‘I will do whatever it takes to make sure she doesn’t fall pregnant to him.’


heather maltman
Heather Maltman spoke about her EC experience to the Studio 10 panel.

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.”

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3 Comments

  1. Consultant Pharmacist
    20/09/2016

    I think these comments are a good opportunity to renew our practice in this area as I feel current practices are positively regressive and a hangover from having to satisfy doctors that Levonorgestrel should be de-scheduled.

    US practice is markedly different with no legal requirements for consultation excluding verifying the patient’s age. Emphasis is given to discussing contraceptive options and helping the patient with future birth control. I think it is insulting to women to suggest that they would not know if they were at risk of pregnancy by the timing of their menstrual cycle. Even if women are at a low risk point in the cycle they should still have the right to take a well-tolerated effective treatment if it eases their mind.

    It is an interesting response from the PSA to say that “Pharmacists are obliged to comply with the protocol we wrote”. This seems particularly circular logic. Shouldn’t we be instead looking to update nearly twenty year old recommendations.

    Guidance to US Pharmacists from the APhA is given on the following link:

    https://www.arhp.org/uploadDocs/CPECUpdate.pdf

  2. amanda cronin
    20/09/2016

    I don’t know if people understand that the morning after pill is not effective if you take it around ovulation. It can’t prevent what has happened so it really is a good idea to make this clear to the patient and this also effects advice if they miss a pill. The new CMI ‘s have excellent clear instructions on what do if you miss one of you pills which is handy to point out your patients. For example if you miss a pill after the seven sugar tablets are taken your risk of pregnancy no matter what emergency contraception is higher.
    I have actually had angry and shocked patients get pregnant on it ( sold at a different pharmacy) who had no idea it was not a sure thing.
    This link offers good information
    http://ec.princeton.edu/questions/eceffect.html I think pharmacist should refresh their knowledge on.

  3. Jarrod McMaugh
    21/09/2016

    The biggest issue I found with the original opinion piece (and potentially with Heather’s experience too, although she doesn’t go in to much depth) is that there didn’t seem to be an attempt to contact the patient.

    This article points out on multiple times that the patient should be contacted by phone if possible.

    This is a bigger issue than with EC, it affects a whole range of what pharmacists do.

    It is not good enough to send people away without knowing what to do next – in my opinion this is professional misconduct, perhaps even negligence.

    If someone presents for codeine and you discover they have an addiction, don’t just refuse outright – provide advice, counselling, and referral (they may not want it, but attempt to provide it).

    If a third party presents with a request for another person, attempt to contact that person when it is relevant (including for newly prescribed medications, OTC requests, etc).

    If someone presents for homeopathy, don’t just say “nope, that’s useless, we don’t sell it” – explain why you don’t sell it and give advice.

    If someone you encounter doesn’t know what to do next after you’ve interacted with them, then you have failed, and should think long and hard about how you practice.

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