The Bush administration today issued a sweeping new regulation that protects a broad range of health-care workers—from doctors to janitors—who refuse to participate in providing services that they believe violate their personal, moral or religious beliefs.

The controversial rule empowers federal health officials to cut off federal funding for any state or local government, hospital, clinic, health plan, doctor’s office or other entity if it does not accommodate employees who exercise their “right of conscience.”

Hey, I wonder who will make the most inane comment on this inane rule? Will it be President George W. Bush? Family Research Council President Tony Perkins? Does Sarah Palin have anything to say about this?

No, okay, let’s settle on Assistant Secretary of Health Joxel Garcia! “Many health-care providers routinely face pressure to change their medical practice—often in direct opposition to their personal convictions,” Garcia said.

Don’t you just hate it when the government comes a-knockin’ at your federally funded business which has been operating PERFECTLY WELL THANK YOU and says you change like EVERYTHING AROUND just to accommodate the constitutional rights of other people? Next they’ll be saying that bus drivers “have” to let black people ride in the front, or that poll workers “have” to let women vote. Thank you President Bush for protecting MY right to use American taxpayer’s money to deny those American taxpayers their own rights.

Wait a minute . . . based on this ruling, could a federal employee—say, I don’t know, Barack Obama—refuse to grant federal funding to one of these anti-contraception, anti-abortion medical providers based on his “right to conscience”? Something to look into!

[Also of interest: For this week's paper, I wrote a story about how pharmacists are denying birth control based on "conscience"---or, you know, whatever].

For most professionals, an acceptable excuse is required to miss work: a swollen appendix, ailing grandmother, whiplash, at the very least.

Pharmacists, on the other hand, may refuse to do their jobs for any old reason—or for none at all. We’re talking about birth control, of course. In the District, for example, pharmacists are not required to provide such products, especially if their “personal views” won’t allow it. According to NARAL Pro-Choice America, only six states bar pharmacists from withholding birth control prescriptions/doing their jobs: California, Illinois, Maine, Nevada, New Jersey, and Washington.

That means that D.C. is a hotbed of the ultimate bullshit defense for denying health care to women. Pharmacists here can refuse to provide women’s health care based on such “personal views” as latent sexism, unsubstantiated medical opinion, or whim. Some other “personal views” local pharmacies have offered up:

It’s private. A pharmacy’s trust factor often relies on its adherence to privacy—its hushed consultations, the 3-foot courtesy bubble between customers, pills wrapped in nondescript white paper packaging. For contraception allies, these conventions help keep birth control a personal transaction not subject to political interference. But right across the counter, the “privacy” excuse allows pharmacists to deny you access to contraception at any time while shirking explanation and accountability-no questions asked. A flack for Wellington Pharmacy defers to the privacy excuse—”it’s a relationship between a person and their physician”—as to why the pharmacy, affiliated with Catholic-leaning Providence Hospital, provides Viagra but no birth control.

This pharmacy is here to deny your rights. Those not interested in providing medications to humans can choose from a host of careers that are not involved in providing medications to humans. And yet, the D.C. area is home to several anti-contraception advocates that insist upon going the pharmaceutical route. For all these pharmacies gets wrong about women’s health-namely, their positions on condoms, birth control, and the morning-after pill-they often get one thing right: At the most fanatical anti-contraception outfits, women at least know what they’re not getting. America’s latest pro-life pharmaceutical poster child, Chantilly’s Divine Mercy Care Pharmacy, defied the tight-lipped industry standard with its grand opening last fall. Holy water slicked the shelves. A bishop blessed the operation. The AP took video. But though the DMC is the only local pharmacy affiliated with anti-contraception group Pharmacists for Life International, it’s less dangerous than the other area pharmacies quietly denying access to birth control.

They’ve got inventory issues. On a recent Saturday, I contacted 10 local CVS pharmacies to see if they had the morning-after pill in stock. Nine did. The pharmacist at the one that didn’t informed me that his store’s Plan B shipments arrived on Tuesdays, so I would just have to wait 72 hours to get my hands on the pill. Never mind that the effectiveness of Plan B decreases with each hour after unprotected sex, and that after 72 hours, its chances of preventing pregnancy are kaput. The representative at another CVS that did have the pill informed me they only had two pill packs left on the shelf. They, too, received new shipments only once a week, on Tuesdays, so my chances of getting the morning after pill depend on a guessing game of how many condoms broke in the District of Columbia in any given week. Here’s a tip, CVS shoppers: If you’re going to need to use the morning-after pill, just make sure that morning falls on a Wednesday.

They’re weirdos. Though it’s not uncommon for pharmacists to operate behind a shield of privacy, some display a distaste for discussing women’s health that borders on good old-fashioned sexism. When it comes to contraception, pharmacists are often skittish about discussing the most basic aspect of their business—which prescriptions they will fill and which they will not. And it’s not just pharmacies with moral motivations against contraception that aren’t talking. In a telephone interview, the proprietor at Dupont’s Tschiffely Pharmacy refused to discuss whether the shop dispensed the morning-after pill. But when I stopped in to try to pick up a pill pack, Plan B was in stock and offered with a smile. Georgetown’s Dumbarton Pharmacy, meanwhile, declined to discuss its contraceptive options at all. Playing coy with contraceptive options is less cute when women need to locate them instantly in order for them to work. No other common, FDA-approved, over-the-counter medication would receive such silent treatment from pharmacists.

Even chain stores like Rite Aid and CVS, which have national policies that adhere to the contraception-access requirement of the six aforementioned states, must draft elaborate plans by which to protect their pharmacists’ idiosyncrasies. Sometimes, those quirks mean losing business. Take Rite Aid’s policy, which outlines a three-step plan by which a pharmacist can avoid personally filling your birth control prescription: 1) Have another technician fill the prescription; 2) if there is no other technician on hand, contact the closest Rite Aid to dispense the medication, then have the prescription delivered back to the customer’s preferred Rite Aid location; 3) if no other local Rite Aid pharmacist will consent to dispensing birth control, locate the nearest competitor that will fill the customer’s need, then follow through until that need is met.

They don’t trust you—or your doctor. Cathedral Pharmacy owner Paul Beringer, a Catholic, will not provide the morning-after pill. “I consider it abortion,” he says. Non-emergency contraception is dispensed on a case-by-case basis-meaning that the pharmacist can nullify the decision of your medical doctor because he thinks a prescription might be faked, is uncomfortable dispensing contraception to women under the age of 18, or otherwise wishes to impose his “personal views” on your body.

They fear your vagina. Target Pharmacy provides prescription birth control as well as the morning-after pill. Other women’s health products, however, aren’t available even with a doctor’s signature.

Parker, 27, who declined to give her full name, came to the pharmacy straight from work with a prescription from her gynecologist’s office. It was 5:30 p.m. and raining, and she needed to fill the prescription that evening in order to prep for a procedure scheduled for the next morning.

But Target’s pharmacist refused to fill the prescription because the doctor instructed that the pill was to be inserted vaginally. Parker’s doctor had prescribed her Cytotec, an FDA-approved treatment for ulcers. The medication is also routinely prescribed off-label to dilate the cervix to induce labor in pregnant women, or, in Parker’s case, to aid in the insertion of an IUD. Parker-who wasn’t pregnant-learned later that the medication can also be used to induce abortion.

The pharmacist, who did not give her name, says she rebuffed Parker’s prescription because she disagreed with the doctor’s insistence on vaginal insertion.”That’s not how it’s supposed to be prescribed,” she says. “It’s supposed to be taken orally.”

The pharmacist says she tried to call Parker’s doctor’s office but wasn’t able to reach anyone at the late hour. Parker says the pharmacist never picked up the phone while she was there and that she had to beg her to consult her doctor before she got an explanation-that the office would be closed and there was nothing she could do.

Parker left the pharmacy in tears. “I got a little hysterical,” she says. “I couldn’t believe that this pharmacist, who has less training than my doctor, would deny me this medication that I needed, because it was specified that it went in the vagina?”

After asking for the name of a supervisor, Parker took solace in Columbia Heights’ other chain pharmacy. Still red-eyed, she crossed the street to the CVS. There, “a very nice, flirtatious Latino man filled my prescription, no questions asked.”

Photo by Darrow Montgomery.

Rite Aid, 1306 U St. NW (and various). (202) 328-8761.

With over 4,900 drugstores in 31 states and the District of Columbia, Rite Aid’s chain of pharmacies stands to dispense a lot of birth control. It’s also prepared for contraception hang-ups. Rite Aid spokesperson Cheryl Slavinsky says that the chain has policies in place to comply with all state and federal regulations for dispensing medication—and deal with those employees who hold moral or religious beliefs against providing contraception.

“Rite Aid pharmacists or any associates are prohibited from imposing their moral or religious beliefs on the customer, and it is his/her responsibility to fulfill their professional duty to the customer,” Slavinsky says. But if an associate chooses not to personally fill a birth control prescription—-or any other medication, for that matter—they have options.

If a Rite Aid associate doesn’t want to provide an over-the-counter item to a customer—like Emergency Contraception or condoms—they’re required to find another associate who is willing to sell the item. But since some Rite Aids only employ one pharmacist, honoring an employee’s objection to filling doctor-prescribed medication is a little trickier. In that case, the pharmacist is required to contact the closest Rite Aid to dispense the medication. In either case, the associate must offer to order the item or pick it up at another Rite Aid location and deliver it back to the customer’s preferred Rite Aid location. In the case that no other local Rite Aid pharmacist will dispense it—a last-resort scenario that Slavinsky calls “unlikely”—the employee is required to find the nearest competitor that will fill the customer’s need, and to follow through until that need is met.

The prescription policy is not unlike that of similar sprawling drugstore chains. But over the counter, Rite Aid’s contraception access differs from Washington’s other major chain, CVS, in one subtle way. CVS places its condoms (and other sexual helpers) behind a case and in front of its pharmacy counter. Rite Aid’s selection is more discrete—tucked into an aisle and outside the range of a pharmacist’s stare. Customers still must alert an employee to remove the packs of condoms from the shelf—they’re secured there with small, plastic locks—but at least one may peruse his options privately before informing a staffer that he intends to become ribbed for her pleasure.

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Mt. Pleasant Pharmacy, 3169 Mount Pleasant St. NW.

Mount Pleasant Pharmacy offers up copies, keys, passports, faxes, and a wheel of sunglasses in addition to its standard arsenal of prescription drugs. The contraceptive options here are similarly comprehensive. Though this 25-year-old independent outfit can double as a local dude hang-out, pharmacist Tony Majeed has got women’s health covered. Majeed says he’d “love to see the D.C. government subsidize women’s health products,” from birth control to over-the-counter anti-fungals. Until then, he’s got all forms of female contraception in stock—pill, patch, ring, and Plan B—behind his counter.

In the past quarter-century, Majeed has seen gentrification force out a number of local independent pharmacies, so he’s quick to note the upsides of fulfilling your women’s health needs at a non-chain outfit. Though the head pharmacist himself doesn’t speak Spanish, his seven employees are bilingual, and prescriptions can be translated on demand. But no matter the language on the pill bottle, prescriptions remain private. “We don’t sell our information to anybody,” says the pharmacist, who suggests that with the chains, you never know if your Valtrex prescription will end up falling into “that deep black hole of medical information” shared on national databases. Over-the-counter contraception options at this neighborhood pharmacy are more private, too. No locksmith necessary here—customers can peruse the shop’s condom choices freely without asking a sales rep to come fumble with a glass case or plastic lock.

Majeed says his shop also seeks to free up the financial burden of women’s healthcare. Customers without health insurance can still find oral contraception on Mount Pleasant Street for 20 to 60 dollars, prices the pharmacist says he doesn’t mark up more than a couple bucks. But Majeed admits that low-profit birth control prices are pretty standard across the industry, which is why some pharmacies can refuse to sell it without suffering economic harm. “They can do that B.S. because they’re not taking a big loss,” says Majeed, who adds that pro-life pharmacies can lose out in the long run. “Women are good customers,” says Majeed.

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Wellington Pharmacy, 1160 Varnum St. NE

Wellington Pharmacy is affiliated with Providence Hospital, which is affiliated with the Roman Catholic Church, which is affiliated with a God who isn’t too hot on contraception. Wellington acknowledges that birth control pills are sometimes prescribed to treat conditions other than the condition of wanting to have baby-less sex, Wellington declines to fill those prescriptions, too. “At the pharmacy, we cannot determine the purpose for why a person has a prescription for birth control. Because we follow the Catholic ethical and religious directions, we don’t offer it,” says Stephanie Hertzog, director of public relations for Providence Hospital. Providence does, however, stock Viagra. “Viagra is actually prescribed for both erectile dysfunction and pulmonary hypertension,” says Hertzog. In this case, that double use benefits a double standard. “It’s a relationship between a person and their physician,” she says about the Viagra prescription. “There are a few uses for it, and they don’t ask which one.”

KNOCK-UP RISK: “Immaculate conception” imminent.

I am the only customer inside Chantilly’s Divine Mercy Care Pharmacy on Halloween morning, and I’m not buying. A week earlier, the pro-life outfit was blessed by a bishop, sprinkled with holy water, and courted by the national press in preparation for its Oct. 21 grand opening. Right now, it’s hard up for any man off the street.

Robert Semler, pharmacist and manager, sits behind a partition separating his pharmacy from the rest of the small shop. Up front, the pharmacy’s face is Pam Semler’s, a nurse and pharmacist’s wife whose soft features are framed by a thick blond fringe and a pair of round glasses. She is the pharmacy’s sole staff member and, as a condition of employment, must “accept the moral teachings of the Roman Catholic Church.” Divine Mercy Care executive director Bob Laird explains later, over the phone, that means “treating every person who comes in as if they are Christ sitting across from you.” It also means that all employees must be pro-life.

As Pam bids me good morning, I break it to her that I’m not a customer. Pam hedges my first question—”business has been fine”—before deferring all other inquiries to a glossy DMC Pharmacy brochure, which provides corporate contact info along with a brief biography of Robert Semler, who does not emerge during my visit. Semler is a “long standing member of Pharmacists for Life International” whose “pro-life beliefs were solidified after hearing Fr. Frank Pavone of Priests for Life stating for Christ, ‘Either you are with Me or against Me,’” the brochure reads.

I sense that Pam already knows which side of the divide I’m on as she gives me the OK to peruse the products that sit in her immaculate shop. She shuffles quietly behind me as Semler announces housekeeping tasks and indulges Pam’s small talk.

“Metamucil comes in a pink lemonade flavor now,” says Pam. “Imagine that.”

“No, I can’t,” her husband replies from behind the partition.

“Sounds pretty unappetizing.”

“Yes.”

At an upcoming Divine Mercy Care fundraising gala, “Platinum Sponsors” who donate more than $10,000 may elect to sit at a table with Semler and his spouse. Fundraising is a significant component of the income of the DMC, which also administers a pro-life OB-GYN clinic, Fairfax’s Tepeyac Family Center.

Laird says the low foot traffic is to be expected of any startup. “We’re expecting the pharmacy to start slow, but we believe it will be a financial success,” he says. “If we didn’t expect it to be a success, we wouldn’t have done it.”

I spend my own audience with the Semlers in silence as I take stock of the Catholic-prepped shelves, carefully arranged with medical accoutrements (no candy, batteries, or magazines here). Many are targeted toward women—Dr. Scholl’s For Her Comfort Insoles, Midol Teen Formula, Vagisil Talc-Free Deodorant Powder. A small waiting area is stocked with two white wicker chairs and a pile of Taste of Home magazines, along with a basket of blank index cards “for recipes.” The female-oriented atmosphere glosses over one glaring omission: The pharmacy will not stock birth control pills or emergency contraception.

Instead, Divine Mercy Care provides its own brand of medical choice. Atop a stack of leaflets about herbal supplements sits a fact-sheet for the Doctor’s Natural Therapy brand of Natural Hormone Balancing Creams. The creams, made of “Natural USP Progesterone from wild yam,” offer up a natural alternative to the therapeutic effects of oral contraception and hormone replacement therapy. “Have you experienced any of these symptoms?” the fact sheet asks before listing 21 problems the ointment resolves: PMS, Hot Flashes, Irregular Menstruation, Cramping, Mood Swings, Hormone-Related Headaches, Fatigue, Irritability, Anxiety, Weight Gain, Water Retention, Confusion, Breast Tenderness, Miscarriages, Infertility, Decreased Libido, Dryness, Bone Loss, Hair Loss, Insomnia, Premature Aging.

I pause briefly at “Confusion” and wonder how the wild yam came to hold the key to curing all symptoms that ail my gender.

But Divine Mercy Care stocks a stronger alternative to birth control: information. Near the exit sits a stack of “Art of Natural Family Planning” student guides distributed by pro-life group Couple to Couple League International. I leaf through a copy as I sit on a wicker chair, waiting for another customer to arrive to provide sound bites explaining the pro-life pharmacy phenomenon. “How does contraception availability compromise your trust in a pharmacist?” I want to ask. “What role does holy water play in your choice of pharmacy?”

But the book provides more insight into the space where anti-contraceptive morality meets reality: The tutorial describes, in minute detail, the “natural” processes by which couples may have sex while avoiding pregnancy-and still adhering to the teachings of the Catholic Church. Natural Family Planning involves eschewing condoms, oral contraceptives, and the withdrawal method in favor of close watch of the woman’s fertility cycle, achieved by monitoring her shifts in temperature and cataloging monthly changes to her vagina, from mucus elasticity to cervix hardness. Laird says that natural family planning helps couples continue “the marital act,” “something that takes place between a man and a woman vaginally, naturally.” A typical requirement for the “marital act” reads like the positioning of troops for battle: “Three normal post-peak temperatures in a rising pattern above the LTL AND the third temperature at or above the HTL OR the cervix closed and hard for three days.”

The guide’s moral justification for this process is more difficult to parse, with reasoning ranging from “providence” to “aesthetics.” “It is God who in His providence has allowed us to learn in the late 20th century about woman’s alternating fertility and infertility-and about Natural Family Planning-at the same time that other medical advances greatly increased the population survival rate,” Couple to Couple explains before detailing a more compelling argument-the sex is better, too. “Contraceptive condoms (male or female), sponges, diaphragms and foams have definite problems in the area of ‘aesthetics’-many couples find them downright unpleasant, and they interfere with spontaneity.”

I weigh the difference between wild yam extract and estrogen, barrier methods and calculated infertile sex, “sex for pleasure” and “family planning,” and wish I could find a customer to help explain her preferences. I consider the fact that on Halloween, even the staunchest pro-life customer might be moved to skip across the street to the CVS, where Kit Kats are stocked alongside condoms. Before I leave, I wonder if I can justify expensing the $24.95 book for further study. Instead, I settle on a companion piece, the “Art of Natural Family Planning Chart Booklet” ($2). I approach Pam for the sale.

“Are you going to use it?” she asks, hesitating to go back behind the counter to ring up my purchase.
Of course I’m not going to use it, I think. I’m going to skim over it, extract its detail, and use it to color my essay on your place of business.

“They’re paired with the books, and we only have a limited number,” Pam explains, still not making the move behind the counter. Her husband sits silent behind the partition. I eye the large stack of charts by the door, which has not opened since my arrival. “So you’re not going to sell it to me?”

Pam doesn’t answer me, just sighs, moves behind the counter, and punches in the data. I stand in silence for several minutes as Pam moves through the arduous sale; the item’s ID number, 123-456, doesn’t register correctly in the pharmacy’s system. Pam follows a dozen curt orders from her husband before dialing a number on the telephone for outside help. I offer to pay for the booklet without a receipt.

At last I leave with booklet in hand. Within it are hundreds of tidy checkable boxes for tracking one’s “coitus record” and “mucus sensations.”

Photo by Gnarles Monkey.

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Tschiffely Pharmacy, 1330 Connecticut Ave. NW.

A call to quaint Dupont Circle outfit Tschiffely Pharmacy, provider of prescription drugs and curios, produces mixed results. The pharmacist on hand says Tschiffely fills birth control pills and provides Plan B over the counter. When asked if he has emergency contraception in stock, though, he wavers. “No, I don’t know if—I’m not going to answer that,” he says, before telling me to call back as a customer to get a clearer answer. When I visit the store a few days later, on a Friday morning, Plan B is in-stock and ready to go. Abortion pills, though, go unstocked on purpose. “I can definitely tell you I don’t have that,” the pharmacist says. So far, no customer with a prescription has tested Tschiffely. “That we haven’t discussed between our stores yet,” he says.

KNOCK-UP RISK: No comment.

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Grubbs Care Pharmacy, 326 E. Capitol St. NE

This neighborhood Capitol Hill pharmacy, run by owner-pharmacist Michael Kim, stocks the whole shebang—birth control, emergency contraception, and the abortion pill. Plan B even comes a bit cheaper here than at your corner CVS, at $41 to CVS’ $50. Abortion-inducing medication is available with a prescription and in-stock; a call to the pharmacy last week found that it will order the pill, and carries Misoprostol, a drug that is approved by the FDA for gastric ulcer treatment, but which can be prescribed off-label for use as an abortifacient.

KNOCK-UP RISK: Capitol Hill trysts that begin loudly at Tunnicliffís may end, discretely, at Grubbs.

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Foer’s Pharmacy, 818 18th S. NW.

Just blocks away from the sexually promiscuous real estate of the George Washington University, Foer’s Pharmacy is in the position to make bank off baby prevention. And though Foer’s displays strange bra-and-stocking-clad mannequins in its front window, its contraception options are less exciting. A Foer’s rep says the pharmacy fills birth control prescriptions and stocks Plan B over the counter. But if preventive measures fail, coeds looking to abort should look elsewhere: Prescriptions for abortion pills will not be filled, said the staffer.

KNOCK-UP RISK: Better start saving for their 529’s, just in case.

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CVS, 1702 Columbia Rd. NW (and various).

This D.C.-dominating chain addresses the birth control question as it does all things: with impatient efficiency. “Yes, yes, yes,” said the pharmacist on call at CVS’ Adams Morgan location when asked about birth control, emergency contraception, and abortion pills. Plan B will run you up to $50; abortion pills such as Mifeprex, which induces contractions to terminate pregnancy, are available with a prescription but could take a few days to stock if not currently on shelves. Condoms, 48 varieties of them, are offered up like vending machine candy bars: Push button, pull lever, remove product.

Mike DeAngelis, public relations director for CVS, explains the chain has a “policy to fill prescriptions for all legally prescribed medications,” including birth control and emergency contraception. (Though the FDA approved over-the-counter sale of emergency contraception in 2006, a prescription is still needed for patients under 18 years old). However, Joe Pharmacist can opt out of filling your pill prescription. “Under federal law and some state laws, we must also accommodate a religious conviction that may prevent a pharmacist from dispensing a medication,” DeAngelis says. Under that circumstance, however, “other arrangements can be made in advance to ensure the customer’s prescription needs can be satisfied.”

KNOCK-UP RISK: Low, low, low. Next.

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Cathedral Pharmacy, 3000 Connecticut Ave. NW.

If the name weren’t enough to tip you off, lead pharmacist Paul Beringer is happy to let you in on Cathedral Pharmacy’s contraception policy: “Depends.” Beringer says he fills birth control prescriptions “sometimes,” according to “the pharmacist’s discretion.” In Beringer’s 46 years at Cathedral Pharmacy, he’s had to use a lot of discretion. “You know, if a 14-year-old kid comes in, I don’t think I would fill the prescription,” he says. “If it was a legitimate prescription, yes. But if it looked in any way shady, no.” But emergency contraception—a pregnancy prevention pill taken after sex that is also known as “Plan B”—isn’t left to circumstance. “I consider it abortion, and I’m pro-life,” explains Beringer, who says his emergency contraception discretion extends to all pharmacists at Cathedral. “They follow my instructions,” Beringer says. “We don’t even stock it.”

KNOCK-UP RISK: Sex will lead to pregnancy, sometimes.