Waging a moral battle from behind the counter Pharmacists' refusal to fill contraception prescriptions Prompts the question: Whose choice is it to make?
By Katie Fairbank
The Dallas Morning News
FABENS, Texas - Steve Mosher's Medicine Shoppe pharmacy is inside a grocery store on one of the two main streets in this small town set amid West Texas scrub. It's the only place where residents can locally fill their prescriptions.
Fabens may be miles from nowhere, but it is smack in the middle of the nation's decades-long fight over reproduction and contraception. Last year, Mr. Mosher decided he'd had enough. He joined the growing ranks of pharmacists refusing to dispense birth control because of moral objections. "I'm a Christian, and I believe that abortion is taking the life of an innocent human being," said Mr. Mosher. Because birth control pills could keep a fertilized egg from implanting, he opposes them, too. "I look at that, that's the same thing as abortion. I know there are a lot of people that don't agree with me, but that's the way I see it," he said. More than three decades after the Supreme Court held that it is a woman's constitutional right to have an abortion, the fight rages on. Now, it's moved into the local drugstore. "This is absolutely a new way to keep women from having access to contraception," said Susan Hays, a Dallas lawyer who has represented minors seeking judicial approval of abortions. "I hear more of this idea from the right wing more and more. It stems out of their concept of when life begins." On one side of this latest battle are pharmacists who refuse to fill prescriptions for birth control on ethical and religious grounds. They particularly oppose such medications as the "morning-after" pill, an emergency contraceptive that can prevent fertilization if taken within 72 hours of unprotected intercourse. An organization known as Pharmacists for Life International, with 1,600 members, urges its members to refuse filling such prescriptions. On the other side are reproductive-rights groups pushing for access to the drugs. And there are others concerned that pharmacists might refuse to dispense a wide range of prescribed medicine, not just birth control. Last year, a Dallas pharmacist refused to fill a child's prescription for Ritalin. "There's a lot more to this than just a reproductive issue," said Julee Lacey, who was denied a birth control prescription by a North Richland Hills pharmacist in March 2004. The month before, a Denton pharmacist denied emergency contraceptive to a rape victim. In that case, the pharmacist and two co-workers were fired for violating policies of the store (an Eckerd, which is now owned by another company). The incident has inspired bills in several states meant to shield pharmacists from losing their jobs if they refuse to prescribe emergency contraception. Ms. Lacey, 33, a mother of two, was unaware of this growing national debate when she went to the CVS drugstore near her house where she regularly filled her birth control prescription. "I pulled up to the drive-through and a pharmacist assistant took the prescription and said it would be ten minutes. It was a Sunday, and I was getting ready for the work week," said Ms. Lacey, 33. "A woman came to the window and said she couldn't fill the prescription." At first, Ms. Lacey thought that something was wrong with the paperwork or that the store was out of the drug. Instead, the pharmacist told her that she didn't believe in birth control. "She said I could go down the street and they could help me," Ms. Lacey said. "She didn't know my medical history. The pharmacist had no idea why I was even taking the birth control pill. I went home and talked to my husband, and he couldn't believe our doctor's prescription could be denied." Ms. Lacey decided to call the company, which ultimately filled and delivered her prescription late the next day. But that hasn't ended the issue for her. Instead, she's gone public with her concerns. "I'm not anyone's spokesperson or any organization's. I just think it's important for anyone to get a prescription from a licensed doctor," she said. "Most people have a prescription at a pharmacy and don't think twice about getting it filled. It's a much bigger issue than women's health. I put my trust in my doctor. It's a matter of the patient-doctor relationship. I don't think a pharmacist should be jumping in the middle." CVS spokesman Mike DeAngelis said it is the company's policy to fill prescriptions for all legally prescribed medications. But, "if a pharmacist wanted an accommodation for a sincerely held religious conviction, we would work to accommodate that pharmacist while ensuring that all customer needs are promptly and completely satisfied," he said in a prepared statement. National group's stance That policy is in line with the American Pharmacists Association. The group, which has 50,000 members, says druggists can refuse to fill prescriptions on moral grounds, but they must make arrangements for a patient to get the medication. But that's not always easy for small-town America. There are 6,093 licensed pharmacies in Texas and mail-order options, but it's a big state with 199 towns that have only one drug store. And those often have only one pharmacist. "If somebody wants to get emergency contraception filled and they go to the one pharmacy and are refused, she then has to go 30 to 50 miles to the next town and just hope she can get the prescription filled in the time frame she has left," said Tony R. Thornton, president and chief executive of Planned Parenthood Association of LubbockInc. "Not everyone has transportation, you know." The problem can be further exacerbated because many stores, including national chains, don't offer all forms of birth control. The morning-after pill is frequently not offered. Large retailers Wal-Mart Inc., one of the nation's largest pharmaceutical chains, doesn't stock it and there are 10 towns in Texas in which Wal-Mart is the only pharmacy. "We do not carry emergency contraceptives, said Wal-Mart spokeswoman Jacquie Young. "It's based on business factors. We have to refer our customers to another pharmacy in the community that can help them in a timely manner just as we do other drugs we do stock." Ms. Young declined to say what went into the decision not to sell emergency contraceptive or whether the retailer could make money on the drug. "It's not political or moral. We carry over 100,000 products every day, and our merchandising teams decide what we carry," she said. National chains deciding against carrying a drug exacerbates the problem of accessibility for women who need it within a short time frame, said Ms. Hays. "The pro-life movement has been very smart about pressuring corporations," she said. "If you pressure Wal-Mart out of the business and you take the money [away] from Planned Parenthood, many poor women will have no access to contraception, and they won't have access to emergency contraception." Mr. Thornton isn't convinced politics has no role when companies decide not to carry contraceptives such as the morning-after pill. "It feels like it's against birth control and women's reproductive rights," he said. "I can almost guarantee you those same pharmacies wouldn't have an objection to Viagra." Mr. Mosher, the Fabens pharmacist, bristles at that suggestion. "I don't see how that could possibly be related to the issue that we're talking about," he said. Mr. Mosher owns the store and said it was his personal decision to stop selling birth control, although he has discussed it with his wife, daughter and two sons. "My wife is unsure, but that's her prerogative. My kids appreciate my taking a stand for my beliefs. I've had a lot of people who don't agree with my opinion, but they understand that I should be able to have the right to make a stand on a moral issue in my own business. I shouldn't be forced to dispense birth control pills if I choose not to," he said. Mr. Mosher's decision has had a financial consequence. He had been filling about five or six prescriptions a day. "It made a huge difference because they would get their other prescriptions somewhere else too. I assumed that would happen, and it did. But enough business has come back," he said. Visitor angered Then last July, an El Paso woman visiting Fabens tried to fill her birth control prescription, and Mr. Mosher said no. She was angered by his refusal, Mr. Mosher said, and she and her husband told a television station in her hometown. "I'd been doing this seven or eight months or longer, and only a few people had said, 'Gosh, this is inconvenient,'" he said. "They threw a fit, and they weren't even people who live there." Few people in the town of 8,000 seem aware that his pharmacy doesn't sell birth control medications, emergency contraceptives and condoms. "I think a lot of people don't know about it," said Jessica Porras, 20, who was shopping at the grocery store this week with her 18-month-old daughter, Audrey Ortiz. "Most of the people are Catholic, and they don't believe in birth control." Those who do drive the 27 miles to El Paso to pick up their prescriptions. Or they head to nearby Mexico. "I have a lot of friends that go across the border and get them cheaper," said Ms. Porras. Andrea Bustamante, 20, who had her baby, Abigail, 14 months ago, said she once asked for birth control pills at the Medicine Shoppe pharmacy and was told Mr. Mosher didn't carry them. She didn't realize then it was because of a moral belief, and she doesn't care now. "I don't see it as a big deal. It's his own religious belief. That's his prerogative," she said. Twenty-three-year-old Carlos Morales said the lack of a local source for birth control pills might explain why his friends use condoms. They can be bought locally at two Good Time convenience stores within a mile of each other. And they're one of the more popular items sold. "We sell a lot of them - especially on Fridays," said Frank Cardenes, 19, a clerk at one of the stores. "We have to reorder every week." Eileen Lopez, 31, was shopping in the convenience store this week and said the whole subject is too touchy for such a small town to handle. "Nobody wants any trouble," said Ms. Lopez, a deputy for the El Paso County Sheriff's Department. "Everybody knows everybody from generation to generation. We don't talk about birth control with our Catholic upbringing." Still, she believes a pharmacist's responsibilities is something that residents should talk about. "I think that a professional such as a pharmacist has to have a stake in his profession and separate it from his beliefs," she said. "It's really not up to them to decide what we need as far as medication is concerned."
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