06-27-2005, 07:45 AM
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Doctors want right to dispense medications
AMA: Physicians Charge Pharmacists With Interference in Medical Care
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CHICAGO, June 20-The American Medical Association's policy-making body voted today to press for state laws that would allow physicians to dispense medications when there is no nearby pharmacist willing to dispense the prescribed drugs.
The new AMA policy is an attempt to overcome what doctors say is a stampede of pharamacists who say they cannot in good conscience dispense certain medications. The issue of conscientious refusal was first raised when some pharmacists refused to fill prescriptions for the emergency contraception pill, called Plan B. Additionally some pharmacists refused to fill prescriptions for birth control pills.
But AMA delegates say the conscience-based refusals have now spread to psychotropic drugs and pain medications.
The new AMA policy states that doctors should be allowed to dispense medications when there is no "willing pharmacist available within a 30 mile radius." That change would require change in state laws regulating both doctors and pharmacists.
The AMA House of Delegates' action went beyond initiatives that had been discussed at reference committee hearings.
The doctors say that many pharmacists compound their refusal to fill prescriptions by not returning the unfilled prescriptions to patients, thereby stymieing efforts to turn to other pharmacists.
"It's not just contraceptives," said Mary Frank, M.D., a family physician from Mill Valley, Calif., during a discussion of the issue. "It's pain medications and psychotropics. And not only are the patients not getting prescriptions filled, but pharmacists are refusing to return the prescriptions and they are lecturing the patients about the drugs."
In response a coalition of medical specialty groups including the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Medical Women's Association, and the Michigan State Medical Society is asking the AMA to press pharmacists to follow ethical guidelines for delivery of healthcare.
The American Pharmacists Association has policy that recognizes an individual pharmacist's right to exercise conscientious refusal and "supports the establishment of systems to ensure patient's access to legally prescribed therapy without compromising the pharmacist's right of conscientious refusal."
Physicians say that language means that pharmacists must "refer patients to other pharmacists who are willing to fill the prescriptions" just as doctors are ethically required to refer patients they are unwilling to treat, said William Golden, M.D., a Little Rock Ark., internist. Dr. Golden pressed the case for AMA action Sunday during a reference committee hearing on the issue.
Several physicians testified that conscientious objection first became an issue with contraceptive prescriptions, especially prescriptions for emergency contraception; the so-called morning after pill called Plan B. But now, they said, the phenomenon has now expanded well beyond contraceptives.
And doctors say that pharmacists are winning support in state houses with 14 states already considering legislation aimed at protecting pharmacists' right to refuse to fill prescriptions based on religious, personal or moral grounds and nine more states in the process of enacting legislation that would allow pharmacists to refuse prescriptions "for any reason."
The AMA House of Delegates, the organization's policy-making body, is expected to vote today on a series of proposals that would require the AMA to mount a lobbying effort to "guarantee patients' access to legally prescribed and medically indicated therapy."
The American Pharmacists Association did not respond directly to the doctors' concerns. Kristina Lunner, director of federal government affairs, said the organization has received no complaints about pharmacists refusing to refer patients or refusing to return prescriptions that the pharamacist refuses to fill.
In a statement issued several weeks ago, however, in response to a critical editorial in The New York Times, the pharmacists' group said:
"Pharmacists, like physicians and nurses, should not be required to engage in activity to which they object. But supporting a pharmacist’s ability to step away from objectionable situations does not require a confrontation with the patient...
"Our organizations support the two-part policy stressing the need to assure patient access to legally prescribed, clinically appropriate therapy in a timely manner when a pharmacist steps away from working with a prescription based on personal beliefs. Pharmacists must not use their position to berate, belittle or lecture their patients -- our organizations oppose such action. Pharmacists must not obstruct patient access to therapy -- our organizations oppose such activity."
Ms. Lunner said pharmacists' organization has no mechanism to censure pharmacists who refuse to refer patients or refuse to return any prescriptions that the pharmacist concientiously objects to filling. She said such complaints are referred to the state licensing board.
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It seems that the recent wave of pharmicist refusals to fill some prescriptions is having a backlash. Doctors are seeking the right to dispense "controversial" drugs themselves. Good idea or bad?
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