On The Docket
David B. Brushwood, BSPharm, JD
It is sometimes challenging to take good care of a patient who engages in demanding behaviors. Professional ethics require that pharmacists provide services and products to patients without judging the patients for who they are, why they became ill, or how they became ill. On the other hand, there may be a time when a pharmacist–patient relationship must reluctantly be terminated. A court in California recently reviewed a lawsuit in which a patient was dismissed from a pharmacy based on her “difficult” behavior. The patient sued the pharmacy for violating the Americans with Disabilities Act (ADA).
Background
The patient and her son had received medications at the defendant pharmacy for many years. On one occasion, the patient went to the pharmacy to have a prescription filled and waited 45 minutes while the pharmacist talked with the patient’s insurance company.
Despite this lengthy conversation, the pharmacist was not able to obtain authorization to submit the prescription as written, and the pharmacist offered an alternative medication that was covered by the patient’s plan. The patient insisted that the pharmacist call the insurer again, which the pharmacist refused to do. The patient had the prescription filled at another pharmacy. The court did not explain whether the patient received the original prescribed medication or the alternative from the second pharmacy.
The patient later called the defendant pharmacy and told pharmacy staff that the prescription had been filled. During that call, the pharmacist told the patient that the pharmacy would no longer be able to fill prescriptions for her or for anyone else in her family.
The patient’s lawsuit claimed that the pharmacy staff had treated her poorly because of her son’s disabilities. The pharmacy staff insisted, to the contrary, that they refused to serve the patient because “she was a difficult and demanding customer who demanded large amounts of employees’ time.” For example, the patient often requested that the pharmacy dispense medication in quantities and doses that were higher than authorized in her prescriptions. She also allegedly “required pharmacy employees to spend anywhere from 20 minutes to an hour on the phone with her insurance company.”
Rationale
The court first noted that the ADA “protects individuals against discrimination on the basis of disability.” It is discriminatory to deny services to an individual because of a “known” disability. The court explained that “a medical diagnosis alone is insufficient to establish a disability. Rather, the ADA requires plaintiffs to offer evidence that the extent of the limitation caused by their impairment in terms of their own experience is substantial.”
The patient contended that the pharmacy staff were aware of her son’s disability because of their social interactions with him at church and because they saw him with a portable oxygen tank. The pharmacy employees admitted that they knew the son suffered from a medical condition, but they did not know what that condition was. The court said that “a single indicia of disability—here, [the son’s] use of an oxygen tank—does not mean a defendant knows that the individual is disabled under the ADA.” The court concluded that the patient had failed to present evidence that the pharmacy staff knew of the son’s alleged disability.
The case against the pharmacy was dismissed.
Discussion
Dismissing a patient from a pharmacy is never pleasant. At times, it is nevertheless the right thing to do when mutual trust, respect, and cooperation have deteriorated beyond repair.
Prior to dismissing a patient from a pharmacy, it may be useful to have a discussion with the patient. If there has been a miscommunication, perhaps it can be resolved.
When the dismissal is necessary, be sure that the patient has a sufficient supply of authorized medication to cover the patient’s needs until a new pharmacy is found. Recommend an alternative pharmacy if possible. Always be polite and concerned for the patient. Thoroughly document the incident.