None of the members of the state Board of Pharmacy have been confirmed by the state Senate and in January Gov. Chris Gregoire could replace the entire panel if she wanted.

And she may. The governor told me last night that she's learned the board members had never been confirmed, neither the two members she appointed or the five appointed by Gary Locke. On Thursday the board voted 5-0, the two non-pharmacists on the board don't get a vote, to to endorse a regulation that would allow pharmacists to refuse to dispense medication on moral grounds. The vote moves the proposal forward to a public hearing in late summer, after which another vote will be taken by the board.

Gregoire has been criticized for not fighting harder to stop the proposal. Now, though, she says she's committed to a tough and aggressive campaign to get the board to reverse its position. And that could mean replacing board members next year.

"This is all about patients' rights and they must focus on patients. And if they're not going to do that I need a group that will. But they've got a chance. They can make it right. They have until August."

I interviewed Gregoire in Yakima last night after she spoke to the Democratic state convention. In the convention hall she papered the room with copies of her letter to the pharmacy board opposing the plan and mentioned it in her speech to delegates.

Gregoire is also working to build a coalition of interest groups to lobby the board. Gregoire said she is trying to enlist groups like the AARP, cancer organizations and doctors. While much of the attention on the proposal has been on emergency contraception, Gregoire says it goes much further.

"What if I came up and you assumed that I was an undocumented (worker), so you're going to deny me, because you decided I was getting some sort of state help and I don't deserve it. Or you decided because I'm getting some prescription having to do with AIDS, therefore I'm gay and you don't like that or I have some sort of cancer and you think I've been a smoker and that's my problem so you're not going to do that. I could go on with the list. I think there's no end to it."

"This board did not appreciate what they were doing. They did it too quickly. They looked for a compromise and they failed to understand what they've done and once I think they are aware of it, I have confidence they'll do the right thing in the end."

Gregoire has been on record since January opposing the plan. But should she have moved sooner to build a coalition and speak out publicly as she began to do just last night? "I've asked myself that today," she told me. But I was left with the clear sense that she didn't think that would have worked before now. Most people, she said, thought about the proposal only in terms of birth control and she said there was "complacency" about the board's deliberations.

Now, though, she seems jolted into action "I don't know of another state that's gone this way and I am shocked that we have," she said.

I'm sure the governor will be criticized for being slow to take on the issue in the high profile way she now seems ready to do. This is how she does things. It has been clear from her two legislative sessions that rather than get out front on issues and use the public bully pulpit, Gregoire is more likely to step in later in the game and then work usually behind the scenes to break logjams. It has become her trademark. UPDATE: Here and here are stories about Gregoire's leadership style.