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Bitter Pill 

Ohio doctors and pharmacists are looking out for you. Unless you need the morning-after pill.

The morning-after pill works for only 72 hours. Good - luck finding one in time. - WALTER  NOVAK
  • Walter Novak
  • The morning-after pill works for only 72 hours. Good luck finding one in time.
At two in the morning on the fifth of July, I should be sleeping away this hangover. Instead I sit in a small room at St. Vincent Charity Hospital's Solon branch, dressed in a thin paper gown that makes me look and feel like a human napkin.

My boyfriend/complicated other and I had a "condom malfunction." In the midst of my panic, I remembered a former sorority sister telling me how she had gotten a prescription for the morning-after pill when her contraception failed. My heartbeat steadied a little, and I tried to think about every article I'd read about the pill. It was Glamour, I believe, that said the sooner it's taken, the more effective it is.

St. Vincent is the closest 24-hour place we know of. The doctor there sports graying hair, huge microscope-like glasses, and an expression as worn as his sneakers. He is not pleased about working the Fourth of July.

"What can I do for you?" he asks, frowning.

"I need a prescription for the morning-after pill."

"Huh." He peers down at me sternly. His glasses slip down his nose.

"We don't do that here. This is a Catholic hospital."

"Oh." My heart descends all the way down to my pedicured toenails.

"Well, do you know a place open now that does? Planned Parenthood is closed for the weekend, and I don't have a personal physician yet."

"I don't do those type of referrals."

"What should I do then?" Panic pushes against my eyes like a steamroller.

"I don't know. You should have thought about that before."

He leaves, the door slamming behind him.


Emergency contraception has existed since the early 1970s, when doctors began administering high doses of birth-control pills to prevent unwanted pregnancies. The practice wasn't approved by the Food and Drug Administration until 1997; within a year, Preven -- the first brand-name emergency contraceptive, or "morning-after pill" -- became available by prescription.

Effective up to 72 hours after sex, the pill works primarily by preventing the release of eggs for fertilization. In some cases, it may also prevent an already fertilized egg from implanting in the uterus. This, pro-lifers contend, is abortion.

Pressure from doctors and women's groups has caused some states to enact legislation easing access to the pill. Six states permit pharmacists to dispense it without a prescription. Illinois requires every pharmacy to stock it. In Oregon, victims of sexual assault are offered the pill free.

But in Ohio, among the reddest of red states where women's health issues are concerned, finding the pill can be harder than scoring crack in Pepper Pike.

"In terms of reproductive health, Ohio ranks an F, and that's only because there's no Y," says Kellie Copeland, executive director of NARAL Ohio, the political arm of the pro-choice movement. She readily ticks off a litany of grievances -- health insurers in Ohio are not required to cover contraception, as they are in many other states; Ohio primarily foots the bill for sex-ed programs that preach abstinence. Two-thirds of Ohio legislators are "anti-choice," as Copeland puts it, as are all but two elected officials.

In response to growing concern that women can't get the pill, NARAL conducted a survey of Ohio's 151 hospitals, from June 2003 to August 2004. To imitate real-life situations, volunteers dialed emergency rooms directly and asked about each hospital's policy on prescribing emergency contraception.

"I knew it was inevitable some hospitals would refuse to prescribe it," says Copeland. But as results rolled in, her stomach rolled over.

According to the study, which NARAL plans to make public today, only two hospitals in Ohio provide emergency contraception without questions asked. Among callers claiming to have been raped, 31 percent of hospitals said they would provide the pill; another 35 percent responded that it depends on the situation -- who the doctor on call is, whether the woman filed a police report, whether she would submit to a rape examination.

One in four Ohio hospitals denies the drug even to rape victims.

Copeland was horrified. "And I don't use the word horrific lightly."


Next stop: Bedford Hospital, a tip from a St. Vincent nurse who had overheard my plea.

I call Bedford on the way, in hopes of avoiding a wait in the ER.

"Okay," the attendant says. "I just need to get some information from you." Her voice sounds sympathetic, like a mother soothing her child while spraying peroxide on his cut.

"Were you raped?" she asks.

"No," I say, waiting to feel the relief in her voice.

"We can't help you then," she says instead, switching to curt mode.

What?

"Unless you were raped, we do not give prescriptions for the morning-after pill. I'm sorry."

Click.


NARAL declines to reveal which two emergency rooms readily dispense the morning-after pill, but they appear not to be in the Cleveland area. Scene contacted the Cleveland Clinic, MetroHealth Medical Center, and University Hospitals to learn their policies on the pill.

According to UH spokesman Eric Sandstrom, the network's hospitals provide emergency contraception only to victims of sexual assault -- and only after the victim has specifically requested it. (In Ohio, the state reimburses hospitals for using rape-evidence collection kits. As part of the counseling process, hospitals are required to inform victims about the availability of emergency contraception, but this policy is not monitored.) If a UH doctor does not wish to provide a prescription, he is not obligated to offer a referral to someone who will.

"What are the other hospitals' policies like?" Sandstrom asks nervously. "Are you finding the same sort of policies?"

Cleveland Clinic and MetroHealth offer no more than a crapshoot. The Clinic's official position on emergency contraception is no position at all. "We're in the process of developing a policy right now," says spokeswoman Lisa Murphy. Representatives of MetroHealth did not respond to numerous interview requests over a period of more than a month.

St. Vincent Charity, like most Catholic hospitals, does not prescribe the pill under any circumstances. According to a spokeswoman, victims of sexual assault who request referrals are sent to University Hospitals.

Jaime Miracle, author of the NARAL study, sighs when discussing her results.

"I was hoping that in places like Cuyahoga, Franklin, or Hamilton counties, that have four-five-six-seven hospitals, we would get good results at at least a couple of hospitals. But we found that women in urban areas are not getting much more access than women in rural areas. In some ways, it's more frustrating. A woman could go to all five hospitals and get denied at all five of them."


With two firm rejections now logged, I call the Cleveland Clinic. It's near Case Western Reserve . . . college kids have lots of sex . . . surely they're used to this sort of thing.

"I hear you've been having some problems," says the doctor who answers. "What can I do to help you?"

I repeat the saga, and she offers to call in a prescription to the nearest pharmacy.

We arrive at the CVS in Aurora mid-morning. And wait.

Finally, the pharmacist summons me to a side window for a private consultation. Strange, since the place is deserted anyway.

"I'm sorry," she says, holding the scribbled order by its corners, as if it were dipped in poison.

"We don't carry this prescription in our store."

I call the doctor to share this news.

She pauses.

"Let me talk to the pharmacist there."

I do not know what the doctor says. I do not know whether there was yelling, threats, or philosophical debates. But once the call is completed, the pill suddenly materializes.


If finding a doctor to prescribe the pill is a cumbersome task, finding a pharmacist to fill it can be a close second.

Pharmacists in Ohio may refuse to fill any prescription they don't feel comfortable dispensing. When deciding whether or not to fill a prescription, the pharmacist is "required to use his or her judgment," says Bill Winsley, executive director of Ohio's Board of Pharmacy. Issues of moral opposition to a drug are not spelled out by state law; this, says Winsley, is the problem.

"Some pharmacists may not be handling the area of moral judgment as well as they could," he says. "A pharmacist's first duty should always be to his patient, the second duty to his employer, and the third to [himself]. Unfortunately, some people have these duties messed up."

The Cleveland Clinic's Crile Outpatient Pharmacy stocks the morning-after pill, but not all customers can actually obtain it, says a former part-time pharmacist there. Fatima Fayed, the pharmacy's supervisor, refuses to dispense emergency contraception because of her religious beliefs. At least a dozen times in the five years the part-timer worked at the Clinic, she contends, Fayed would reject the patient's request. (The former employee spoke for this story on the condition that her name not be used; her current workplace prohibits talking to the media.)

Fayed's policy was well known among pharmacy staff. "Fatima just let another one go," became a recurring refrain, says the former co-worker. Eventually, technicians at the drop-off window would falsely tell customers the pharmacy was out of the pill, so they wouldn't have to watch Fayed turn another woman away.

Fayed declined to be interviewed for this story. The Clinic responded to an interview request with a written statement, which read in part that administrators "respect our employees' religious, cultural, and ethical beliefs. Should an employee choose not to participate in an aspect of patient care because of these beliefs, we have procedures in place that ensure our patients' needs, our priority, are met." Fayed remains the pharmacy's supervisor.

"I don't think this should happen," says the former colleague, who left the Clinic last year. "Pharmacists shouldn't impose their religious beliefs on patients." Her new pharmacy always stocks and fills the morning-after pill.

For the past three months, Planned Parenthood of Cleveland has surveyed pharmacies in nine counties -- including Cuyahoga, Lorain, Lake, and Geauga -- on their policies toward the pill. It's too early to draw conclusions, according to Public Policy Director Mary O'Shea, but she says that "a woman walking in off the street looking for emergency contraception has no guarantees."

The main problem, O'Shea says, is not with morality issues, but rather that pharmacies often do not carry the drug or claim to be out of stock.

Karen Brauer, president of the Ohio-based lobbying group Pharmacists for Life International, cackles when she hears this.

Sometimes, "'Out of stock' simply means, 'I'm not going to give you this, because I don't want to prescribe it,'" says Brauer. It's the same line she used as a pharmacist at a Cincinnati-area Kmart. In 1996, a customer Brauer turned away learned that the pharmacy really did have the drug, and Brauer was later fired. She filed a federal suit against Kmart, citing, among other things, violation of her religious rights.

"I don't believe in ending a life," Brauer says. "And I don't think I should have to tell someone where to go to help with the killing."

Ashley, a pharmacist in an East Side Walgreen's, agrees with Brauer's views on contraception, but suppresses her own ethics on the job.

"I took an oath for the betterment of my patients," she says, seated on a wooden bench in front of a row of cold medications. "My job is to fill my patient's prescription, even if I wouldn't take it myself."

Last year, Ashley (she asked that her last name not be used because of her employer's policy against speaking to the media) worked alongside a pharmacist who refused to provide emergency contraception.

"They would get upset. Some were angry. Others would cry," she says of the customers who were turned away, wincing as she recalls the incidents. Ashley's colleagues, she believes, are forgetting the ideals of their profession.

The moral leeway granted to Ohio pharmacists may soon grow even wider. Last October, state Representative Keith Faber (R-Celina) introduced a bill that would broaden Ohio's definition of abortion to include the morning-after pill. Moreover, House Bill 68 would protect doctors and pharmacists from legal action as a result of their refusal to prescribe or fill orders.

"There are very few instances where a profession requires you to do something you morally or ethically disapprove of," says Faber. He opted not to include in his bill a mandatory referral system for the pill. Women, he reasons, "could always go to a hospital to get it filled."

Winsley, of the Ohio Board of Pharmacy, sees the bill as nothing more than political posturing. "This does not call for a legislative resolution," he says. "It's a moral issue, not a legal one."

Faber's bill passed the Ohio House, but failed in the Senate, after an unrelated issue was tacked on at the 11th hour. He plans to introduce a revised bill in the next session. By then, the decision over emergency contraception may be taken out of pharmacists' hands.

Barr Pharmaceuticals is seeking FDA approval for its morning-after pill, Plan-B, to be sold over the counter. In March, the FDA's acting commissioner, Lester M. Crawford, promised that a ruling would be made within weeks. "The science part is generally done," he said at the time. "We're just now down to what the label will look [like]."

Four months later, there's still been no decision, and Copeland believes there may never be one.

That would be fine with Winsley. Approval of an over-the-counter morning-after pill would resolve pharmacists' moral issues, but "It's not a good move," he says.

"No matter how many people try to paint it as harmless, I don't believe it's fit for over-the-counter. It's not a simple product."


Back in the car, I take a swig from a bottle of water and swallow a pill. Twenty minutes later, I try to slip silently into the house, but my friend is awake, eagerly awaiting my arrival.

"Anything exciting happen last night?" she asks.

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