Reprimand advised for pharmacist
Beliefs, duties clash; he refused to fill birth control order
By STACY FORSTER
[email protected]
Posted: Feb. 28, 2005
Madison - In a case that highlights the clash of religious beliefs and legal responsibilities for medical professionals, a judge recommended Monday that the state reprimand and limit the license of a pharmacist who refused to refill a young woman's prescription for oral contraceptives.
The case has garnered international attention. Christopher Klein, executive assistant at the Department of Regulation and Licensing, said media organizations from as far away as the United Kingdom were seeking updates about the situation.
Baird found that Noesen "fell far short of satisfying the standard of care" outlined in the code of ethics for pharmacists, and he hadn't done enough to ensure that the patient had another way to have her prescription filled.
"(Noesen's) testimony gave the distinct impression that satisfying his own moral code was his only concern," Baird wrote.
Wisconsin is one of 47 states with a law that allows health care providers to refuse treatment on moral grounds, but pharmacists aren't included in those protections here, according to the National Abortion and Reproductive Rights Action League. Wisconsin was, however, among 19 states that considered measures last year to allow health care entities or providers to refuse on religious grounds to provide contraception or other pharmaceuticals.
More battles likely
Decisions like those recommended by Baird will help more "conscience clauses" to protect pharmacists become law, said Karen Brauer, president of Pharmacists for Life International, a Powell, Ohio, organization that protects refusal rights of pharmacists.
"This is a real problem," Brauer said. "We've got judges practicing medicine without a license."
Kelda Helen Roys, executive director of NARAL Wisconsin, said the recommendation makes it clear that Noesen had violated the code of ethics and puts the safety of patients ahead of the principles of providers. She agreed with Brauer that recommendations like those in the Noesen case will embolden those who want to provide moral protections for pharmacists and other health care providers.
"It's the next step because abortion has been so drastically restricted, that now (abortion opponents) are moving on to other goals," Roys said. "This is the kind of thing where you have huge public outrage when you find out a pharmacist gets to inject personal morality into a relationship between doctor and patient."
The Wisconsin case stems from an incident in July 2002, when Noesen was working a Saturday shift as a freelance pharmacist at a Menomonie Kmart pharmacy. He refused to fill a prescription for contraceptives for University of Wisconsin-Stout student Amanda Phiede.
At an October Department of Regulation and Licensing hearing, Phiede and Noesen testified that he asked her whether she was using the drug for contraception, and she said yes. That's when he refused to fill the prescription, both said.
Noesen said at the hearing that he had told the agency that placed him that his Roman Catholic beliefs prevented him from dispensing contraceptives because he didn't want to commit a sin.
Phiede left Kmart and went to a nearby Wal-Mart pharmacy to have the prescription filled, but Noesen refused to transfer the prescription to another pharmacy. Despite trying again that Sunday to have the prescription filled, Phiede had to wait until another pharmacist returned to the store Monday, meaning she missed one of her doses.
An attorney for Noesen didn't immediately return calls for comment. The department represented Phiede in the proceedings and she didn't issue a comment, said Klein of the Department of Regulation and Licensing.
Restrictions recommended
In addition to the reprimand, Baird recommended that Noesen's license be subject to certain conditions. Before working at any pharmacy, Noesen would have to prepare a written notice specifying which practices he won't perform, as well as the steps he would take to ensure that a patient has access to necessary medications. The notice should be provided to an employer five days before starting work, Baird said.
Baird also concluded that Noesen should spend six hours in ethics education and pay the cost of the proceedings against him. Klein said those costs haven't been calculated yet.
Brauer said she and other pharmacists who refuse to perform certain practices already make it a habit to inform employers about their objections.
State Rep. Carol Owens (R-Oshkosh) is working on a bill to protect pharmacists from losing their jobs because of religious or moral beliefs; it is expected to be introduced this spring.
"The employer in this case was asking him to do something that was against his moral convictions, and no one should lose a job because of that," Owens said.
Chris Taylor, political director of Planned Parenthood of Wisconsin, said she expects that attention about the Noesen case will bolster opposition to the "conscience clause" in Wisconsin. With Republicans controlling both houses of the Legislature, however, she acknowledged it will be tough to defeat those types of measures.
"There's a very real chance these bills will pass even though there's enormous public opposition," Taylor said. "This will heighten some awareness and put some pressure on the Legislature to take action that will protect patients and not leave them vulnerable."
AGH! Unbelievable!
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