Pharmacist requirement can hurt rural poor, health departments say
By Deborah Yetter
FRANKFORT, Ky. -- For decades, poor Kentuckians could go to their local health department for free medicine such as antibiotics, tuberculosis drugs, birth-control pills -- even fluoride drops for cavity prevention in children.
But on Jan. 1, most public health departments across the state were forced to stop giving out medicine. Now, they pack up the drugs that they buy, take them to a local drugstore and pay a pharmacist to dispense what nurses and nurse practitioners used to hand out.
The change, which resulted from opposition by anti-abortion activists to the practice of health departments' giving out birth-control pills, does not add to the cost for people getting the medicine. They pay a fee for office visits but not for the drugs.
But workers in rural health offices say many of the people they see face transportation difficulties that are compounded by having to make another trip to the drugstore.
And Public Health Commissioner Rice Leach said the change could cost the state up to $500,000 a year to pay pharmacists to dispense the drugs, which he said mainly involves birth-control pills to most of 110,000 women who get familyplanning services from the state.
''It's foolish. It's crazy,'' said state Rep. Barbara Colter, RManchester, who is sponsoring a bill that would allow nurses and nurse practitioners to resume handing out such medicine.
Colter's bill, House Bill 67, leaves it up to local health department boards to decide whether to dispense the drugs. The Senate Health and Welfare Committee is expected to vote on the bill today.
The dispensing change came after public health officials found last year that the law doesn't specifically allow nurses and nurse practitioners to dispense medicine -- even though the law now allows nurse practitioners to write some prescriptions, such as for antibiotics.
Leach sent a directive to health departments ordering them to establish an affiliation with a local pharmacist. Only a handful of mostly urban health departments with physicians on staff, such as in Jefferson and Fayette counties, can continue to provide medicine.
The potential increased cost comes as local health departments are struggling to absorb last year's round of cuts prompted by a state budget shortfall.
Colter's bill, which has already cleared the House, sparked strong opposition from pharmacists.
When the bill came up for discussion last week before the Senate Health and Welfare Committee, pharmacists argued that only they should be allowed to hand out medicine.
Sen. Richard Roeding, RLakeside Park and a pharmacist, said he objects to nurses acting as pharmacists.
''I don't want to see my profession diluted,'' he said.
Several pharmacists pointed out that they are trained to counsel patients and oversee prescribed medication.
''This is a patient-safety issue,'' said Harold Cooley, a Prestonsburg pharmacist.
''We're opposed to anyone but pharmacists dispensing pharmaceuticals,'' Mike Mayes, executive director of the Kentucky Pharmacists' Association, said in an interview.
Leach said he supports HB 67 and is not aware of any problems during the many years that health departments handed out such medicine.
''We've been doing this for 30 years without any significant incidents,'' said Leach, a physician.
Backers of the bill say that it's critical to help poor people from rural areas obtain medicine and that many can't -- or won't -- make the extra trip to a pharmacy, especially if it involves birth control or antibiotics for a sexually transmitted disease.
''Any time they have to leave these walls, we can't guarantee confidentiality,'' said nurse practitioner Jessica Mills, who treats women in Bell and Harlan counties for the five-county Cumberland Valley District Health Department in Eastern Kentucky.
In addition, she said, many of her patients live in remote areas with no transportation and often walk miles just to get to the health department.
''They're really creating hardships for the patients,'' Mills said. ''I've had patients say they can't go to the drugstore.''
Colter's home county, Clay, has struggled for years to reduce a high teen-age birth rate. Many girls and young women in her district live in remote hollows and have no transportation. She said she doesn't believe committee members from urban areas understand the hardships her constituents face.
''You have to walk in these girls' shoes,'' Colter told the committee.
Some committee members expressed concern about health departments dispensing birth-control pills, especially to girls under 18, and asked whether health departments stress abstinence from sex. They also asked whether parents should be involved in the decision.
Leach said in an interview that state law allows health departments to treat teens 14 or older for sexually transmitted diseases and provide family-planning services.
Roeding has offered an amendment to Colter's bill that would reverse that law and ban those under 18 from getting treatment and medication without permission of a parent. But Colter said the amendment would worsen the situation she is seeking to improve.
Colter and several health department employees testified that they encourage parent involvement but in some cases, teens simply would go without birth control or treatment for sexually transmitted diseases rather than involve a parent.
Mills said that when a teen comes in for birth control, a nurse talks to her about abstinence and her right not to be coerced into sex, and urges her to discuss the matter with her parents. But in most cases, the girl comes in because she is already sexually active and had a pregnancy scare, Mills said.
''If she's made a decision, it's our obligation to see that she's protected from pregnancy and sexually transmitted diseases,'' Mills said.
Several committee members, including Sens. Joey Pendleton, D-Hopkinsville, and Daniel Mongiardo, DHazard, a physician, spoke in support of Colter's bill.
Mongiardo said some lawmakers have politicized the issue because they don't like the family-planning services that health departments provide.
''It's about the birth-control pill,'' he said. ''Because that's involved here, it's political.''
Mongiardo said it's shortsighted to make it more difficult to get drugs that were once available at health departments. ''This is important to the quality of health care,'' he said.