Judgment Day for Ralph's: The pharmacy board supports women's access to emergency contraception

author : Janet Blanding topic : Plan B | Ralph's / Bayview Thriftway

by Janet Blanding

A recent Board of Pharmacy decision to adopt new rules requiring pharmacies to fill all prescriptions means a different kind of Judgment Day is looming for the owners of Ralph's Thriftway Pharmacy.

Soon, the Pharmacy Board will be deciding what disciplinary action is appropriate for Ralph's, based on its flagrant refusal to conform to state pharmacy regulations. Ralph's Thriftway (along with its sister store, Bayview Thriftway) has been the object of a community boycott since July 2006, due to its refusal to carry emergency contraception, supposedly "for moral reasons."

In July 2006, nine complaints against Ralph's were filed by women whose prescriptions for Plan B emergency contraception were refused; resolution of these complaints is expected some time in May.

According to Lisa Salmi, Executive Director of the Washington State Board of Pharmacy, an investigation into the complaints against Ralph's has been concluded, and a member of the Board of Pharmacy is now reviewing the complaints prior to presenting them to the entire Board, which will make a decision on what disciplinary action is appropriate. The Board has the power to revoke Ralph's Thriftway Pharmacy's pharmacy license if they are found to be out of compliance with state pharmacy regulations.

A code the public can live with

Women's advocacy groups such as the Northwest Women's Law Center and naral, along with Governor Christine Gregoire, worked closely with the Board of Pharmacy to craft a "Pharmacist's Responsibility Rule," after a disastrous rule was proposed at the Pharmacy Board meeting of June 1, 2006. The rule would have allowed a pharmacist to refuse to fill any prescription for any reason. Most certainly, it would have allowed pharmacists whose religious leaders had duped them into regarding emergency contraception as an abortifacient to refuse to fill prescriptions for Plan B.

Although evangelical Christians and conservative Catholic organizations were delighted with this proposed rule, the majority of the public responded negatively, and the Board of Pharmacy received thousands of communications from the public, objecting to the proposed code.

Responding to this pressure, and with the assistance of the governor and women's advocates, new rules were devised, which were unanimously adopted on April 12, 2007, at the Board of Pharmacy meeting in Tumwater. This new code, which will allow a pharmacist or pharmacy tech to refuse to fill a prescription or to dispense a drug only if another member of the pharmacy staff can fill it on the spot, will take effect in mid-June.

Compliance with current stocking regulations

The newly adopted code does not require a pharmacy to stock emergency contraception; that is because stocking is required by existing code, and has been all along. The current code that requires pharmacies to stock an array of drugs to "meet the pharmaceutical needs of its patients" was the basis of the complaints filed against Ralph's, and has not changed.

The new code does, however, refer to the existing code, when it spells out expectations for pharmacies when they are unable to dispense medication to a patient due to "unavailability of drug or device despite good faith compliance with wac 246.869.150."

In these instances, the pharmacy is now required to contact the prescriber to obtain authorization to provide a therapeutically equivalent product. Where emergency contraception is concerned, the doctor may simply prescribe a large dose of regular birth control pills, which are exactly the same chemically, and therefore therapeutically, as emergency contraception. The Ralph's Thriftway pharmacy does stock levonorgestrel, the active ingredient in Plan B, in daily doses. It is unlikely, however, that Ralph's would be willing to comply with the new code, as they have clearly demonstrated over the last year their willingness to defy current regulations.

The Board of Pharmacy held a public hearing on March 29 to hear comments on the proposed code. As it was held on a workday at 9 am, it was difficult for ordinary working people to attend -- I was the only woman from Olympia who had filed a complaint who was able to show up and testify about my experience of being unable to fill a prescription for Plan B. The Archdiocese of Seattle, however, had rented a bus, and droves of anti-choice Catholics and evangelical Christians, mostly retirees, showed up to share their two cents' worth.

Many of them were more willing than able. There was some confusion over how to complete the sign-in sheets. So many of the rules' opponents erroneously indicated that they were present to support the new rules -- rather than oppose it -- that the hearing had to be stopped. Members and staffers of the Board of Pharmacy had to carefully explain the implications of the rules, and sign-in sheets had to be recirculated so that the bussed-in opponents could register correctly.

The new rules can be a little confusing, as they allow a pharmacist to step aside in filling prescriptions, but require the pharmacy to ensure that they are filled. (It should be noted that Plan B emergency contraception is now available to women 18 and over without a prescription, although its distribution is restricted to pharmacies. The new code covers both prescription drugs and devices, and drugs and devices whose distribution is restricted to pharmacies. The new rules apply to Plan B as well as medications that are sold only by prescription.)

Members of the public had trouble getting this straight, and several times members of the Board of Pharmacy were asked, "What box do I check if I support the pharmacist's right of conscience?" The new code was patiently explained several times, but the nuances were difficult for some hearing attendees to grasp, and grumbling was heard to the effect of, "They're trying to confuse us."

Existing code requires that Plan B be stocked

At one point, a confused emergency contraception opponent stood and asked, "What box do I check if I don't think the pharmacy should have to carry Plan B?" A Pharmacy Board staffer replied that the code under consideration did not specifically address the issue of stocking medications, because existing code already requires that a pharmacy stock emergency contraception if its clientele includes women of child-bearing age. The stunned anti-choicer expressed disbelief and indignation, but the staff member patiently maintained her position, and moved on to the next question.

Approximately 250 people were present at the hearing, where each speaker was limited to two minutes. My speech chiefly consisted of a list of women who were refused prescriptions for Plan B at pharmacies in Olympia and Lacey, a total of 17 incidents in all. My list was so long that I didn't have time to say much else.

What made it particularly satisfying to share this information was that three of the speakers who preceded me, speaking against the proposed code, had stated that the new code was unnecessary because there hadn't been any actual incidents of refusal at pharmacies. My list of nine women, four pharmacies, and 17 separate incidents of refusal, complete with names and dates, clearly refuted their contention.

Co-opting the language of the left

At the public hearing, I was seated next to a man who was seemingly opposed to the new rule on religious grounds. He applaud ed speakers who opposed the proposed code on religious and moral grounds and laughed loudly at their attempts at humor. However, when it was his turn to speak, religious objections to the new code were not discussed. Instead, he introduced himself as a pharmacist and pharmacy owner, and decried the new code as "discriminatory," complaining that it would have a "disparate impact" on small business owners such as himself, as he would be forced to hire other personnel to dispense emergency contraception when the pharmacist on duty was unwilling to do so on the basis of conscience. This tactic of co-opting the language of the left was reminiscent of the many speakers at the legislative hearings for the domestic partnership bills who complained that granting some rights to same sex couples amounted to discrimination.

Language is important. Opponents of emergency contraception have repeated the lie that emergency contraception is an abortifacient so many times that many people think that Plan B is the same as ru-486, or the "abortion pill." It is not; ru-486 works after a pregnancy is established, and is available only in clinics, while Plan B will not affect an existing pregnancy and is distributed without a prescription through pharmacies.

In a dismaying recent Supreme Court decision, a ban on late-term abortions was upheld. These abortions are often referred to in the media as "partial birth abortions," although that term has no meaning from either a medical or legal standpoint. The Supreme Court's majority decision showed a disheartening propensity to use right-wing phraseology to discuss abortion -- for instance, referring to a fetus as a "baby," and a "child."

It is important to be wary of the manipulative use of language surrounding choice issues: A d&x ("dilation & extraction") abortion is not "partial birth." Emergency contraception is not an "abortion pill." Requiring pharmacists to fill valid prescriptions -- in essence requiring them to do their job -- does not amount to "discrimination." Most of all, refusing to meet the pharmaceutical needs of women who need birth control, because of birth control failure or possibly because they were coerced into sexual activity, is not a "moral" act.