Protestors march toward City Hall in New Orleans to protest the U.S. Supreme Court’s ruling June 24, 2022, that overturned the landmark Roe v. Wade decision that legalized abortion. Louisiana is now trying to develop a list of conditions that would warrant an abortion, despite the state’s abortion ban. (Piper Hutchinson/Louisiana Illuminator)
More than a dozen Louisiana physicians, including the former leader of the state health department under Gov. John Bel Edwards, have filed sworn affidavits in support of the preliminary injunction that would block Louisiana’s strict abortion laws from going into effect.
The physicians detailed their concerns that the trigger laws would lead to significant increase in fatal or near-fatal outcomes for pregnant patients.
“Fear of punishment aligned with lack of clarity on how this law will be enforced can lead to devastating consequences for Louisiana women as well as moral distress for the clinicians who care for them and have taken the Hippocratic oath to do no harm,” Dr. Rebekah Gee, former Louisiana Department of Health secretary, wrote in her statement.
The affidavits were filed in advance of a hearing Friday in Orleans Parish Civil District Court on the merits of a case filed by Hope Medical Group for Women, an abortion clinic in Shreveport, its administrator Kathaleen Pittman and the New Orleans chapter of Medical Students for Choice.
A temporary restraining order was granted June 27 that stopped enforcement of Louisiana’s abortion law and allowed clinics to continue operating at least until Friday’s hearing.
The plaintiffs claim Louisiana’s abortion laws are conflicitng.
Louisiana Attorney General Jeff Landry has asked the Louisiana Supreme Court to allow enforcement of the abortion ban, arguing that the plaintiffs in the case “are willfully misreading clear terms in the law in an attempt to manufacture arguments that the statutes are unconstitutionally vague.”
‘Hesitating due to fear of prosecution’
Each physician’s affidavit shared concerns that the confusing language in the state laws would lead to doctors hesitating to provide needed care due to the fear of prosecution.
“Decisions in emergency situations may need to be made in the moment – including the middle of the night and weekends, when legal counsel may not be available – and hesitating due to fear of prosecution is not safe for our patients,” Dr. Eric Stiegel, an OB/GYN in New Orleans wrote.
Stiegel raised concerns about the requirement that two doctors agree that a pregnancy is medically futile in order for an abortion to be allowed, raising questions about what kind of physician can fulfill that requirement.
“Does it have to be another OB/GYN? Can an anesthesiologist be the one to agree? What about a resident, who is an M.D. but performing under my supervision and not yet board-certified?” Stiegel wrote.
Other doctors wondered how badly a pregnant person’s health needs be before an abortion is allowed to save the life of the mother. State law includes language that allows for an abortion if a “life-sustaining organ” is threatened.
“To satisfy these laws – does it have to be her heart that fails, what about her lungs, her kidneys, and so on, what organs would this law decide are necessary to protect her life?”
Dr. Anna White, a practicing OB/GYN who also trains residents, said in her affidavit that the prospect of jail time for treating her patients was making her consider leaving Louisiana.
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Accreditation, OB/GYN training at risk
Many of the physicians who filed affidavits argued that allowing the ban to go into effect will inhibit the state’s medical schools from properly training OB/GYN residents, which will lead to many choosing not to come to Louisiana to study.
“Through fear of prosecution and the heavy penalties involved, the Trigger Ban will also discourage medical students to seek residency training in Louisiana, contributing to our physician shortage and ‘brain drain’ in the state,” Dr. Nina Breakstone, an emergency medicine doctor for Ochsner, said.
Dr. Valerie Williams, an OB/GYN in Orleans Parish, shared that she formerly served as the director of the Ryan Program at LSU Health Sciences New Orleans, which connected LSU residents with resources needed to receive abortion training in the state, which is necessary for accredited OB/GYN residency programs.
Williams said that before the program was established, students had to travel out of state, often at their own expense, to be trained on abortion procedures, which are also used to treat miscarriages.
“Ever since the Ryan Program started at LSU Health, the quality of medical students applying to the LSU OB/GYN residency program has skyrocketed,” Williams said. “Students from all over the country are attracted to LSU in part due to the quality of abortion training.”
With no options for abortion training in Louisiana, Williams worried that the state’s OB/GYN programs will lose accreditation or, even if they retain it, that top students will be deterred from coming to Louisiana.
Louisiana, like most states, is experiencing a shortage of healthcare providers, according to state health officials. Many providers left clinical settings during the pandemic due to burnout and never returned.
A March of Dimes analysis found over one-third of Louisiana’s 64 parishes have no practicing OB/GYNs at all, which many consider to be a contributing factor to the state’s high maternal mortality rate, which is the highest in the nation at 58 deaths per 100,000 births.
“Because physicians tend to practice where they do their residency, this will, in the long term, negatively affect the quality of OB/GYNs in Louisiana overall,” Williams said in an affidavit.
Impact on patients who aren’t pregnant
Several of the physicians who filed statements were not OB/GYNs but specialists in emergency or family medicine. They pointed out that the language in state laws could have impacts outside of the field of obstetrics and gynecology.
Dr. Clarissa Jo Beutler Hoff, a family and preventive medicine physician who teaches at Tulane, said she treats patients with Methotrexate, one of the medications used as an abortifacient, for lupus and rheumatoid arthritis. She has also prescribed Depakote and Topamax, which also can cause miscarriages.
“I am scared that I may be charged and convicted of violating these criminal statutes for treating my patients with medications that can end up being unsafe for pregnancy or leading to termination,” Hoff wrote.
Even within the field, physicians report that the ban is having effects for patients who aren’t pregnant.
Dr. Alexandra W. Brand, an OB/GYN and professor in New Orleans, said that after the Supreme Court decision to overturn Roe v. Wade came down June 24, Walgreens refused to fill her patient’s prescription for Methotrexate, even after Brand certified that it was for placement of an IUD rather than for an abortion.
Reports that Walgreens has been refusing to fill the prescription in Louisiana have been circulating since Roe was overturned, but this appears to be the first time a practicing physician has publicly confirmed it.
Walgreens declined to comment.
In addition to their own anxieties, physicians reported that they have had to deal with fearful patients.
Williams wrote that one of her patients found herself pregnant despite being on birth control, and the patient hoped her pregnancy was ectopic so that she would be able to get it treated in Louisiana.
“It is horrific that patients are hoping to have a life-threatening health complication so they can get appropriate care,” Williams wrote.
Williams said some of her patients fear being prosecuted in the wake of the Supreme Court ruling and have asked if she will report them to the government for having an IUD.
“If patients are concerned that I will turn them into the state for telling me the truth, I will not have a full picture of their medical history – and therefore cannot treat them or counsel them appropriately,” White said.
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