Hospitals and doctors are struggling to distinguish between providing life-saving measures to women and wading through a legal gray area that has emerged in the absence of abortion rights.
In the weeks following the Supreme Court’s decision to overturn Roe v. Wade, a pregnant woman visited Katie McHugh, a gynecologist and abortion provider in Indiana. The patient, who was 8 to 12 weeks pregnant, was bleeding and cramping. An ultrasound showed a miscarriage was inevitable, but the woman had to cross state lines for treatment because her doctors in Kentucky refused to terminate the pregnancy.
This is because Kentucky is one of
“They’re worried about their own legal safety, about their careers,” McHugh said.
Although Kentucky allows exceptions for abortion when it will save a mother’s life, conflicting state and federal guidelines have left doctors struggling to figure out how the bans — and exemptions — apply. In pregnancy-related emergencies, doctors must assess how quickly a patient’s health is deteriorating and make quick decisions to prevent a situation from becoming life-threatening.
Now doctors are dealing with the added stress of having to figure out when it is legally acceptable to intervene. There is also the question of what happens when a patient has to undergo treatment such as
“There are a lot of gray areas in medicine,” said Rebekah Gee, former secretary of the Louisiana Department of Health and founder and CEO of primary care company Nest Health. “The human body is very complicated. These laws are not grey, they are black and white.
Many of the new abortion bans remain stalled in court, including those in Kentucky. On Monday, the U.S. Department of Health and Human Services issued guidelines stating that under its Emergency Medical Treatment and Active Labor Act, if an emergency abortion is necessary, the physician “must provide this treatment”.
Even with the latest HHS guidelines, Gee said doctors take laws like those in his home state of Louisiana seriously and “given the severe penalties, they will continue to practice in fear.”
“This fear of punishment coupled with lack of clarity can have devastating consequences,” she said.
Sylvia Law, a law professor at New York University who studies the intersection of law and the US healthcare system, said she hopes “the new guidelines will make a difference. But that will depend on the individual doctors, the hospitals they work for and the lawyers advising them.
Law said doctors in states where abortion is banned may not be able to perform the procedure even though it’s the best way to remove a dead fetus, putting the patient at risk for septic shock. . “There is nothing in the Supreme Court opinion that tells you anything” about such situations, she said.
According to Katrina Green, an emergency physician in Nashville, Tennessee, it’s just up to doctors to try to figure out when to provide much-needed care without breaking state laws. She and other providers have been in discussions with attorneys about how to navigate the state’s new law that almost entirely bans abortions unless it’s to save a mother’s life.
“Where is the line where we can intervene?” said Green. “If we intervene too soon, a lawyer could sue us.”
Women also struggle to fill prescriptions for pills they would normally take for miscarriage as well as other medications that carry the risk of terminating a pregnancy. It even ensnares women who are not pregnant.
Read more: Abortion bans limit what some doctors and medical students receive from education
Jacqueline McLatchy, an obstetrician and gynecologist in Georgia – who is expected to enact her own ban soon – often prescribes to her patients
One patient needed the pill after an incomplete miscarriage, and the other needed it to expel tissue that was still in the uterus after a miscarriage.
Two different pharmacies told his patients they did not carry the drug, McLatchy said. But when she called to find out why, the pharmacists told her a different story. Her understanding was that “until there is better clarification” of the abortion rules, pharmacists “don’t want to cross any borders.”
Methotrexate is a commonly prescribed drug that doctors say is becoming increasingly difficult for patients to obtain. It treats chronic diseases like rheumatoid arthritis, but it increases the risk of birth defects and pregnancy loss. At higher doses than those used for chronic conditions, it can be used to treat ectopic pregnancies.
Jennifer Crow, who lives in Tellico Plains, Tennessee, started taking methotrexate in the spring for inflammatory arthritis and a neuromuscular condition called myasthenia gravis. She received a robocall from her CVS pharmacy in early July informing her that her methotrexate refill was awaiting a response from her prescribing physician. Eventually, her doctor fixed the problem, but the delay in taking the medication caused her joint pain to return, which made even getting dressed in the morning difficult.
“It’s an unnecessary nightmare for so many people,” she said. Even more frustrating for Crow is that she had a hysterectomy before she started taking the drug, so there was no way she could get pregnant in the first place.
A CVS spokesperson did not comment specifically on Crow’s case, but said “before filling a prescription for methotrexate or misoprostol in some states, we ask our pharmacists to validate that the intended indication is not not to terminate a pregnancy. We encourage providers to include their diagnosis on the prescriptions they write to ensure patients have quick and easy access to medication. It was not clear if this was a new politics for the post-Roe world.
Walgreens said it was changing its policies following the Supreme Court ruling. “We are prepared to adhere to new federal and state laws and regulations, and will update all protocols following the Supreme Court’s decision,” a spokesperson said. “Members of our pharmacy team work with prescribers to ensure that all prescription drugs, including pregnancy termination drugs, are dispensed in accordance with applicable laws.”
Rosalind Ramsey-Goldman, Gallagher Research Professor of Rheumatology at Northwestern University Feinberg School of Medicine, worries that denying patients access to methotrexate could reverse decades of medical progress. In the 1980s, patients with rheumatoid arthritis developed significant deformities when methotrexate was not used in treatment early on.
“That’s what plagues rheumatologists, especially those of us who have been around for a while,” she said. “Going back to what was happening in the 80s and before, it’s just unbearable.”
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