Walmart is denying that a Georgia store refused to fill a prescription for a miscarrying woman because the drug, misoprostol, is also used in medication abortions. A Walmart spokesman says that the pharmacist refused to fill the prescription because she “believed that it was not medically indicated because it wasn’t FDA-approved” for miscarriage management.
That’s a bullshit excuse and I don’t believe it, but first, the facts: on April 9, Brittany Cartrett posted a public status update to Facebook saying that she’d just been denied miso at a Milledgeville, Georgia, Walmart, one of two pharmacies that refused to fill the prescription. (Ironically, Cartrett also says she used to work at the Milledgeville store.)
Cartrett wrote that she’d learned she was pregnant in March. “At the first ultrasound we knew immediately that baby#2 was not progressing like he/she should be,” Cartrett wrote. “And after going to the doctor every week since then, we finally were able to confirm I miscarried, probably around 5-6 weeks. After discussion with my Doctor, we decided to go the less invasive route and choose a medicine that I could take at home to help miscarry naturally, especially since my body wants to hold on to the little miracle.”
In other words, rather than having a dilation and curettage (a D&C, the same method using many early abortions) to get the fetal remains out of her uterus, Cartrett’s doctor was recommending that she take miso instead to gently pass the tissue.
Her pharmacist had other ideas. From Cartrett’s note:
I get a phone call from the doctor stating that the #Walmart in Milledgeville, GA(yes the one I used to work at) doesn’t feel comfortable with filling this prescription. She was going to call and figure out what is going on and call me back. Well about 5 minutes later she calls and says, “They won’t fill it. They won’t tell me why. But they won’t fill it.” So we find another place to fill it and I thank her. ....They WON’T fill it. Not that they CAN’T. But they WON’T. Now, I have another prescription there that I have to get. So I go up to Walmart and I get my prescription and the #Walmart pharmacist comes to me for my consultation and asks If I have any questions. I tell her yes, but not about this one. I ask her why they refused to fill the other prescription I had. She looks at me, over her nose and says “Because I couldn’t think of a reason why you would need that prescription.” ..... Excuse me?! I tell her my reasons for needing it, and she says “Well, I don’t feel like there is a reason why you would need it, so we refused to fill it.” I said “Well ma’am, it’s not your job to know what I need or don’t need. It’s your job to fill a prescription. The job of knowing what I need or don’t need is between my doctor and myself. I shouldn’t have to come up here and explain myself or why I need any kind of medication.” After a few more comments, I thanked her for my other prescription and walked away.
Cartrett believed the drug was being denied to her because the pharmacist believed she was using it for an abortion: “Listen, the pill is a pill to assist with abortions. I get it,” she wrote. “Make your judgement lady. But she didn’t know the whole story and didn’t need to know the whole story. Who was she to judge me on what I needed.”
Walmart spokesperson Brian Nick told MSNBC that Cartrett was denied because miso isn’t FDA-approved for miscarriages. “The pharmacist exercised professional judgment about the medication and chose not to fill the prescription, and reached out to customer’s doctor and shared that information,” Nick told MSNBC. “This was not a conscientious objection.”
Except, according to Cartrett, the pharmacist didn’t actually explain that she believed it wasn’t “medically indicated.” She didn’t ask why Cartrett needed it or if she understood how it was used or offer an alternative. If Cartrett’s account is accurate, she just said, “I don’t feel like there is a reason why you would need it.”
But it does look like Walmart spokesman Brian Nick is right that the pharmacist wasn’t invoking the “conscience clause” that six states have in place to allow pharmacists to refuse to refill prescriptions on moral grounds. That’s because the conscience clause is really only supposed to apply to emergency contraception, although it’s also often used for abortion drugs.
So did the pharmacist have any actual right to refuse? Besides the conscience exception, which seems to cover a wide variety of sins, the Code of Conduct for Georgia pharmacists, part of the official and legally binding rules and regulations for the state, does give them room to refuse a prescription if they believe it contains any “error, omission, irregularity or ambiguity.” The pharmacist is supposed to “contact the prescriber and confer with him/her before dispensing the prescription.”
Instead—again, according to Cartrett’s account—the pharmacist simply called the doctor and said she was refusing to fill it. That’s not “conferring.”
Finally, there’s the pharmacist’s claim that miso isn’t approved by the FDA for miscarriages. That is true; in fact, it’s only technically approved for the prevention and treatment of gastric ulcers. But the FDA is well aware that miso is being prescribed for abortions and miscarriages, and has said in the past that it’s fine for doctors to prescribe it off-label that way at their discretion. As Mother Jones’ Molly Redden points out, the American College of Obstetricians and Gynecologists says miso is safe and effective for passing fetal tissue before 12 weeks of pregnancy, bringing on a complete miscarriage about 80 percent of the time within 24 hours. ACOG calls the risks of the drug “minimal.” Several clinical studies have also concluded that miso is acceptable to use for early miscarriages, as long as the woman doesn’t have an IUD in place or a bleeding disorder.
The unnamed pharmacist is unlikely to face any actual consequences for refusing the drug, besides a little bad press (nothing Walmart isn’t used to). And this incident shows that despite medical wisdom, common sense, professionalism and basic human decency to the contrary, pharmacists in conscience clause states can do pretty much whatever they want and get away with it. Cartrett was eventually able to fill her prescription, but the next woman may not be so fortunate.
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