Last week, 35-year-old Nicole Arteaga shared some personal news in a Facebook post: On Tuesday, a doctor had informed her that two months into her pregnancy she would have a miscarriage. The fetus’s development, the doctor told her, had simply “stopped,” and she had two options for how to address it — have a doctor perform a dilation and curettage procedure to have the pregnancy removed, or take a prescription medication. Arteaga opted for the latter, only to arrive at her local Walgreens, in Peoria, Arizona, and have the pharmacist on duty refuse to fill the prescription.
The pharmacist was well within his right to do so.
Arizona is one of six states that explicitly give pharmacists permission to refuse to fill patients’ prescriptions, should those prescriptions be at odds with their own moral or religious beliefs. In Arizona, the law specifically applies to “emergency contraception or any drug or device intended to inhibit or prevent implantation of a fertilized ovum,” according to the National Women’s Law Center.
For the pharmacist Arteaga encountered in an Arizona Walgreens, that included the medication Arteaga needed to induce a miscarriage.
“If you’re in need of this medication, if you’re experiencing a pregnancy loss, it’s a time-sensitive thing and you already may be experiencing some trauma — to be turned away only adds to the trauma,” Kelli Garcia, senior counsel at the NWLC, tells Broadly. “Patients are needing these forms of care during times when they’re vulnerable, and, in certain states, the reality is that they might not get what they need.”
State law in Arizona and Idaho dictates that pharmacists who refuse to fill someone’s prescription on moral or religious grounds have certain obligations. In Arizona, the pharmacist must return the prescription to the patient, so they can bring it to another pharmacist or to another pharmacy to fill. In Idaho, pharmacists must notify a supervisor that they plan to refuse to fill a prescription they’re opposed to in advance, and if someone else isn’t on duty at the time to fill a prescription to address a life-threatening condition, the pharmacist must do it themselves, regardless of their beliefs.
"Our policy allows pharmacists to step away from filling a prescription for which they have a moral objection," Walgreens explained in a tweeted statement. "At the same time, they are also required to refer the prescription to another pharmacist or manager on duty to meet the patient's needs in a timely manner."
But Arkansas, Georgia, Mississippi, and South Dakota have no such requirements, meaning pharmacists who object to a woman’s use of certain medications can hold onto the prescription, forcing her to seek out another pharmacy altogether or go back to her doctor for a new prescription — circumstances that advocates say can pose a serious health problem for women in rural areas, women who rely on public transit, or women who can’t afford to take another day off of work for an additional doctor’s visit.
Garcia said she’s encountered numerous cases where women end up electing for more invasive procedures, tired and humiliated after being turned away by multiple pharmacists. Many women, like those who shared Arteaga’s viral post over the last few days, are surprised to learn about these state laws, and most only do when they come to encounter their restrictions firsthand.
Garcia had some practical advice for those who do: “Immediately ask to speak with someone else,” Garcia said. “The person may not offer to find someone else to help, but if you ask in a point-blank way, you may still be able to get the prescription filled right then and there.”
“Patients are needing these forms of care during times when they’re vulnerable, and, in certain states, the reality is that they might not get what they need.”
If the pharmacist refuses to do so, or says there’s no one else on staff at the moment who can help, take down all of the who, what, when, where and why of the situation — it could help later down the line.
“Even if there no legal options available to you, you can use the information to put pressure on the pharmacy or larger corporation,” Garcia said. “Walgreens, for example, has a responsibility to their customers to make sure they get the care they need. If they aren’t doing that, we can come in and hold the corporation accountable to that. That’s a lever we can all use.”
Putting a spotlight on Walgreens worked out in Arteaga’s favor.
On Saturday, she updated her Facebook post, writing that the pharmacist who’d refused her prescription had it transferred to another Walgreens, where she was able to purchase it without a hitch. She’d also spoken to the store manager at the Peoria Walgreens, Walgreens corporate office and filed a complaint with the Arizona Board of Pharmacy.
“After learning what happened, we reached out to the patient and apologized for how the situation was handled," Walgreens later wrote in a statement. "We are looking into the matter to ensure that our patients' needs are handled properly.”
“I left Walgreens in tears, ashamed and feeling humiliated by a man who knows nothing of my struggles but feels it is his right to deny medication prescribed to me by my doctor,” Arteaga wrote in her initial post. “I share this story because I wish no other women have to go [through] something like this at time when you are vulnerable and already suffering.”
Reproductive health advocates also spoke out to offer support to Arteaga and lambast state laws that make it difficult to women like her to access the care they need.
“No woman should ever have to face the humiliation of being discriminated against and denied essential medication or any other healthcare because of someone else’s personal beliefs,” NARAL Vice President Adrienne Kimmell said in a statement. “If healthcare providers and workers can refuse care to people they might disagree with, what we have is essentially a system of legalized discrimination, which runs counter to the very notion of healthcare.”