TESTIMONY
Senate Public Health and Welfare Committee
HB 2711
Madam Chair, and members of the Public Health and Welfare
Committee, I would like to thank you for the opportunity to speak today. My name is Paula Koch and I’m a licensed
pharmacist in
In October of 2000 my employer threatened to fire me because I did not want to dispense the morning after pill, a medication that violates my Christian faith. Approximately 18 months before this incident I had discovered that our clinic dispensed the morning after pill. I made arrangements with the pharmacy supervisor for him to dispense the prescription. I met with the Chief Physician to discuss why I didn’t want to dispense the morning after pill and asked if she would come to the pharmacy and dispense the prescription when my supervisor was absent. She agreed.
In the next 18 months, on 3 different occasions the physician dispensed the morning after pill instead of me. In October of 2000 however she refused to dispense the prescription. She stated she was too busy and also refused to let the nurse practitioner come to the pharmacy to dispense it. I was told by the Clinic Administrator that I did not have the option to refuse to dispense any medication. I filed an appeal with the medical staff committee per clinic policy and my pharmacy supervisor attempted to make accommodations with the physician. After the October incident the pharmacy pre-packaged and pre-labeled morning after pills. All the prescriber had to do was walk to the pharmacy or send a nurse to the pharmacy, pick up the pre-packaged prescription and take it to the patient in the exam room. This entire process would take less than one minute.
Despite these changes, the Chief Physician refused to accommodate me. After the medical staff committee meeting where the modifications and my appeal were allegedly discussed, she met with my supervisor and myself. She told me that “Your religion does not matter and as long as I write a legal prescription you have to fill it. I am your commanding officer. If you do not follow my direct order you will be written up for insubordination and consequently fired.” She did not mention the proposed accommodations or the fact that they would be necessary two or three times a year. Instead, I was reprimanded about understanding the consequences of my actions and how I had damaged the reputation of the clinic.
After this meeting with the Chief Physician I filed a complaint at the local clinic, requesting a blanket accommodation. This request was denied. I then filed a complaint with the Regional EEO office. Eventually I had to hire an attorney and file a lawsuit. Finally, in July of 2001-nine months after the original incident, my employer agreed to accommodate me.
During this process I battled many things. First was anxiety over job security. Every time my supervisor was scheduled to be gone I had difficulty sleeping. I worried if that workday would be the day I was commanded to dispense a prescription I believed was harmful. Secondly, I had to deal with the belittling of my job performance. The physician’s position was that it had been my responsibility to inform the clinic I would not dispense the morning after pill BEFORE I was hired. Then she stated they would not have hired me and would have hired a pharmacy technician instead. Since I did not want to dispense the morning after pill, I was being equated with a pharmacy technician. My license, six years of pharmacy school, and 3 and ½ years of experience did not seem to matter. Since I did not want to dispense a medication that is considered legal, but that I believe is potentially harmful; I was not worthy of being called a pharmacist. I was also told that a “pharmacist” conscience clause was bizarre because a pharmacist is simply a conduit of the physician’s wishes. Pharmacists have worked very hard to be considered partners in the health care team. We are jointly responsible for every prescription that is prescribed and subsequently dispensed by the pharmacy. Physicians have full protection of the law. If they do not wish to provide a health care service based on moral, ethical, or religious convictions they may do so without fear of termination. I firmly believe pharmacists and other health professionals should be granted this same right. HB 2711 gives a health care provider an option to follow his or her conscience.
I have been a pharmacist for less than five years and would like to continue for several more years. I have dedicated my professional life to serving the public and teaching pharmacy students. I’ve used my vacations to serve as a pharmacist in a Guatemalan mountain village medical clinic. I love being a pharmacist. However, I am unsure how long I will be able to practice pharmacy. As a pharmacist I took an oath to protect life and not harm it. I in good conscience cannot dispense a prescription I believe has the potential to destroy a life. To do so would violate both my religious beliefs and my professional ethics. When an employer commands me to dispense a prescription that violates my conscience, he or she is forcing me to go against the very essence of who I am.
During my lawsuit I was told I needed to separate my spiritual life from my professional life. This simply is not possible. My faith is the foundation of all areas of my life, including my career. We do not ask health care providers to leave their race or ethnicity at the door when they clock into their job. Why should we ask them to leave their ethical, moral, or religious beliefs? These beliefs can define a person as much as race or ethnicity.
In August of this year I had the opportunity to change jobs. During my interview with my prospective supervisor I discussed my conscience objection to the morning after pill. He replied, “I don’t have to agree with you to respect you.” We then discussed options and alternatives if I was presented with a prescription I conscientiously objected to. I feel very fortunate that my current employer is willing to accommodate me. As I have testified, that is not always the case.
The Kansas Pharmacists Association representatives are officially opposing this bill despite the fact that 86% of Kansas pharmacists support a pharmacist’s right of conscientious objection, as reported in the December 2001 issue of The Journal of Kansas Pharmacy. I attended the KPhA annual meeting in September of 2001 where the conscience objection resolution was discussed and passed. We discussed the balance of recognizing and respecting a pharmacist’s conscience with ensuring that a patient has access to a prescribed medication. I believe this bill accomplishes both these goals. This bill requires health care providers to provide prior, written notice to their employer. This prior notification allows each unique health care setting to create its own alternative system. KPhA wants more details of “establishing systems” before it will support this bill. I do not believe this is realistic nor the intention of Kansas pharmacists when they voted for a conscience objection resolution. How can a law encompass exact systems that will accommodate each unique health care setting as well as each health care provider? As a pharmacist I have worked in a hospital, a health clinic, and a retail pharmacy. Creating an alternative system for a conscientious objector would be very different in each of these settings. It would be difficult to pass a law that provided each health care setting a practical system. This bill in its current form gives each health care setting the freedom to establish a “custom-fit” alternative system. I’m very disappointed that my state association is opposing this bill. I do not think KPhA is accurately reflecting Kansas pharmacists or the spirit of the resolution passed at our annual meeting.
Unlike the KPhA, the American Pharmaceutical Association is unequivocal in its recognition of conscience rights. The national association “…recognizes the individual pharmacist’s right to exercise conscientious refusal and supports the establishment of systems to ensure patient access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal.”
In closing, I would like to ask each of you to think about your own lives. What if your employer demanded you to do something you believed was wrong? How would you respond? It’s a big decision with difficult consequences resulting from either choice. Would you do it simply because it was your job and that was expected of you? If you did, would you be able to look at yourself in the mirror every morning and evening, knowing you did something that violated your personal code of ethics? Are you willing to risk losing your job and perhaps your professional reputation? “To thine own self be true”, is it worth all the possible consequences? This is the very dilemma that health care professionals are facing. These are not isolated incidents and these issues will not go away. Now is the time to address them. HB2711 gives health care professionals the freedom to make difficult choices without fear of demotion or termination.
Thank you for your time.