Michigan pharmacist refuses medicine to woman having miscarriage

Kristen Jordan Shamus | Detroit Free Press

Show Caption Hide Caption Michigan pharmacist refuses medicine to woman having miscarriage Michigan pharmacist refuses medicine to woman having miscarriage

An Ionia woman is demanding that Meijer discipline a Petoskey pharmacist and implement a company-wide policy for how pharmacists should handle religious and moral objections to dispensing medication after she was denied a prescription to help complete a miscarriage.

Rachel Peterson, 35, alleges a pharmacist at the Meijer store on Lears Road in Petoskey refused to fill her prescription for a drug called misoprostol (brand name Cytotec) in July because of his personal religious views. She says he also refused to transfer the prescription to another pharmacy.

Misoprostol can be used to prevent stomach ulcers and also can be used to induce labor during pregnancy, to aid in the completion of a miscarriage and in the treatment of postpartum hemorrhage. When combined with another drug, it can be used to induce an abortion.

The American Civil Liberties Union of Michigan sent a letter Tuesday on Peterson's behalf to Meijer, saying what the pharmacist did was discriminatory and violated the state's public accommodation laws.

"I think it’s very clear in this case that had Rachel been a man seeking this exact same medication for stomach ulcers, she wouldn’t have been turned away for the same reason," said Merissa Kovach, a policy strategist for the ACLU of Michigan. "So Rachel was denied this based on the personal beliefs of this pharmacist and then also because she’s a woman.

"Unfortunately in Michigan, we don’t have an explicit state law that goes so far as to protect patients like Rachel," she said. "What we would hope is that Meijer and other pharmacies would agree that they’re allowed to accommodate the personal beliefs of their employees, but that accommodation cannot include permitting discriminatory denials of care that burden patients and customers.

"Any customer should be able to expect the same service regardless of who they are and what their prescription is."

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Meijer spokeswoman Christina Fecher declined to comment on what happened to Peterson because of health privacy laws, but did say the company "works hard to support all of our pharmacy customers' needs."

"We recognize the right of a pharmacist to abstain from filling a prescription based on his or her religious beliefs, but the pharmacist is required to have another Meijer pharmacist fill the prescription or, if no other pharmacist is available at that time, to transfer the script to another pharmacy convenient to the customer. This is consistent with guidelines spelled out in the American Pharmacists Association policy manual."

Fecher did not say whether the pharmacist still works at the store or whether he has been disciplined.

The miscarriage

Peterson recalls an emotional roller-coaster that began earlier this year, when she and her husband, Robby, decided to start trying to have a baby.

"We were trying," she said. "This was our first time. This year, we decided that we were going to try, and it happened. ... It was very exciting, and I was nervous. There was a whole range of emotions."

Complications soon followed, and Peterson found herself in the emergency room in June. There, she was told she had been about nine weeks pregnant with twins, but had miscarried one. The other fetus, the hospital doctors told her, was a molar pregnancy and not viable.

Distraught by the news, Peterson followed up later that day with her obstetrician.

"I had another scan, and they said ... I had a bicornuate uterus and because of where the sac was, that it was not viable and that I most likely would never be able to have kids. They were sending me to the University of Michigan to be evaluated because if I continued the pregnancy, it would be life-threatening for me."

She and her husband went to Ann Arbor. Peterson's mother, Nancy Bianchi, met them there.

After more tests and evaluations, she learned that her uterus was not abnormal, her life was not at risk, and that her pregnancy was still viable — but there was a complication. A large blood clot had developed near the fetus.

"Pregnancy-wise, I was fine. I was just at a higher risk for miscarriage due to that large blood clot there," she said. "So it was an emotional, exhausting day, that’s for sure."

She was buoyed by the news that she was still pregnant, and that there was still a chance she could have a healthy baby.

Nearly two more weeks passed.

"I had really bad morning sickness and was really fatigued, and then one day it all just went away," she said. "I thought it was alarming."

She went to her obstetrician to get checked out.

"They did a viability scan and unfortunately, there was no detectable heart rate," she said. The fetus had died.

Options for miscarriage

Peterson's doctor laid out three options:

Wait and see whether her body would be able to completely miscarry without any intervention.

Try the drug misoprostol to help move the miscarriage along.

Schedule a procedure called dilation and curettage, which is commonly called a D&C, to surgically empty the uterus of any remaining fetal tissue.

She chose the least invasive option, and wanted to see what her body could do on its own. When the process took longer than expected, her doctor prescribed the misoprostol to ensure that Peterson would complete the miscarriage and wouldn't develop an infection.

For women who don't completely miscarry, there is a risk of developing an infection called sepsis, which is dangerous and can be fatal.

Peterson and her husband were in Petoskey when she tried to have the prescription filled, on a weekend getaway to try to grieve the loss of their pregnancy.

Just as they were about to go to the store to pick up the medicine, Peterson said she got a call from the Meijer pharmacist.

"He said that he was a good Catholic male and that he couldn’t in good conscience give me this medication because it’s used for abortions, and he could not prescribe that," Peterson said.

"When I divulged to him that the fetus was no longer viable, and that ... I needed to progress the situation further, he said, 'Well, that’s your word and I don’t believe you,' and he refused to fill it."

Peterson said she asked him whether he could transfer it to another local pharmacy and he refused.

"I was really upset. I was angry too," she said. "When you’re at one of the lowest moments in your life, you don’t think someone would do that to you — especially to call you a liar and not be understanding or empathetic at all."

She called her hometown Meijer pharmacy about three-and-a-half hours away in Ionia to see whether the pharmacist there would be willing to fill the prescription for her. He had difficulty retrieving the prescription from the Petoskey store, but was finally able to do it.

"He was wonderful," Peterson said. "He was super supportive, and he said he would do everything he could to get the script for me. And if he had to, he would call my OB to get it filled."

The Petersons packed up their things, ended their trip to Petoskey and drove home to Ionia to get Rachel's medicine.

"There was really no reason for him not to give it to her, regardless of the situation," Robby Peterson said. "In my opinion as a pharmacist, it’s his job to prescribe meds. If he had an issue with anything, then he should have called the doctor first to get the story.

"I was pretty upset."

Pharmacist denies medicine, causes harm

Rachel Peterson called her mom, Nancy Bianchi, 57, of Clinton Township and tearfully told her what happened.

"She called me sobbing, just sobbing, and said he wouldn’t fill the prescription," Bianchi said. "And so I listened to her, and the whole time, I was trying to be calm, being her mother, and I told her it would be OK, and to try to get her doctor to call it in to another place. While I was talking to her, I was Googling the Meijer pharmacy phone number. I was seething.

"I said I would call her back in a little bit. The minute I got off the phone with her, I called the pharmacy."

She spoke to the pharmacist who'd just refused to dispense her daughter's prescription.

"I said, 'I don’t think you have any idea of what you just did to my daughter.' ... To be honest, I went off on him," Bianchi said.

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He tried to tell her he didn't know Peterson had miscarried, and explained to Bianchi how the drug is commonly used.

"I said, 'It’s not your job to know the full story. Your job is to be a professional and fill a prescription,' " Bianchi said. "A medically licensed doctor gave you a prescription to fill, and you have absolutely no right. ... If you, who call yourself a Christian, decided that you could not do this, then you needed to pass it off, as the law states, to somebody that could fill it.

"All you had to say was I’m transferring this to another pharmacy. For you to put your judgement into it, has no place. … for you to call and give her a sermon about this, when you knew nothing about what was going on."

Bianchi complained to a manager at the Petoskey store, and said she also asked to speak to someone in human resources.

"Rachel was not only going through the worst thing in her life, but he was judging her and making her feel bad about that. She needed to get that medication. She was in such a fragile state, and had gone Up North to just try and grieve what was happening, and for him to have treated her that way was just terrible."

By telling Bianchi details about the medication Peterson was prescribed and discussing her case, the American Civil Liberties Union of Michigan alleges the pharmacist also broke health privacy laws.

"That really upset me, too," said Peterson, who works as a cardiovascular sonographer. "Being in the medical field, that is an absolute no. You cannot talk to anybody about it without their consent and permission. What if it was someone posing as my mother? He had no idea."

How common is medication denial?

It's difficult to say how many other women like Peterson are denied medication to help them complete a miscarriage because of a religious or moral objection of the pharmacist, Kovach said.

"We do know anecdotally that pharmacy refusals are common and that they happen often," Kovach said. "But it’s hard for us to track exactly how prevalent it is because so many patients don’t come forward.

"It’s a lot of untold stories, I think. It’s an issue that I think has not had much of a light shined on it. ... We have been working on religious refusal cases, especially in health care and reproductive health care, for years now, and we’ve seen it play out in the Catholic health care system with women needing care for miscarriages when they’re admitted into the emergency room to women being denied tubal ligations, sometimes in life-threatening situations."

Peterson filed a complaint about the pharmacist with the Michigan Pharmacists Association, a professional organization.

But CEO Larry Wagenknecht said the pharmacist who denied Peterson her medicine is not a member of the organization and did not respond to two letters sent to him to inquire about the incident.

"In this particular case, our read of it was that he did not necessarily violate the Michigan Public Health Code, but he did violate our official position on the individual’s conscientious objection," Wagenknecht said.

"We believe that there’s an ethical responsibility to assure that the patients needs are met. ... He should have reached out to a neighboring pharmacy. That he refused to pass it on or to transfer it or to even make a phone call, from our perspective, that was not appropriate.

"Unfortunately, when these things happen, they are always a difficult situation for the patient, and we, as pharmacists, we do believe we have a responsibility to the people of Michigan. We certainly believe that even if a person does have this conscientious objection to this or some other medication ... they have a moral obligation to link the patient with another pharmacist."

Wagenknecht said the MPA ordinarily refers people with complaints about violations of the law to the state Department of Licensing and Regulatory Affairs, which licenses medical professionals, including pharmacists. But that didn't happen in Peterson's case.

"I don’t know what happened," Wagenknecht said.

A state LARA spokesperson said Wednesday that there have been no formal complaints on the pharmacist who denied Peterson her medication. He remains licensed as a pharmacist.

Peterson said she's coming forward publicly with her story to ensure that the public knows their rights.

"I just want people to know that I’m doing this to make sure that people do not have to encounter the same situation that I did," Peterson said. "There’s no greed associated with this. It’s just a basic human right. He is a medical professional, and he took an oath to take care of patients, and he failed to do that.

"I don’t wish any ill intent on anyone. I want pharmacists to have some type of sensitivity training in regard to this so they understand where we as patients are coming from.

"I wanted to make sure people are aware of this because I had no idea. I was naive in that sense. I knew there were people that opposed things like birth control and Plan B (emergency contraception also known as the morning-after pill), but I didn’t think I could get denied a prescription from my doctor. It was quite an eye-opener for both of us and for my family as well."

Contact Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus.