Thursday, January 13, 2011

Walgreens Doesn't Confirm Nor Deny Corrective Action in Prescription Refusal Incident

Posted By on Thu, Jan 13, 2011 at 9:30 AM

Methergine (methylergonovine maleate) is a semi-synthetic drug used for the prevention and control of hemorrahaging of the uterus following childbirth or an abortion.

Structural formula of Methergine
  • Structural formula of Methergine

On November 6, 2010 a nurse practitioner called in a prescription for methergine to a Nampa Walgreens. What happened next resulted in a formal complaint and an investigation by the Idaho Board of Pharmacy.

You can read the full letter of complaint from the nurse practitioner—who is employed by Planned Parenthood of the Great Northwest—after the jump.

"To the best of our knowledge the Idaho Board of Pharmacy has not taken any adverse action against Walgreens or the pharmacist," Tiffany Washington, a spokesperson at Walgreens corporate offices in Illinois, told Citydesk this morning,

When asked what, if any, disciplinary or corrective action was taken by Walgreens, Washington said, "I can neither confirm nor deny any corporate action. It's our company policy not to comment."

November 17, 2010

Ms. Jan Atkins
Senior Compliance Officer
Idaho Board of Pharmacy
PO Box 83720
Boise, ID 83720-0067

Dear Ms. Atkins,

On November 6, 2010 I contacted the Walgreens pharmacy located at 932 Caldwell Blvd., Nampa, Idaho in order to call-in a prescription for Methergine. I am a nurse practitioner at Planned Parenthood of the Great Northwest’s Boise heath care center, and the prescription was for one of my patients. As you may know, Methergine is commonly used to prevent bleeding from the uterus following childbirth or an abortion, as treatment for an enlarged uterus, miscarriage management, to help deliver the placenta after childbirth, and as a migraine treatment.

I spoke with the female pharmacist on duty at approximately 2pm (unfortunately I did not get her name). The pharmacist asked for our center phone number and the name of our health center. I provided that information. The pharmacist then asked if the patient had undergone an elective abortion. In keeping with the standards of conduct outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I refused to breach my patient’s confidentiality by answering her question. The pharmacist then stated that if the patient had an abortion, she would not fill the prescription. I again referenced HIPPA, and I informed her that Methergine is not an abortifacient and it serves multiple purposes in post-partum care. I asked that she refer me to another pharmacist to fill the prescription, and she hung up.

I believe a complaint is in order for three reasons. First, the pharmacist asked that I breach my patient’s confidentiality. Patient privacy is not only a requirement of the law, but it is also the bedrock of patient-provider trust. Lack of trust and privacy can only negatively impact health outcomes and standards of care. Nor is it necessary for a pharmacist to know for what purpose a drug is being prescribed. As a trained practitioner and a licensed nurse, I am fully capable of determining treatment regimens that are appropriate to the medical condition at-hand and ensuring that those regimens do not negatively interact with concurrent prescriptions. The pharmacist’s request was therefore both unlawful and unnecessary.

Secondly, I believe the pharmacist wrongly applied the conscious protections outlined in Idaho Code § 18-611 in refusing to dispense Methergine. Section § 18-611 of Idaho code does allow medical professions to refuse to provide health care services that conflict with their “religious, moral or ethical principles.” However, “health care services” is defined in section § 18-611(f) as “an abortion, dispensation of an abortifacient drug, human embryonic stem cell research, treatment regimens utilizing human embryonic stem cells, human embryo cloning or end of life treatment and care.” Methergine does not fall within that definition. Thus, it would seem the pharmacist had no grounds on which to refuse to dispense the medication.

Lastly, not filling the prescription could have placed my patient in grave danger. The medication was prescribed to prevent a potentially life-threatening situation from taking place. Had I not been able to find a pharmacist to fill the prescription, I would have had to refer my patient to a local hospital for emergency care. Simply filling the prescription would have ensured my patient’s heath and prevented the need for a burdensome and costly trip to the emergency room.

I would appreciate your prompt attention to this matter, and please keep me informed as to the outcome of this complaint.

Sincerely,

Nurse Practitioner
Planned Parenthood of the Great Northwest
1109 Main St, Ste 500
Boise, ID 83702

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