Monday, Jan. 30, 2006 | 7:39 a.m.
In the controversy over whether pharmacists should be allowed to refuse to fill prescriptions because of their moral beliefs, Caliente pharmacist Adam Katschke could be the poster boy.
Emergency contraception -- the "morning-after pill" -- conflicts with Katschke's Mormon beliefs. But his professional obligation to give people the pills that their doctors say they need tugs him in the other direction.
"My religion is against it, but as a professional, I feel I can't be," Katschke said in a recent interview. "I know, if I went to my clergy, I know what they'd say."
And yet he knows that his independently owned drugstore, Meadow Valley Pharmacy, is the only place to fill prescriptions within 110 miles. If he turned down a patient, the next-nearest place to get the medication would be St. George, Utah.
Two sides of an extremely politicized national debate are fighting for Katschke's soul. Reproductive-rights advocates want to force him to fill prescriptions even if he does not approve of them, while anti-abortion groups are urging him to decline to give out certain drugs.
Currently, no Nevada law says he can refuse to fill a prescription. And no law says he can't. Most states face a similar gray area on the issue.
Last month, the state Board of Pharmacy dropped an effort to create regulations that would have allowed so-called "conscience refusals" while setting guidelines for them. The proposed guidelines would have required a pharmacist to disclose moral or religious beliefs at the time of employment and to have a backup plan to ensure that prescriptions could still be filled at that pharmacy or another nearby.
State lawmakers asked the board to back off, saying the issue was too political for an appointed board charged primarily with licensing and inspecting pharmacies.
"The legislators asked us to let them handle it in the Legislature," Pharmacy Board executive secretary Larry Pinson said.
And yet chances the Legislature will do so are slim to none.
The Legislature has already taken up the matter twice, in 2003 and 2005. Both times, a measure that would have banned pharmacist conscience refusals passed the Democratic-controlled Assembly and died in the Republican-controlled Senate.
Sen. Maggie Carlton, D-Las Vegas, was one of the lawmakers who urged the Pharmacy Board not to act. Yet she admitted that the Legislature was unlikely to address the issue in 2007.
"It would depend on the election," she said. If the November vote does not result in dramatic, unexpected Democratic gains in the Senate, it is unlikely that the Assembly would find it worthwhile to try to again pass an anti-refusal measure, she said.
Carlton defended asking the Pharmacy Board to drop the issue. "If the Legislature locked horns on it, I don't think a board should take it up," she said. "They're not supposed to make public policy, they're supposed to make administrative regulations."
The law, as it stands, can be interpreted either way. Carlton believes the board's rules do not allow pharmacists to cite morality as a reason for turning down a prescription.
Sen. Warren Hardy, R-Las Vegas, interprets the law the other way. Since no law forbids it, pharmacists are free to turn down anyone for any reason, he said. In addition, the Legislature's failed attempts at a ban signify a legislative intent to keep conscience refusals legal, he contends.
Hardy said that, while he is against abortion, he sees the matter as one of limiting government. "It's just not the function of government to compel people to act against their conscience."
The chief interest groups on both sides of the issue, locally and nationally, have been those active in the abortion debate. It was the state's Planned Parenthood chapter that proposed both legislative efforts, and their opposition came from groups such as Nevada Life and Nevada Right to Life.
Nationally, Planned Parenthood, the National Organization for Women and NARAL Pro-Choice America have campaigned against conscience refusals, whereas the Christian Legal Society, the U.S. Conference of Catholic Bishops and a group called Pharmacists for Life International have advocated for a pharmacist's right to refuse.
Women are increasingly being denied emergency contraception or even birth-control pills by pharmacists who disagree with their choices, according to information collected by the Planned Parenthood Federation of America, which has cataloged incidents in more than 10 states.
In some cases, women reported, they were given anti-abortion speeches or literature instead of the drugs prescribed by their doctors. Some said they needed the pills because they had been raped or had a condom break. A Wisconsin pharmacist was disciplined when he not only declined to fill a woman's birth-control prescription, but also refused to give it back to her or transfer it elsewhere.
The only documented case in Nevada was 20 years ago, when a pharmacist told Lisa Lynn Chapman, then 18, that he would not give her birth-control pills without a note from her parents, according to Chapman's recent testimony before the Legislature.
But anti-refusal groups believe that there are countless more cases, in Nevada and elsewhere, that go unreported because women are ashamed to expose their sex lives.
Four states -- Arkansas, Georgia, Mississippi and South Dakota -- have passed rules permitting conscience-based refusal of prescriptions. Only one has a rule banning the practice: By order of the governor, Illinois pharmacists must fill contraceptive prescriptions. In three other states -- Massachusetts, North Carolina and Wisconsin -- board rulings or statements appear to go against conscience refusal.
Many more states, such as Nevada, have deadlocked. In 2005, 15 state legislatures considered proposed legislation on the issue.
To Pinson, the recently halted effort to enact administrative regulations was an attempt at compromise. Pharmacists' beliefs would be respected and patients' prescriptions would get filled at the same time, he said.
"Rather than have a patient turned away, the pharmacist would have an arrangement in place," he said. "Our main concern is to take care of the patient."
The sticking point, however, would be places like the Caliente drugstore. Not only is it the only pharmacy for 100 miles, but Katschke, who owns the business, is the only pharmacist in the store.
The situation came to a head when a patient handed Katschke a prescription for emergency contraception. Forced to make a decision, his professional obligation won out over his faith's doctrine.
"If I were in the city, I don't think I would have a problem denying someone, because there would be plenty of other pharmacies that would fill (the prescription)," Katschke said. "But out here, I felt I had to handle it professionally."
To Katschke, it was a matter of common sense and compassion.
"If someone were to interview our prophet, I think he'd say, 'We're against it, but you have to exercise your professional judgment,' " he said.
Molly Ball can be reached at 259-8814 or at [email protected].
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