The war against physicians regarding reproductive healthcare, part 2

1 May 2023

There is little doubt that antiabortion laws in red states (controlled by the Republican Party) endanger the lives of women and girls. However, these laws also endanger physicians by making it a felony to provide reproductive healthcare according to the standard of care. Physicians may be forced to delay or deny care to pregnant patients to avoid being charged with a crime.

Source: New York Times

Physicians in red states may be prohibited from following the standard of care for patients with pregnancy complications

Red state laws often prohibit physicians from providing abortions to save or protect the life of the mother, even when it is clear the fetus will die. Under these laws, it is often unclear at what point an abortion is allowed, yet physicians with patients in crisis need to make decisions quickly and cannot reasonably wait to consult with lawyers, an ethics board or a judge. To avoid being charged with a felony, many physicians are forced to delay or deny appropriate care even though they know they are endangering their pregnant patients.

Many of these laws are unclear even to hospital administrators. A recent study concluded:

Not a single hospital in Oklahoma appeared to be able to articulate clear, consistent policies for emergency obstetric care that supported their clinicians’ ability to make decisions based solely on their clinical judgment and pregnant patients’ stated preferences and needs.

Here are some examples:

Oklahoma: Jaci Statton presented to the hospital with a partial molar pregnancy, which cannot produce a living baby. In her case, the condition was malignant. Her physician told her she was at risk of hemorrhage and even death but that due to the State’s laws, she couldn't get treated there. Ultimately, she drove three hours to Kansas and had a dilation & curettage (D&C), the standard abortion procedure.

Texas: Amanda Zurawski testified before Congress (see above). At 18 weeks of pregnancy, her water broke, which put her at high risk for a life threatening infection. There was no possibility that the fetus would survive. She indicated that her doctors:

didn’t feel safe enough to intervene as long as her [the fetus’s] heart was beating or until I was sick enough for the ethics board at the hospital to consider my life at risk and permit the standard health care I needed at that point — an abortion.

As a result, she developed sepsis and spent three days in an intensive care unit (ICU) battling for her life. It is unclear if she can get pregnant again due to damages from the delayed treatment.

Her Senator, John Cornyn, suggested that she file a medical malpractice lawsuit against her doctors.

Zurawski responded:

Quite frankly, my physician and my team of health care professionals that I saw over the course of three days, while I was repeatedly turned away from health care access, made the decision to not provide an abortion because that’s what they felt they had to do under Texas’ law,” Zurawski said. “And that will continue to happen and it is continuing to happen, and it’s not a result of misinterpretation. It’s the result of confusion and the confusion is because the way the law is written.

Some red states are forcing physicians to lie and to deny patients information about treatment in other states.

In addition, some States are now mandating that physicians lie to their patients. For example, in Kansas, physicians are now required to tell patients that medication abortions can be reversed, which is not true.

Many physicians are fleeing red states because of their antiabortion laws

Doctors in states with abortion bans have fled to states with less restrictions and fewer penalties for providing the full-spectrum of reproductive health care. In Idaho, maternal-fetal medicine specialists have left due to the near-total abortion ban. Some physicians that remain have gone to the courts to fight for their rights and seek legal clarity.  News From The States

Several predictable but depressing outcomes of abortion bans: Doctors, and especially those who specialize in reproductive health care, are fleeing red states, leaving pregnant women with fewer and fewer options; medical students and residents are choosing to complete their educations in more liberal states, because they cannot get complete training in conservative ones; and red states, which already tend to have poorer health outcomes for mothers, babies, and their citizens generally, have worsened their abysmal health systems in the name of being “pro-life.” Jill Filipovic

Maternity care deserts are common

Source: CNN

Although the Dobb’s decision is recent and State abortion laws are still in flux, OB/GYNs and other physicians are considering leaving or have actually left many red states including Arkansas, Florida, Georgia, Idaho, Indiana, Kentucky, North Carolina, North Dakota, Ohio, South Dakota, Tennessee, Texas, West Virginia and Wyoming for blue states or have decided to stop practicing medicine. This will leave many areas without any obstetricians (“maternity care deserts”) and with other physician shortages, which damages women and girls further. The passage of fetal personhood laws may further upend medical practices.

Physicians in red states must think about their next steps

I suggest that physicians in red states, particularly specialists in OB-GYN, emergency medicine, family practice or rheumatology (who prescribe drugs with adverse effects on a fetus, which may be prohibited or unavailable in red states) become more politically active, start considering where they might move or actually take steps to move to Michigan or another blue state. Hoping the issue will go away and doing nothing, although a common response, is not reasonable in these times.

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