Religious Exemption Bill Could Leave LGBTQ Texans Scrambling for Health Care

About a quarter of Texas counties have two or fewer primary care doctors and pharmacists. What happens if they refuse service?

Published on Apr 30, 2019

Matthew Glass said the first red flag was when the pharmacist called across the room, loud enough for other customers to hear, “What’s the Truvada for?”

Truvada is the brand name for a common HIV medication — a fact the head pharmacist at a CVS in Montgomery County surely knew, Glass suspected. In a complaint filed with the Texas State Board of Pharmacy, Glass alleges the pharmacist violated his right to health care privacy by failing to “make my conversation with you confidential and private.”

“She didn’t call me some faggot or anything, but when the Truvada came up she braced — there was a definite reaction,” Glass said in an interview with the Observer. A 46-year-old former college theater professor who is gay, physically disabled and HIV-positive, Glass recently moved from Florida to a neighborhood near the pharmacy to be closer to his family.

From there, Glass said the interaction, which happened in late December, got even worse. He he received his Truvada prescription and medications for Parkinson’s disease, but said the pharmacist refused to fill the Klonopin and Xanax that he takes to control his seizures. Despite having a prescription for both from his doctor, Glass told the Observer the pharmacist said she would only fill one, based on her discretion. Glass took the Klonopin and hoped for the best.

In the complaint — filed with the state in February after a second attempt to fill the prescription failed — Glass alleges that the denial of his Xanax caused him to go into withdrawal, triggering more of the seizures that the medications were prescribed to treat and racking up subsequent medical bills. Complaints like these aren’t public, but Glass shared his with the Observer.

The board confirmed Glass’ case is still under investigation and declined to comment on specifics. Mike DeAngelis, senior director of corporate communications for CVS, said in a written statement that Glass’ allegations “are not true.”

“Due to our patient privacy policies and HIPAA, we cannot comment on a patient’s specific prescription,” DeAngelis wrote. “Generally speaking, our pharmacists consider a variety of factors when exercising their professional judgment as to whether or not to fill certain prescriptions.” He added that “discriminatory behavior of any type is strictly prohibited.”

Records show that both the specific pharmacy and the individual pharmacist, who has been licensed for five years, have no prior disciplinary actions from the state board. But that doesn’t mean Glass’ experience was unusual. LGBTQ folks are often the targets of discrimination in the health care industry. Those effects are exacerbated outside of major cities, where there’s an increasing shortage of providers.

Zoom to view county names. Lighter colors indicate fewer providers. Click here to view a spreadsheet of the data.

According to data obtained by the Observer from the Department of State Health Services, 72 Texas counties — more than 28 percent — had two or fewer primary care physicians practicing in 2018. Of Texas’ 254 counties, 13 had two primary care doctors, 25 had only one and 34 had none at all. Sixty counties had two or fewer pharmacists. And specialists are much harder to come by. For example, 154 counties didn’t have a single gynecologist or obstetrician, and 175 counties had no psychiatrist.

Now, conservative lawmakers are further complicating the rural health care landscape with a religious exemption bill that critics say specifically targets Texas’ LGBTQ population. Senate Bill 17, authored by state Senator Charles Perry, R-Lubbock, would prevent state professional licensing boards from taking adverse action against licensees who refuse service on religious grounds. More than 65 professions would be affected by the bill, including doctors, nurses, pharmacists, psychiatrists and other health care providers. First responders and others providing immediate lifesaving care are not covered by the bill.

“Simply put, if an [LGBTQ] person in a rural setting is discriminated against by their doctor — which religious exemptions may increasingly allow — it can effectively eliminate all health care options for that person,” concluded a recent report from the Movement Advancement Project.

Zoom to view county names. Lighter colors indicate fewer providers. Click here to view a spreadsheet of the data.

A 2017 survey by the Center for American Progress found that 41 percent of LGBTQ people living outside major cities said it would be “very difficult” or “not possible” to access comparable medical services if their local hospital turned them away. Advocates at the Transgender Education Network of Texas say it’s common for transgender Texans to drive one to three hours to access transition-related health care.

Cathryn Oakley, the state legislative director and senior counsel for the Human Rights Campaign, told the Observer that the religious exemption bill could magnify a serious problem.

“There are certainly some hospitals that have great nondiscrimination policies for patients, for visitors, for staff, and maybe you’re fortunate enough to live within driving distance of one of those places,” Oakley said. “But if you’re hit by a car, the ambulance picks you up and takes you wherever they take you. You don’t get to choose — you’re at the mercy of the caregivers there.”

Perry’s office did not respond to multiple requests for comment, but in Senate floor debate he was adamant that his intent for SB 17 wasn’t to encourage discriminatory behavior.

Still, many critics — including LGBTQ groups, two dozen major companies and chambers of commerce from across the state — say the bill would cause tangible harm outweighing Perry’s age-old First Amendment argument.

“It’s boggling to me that people think that their ability to practice their religion translates into their ability to harm other people or oppress other people’s equal right to exist and access the same world that they do,” said Emmett Schelling, the executive director of the Transgender Education Network of Texas. “Where’s the part where people get really zealous about loving their neighbors?”

While SB 17 and similar bills steadily work their way through the Legislature, Glass is on a crusade. In addition to his complaint to the State Board of Pharmacy, he’s written scathing letters about the incident to U.S. Senator Ted Cruz, the Better Business Bureau and others. Because SB 17 is still just a proposal — and the Texas State Board of Pharmacy’s investigation isn’t public — there’s no way to know if the pharmacist’s refusal had a religious motivation. In the complaint, Glass claims she violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and her profession’s best practices by acting in a “homophobic” way.

The state board receives nearly 6,000 complaints each year; approximately 600 of those complaints result in disciplinary action.

“If an [LGBTQ] person in a rural setting is discriminated against by their doctor — which religious exemptions may increasingly allow — it can effectively eliminate all health care options for that person.”

Earlier this month, Glass went back to the same CVS in an effort to fill his prescriptions. He’s transferred most of his prescriptions to another pharmacy, but two are still active at CVS. I went along. The pharmacy manager at the center of Glass’ complaint wasn’t there.

The pharmacist working that day found the two prescriptions, but said that her supervisor instructed her not to fill them. Glass became frustrated. His voice got louder as he demanded a full explanation.

Before Glass was escorted out of the store by another employee for being “disrespectful,” the pharmacist told him: “I wasn’t here, I don’t know what the interaction was. I was just told that we are no longer a pharmacy that can provide for you.”