By KRISTIN L COLETTI-GIESLER, MSN, APRN, FNP-C, FAAMFM, ABAAHP

Access to specialized healthcare is already limited in many parts of Alaska, and patients face additional barriers when pharmacists obstruct medically necessary care. This challenge is even more significant for patients seeking uniquely specialized alternative treatments, such as in anti-aging, functional, and metabolic medicine, and particularly in the rare specialty of environmentally acquired illnesses.

Unfortunately, the misuse of authority by pharmacists to delay or deny prescriptions is a troubling trend that demands immediate attention.

Recently, I encountered a situation in which a pharmacist refused to fill a prescription for a child suffering from Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANDAS is a devastating neuroimmune condition that can be triggered by a streptococcal infection, such as strep throat or scarlet fever (Swedo et al., 1998).

This condition causes the sudden onset of obsessive-compulsive disorder, tic disorders, or both, and requires timely treatment to prevent severe complications such as cognitive decline, debilitating tics, and even self-harm (Murphy et al., 2015). It is also often accompanied by other environmentally acquired illnesses, making timely treatment a necessity.

As Dr. Jill Crista writes in her book “A Light in the Dark,’ the longer we delay treating inflammation in the brain, the harder it becomes to reverse.

“Timing is everything when it comes to treating PANS and PANDAS,” Crista wrote. Unfortunately, instead of fulfilling the professional obligation to dispense the medication promptly, the pharmacist delayed care by berating the provider, questioning the diagnosis, and asking whether the child had sought a second opinion.

Ironically, I was actually their third opinion, and they found me through researching the experts in environmentally acquired illnesses, my mentors Dr. Neil Nathan and Dr. Jill Crista, who have contributed significantly to understanding the interplay of PANDAS, PANS and environmental factors.

This is not an isolated incident. Patients across the state have experienced similar delays and denials, especially during the Covid-19 pandemic, when pharmacists refused to fill prescriptions for critical, evidence-based treatments for serious conditions. Alaska’s former Board of Pharmacy chair allowed such abuses to persist unchecked. Under his leadership, countless Alaskans were denied access to alternative treatments, leaving them to suffer unnecessarily. This behavior not only delayed care but also eroded public trust in the pharmacy profession.

The Pharmacist’s Role and Responsibility

While pharmacists play a critical role in the healthcare system, their scope of practice does not include second-guessing the medical decisions of licensed healthcare providers. When pharmacists interfere by questioning valid prescriptions or demanding to see clinical protocols, they overstep their boundaries and put lives at risk. Their role is to ensure that prescriptions are dispensed safely and appropriately—not to obstruct care due to a lack of understanding about complex medical conditions (American Pharmacists Association, 2021).

As Dr. Neil Nathan states in “Healing Is Possible,” “Patients with complex illnesses are often hanging on by a thread. Any delay in treatment, especially for those suffering from neuroinflammation, can cause the thread to snap, leading to further deterioration and prolonged suffering.”

The Right to Alternative Care

Every patient has the right to seek alternative and integrative care, especially when conventional approaches fail to address their needs. As a provider specializing in environmentally acquired illnesses, chronic infections, and neuro-immune conditions like PANS and PANDAS, I work with some of the sickest patients in Alaska. These patients often require timely and innovative interventions to reverse their illnesses and improve their quality of life.

When pharmacists abuse their power by refusing to fill prescriptions, they are not just delaying care—they are actively jeopardizing patients’ right to choose their own path to wellness.

A Call to Action

The people of Alaska deserve better. It is time to hold pharmacists and the institutions that employ them accountable. Patients should not have to fight for their basic right to access the medications prescribed by their trusted healthcare providers.

To achieve this, we must:

• Demand accountability: Pharmacists who delay or deny care without valid legal or medicaljustification must face consequences, including reprimand or termination.
• Educate pharmacists: Require additional training for pharmacists to ensure they are well- informed about complex medical conditions and their treatments. Contrary to common misconceptions, our approach is thoroughly evidence-based, supported by extensive research. Numerous resources, including a wealth of studies, are available through organizations such as the International Society for Environmentally Acquired Illness, the International Lyme and Associated Diseases Society, and the American Academy of Environmental Medicine.

For example, last year, a local pharmacist refused to fill medications for a patient with Chronic Inflammatory Response Syndrome and Babesia, a tick-borne disease. The provider brought this pharmacist a copy-paper-sized box of over 1,000 studies. The pharmacist never questioned that provider again. However, this was a daunting, time-consuming task, and as providers, we simply do not have time to do this for every uninformed pharmacist.

• Advocate for patients’ rights: The public must be made aware of their right to seek alternative care and report any interference by pharmacists to regulatory authorities.

As Dr. Crista states, “The brain doesn’t wait. Ignoring or delaying care for neuroinflammatory conditions only causes deeper harm and greater suffering in the long term.”

I also want to acknowledge the many amazing pharmacists I work with who genuinely care about their patients. When they have concerns or need clarification, they reach out with professionalism and respect, seeking to collaborate rather than obstruct care. Their dedication to supporting providers and patients alike is invaluable, and I am deeply grateful for their efforts. It is my hope that all pharmacists will aspire to this standard, fostering a culture of collaboration that ensures patients receive the timely and compassionate care they deserve.

The pharmacy profession is built on trust and collaboration between healthcare providers, pharmacists, and patients. When that trust is broken, it is the patients—often the most vulnerable— who bear the consequences. These abuses of power are not just professional failures; they are ethical breaches that jeopardize lives. It is imperative that we hold pharmacists accountable and demand systemic changes to ensure that Alaskans can access the care they need without unnecessary barriers or delays. The time to act is now—patients cannot afford to wait.

Kristen L. Coletti-Giesler is licensed with the following degrees: MSN, APRN, FNP-C, FAAMFM, ABAAHP. She is a family nurse practitioner at Be-Well Medicine on the Kenai Peninsula, an adjunct nursing instructor; and an advanced fellowship diplomat in anti-aging, metabolic, and functional medicine.  

References

1. Brimberg, L., Benhar, I., Mascaro-Blanco, A., et al. (2012). Antibody-mediated behavioraland neurochemical changes in the basal ganglia: A possible mechanistic model for neuropsychiatric symptoms in PANDAS. The Journal of Neuroscience, 32(5), 10229– 10242. https://doi.org/10.1523/JNEUROSCI.0535-12.2012
2. Chang, K., Frankovich, J., & Cooperstock, M. (2015). Clinical evaluation of youth with pediatric acute-onset neuropsychiatric syndrome (PANS): Recommendations from the 2013 PANS Consensus Conference. Journal of Child and Adolescent Psychopharmacology, 25(1), 3–
   13. https://doi.org/10.1089/cap.2014.0084
3. Crista, J. (2022). A light in the dark: Understanding PANDAS and PANS. Two Ponds Press.
4. Murphy, T. K., Gerardi, D. M., & Leckman, J. F. (2015). PANDAS: Reaction to infection or to the treatment? The American Journal of Psychiatry, 171(4), 356–
   359. https://doi.org/10.1176/appi.ajp.2013.13091201
5. Nathan, N. (2018). Toxic: Heal your body from mold toxicity, Lyme disease, multiple chemical sensitivities, and chronic environmental illnesses. Victory Belt Publishing.
6. Nathan, N. (2024). The sensitive patient’s guide to healing: Top experts offer new insights and treatments for environmental toxins, Lyme disease, and EMFs. Rogue Health Press.
7. Swedo, S. E., Leonard, H. L., Garvey, M., et al. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): Clinical description of the first 50 cases. American Journal of Psychiatry, 155(2), 264–
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