The Wanton Debauchery of a Nampa Pharmacist and the Idaho Pharmacy Act

A nurse in Idaho calls in a prescription at the local Walgreens pharmacy for Methergine, an uterotonic drug commonly used in obstetrics and gynecology to prevent/control uterine bleeding.

The pharmacist allegedly asked if the medication was to be used in post-abortion care, which the nurse practitioner refused to answer citing patient confidentiality requirements. The pharmacist said the prescription would not be filled unless the question was answered. When the nurse asked to be referred to another pharmacy, the pharmacist hung up....

A complaint is made against the pharmacist, the Idaho Board of Pharmacy investigates and takes no action because:

1) You say a duty to fill Rx, I say a gentle, whispered suggestion

Turns out the privilege of being granted a state monopoly on dispensing/selling drugs does not come with a responsibility to actually, you know, fill prescriptions.

Seriously, I'm not kidding. According to the Board, the Idaho Pharmacy Act does not require a pharmacist to fill a prescription.

2) HIPAA violation, SHMIPAA violation

According to the Board of Pharmacy’s response, Planned Parenthood alleged the pharmacist’s inquiry violated privacy provisions of the federal Health Insurance Portability and Accountability Act, which the board is not entitled to enforce. Under the Idaho Pharmacy Act, releasing such information would be a violation, but requesting it is not, the response states.

No word yet from the Idaho Board of Pharmacy on whether imposing arbitrary conditions, like forcing the patient to bark like a seal, or the need for the pharmacist's blessing on matters unrelated to a drug's indication, as a prerequisite to filling out a prescription is, in fact, considered professional conduct in Idaho.

3) No organ failure and the patient is still alive, so what's the problem?

[Idaho Board of Pharmacy Executive Director Mark Johnston] stated that the argument that the patient's health could have been jeopardized by the refusal of the pharmacist was inaccurate. Johnston said, "The board's investigation confirmed that the patient received treatment elsewhere and therefore no 'grave danger' was realized." The investigation is closed "without any further action," he said.

Ah, yes, that most scientific, professional, and beloved pharmacy standard of all times, the "SSS Grave Danger", the one that applies exclusively to prescriptions for female patients of reproductive age.

In case you've been fortunate enough not to be subjected to this standard yet, best to become familiar with it. When your ability to fill prescriptions depends on the mercy and sunny disposition of your local pharmacist you never know when your time is up. So here are the "SSS Grave Danger" pharmacy standard basics.

The pharmacist can jeopardize your medical care by refusing to fill your prescription because your performance on the jumping through hoops requirement s/he imposed on you as a condition for filling the prescription was not satisfactory. That is all good, legal, and professional.

On top of that, the pharmacist has no duty to assist you in rectifying the health problem s/he created for you in the first place.

As long as you Somehow manage to get the medicine, from Someone, Somewhere, at some time before you become incapacitated and/or die, the pharmacist need not bother with a referral to a competent pharmacist.

Of course, in all fairness, a referral to a competent pharmacist in Idaho might be problematic.

Between the reckless disregard for professional standards enshrined in the Idaho Pharmacy Act and the impotence of Executive Director Mark Johnston and the Idaho Board of Pharmacy to do anything about it, it's unclear if there are any competent pharmacists left in Idaho.

Missouri Politicians Abolish Professional Duties, Standards for Pharmacies

Missouri politicians just passed a law that strikes a serious blow to Communism on American soil.

The Missouri House on Tuesday voted 115-43 to approve HB 226, an amendment that [s]pecifies that no pharmacy can be required to perform, assist, recommend, refer to, or participate in any act or service resulting in an abortion and it will be immune from liability for refusing to do so.

By definition, when it comes to women of reproductive age, refusing to provide professional services to patients you deem undesirable is an inalienable right. As such, there's nothing special about politicians enacting laws to shield medical professionals from liability. These politicians are just doing [insert deity of choice]'s work. (Hear that malpractice lawyers!)

What is remarkable about Missouri's HB 226 is that it represents a quantum leap forward from the noble pursuit of playing games with your untouchable patients' trust, dignity, and health without any professional or legal liability.

This law HB 226 allows pharmacies and pharmacists to take advantage of all the benefits of having a monopoly on the sale of drugs without any requirements to abide by those pesky professional duties and standards that are usually a condition of being granted a State monopoly.

Like so:

No licensed pharmacy in this state shall be required to perform, assist, recommend, refer to, or participate in any act or service...

No duty to dispense drugs, talk to or advise patients, refer them to another pharmacist, or refrain from stealing taking a patient's prescription and refusing to return it to her.

...in connection with any drug or device that is an abortifacient, including but not limited to the RU486 drug and emergency contraception such as the Plan B drug...

No requirement to adhere to the professional standard of using science when dispensing drugs. (The medical definition of abortifacient is out, the personal definition is in.)

No duty to dispense drugs to *pregnant* patients, since most prescription medications are Category C. (Good luck with that asthma attack if you're a pregnant woman in Missouri!)

...not limited to the RU486 drug...

No requirement to stock or dispense a drug, RU-486, that cannot be legally stocked by pharmacies or dispensed by pharmacists to begin with.

No duty to provide pain meds or antibiotics to a patient who's been administered misoprostol and RU-486 by her physician, or, for that matter, to a patient who has an IUD, is already using birth control pills, or to men who are wearing tight underwear. (Hey, when you legislate science out of medicine, defining man panties as a device that is an abortifacient is perfectly valid.)

You tell me, what is more anti-communist than having the State grant a monopoly to an enterprise, remove duty and standard requirements, and then shield the entity from liability?

Here is the full text oh HB 226; read it and weep:

338.575. 1. No licensed pharmacy in this state shall be required to perform, assist, recommend, refer to, or participate in any act or service in connection with any drug or device that is an abortifacient, including but not limited to the RU486 drug and emergency contraception such as the Plan B drug.

2. No civil or criminal cause of action shall accrue against a pharmacy due to a refusal to perform, assist, recommend, refer for, or participate in any act or service in accordance with subsection 1 of this section.

3. No board, commission, or other agency or instrumentality of this state shall deny, revoke, suspend, or otherwise discipline the license of a pharmacy, nor shall it impose any other condition of operation due to a refusal to perform, assist, recommend, refer for, or participate in any act or service in accordance with subsection 1 of this section.

4. No pharmacy shall be denied or discriminated against in eligibility for or the receipt of any public benefit, assistance, or privilege of any kind due to a refusal to perform, assist, recommend, refer for, or participate in any act or service in accordance with subsection 1 of this section.

One last thing. I have a question for Rep. Ed Emery, Rep. Cynthia Davis, and all the other Missouri politicians who passed HB 226. Since you've removed the professional duty and standard requirements for the sale of drugs, can I haz street stand for the glorious, Capitalist selling of Plan B in your state?


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Chlamydia Testing and Treatment Without Prescription

Looks like people in the UK are now able to walk into a pharmacy and have access to Chlamydia Test and Treat services:

Members of the public can purchase a chlamydia test kit from any participating pharmacy for £25, send a urine sample for testing and, if a positive result is returned, purchase treatment over the counter for a further £20. Testing of samples is included in the cost of the test kit, with results returned either direct to the customer or to the pharmacy where the test kit was purchased – or both.

Azithromcyin is available as Clamelle Tablets for people 16 years and over who have tested positive for chlamydia but have no symptoms and for their sexual partners.

Pharmacists can only supply Clamelle tablets to individuals who are confirmed as having a positive Nucleic Acid Amplification Technique (NAAT) chlamydia test result and to their sexual partners (without them needing to take a test).

Meanwhile, here in the US, our beloved politicians are still trying to decide if [female] patients can walk and chew gum at the same time, while principled pharmacists insist that dispensing meds is all about them.

By the Grace of God, Court Affirms Belief-Based Plan B Sales

Photo by babasteve

When it comes to dispensing Plan B, a safe and effective drug with no major side effects, it's not only the pharmacist's religious beliefs that take precedence over the patient's health, her autonomy and her relationship with her physician.

The pharmacist's religious sado-masochistic tendencies also play a deciding role. For you see, as long as the pharmacist keeps his/her S&M tendencies in check and only inflicts reparable harm on the patient, it's acceptable for the pharmacist to commit malpractice and refuse to sell a legal drug.

Bottom line: A court just decided that, when it comes to Plan B, suffering irreparable harm is the standard for access to an OTC drug. There's no way to go but down from here.

Belief-Based Pharmacology

Photo by sonofgroucho

"The Constitution tells me that I should have the ability to practice what I believe is right."

Had I known that the Constitution and personal belief guide the practice of pharmacology I wouldn't have bothered with reading all those pharmacology books.

Maybe I'll move to Washington state and, in cooperation with Stormans pharmacy, start a belief-based medical practice.

Pharmacy Benefits Plan, Pope Benedict XVI Style

In a speech to participants at the 25th International Congress of Catholic Pharmacists, Pope Benedict XVI urges pharmacists to adhere to his snazzy Most Holy Righteous (TM) practice guidelines:

1. Avoid dispensing drugs.

2. Use the time not wasted filling Rxs to proselytize to your captive audience patients.

Which makes one wonder, is pharmacology still a science-based profession or do drug molecules (umm, sorry, I mean products that have clearly immoral purposes) have shifting pharmacological properties depending on the dispenser's preferred Sky Fairy? Also, what exactly is an euthanasia drug?

Me, Me, Me!

Unfortunately, if you're a woman, it has come to this. To have a shot at receiving proper health care, you better make sure you have a contingency plan:

During the summer of 2002, Noesen was an independent contractor and worked as a "relief" pharmacist at K-Mart pharmacy in Menomonie.

Prior to working at the pharmacy, Noesen told the managing pharmacist that due to his beliefs, he could not fill birth control prescriptions because he believed they could cause an abortion.

The managing pharmacist said Noesen would not have to fill those orders, and that the managing pharmacist would fill them later. There was no discussion of whether Noesen would transfer such a prescription, but the managing pharmacist assumed Noesen would.

A doctor prescribed a young woman Loestrin FE on June 3, 2002, and authorized refills until June 6, 2003.

...

On June 8, 2002, the young woman gave the prescription to the K-Mart Pharmacy to have it on file for future use.

On Saturday, July 6, 2002, the young woman went back to refill the prescription that was already on file.

Noesen was the only pharmacist working when the young woman came in. Noesen asked her if she was using it for birth control purposes. When she replied "yes," he told her that it was against his personal religious beliefs to fill the prescription.
The young woman then asked Noesen where she could go to get it filled. Noesen told the woman that he couldn't provide her with that information. Noesen did not tell the young woman that according to Wisconsin Administrative Code PHAR 7.05(3) it was her right to have the prescription transferred to another pharmacy.

Later that day, the young woman went to a Wal-Mart Pharmacy to have her prescription filled. The Wal-Mart pharmacist called Noesen to get the prescription ordered transferred.

Noesen refused to transfer the prescription based on his religious beliefs.

The young woman then called K-Mart and talked to an assistant store manager who asked if she could wait until Monday to have the prescription filled. The young woman told the assistant manager that she couldn't wait because her prescription cycle would begin on Sunday. The assistant store manager said the managing pharmacist would come in on Sunday to fill the prescription.

The young woman called on Sunday to check on the prescription. The assistant store manager said the managing pharmacist hadn't been in and hadn't filled the prescription. The assistant store manager again asked if she could wait until Monday. She again said "no" and said that she either needed it filled or needed to have the prescription order back so she could fill it somewhere else.

The assistant store manager called the managing pharmacist who was out of town. He told the assistant store manager that if Noesen wouldn't fill the order that he should transfer it. The assistant store manager told Noesen this, but he still refused.

And the reason Mr. Noesen decided to refuse treatment:

Noesen said that the precedent for the case is what mattered to him-so that others could follow their conscience without fear.

"Conscience and worker rights are at the center of the issue, and conscience is at the center of humanity," said Noesen.

What patient? What patient's needs? In Mr. Noesen's world it's all about: Me, Me, Me!

In a more encouraging development, Oregon residents can now purchase birth control online [which makes one wonder, if this trend catches on, who'd be left as an experimental subject for the likes of Mr. Noesen]:

The service is limited to women who live in Oregon and have a credit card and access to a computer with Adobe Acrobat Reader. It requires paying a $35 fee, filling out a medical questionnaire and talking by phone with a nurse practitioner. The service makes three types of contraception available: birth control pills, the Ortho Evra patch and the NuvaRing device.