Though deemed exempt from measure on abortions, doctors at 2 hospitals quit doing them
1:17 AM, Jun. 27, 2011 |
A federal court put on hold two parts of a major anti-abortion law Friday on the grounds that both measures -- one ending Medicaid funding to abortion providers and one interfering with what doctors can tell patients -- have "a reasonable likelihood" of being permanently struck down.
The fact that the judge was able to find grave problems with the legislation after barely a month of court argument raises questions about how much consideration -- and how much input from doctors -- went into drafting those two measures in the first place. And, in a series of recent interviews, The Indianapolis Star found some startling answers.
In order to comply with the law, The Star discovered, doctors at Indiana University and Wishard Memorial hospitals several weeks ago stopped offering patients the option of terminating pregnancies, including in cases where the woman's health was at serious risk and where there was no possibility the fetus would survive.
The law's author said the intention was to allow such procedures, and the state Medicaid agency disagrees with IU's interpretation. But the controversial wording was inserted into the anti-abortion bill on the Senate floor -- after a similar measure died in the House -- giving no opportunity for public testimony about potential unintended consequences.
The other provision suspended by the court Friday -- requiring doctors to tell patients seeking abortions that fetuses can feel pain -- also was drafted with limited input from physicians.
Doctors were not entirely shut out of the legislative process. The Indiana State Medical Association chose to pass up its chance to publicly weigh in on the abortion bill and took no position on it. And doctors did have some influence on the bill. After hearing testimony from an oncologist with the IU Simon Cancer Center, lawmakers removed a provision requiring doctors to tell patients that abortion is linked to breast cancer.
The Star found strong evidence, however, that medical considerations were secondary at best. In interviews last week, the lawmaker who drafted the fetal-pain clause admitted she had consulted no scientific studies.
U.S. District Judge Tanya Walton Pratt, who issued the order suspending enforcement of the law, said she had been given no evidence that "within the scientific community even a minority view exists that contends pain perception is possible during the first trimester of pregnancy."
Yet the law requires that women in any stage of pregnancy must hear the warning about pain.
Pratt's order suspends the two controversial provisions until a court challenge is heard. But the attorney general's office has said it "likely" will appeal her ruling, meaning the law could be back in effect if the state prevails.
Clarifying the exemption
Since the law took effect six weeks ago, The Star has learned, doctors at IU and Wishard hospitals stopped offering to terminate pregnancies for about 70 patients, including many with complications that put the patient's health at serious risk or where there was no possibility the fetus would survive. The IU School of Medicine's faculty practice determined that its doctors had to take that step to comply with the law, despite the fact that the law exempts hospitals.
The IU doctors are part of a private practice not technically employed by the hospitals, and therefore they do not fit under the language of the exemption.
These doctors -- and likely many others -- had to choose from a limited range of treatment options or send patients out of state for terminations after the law took effect May 10.
The law was aimed at cutting off Medicaid funding to Planned Parenthood of Indiana. But the IU doctors feared that if they continued to terminate pregnancies -- even in cases where it was medically advisable -- they would also lose the ability to treat Medicaid clients, who make up a substantial portion of their cases.
Briefed on the situation by The Star on Friday, state Sen. Scott Schneider, the author of the defunding amendment, reacted with surprise and concern.
"This was not the intent," said Schneider, R-Indianapolis. "We exempted this type of medical procedure in a hospital. So if something needs to be fixed, we'll look at it."
Gov. Mitch Daniels' Family and Social Services Administration had already taken steps to clarify the exemption to include doctors working in hospitals -- but only through a process that would take several months. Spokesman Marcus Barlow said he disagreed with the IU School of Medicine's interpretation of the law.
Risk to the mother
Doctors are sensitive to the controversy surrounding the termination of any pregnancy, even for medical purposes, and many declined to comment on the law's effect.
However, Elizabeth Ferries-Rowe, chief of obstetrics and gynecology for Wishard, said in a letter to The Star that the legislature and Daniels had "tied the hands of physicians attempting to provide medically appropriate, evidence-based care in the setting of routine obstetrics and gynecology" in "a politically motivated move to de-fund Planned Parenthood."
Ferries-Rowe, who described herself as a Catholic, said Wishard continued treating women in mortal danger, such as those suffering from ectopic pregnancies -- when a fertilized egg implants outside the uterus.
But she said she would be unable to terminate the pregnancy of a woman whose amniotic membranes had ruptured at 16 weeks with complete loss of fluid. Under those circumstances, Ferries-Rowe said in an interview, the baby would likely be born so early that it wouldn't survive, and a woman who chose not to terminate the pregnancy would run the risk of sepsis, which can cause permanent organ damage, loss of limbs, brain damage or death.
She said no IU School of Medicine doctor was able to give a patient the option of abortion even in the case of congenital fetal anomaly incompatible with life -- in other words, zero chance of survival.
The consequences of the defunding law were particularly significant for IU School of Medicine doctors because they treat women with high-risk pregnancies who have been referred by other health providers across the state.
Pam Perry, director of public and media relations at the IU School of Medicine, confirmed that the school's doctors have been affected. "Yes," she said, "it has had an impact on their ability to provide care to a significant group of patients."
Not "scientific" studies
At least seven states mandate warnings about fetal pain, but almost all of them require those warnings only for patients more than 20 weeks pregnant.
An article published by the American Medical Association, and provided to The Star by Indiana Right to Life, surveyed research on fetal pain and found some evidence of the possibility of fetal pain -- after 23 weeks. But the vast majority of abortions are performed in the first 12 weeks of pregnancy.
State Rep. Mark Messmer, R-Jasper, a sponsor of the bill, said the warning that a fetus can feel pain "at or before 20 weeks" was never meant to make women think that fetuses can feel pain at any stage of development.
"We're not saying that a fetus can feel pain at three weeks," Messmer said.
However, Rep. Sue Ellspermann, R-Ferdinand, who said she wrote the original draft of the fetal pain warning language, acknowledged to The Star that she consulted no doctors, scientists or studies -- "not to the extent that I would call them scientific studies" -- while preparing the legislation.
She said she had seen video footage "of the baby (in the womb) shying away from the needle."
"As technology moves forward," Ellspermann said, "we're getting closer to proving that research."
She said she felt confident inserting the language into Indiana law because she had seen it in other state legislation. When asked for supporting evidence, she told The Star: "I am not a medical doctor, so I would suggest that you continue to look for that and search various sources. But you're asking good questions."
The bill's author, Rep. Eric Turner, R-Cicero, said the purpose of the bill was to "make sure pregnant ladies have as much information as possible about the procedure so they (can) make an informed decision."
How important it was to the sponsors that the information stand up to scientific scrutiny, however, remains an open question.
Sen. Vi Simpson, D-Ellettsville, proposed an amendment requiring information given to women seeking abortions be "medically and scientifically accurate."
A Senate committee voted it down.
A federal court put on hold two parts of a major anti-abortion law Friday on the grounds that both measures -- one ending Medicaid funding to abortion providers and one interfering with what doctors can tell patients -- have "a reasonable likelihood" of being permanently struck down.
The fact that the judge was able to find grave problems with the legislation after barely a month of court argument raises questions about how much consideration -- and how much input from doctors -- went into drafting those two measures in the first place. And, in a series of recent interviews, The Indianapolis Star found some startling answers.
In order to comply with the law, The Star discovered, doctors at Indiana University and Wishard Memorial hospitals several weeks ago stopped offering patients the option of terminating pregnancies, including in cases where the woman's health was at serious risk and where there was no possibility the fetus would survive.
The law's author said the intention was to allow such procedures, and the state Medicaid agency disagrees with IU's interpretation. But the controversial wording was inserted into the anti-abortion bill on the Senate floor -- after a similar measure died in the House -- giving no opportunity for public testimony about potential unintended consequences.
The other provision suspended by the court Friday -- requiring doctors to tell patients seeking abortions that fetuses can feel pain -- also was drafted with limited input from physicians.
Doctors were not entirely shut out of the legislative process. The Indiana State Medical Association chose to pass up its chance to publicly weigh in on the abortion bill and took no position on it. And doctors did have some influence on the bill. After hearing testimony from an oncologist with the IU Simon Cancer Center, lawmakers removed a provision requiring doctors to tell patients that abortion is linked to breast cancer.
The Star found strong evidence, however, that medical considerations were secondary at best. In interviews last week, the lawmaker who drafted the fetal-pain clause admitted she had consulted no scientific studies.
U.S. District Judge Tanya Walton Pratt, who issued the order suspending enforcement of the law, said she had been given no evidence that "within the scientific community even a minority view exists that contends pain perception is possible during the first trimester of pregnancy."
Yet the law requires that women in any stage of pregnancy must hear the warning about pain.
Pratt's order suspends the two controversial provisions until a court challenge is heard. But the attorney general's office has said it "likely" will appeal her ruling, meaning the law could be back in effect if the state prevails.
Clarifying the exemption
Since the law took effect six weeks ago, The Star has learned, doctors at IU and Wishard hospitals stopped offering to terminate pregnancies for about 70 patients, including many with complications that put the patient's health at serious risk or where there was no possibility the fetus would survive. The IU School of Medicine's faculty practice determined that its doctors had to take that step to comply with the law, despite the fact that the law exempts hospitals.
The IU doctors are part of a private practice not technically employed by the hospitals, and therefore they do not fit under the language of the exemption.
These doctors -- and likely many others -- had to choose from a limited range of treatment options or send patients out of state for terminations after the law took effect May 10.
The law was aimed at cutting off Medicaid funding to Planned Parenthood of Indiana. But the IU doctors feared that if they continued to terminate pregnancies -- even in cases where it was medically advisable -- they would also lose the ability to treat Medicaid clients, who make up a substantial portion of their cases.
Briefed on the situation by The Star on Friday, state Sen. Scott Schneider, the author of the defunding amendment, reacted with surprise and concern.
"This was not the intent," said Schneider, R-Indianapolis. "We exempted this type of medical procedure in a hospital. So if something needs to be fixed, we'll look at it."
Gov. Mitch Daniels' Family and Social Services Administration had already taken steps to clarify the exemption to include doctors working in hospitals -- but only through a process that would take several months. Spokesman Marcus Barlow said he disagreed with the IU School of Medicine's interpretation of the law.
Risk to the mother
Doctors are sensitive to the controversy surrounding the termination of any pregnancy, even for medical purposes, and many declined to comment on the law's effect.
However, Elizabeth Ferries-Rowe, chief of obstetrics and gynecology for Wishard, said in a letter to The Star that the legislature and Daniels had "tied the hands of physicians attempting to provide medically appropriate, evidence-based care in the setting of routine obstetrics and gynecology" in "a politically motivated move to de-fund Planned Parenthood."
Ferries-Rowe, who described herself as a Catholic, said Wishard continued treating women in mortal danger, such as those suffering from ectopic pregnancies -- when a fertilized egg implants outside the uterus.
But she said she would be unable to terminate the pregnancy of a woman whose amniotic membranes had ruptured at 16 weeks with complete loss of fluid. Under those circumstances, Ferries-Rowe said in an interview, the baby would likely be born so early that it wouldn't survive, and a woman who chose not to terminate the pregnancy would run the risk of sepsis, which can cause permanent organ damage, loss of limbs, brain damage or death.
She said no IU School of Medicine doctor was able to give a patient the option of abortion even in the case of congenital fetal anomaly incompatible with life -- in other words, zero chance of survival.
The consequences of the defunding law were particularly significant for IU School of Medicine doctors because they treat women with high-risk pregnancies who have been referred by other health providers across the state.
Pam Perry, director of public and media relations at the IU School of Medicine, confirmed that the school's doctors have been affected. "Yes," she said, "it has had an impact on their ability to provide care to a significant group of patients."
Not "scientific" studies
At least seven states mandate warnings about fetal pain, but almost all of them require those warnings only for patients more than 20 weeks pregnant.
An article published by the American Medical Association, and provided to The Star by Indiana Right to Life, surveyed research on fetal pain and found some evidence of the possibility of fetal pain -- after 23 weeks. But the vast majority of abortions are performed in the first 12 weeks of pregnancy.
State Rep. Mark Messmer, R-Jasper, a sponsor of the bill, said the warning that a fetus can feel pain "at or before 20 weeks" was never meant to make women think that fetuses can feel pain at any stage of development.
"We're not saying that a fetus can feel pain at three weeks," Messmer said.
However, Rep. Sue Ellspermann, R-Ferdinand, who said she wrote the original draft of the fetal pain warning language, acknowledged to The Star that she consulted no doctors, scientists or studies -- "not to the extent that I would call them scientific studies" -- while preparing the legislation.
She said she had seen video footage "of the baby (in the womb) shying away from the needle."
"As technology moves forward," Ellspermann said, "we're getting closer to proving that research."
She said she felt confident inserting the language into Indiana law because she had seen it in other state legislation. When asked for supporting evidence, she told The Star: "I am not a medical doctor, so I would suggest that you continue to look for that and search various sources. But you're asking good questions."
The bill's author, Rep. Eric Turner, R-Cicero, said the purpose of the bill was to "make sure pregnant ladies have as much information as possible about the procedure so they (can) make an informed decision."
How important it was to the sponsors that the information stand up to scientific scrutiny, however, remains an open question.
Sen. Vi Simpson, D-Ellettsville, proposed an amendment requiring information given to women seeking abortions be "medically and scientifically accurate."
A Senate committee voted it down.
No comments:
Post a Comment