Dear Supreme Court, legislating substandard abortion care IS an undue burden

The Texas law that uses “safety regulations” to limit abortion services in Texas is set to go to the Supreme Court.

The law in question is HB2 and it includes:

• A 22 week ban
• 4 visits for a medical abortion
• Abortion providers have admitting privelgaes at a hospital within within 30 miles
• Abortion clinics must meet the space requirements of ambulatory surgical centers

Each one of these is either bad medicine or unnecessary medically (you can argue that is bad medicine too as unnecessary care is something we are all trying to fight against to lower the costs of health care in America and make medicine safer, oh the irony).

Let’s break each one down

A 22 week ban

The GOP is in love with the lie that women hop into abortion clinics at 30 weeks on a whim. but only 1.3% of women have abortion after 21 weeks and 80% of them are for birth defects. Apparently the law allows for an abortion for a “severe fetal anomaly,” but who will decide? If your fetus has Down’s syndrome will that qualify? What about microcephaly? Will doctors be calling the Governor for guidance?

There is also a health of the woman clause, but how sick you have to be is not known. It is this kind of idiotic ambiguity that kills women. If you are 22 weeks with ruptured membranes and want to be induced because you have three children at home and the idea of getting a serious intrauterine infection is just too high for your own risk/benefit ration will you be denied? After all, you aren’t sick yet. What if you have signs of an early infection? Medicine says delivery, but what if the law says not sick enough!  Doctors are not legal experts and undoubtedly someone will wait too long. This is not a stretch, this is what happened to Savita Halappanavar in Ireland.  I used to practice in a state where we to call the senator who wrote an anti-choice bill to find out if a woman who was really, really ill was actually sick enough by his standards to get an abortion.

4 visits for  a medical abortion

This is medically unnecessary. Shouldn’t that be enough to demonstrate undue burden? A medical abortions is safer than a colonoscopy, yet no one needs 4 visits to get that done. I hope the lawyer says, “Imagine if you needed 4 visits to have your colonoscopy, would you consider than an undue burden if the American Society of Gastroenterology said one were medically necessary?”

Admitting privileges

You do not need admitting privileges within 30 miles to get your patient cared for. Ever. This is such a joke I just don’t know where to begin. I would probably bring up colonoscopies again as the serious ocmplication rate is about the same as abortion. I would argue that if a gastoenterologist perforates a colon during an ambulatory colonoscopy he doesn’t admit the patient, a general surgeon does. Admitting privileges mean nothing except that your license is current and everyone liked you enough at the hospital. Every single doctor knows a doctor who has admitting privileges who they would never, ever send anyone to. There are bad doctors who have admitting privileges and I know amazing doctors who don’t have admitting privileges anywhere because their work is all out outpatient and when their patient is sick enough to need admission they transfer. The point, admitting privileges are paper work for regulatory agencies and not a benchmark of medical training or skill.

Space requirements.

Trying to improve abortion safety is very hard because it is already so safe. Abortion is one of the safest procedures a woman in the United States can have. Nationwide an average of 6-12 women annually die from an abortion-related death. The case-fatality nationwide per 100,000 procedures is 0.67, so abortion in Texas was already safer before HB2 than the national average. According to the Centers for Disease Control (CDC) the numbers of abortion-related deaths are just too low to draw meaningful conclusions about safety or areas for improvement. There is no data to show the one abortion-related death in the last 5 years in Texas could have been prevented by performing the procedure in a hospital or an accredited surgery facility. In fact no data anywhere shows that complications are lower in accredited surgical facilities versus a clinic or office. The last 4 years of stats from Texas show no abortion related deaths, so how exactly would HB2 change that?

More people die from dental care in Texas than do from abortion, many more. A staggering 85 people died in Texas from dental care over 5 years but no one in the government seems concerned about them at all!

The American Congress of OB/GYN has also denounced the bill.

HB2 is simply bad medicine and allowing it to stand means that doctors don’t get to decide good medicine and that should scare everyone.