Pharmacy Law: Accommodating Pharmacists Who Refuse Certain Patients

Mr. Fink is professor of pharmacy law and policy at the University of Kentucky College of Pharmacy, Lexington.

Issue of the Case When a pharmacist objects on religious grounds to dealing with patients who present prescriptions for birth control products, may the pharmacist maintain a lawsuit alleging religious discrimination when the employer refuses to make practice accommodations?

Facts of the Case

The pharmacist was recommended to the employer in this case by a placement firm, despite his pharmacy license having been restricted by the state board of pharmacy for his refusal to dispense- or to refer to another pharmacy-a patient's prescription for contraception. The board's restriction required that he notify potential employers in writing of the services he would not perform and the steps he would implement to ensure patients will have access to desired medications.

The pharmacist did so with the pharmacy manager at the location where he had been placed, indicating that he would "decline to perform the provision of, or any activity related to the provision of, contraceptive articles." He wrote that this included "complete or partial cooperation with patient care situations which involve the provision of or counsel on contraceptive articles." The manager made a number of accommodations. The pharmacist did not have to dispense federal legend oral contraceptives; take requests for them from prescribers or patients; hand such medications to patients; or perform checks on such prescriptions before dispensing. The manager also arranged for these medications to be placed in a separate will-call basket so the pharmacist would not need to handle them. He also scheduled employees so someone else would be available to handle such prescriptions and respond to patients' questions.

But the pharmacist went further. If a physician called in a prescription for a contraceptive product, he would place the caller on hold but not tell another staff member someone was on hold. Further, when a patient approached the pharmacy counter with a question about a contraceptive matter, the pharmacist would merely walk away without alerting another employee that the patient needed assistance.

The manager offered to have him deal only with female patients not of childbearing age and males. But that was not acceptable. The pharmacist wanted to be relieved of all duties related to the front counter and telephone unless patients were prescreened to ensure they did not have contraceptive-related questions. The manager agreed that he and the pharmacist intern would do this screening but indicated that due to the workload, the pharmacist needed to answer incoming telephone calls.

On his fifth day of work, the pharmacist refused the modified work assignment and was fired. At that point, he refused to leave the premises. He began lecturing customers about his feeling that the employer practiced discrimination and had to be carried out of the building by police. He also was dismissed by the health professional placement firm based on his conduct at the pharmacy.

The pharmacist filed a lawsuit against both the placement firm and the pharmacy employer, alleging that they discriminated against him on the basis of his religion by refusing to exempt him from having any contact with patients seeking contraception. He also sued the state government. The federal trial court resolved all claims in favor of the defendants and the pharmacist appealed.

The Court's Ruling

The US Court of Appeals concluded that no violation of rights protected under Title VII of the Civil Rights Act of 1964, the portion of the statute dealing with religious discrimination, had occurred.

The Court's Reasoning

The additional accommodations requested by the pharmacist would have caused undue hardship on the employer and would have required other pharmacy employees to take up a disproportionate workload. The Civil Rights Act requires employers to make reasonable accommodations for their employees' religious beliefs and practices unless doing so would result in undue hardship. A reasonable accommodation is one that eliminates the conflict between employment requirements and religious practices. Undue hardship occurs when a religious accommodation would cause more than minimal hardship to the employer or other employees. An employer has no obligation to rearrange staffing and incur costs to accommodate an inflexible employee.

The claim against the state government was dismissed because it was not an employer of the pharmacist, a prerequisite to a claim of religious discrimination in employment.