether he morally agrees with the reason it was written. jsut my opinion 🙂

 

[baggywrinkle]

Originally posted by Modnar
The pharmacist would be out of line by refusing to fill the prescription without even asking the doctor for an explanation. (...)

If you live in the middle of nowhere and Wag's is the only game in town, what are you going to do if they won't fill your prescription?

The bottom line is the pharmacist is in business and is not obligated to serve anybody, though he must be diplomatic. Refusing to fill for reasons of race or socio-economic status and saying so outloud is foolish. But I would not hesitate to refuse to serve a hostile customer and **HAVE** enforced it with a police escort off the premises.

It would be reasonable for a store owner to refuse to stock a drug such as preven for ethical reasons and not need to answer to anyone. Don't have it, can't get it is all he need say. Nobody can force you to put your name on any prescription and thus claim ownership and responsibility for any consequences any more than you can force an engineer to design your bridge.

The second part of the quote above is not your concern. Harsh, but true. I encounter this frequently on my night shift. I am the only pharmacy open in my end of the county. You bring me a prescription for oxycontin with frequent flyer written all over your profile and I don't know you as one of my regular pain control patients - I don't care if your flight is leaving in an hour to attend your poor mother's funeral - I am gonna break your heart.

Your duty is to exercise professional judgement to protect your customers. This does not only mean protecting them from harm, it also means ensuring that a prescription is written for legitimate purposes such that you are obliged to refuse the prescriptions of a candyman mascarading as a physician. While the spurned physician doth protest rest assured the inspectors are not only building their case against him they are also looking at who aided and profited with him.

Having said all this. I personally do not have a problem dispensing a drug like preven. Have done so many times. But I will defend a pharmacists right to refuse till the cows come home. It is basic. Take that away and you might as well ask if you would like frys with that order and all your book learnin was a waste of six good years of your life.

 

[baggywrinkle]

Originally posted by kidmel45
Thanks for all the info. This is a pretty interesting topic. Can the pharmacist be fired for letting his/her religious beliefs interfere with the job they are licensed to do?

Yes, it was depoprovera This doctor's office has the pt get it filled at the pharmacy and bring it back to the office to get the shot (not sure why).

The pharmacist sounds misinformed in this instance. But as I mentioned the identical situation went to trial in California and the RPh won. It also happened in my county; a colleague was Catholic and refused to fill preven inviting them to go across the street. Yes, a pharmacist is likely to be fired especially by WAG who will sell their own mother to separate the customer from her cash - depending on how the pharmacist handled the refusal. Offering directions to another pharmacy works. Tearing the prescription up doesn't. Catholic Kathy still works for WAG minus one disgruntled customer and plus lots of negative publicity. At least they spelled her name right 🙂

 

[Modnar]

Originally posted by baggywrinkle
But I would not hesitate to refuse to serve a hostile customer and **HAVE** enforced it with a police escort off the premises.

...

The second part of the quote above is not your concern. Harsh, but true. I encounter this frequently on my night shift. I am the only pharmacy open in my end of the county. You bring me a prescription for oxycontin with frequent flyer written all over your profile and I don't know you as one of my regular pain control patients - I don't care if your flight is leaving in an hour to attend your poor mother's funeral - I am gonna break your heart.

Oh, I definitely agree with not dispensing to a hostile customer. If someone acts threatening towards me, I'm calling the police. No prescription is worth my getting killed or injured.

And I'm sorry, but I do believe it is my concern. If I'm the only source and the patient has a legitimate need (in other words, not the "frequent flyer" guy you spoke of), it's my responsibility to fill the script. The patient can't come back to my pharmacy if he dies. And maybe it isn't that serious, but that's not a chance I'm willing to take.

 

[baggywrinkle]

Originally posted by Modnar
And I'm sorry, but I do believe it is my concern. If I'm the only source and the patient has a legitimate need

Nothing like a good ethics debate - ehh?

Legitimate need; Augmentin suspension, pedi patient in dire need, teen mother, medicaid insurance is expired on Friday night, cost of prescription is over 100 bucks, Momma doesn't have the money, ER doc won't change to something else. give her the Augmentin and it is a freebie out the door you won't see her again.

You can

a. Give her the script back
B. Give her the Augmentin and risk losing your job
C. pay for it out of your pocket cause you're a
good bloke, but remember there are several of these a week and you have your own family to feed...

Momma's looking at YOU, what's it going to be?

 

[GravyRPH]

You offer to give it to her and have her straighten out the insurance or return when she has the money. You have her name and number and you call her if she doesn't. She will understand what you did for her, and 90% of the time WILL pay. If she doesn't, you turn it over to your collection department.

You could very well be held liable if you refuse to fill a prescription and the patient has nowhere else to go and suffers harm. I would hate to be a night shift pharmacy and the only pharmacy opened. Suppose that oxycontin fellow has a withdrawl seizure and crashes his car into a happy family. Too bad for that night pharmacist, even if the guy's a druggy, I'm sure his doctors would be happy to testify to his fibromyalgia and how you deprived him of his pain medications and caused the death of a few kids. You have to be very careful about turning prescriptions away without REAL good cause.

Its not easy being a pharmacist. Thats why I have said before its a lot different being an Intern than being the sole liable person on shift. Youre responsible for your tech, clerks, and interns. And you have to make the right decisions, all the time.

I have refused to fill prescriptions numerous times, but when I did they were either obviously fraudulent, or I had plent of evidence to prove they were.

 

[Caverject]

Baggywrinkle,

Dont know if your an RPH or a student, but in response to the $100 Augmentin, isint there a law in Florida within Medicaid saying you must treat the patient for any serious urgent matter regardless if Medicaid is down and its Friday night? I used to work in Florida for 7 years before I came a student here in Georgia this year. I could have sworn I came across something like that when we were being inspected by the state board. (Routine inspection, nothing to be alarmed about) Just curious...

 

[baggywrinkle]

Originally posted by South2006
Baggywrinkle,

Dont know if your an RPH or a student, but in response to the $100 Augmentin, isint there a law in Florida within Medicaid saying you must treat the patient for any serious urgent matter regardless if Medicaid is down and its Friday night? I used to work in Florida for 7 years before I came a student here in Georgia this year. I could have sworn I came across something like that when we were being inspected by the state board. (Routine inspection, nothing to be alarmed about) Just curious...

There is no law that I have ever seen in Florida which requires dispensing for gratis other than the acknowledged standard of care for good samaritans - the duty to treat. In actual practice there is considerable pressure to hold medication which has not adjudicated and demand cash payment. For this specific example I would call the ER and tell them she ain got no money would they change it please, and if they refuse I would tell Momma to come up with the cash or take the child BACK to the ER to be admitted or risk coming to harm.

For the frequent flyer with the Oxycontin script it is in writing that you shall not dispense a prescription for other than a legitimate purpose and you are obliged by Florida law to verify the RX & photocopy the drivers license if you choose to dispense as well as report any practitioner you suspect of being a candyman. Without verification I will not dispense and the patient is no worse off than he was before the day of 24 hour pharmacies. Tough bickies. Mind you, I am the easy going one. Many of my fellows on night shift don't have it and won't fill it regardless. I will fill it **if** you take the trouble to establish yourself as a regular patron who is known to me which means getting verified and not doctor/pharmacy shopping