Despite celebrities’ concerns, refusal of third-party EC supply can sometimes be justified, pharmacists have told AJP
Over the weekend former Home and Away star Christie Hayes wrote a blog on Mamamia explaining that her husband had been refused supply of emergency contraception on her behalf, and when she presented to the pharmacy afterwards she felt judged and was not counselled or asked any questions.
Now pharmacists remain under scrutiny after a second celebrity has come out saying her male partner was denied emergency contraception in pharmacy.
Yesterday former Bachelor contestant Heather Maltman told the Studio 10 panel that she miscarried after her boyfriend was refused emergency contraception by a pharmacist.
Her then boyfriend had gone to the pharmacy for emergency contraception, but was refused sale.
“He actually couldn’t pick it up. They said no to him and because of it I took it too late and I actually ended up having a miscarriage,” Maltman (pictured) said.
“It needs to change,” she said. “It absolutely has to change.”
“Contraception is a responsibility for men and women, for the two of them, and I think for a pharmacist to make some kind of judgement based on that is not on,” added Studio 10 host Jessica Rowe.
However Karen Brown, owner of Pharmacy of the Year finalist Samford Chemmart, told the AJP today that sometimes it is entirely appropriate to refuse emergency contraception supply to a third party.
She gave her own example.
“A lady came in, she was probably mid-50s, and she said it was for a girl who was in fact her son’s girlfriend,” Brown told the AJP.
“I’m a firm believer that you have to get the consent from the female, whether that’s on the phone or in person – I need to talk before selling to a third party.
“I asked her about this and she said, ‘I will do whatever it takes to make sure she doesn’t fall pregnant to him’.
“And these weren’t 15-year-old kids, they were mid-20s. Imagine if she could just walk in and get that!
“I had to tell her that it’s their decision, not her decision, and unless I could speak to the girlfriend I would not be supplying her with the tablet. You absolutely need to get consent from the female to make sure it’s their choice.”
Several pharmacists also told AJP there are several issues around third party supply, including whether or not the unprotected sex, or taking emergency contraception, was consensual.
“The PSA has guidance for provision of the emergency contraceptive pill, and there is guidance there on supplying to a third party,” says Dr Esther Lau, from the QUT Faculty of Health.
“So it’s down to professional judgement as to whether we can get the appropriate information to make that clinical decision from the third party.
“For example, as part of the information you should be collecting from your patient, you should be asking about their menstrual cycle so you can gauge their likely risk of becoming pregnant, and whether or not the partner can provide that information is another question.
“It’s why sometimes we do need to talk to the patient themselves, whether on the phone or in person.”
Both Brown and Dr Lau said that it was vital for pharmacists to take the time to counsel the patient on taking EC.
Brown gave another example of a woman who was breastfeeding a four-month-old baby and needed information on how to safely stop breastfeeding temporarily while she took the new five-day EC pill, for which her doctor had given her a prescription.
“I find S3s are all about educating about the condition, rather than concentrating on a particular product,” Brown says. “I finish with asking patients whether they have any questions for me, and I’ve had young girls asking me if they need it for oral sex.
“The level of active ingredient in the EC pill is a hundred times greater than in the normal contraceptive pill – does the patient realise that’s how strong this one tablet is, how much that will affect their cycle?
“If the reason they’re not on a regular contraceptive pill is that it makes them feel sick, are they prepared to take this?
“It’s all about education, and maybe we need to educate more about it than it being a taboo.”
Dr Lau said that it is important that pharmacists counsel patients that using EC is not a 100% effective means of contraception.
“They need to know this, and they need to know what to do and problems to look out for,” she says.
“A lot of people request the EC because they might have missed their regular contraceptive pill, so you have to give them advice on what to do with the existing pill they’re taking. If they’re not on a regular contraception, they should probably be looking to go onto one, so that’s about advice and referral.
“And if they come in when it’s been more than 72 hours, they should be referred onto the doctor. That’s why you need to ask those questions.”
Another issue raised by Hayes in her blog was that she felt judged when the pharmacy staff whispered after she requested the medicine.
“She walked away to another woman, started whispering, ‘She needs the morning after pill’ and as they both stood there hush hush-ing, I was seriously close to pointing out to them that it wasn’t a library, they didn’t need to whisper,” Hayes wrote.
“We’re not going to yell out, ‘Morning after pill in aisle two please!’” said Brown. “You get in trouble for privacy reasons if you yell it out, but if you whisper it’s deemed you’re joking about it.”
Consultant pharmacist Debbie Rigby said that discretion is important when dispensing EC to protect patient privacy.
“This highlights the need for community pharmacies to have a private counselling area and to actually use it,” Rigby says.
“The patient’s perception that they are whispering about her may be in their head, but if you’re automatically saying, ‘Is it okay if we talk about this in a private area’ routinely when the product is requested, that would be a good approach.
“This privacy issue is an easy thing that pharmacists can be challenged on all the time, so we’ve got to get better about it and use our counselling rooms.”