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Can pharmacists refuse to fill prescriptions for drugs that can be used in abortions?

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2 years ago

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Under this Supreme Court, patients could struggle to obtain lifesaving drugs like methotrexate

Methotrexate is a fairly common drug that treats a wide range of medical conditions. I take it to help control an autoimmune disorder. So do about 60 percent of rheumatoid arthritis patients. It is used to treat some cancers, such as non-Hodgkin lymphoma. It also has at least one other important medical use.

The drug is the most common pharmaceutical treatment for ectopic pregnancies, a life-threatening medical condition where a fertilized egg implants somewhere other than the uterus — typically a fallopian tube. If allowed to develop, this egg can eventually cause a rupture and massive internal bleeding. Methotrexate prevents embryonic cell growth, eventually terminating an ectopic pregnancy.

And so many patients who take methotrexate say they have become the latest victims of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization — the decision overruling Roe v. Wade.

It’s unclear how widespread this phenomenon is, though the problem is serious enough that the Arthritis Foundation put out a statement warning that “arthritis patients who rely on methotrexate are reporting difficulty accessing it,” and that “at least one state — Texas — allows pharmacists to refuse to fill prescriptions for misoprostol and methotrexate, which together can be used for medical abortions.”

In some cases, pharmacists are reportedly reluctant to fill methotrexate prescriptions in states where abortion is illegal, and doctors are similarly reluctant to prescribe it. In other cases, pharmacists may refuse to fill valid methotrexate prescriptions because they personally object to abortion, even in states where the procedure remains legal.

The phenomenon of patients struggling to obtain therapeutic drugs that can be used in abortion care appears to be severe enough that, on Wednesday, President Joe Biden’s administration released a four-page “Guidance to Nation’s Retail Pharmacies.” It informed them that federal laws prohibiting discrimination on the basis of disability or pregnancy may require pharmacists to fill prescriptions for drugs like methotrexate. (The question of whether a particular denial by a particular pharmacist violates federal law will depend on the specifics of the case.)

Ultimately, however, laws are only as good as the courts that interpret them. And disputes over whether states can ban mifepristone, or whether pharmacists can simply refuse to dispense certain drugs, are likely to be resolved by the same justices who gave us Dobbs.

At best, that means a lot of confusion for patients until the courts sort these issues out. And, given this Court’s hostility toward abortions and sympathy for religious conservatives, it is likely that many patients will be denied prescription drugs.

Federal civil rights law probably requires pharmacists to dispense lawful drugs, but this Supreme Court is likely to give an exemption to religious conservatives.

It is always dangerous to predict what kind of laws may emerge from the fever swamps of the Texas state legislature. But red states are probably less likely to enact a blanket ban on drugs like methotrexate, which have many therapeutic uses unrelated to abortion, than they are to ban drugs like mifepristone that are primarily used in abortion care.

Even if drugs like methotrexate remain legal in all 50 states, however, individual pharmacists may refuse to dispense them, and doctors may be reluctant to prescribe them — out of a misguided belief that the drug is illegal, a fear of being targeted by overzealous prosecutors, or a religious or moral objection to abortion.

In its Wednesday guidance, the Biden administration argues that federal civil rights laws prohibiting “discrimination on the basis of sex and disability” may require pharmacists to dispense certain drugs even after Dobbs. The primary anti-discrimination law governing health care, which was enacted as part of the Affordable Care Act, prohibits discrimination by “any health program or activity” that receives federal funding through a program like Medicare or Medicaid. So most doctors, hospitals, and pharmacies are covered by this law.

Suppose, for example, that “an individual experiences severe and chronic stomach ulcers, such that their condition meets the definition of a disability under civil rights laws.” If a doctor prescribes the drug misoprostol, which is used to prevent stomach ulcers but is also used in medication abortions, then a pharmacy “may be discriminating on the basis of disability” if it refuses to dispense this drug “because of its alternative uses.”

Similarly, the guidance argues that a pharmacist may violate federal sex discrimination laws, which also prohibit discrimination on the basis of pregnancy, if it refuses to dispense methotrexate to a patient with an ectopic pregnancy.

Even if federal civil rights law does require pharmacists to dispense these and similar drugs, however — and that question will need to be litigated — it is likely that this Supreme Court will permit pharmacists with religious objections to those drugs to ignore federal law.

In June 2016, the Supreme Court announced that it would not hear Stormans v. Wiesman — a case involving a pharmacy that refused to dispense emergency contraception, in violation of a state regulation, because the owners objected to this form of contraception on religious grounds. The timing of this refusal to hear the case was significant: Justice Antonin Scalia had died just a few months earlier, depriving the Court’s Republican appointees of the majority they’d enjoyed for many years.

Without the votes he needed to take up the case, Justice Samuel Alito wrote an absolutely livid dissent in Stormans, accusing the state of “hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State.” Notably, Alito’s opinion was joined by Chief Justice John Roberts, the most moderate member of the Court’s current six-justice conservative majority.

It is exceedingly likely, in other words, that if a similar case were to arise today — perhaps a case involving a pharmacist who objects, on religious grounds, to dispensing drugs like methotrexate, mifepristone, or misoprostol — that this Supreme Court would side with the pharmacist. It’s also likely that this Supreme Court would show similar solicitude to a doctor or other health provider who refuses to prescribe a medication because of a religious objection.

In a densely populated city, that kind of decision is likely to inconvenience many patients, who might have to walk several blocks to a different pharmacy in order to get their prescription filled. But in rural areas where patients could have to drive to another town to find another pharmacist, one pharmacist’s refusal to fill their prescription could be a very serious imposition — and that’s assuming that the pharmacist in the next town doesn’t also have religious objections to certain drugs.

In sparsely populated areas, in other words, patients are not only likely to struggle to find abortion care. Patients with common conditions like rheumatoid arthritis or psoriasis may also struggle to fill their prescriptions, even if they take these drugs for reasons that have nothing to do with a pregnancy.

♦ Culled from The Vox

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Africa

Uganda’s President Museveni tests positive for COVID -health official

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11 months ago

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June 8, 2023

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NAIROBI (Reuters) – Uganda’s President Yoweri Museveni has tested positive for COVID-19, is in good health and will continue his duties, while getting treatment, a senior health ministry official said late on Wednesday.

“Today …the President tested positive for COVID-19. This was after developing mild flu-like symptoms. However he is in robust heath and continues to perform his duties normally while adhering to SOPs,” Diane Atwine, permanent secretary at the health ministry, said on Twitter, referring to standard operating procedures for handling COVID cases.

Earlier on Wednesday after giving a State of the Nation address at the parliament’s grounds, Museveni, 78, gave a first hint that he may have contracted COVID, saying in the morning he had felt a slight cold, prompting him to request COVID tests.

He said two of three tests he had done were negative, and he was waiting for the outcome of another.

“So I am a suspect of corona and I am standing here. That is why you saw me coming in separate cars with Mama,” Museveni said, referring to the First Lady Janet Museveni, who accompanied him to parliament.

At the height of the COVID-19 pandemic, Uganda had among Africa’s toughest containment measures that included curfews, businesses and school closures, the shutting of borders and other steps.

It fully reopened in February 2022.

During the pandemic, Museveni, who is vaccinated against COVID, was always been seen in public wearing a mask and has always conducted his official duties while social distancing and would often be seen seated alone in a tent on the lawn of his office when meeting visitors.

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Facts and Myths about Weight Loss: Finding Your New You

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1 year ago

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December 12, 2022

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You would agree with me that the social and digital media has been saturated with innumerable diet advices and trends. Influencers would promise everything from “easy quickie” weight loss; nutrition habits to diet management, using those to engage and lure unsuspecting naive readers who fall for the gimmicks. At last, they leave people disappointed, discouraged, and often weighing even more than they did before they started.

My name is Faith Ononye Onyechefuna, your provider at the Walter J. Family and Wellness Clinic. Based on my observation from several patients I have interacted with, I will share with you in this article, the facts and myths about Weight Loss.

Now let’s get to business:

First is the perception that it does not matter what you eat as long as you count calories

Here are the facts: Believe it or not, what you eat matters. According to National institute of health, a calorie is a unit of energy in food. Our body uses energy derived from foods to function. 1 gram of carbohydrate is 4 calories, 1gram of protein is 4 calories, 1 gram of fat contains 9 calories according to department of health. Adult females need between 1,600 to 2400 calories a day and adult males need 2,000 to 3,000 calories according to United States Department of Agriculture (USDA) guidelines.

One notion about weight loss is the tendency to reduce calorie intake but one must be careful not to cut back too much. Caloric counting encourages quantity over quality. The main goal is to focus on the appropriate range of calories for amount of fuel you are burning. One also need to consume nutrient dense diet that stabilizes blood sugar and help trigger satiety

Another perception is cutting back on carbs to lose weight

Here are the facts: Are you aware there are different forms of carbs? Simple and complex. Simple carbs can be found in junk foods like cookies, candies which lacks nutrients. Foods with complex carb like whole wheat bread and fruits have lots of nutrients that are good for you. Cutting back on sweets like the simple carbs are wonderful way to navigate toward healthy eating habits

Next is setting high goals if you want to lose weight and it is one size fit all

Here are the facts:  weight loss goals are attainable when it is realistic. High goals maybe unattainable and make you give up. Weight loss process is highly individualized. What works for someone else may not work for you. Be ready to modify your plan as you and your healthcare provider discovers what works for you. Weight loss is a lifetime commitment. It is a journey that begins when you are ready. Weight loss readiness questions include:

  • Are you motivated to make long term lifestyle changes?
  • Have you identified and address the big distractions in your life? Such as marital problems, job stresses, illnesses, financial worries
  • Do you have a realistic picture of how much weight you’ll lose and how quickly? The aim of losing 1 to 2 pounds a week until you reach your goal is more realistic than loosing 1 to 2 pounds daily.
  • Do you have support and accountability? Having someone to offer encouragement can help or you may consider joining weight loss support group. One must commit to regular weighing and tracking of diet and activities to achieve effective weight loss goals.

Another significant misconception we have about weight is that obesity is by choice, not nature

Here are the facts: Obesity is not by choice. Obesity is caused by cascades of genetic variables. The body has many biological pathways and hormones that function harmoniously to regulate body weight; these pathways may be dysfunctional in people that are obsessed, making weight loss goals unattainable. Numerous medical conditions, such as hypothyroidism, polycystic ovarian disease, depression have been linked to one or more disruptions in hormonal levels thereby increasing risk of weight gain. For instance, body resistance to hormone leptin may lead to obesity. Leptin is a hormone that inhibits hunger and regulate energy balance, so the body does not trigger hunger responses when it does not need energy. Resistance to leptin makes the brain think one is in starvation mood and thus consume more. Therefore, for a weight loss program to be effective, a provider must draw labs to check hormonal level and make necessary correction to achieve realistic weight loss goals.

As a wellness professional, I can tell you right away that path to healthy, enduring weight management habit is not very rosy but could be turned into an exciting fun activity if you seek professional counsel. By the way, Walter J. is a Pearland, Texas – based family clinic providing individualized affordable healthcare to families across lifespan; preventing illness and improving quality of life through education, wellness, treating and controlling diseases. Our weight-management programs are most innovative and highly effective.

For free consultation about your weight, you may call me directly: 832-400-2118

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Houston Health care clinic and home health owners sentenced for fraud

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2 years ago

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October 15, 2022

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Alatan was the owner of Colony Home Health Services, while Ekene was the owner of Milten Medical Clinic, both businesses located in Houston.

HOUSTON, TX — Two individuals have been ordered to federal prison following their convictions of conspiracy to commit and committing health care fraud, announced U.S. Attorney Jennifer B. Lowery.

A federal jury convicted Francis Ekene, 71, Sugar Land, on all counts following a three-day trial.

Today, U.S. District Judge Sim Lake imposed a 120-month-term of imprisonment to be immediately followed by three years of supervised release. In handing down the prison term, Judge Lake noted that despite his health issues, it was important for him to serve his punishment.

Also convicted at trial was Alfred Olotin Alatan, 63, formerly of Houston and now residing in Fulshear. He was previously sentenced to 120 months in prison.

Alatan was the owner of Colony Home Health Services, while Ekene was the owner of Milten Medical Clinic, both businesses located in Houston.

At trial, the jury heard that Alatan paid recruiters to bring patient information to be billed for home health services regardless of whether they needed it or not. Beneficiaries testified in trial and admitted they did not need home health services at the time the health care service providers billed them.

Additional testimony revealed a doctor had signed off on plan of care forms at the Milton Clinic when patients were not actually under his care.

Previous employees Susana Bermudez and Rita Kpotie Smith also testified. Bermudez admitted she and Smith operated both clinics and that Alatan was the leader of the scheme. Both Alatan and Ekene would consult Bermudez and Smith who directed them and provided assistance in carrying out the scheme within both offices.

At trial, the defense attempted to convince the jury they were not involved in the daily operations and did not know the provided services were unnecessary and fraudulent.

Alatan and Ekene were permitted to remain on bond and voluntarily surrender to a U.S. Bureau of Prisons facility to be determined in the near future.

Bermudez and Smith, both 55, and of Houston, previously pleaded guilty to their roles as co-conspirators in the scheme. Bermudez is currently serving 30 months in federal prison, while Smith is serving is serving a 60-month sentence.

The Department of Health and Human Services – Office of Inspector General conducted the investigation with the assistance of the FBI. Assistant U.S. Attorneys Tina Ansari and Grace Murphy prosecuted the case along with paralegal Judith Cardona assisted with the case.

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