Natasha Ahmed’s patient had miscarried her pregnancy and was bleeding. Using an ultrasound, Ahmed, an obstetrician-gynecologist based on the Kansas side of the metro, judged that some tissue remained in the woman’s uterus.
They talked through her medical treatment options and together decided on a course of misoprostol, a drug commonly used for miscarriage management, to expel the remaining tissue.
Ahmed sent a prescription to a Walgreens pharmacy across the state line, in Grandview, and wrapped up her Monday.
The next morning she found a fax response with a message from an employee at the store: “Under Missouri law medication abortion is now illegal. Please advise patient to fill across Kansas border.”
Misoprostol is a drug that can be used for medication abortions, but, as Ahmed pointed out, that’s not what this prescription was for. The drug is also used for ulcers and procedures like intrauterine device (IUD) insertion and endometrial biopsies, and, as in this case, for miscarriage management, Ahmed said. It’s one she’s prescribed commonly in the past.
Why wasn’t her prescription being filled in this case?
Ahmed called and spoke to another employee at the pharmacy who determined the earlier worker had been wrong for not filling the prescription. They checked to see if there had been any errors in the diagnosis code sent to the pharmacy, and determined there hadn’t been any. The employee filled the prescription.
“It wasn’t like there was any error on anyone’s part, it’s just that the pharmacist who was there that evening prior, I suppose, took it upon himself to refuse the medication,” Ahmed said in an interview with The Star.
“It was the right dosage, it was for the right (reason),” she added.
“I think that unfortunately pregnancy has become very politicized and people are having opinions and making decisions on the care of women when they don’t have a right to, but also shouldn’t need to,” Ahmed said.
‘Increased risk for no reason’
Ahmed called back to the pharmacy later to speak with the first employee who rejected the prescription. He relayed that he hadn’t known the diagnosis code, which led him to refuse the medication, she said.
Ahmed said the issue was resolved quickly enough that it didn’t affect her patient’s care, but noted that the condition of a patient dealing with an issue like blood loss or an infection can change quickly.
“We had an educational conversation about why it’s important to get patients the medications they need, especially ones that are time-sensitive, because you’re putting her at increased risk for no reason,” she said.
In an email to The Star, Fraser Engerman, a spokesperson for Walgreens, said because of privacy concerns the company doesn’t comment on individual patients, but said it was investigating the incident.
“In the event of any prescription error, our first concern is always for a patient’s well-being,” Engerman said. “Our multi-step procedure includes several safety checks to minimize the chance of human error and we review this process with our pharmacy staff in order to prevent such occurrences.”
Ahmed said it hasn’t been until recently that she has seen hurdles like this one in getting patients routine medications. She believes people being uninformed about pregnancy care and fear of making mistakes related to abortions are contributing factors.
In one case, she prescribed an anti-depressant for a pregnant patient, who later called her in tears after a pharmacist pulled her aside and said the drug was unsafe for her baby, she said.
“Everybody has an opinion about abortion and even though this has nothing to do with abortion, it’s sort of leaching out,” Ahmed said.
“Managing someone’s depression in pregnancy should not be something political. Managing someone’s miscarriage should not be political. I am certainly not someone who will speak up politically for anything, but patient care is something that, of course, I’m passionate about because we deal with it on the daily.”
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