Doctors concerned about how West Virginia’s abortion ban works

Doctors caring for pregnant patients say they worry about the effects of strict abortion policies passed by the West Virginia legislature.

Dr. William Artrip

“All of this has a negative influence on the health of the people of West Virginia. It’s going to drive doctors into retirement or drive them out of the state,” Dr. William Artrip, an obstetrician-gynecologist from Ronceverte, said in an interview this week.

Artrip’s practice, Greenbrier Physicians, has three doctors, so there’s not much to give away. “It’s going to make it difficult to be an obstetrician/gynecologist in this state,” he said. “And there are already very few of us.”

The U.S. Supreme Court case that overturned a federally guaranteed abortion right initially raised the question of whether a West Virginia law from the late 1800s that made abortion abortion an offense punishable by imprisonment had come back into force. A coalition of abortion rights advocates won an injunction against the ancient law in circuit court, alleviating some of that concern.

West Virginia lawmakers met in a special session in late July and initially considered a bill that still would have imposed criminal penalties. Lawmakers have battled over whether the jail term should stand with some members of the GOP majority, particularly Sen. Tom Takubo, arguing that granting a medical license, rather than jail, would be a tool adequate to enforce abortion law.

“There were people who were really insistent that they wanted to impose sanctions on doctors, and I don’t think they even understood what they were asking for,” Takubo said this week on MetroNews’ “Talkline.” “The vast majority of doctors do not perform elective abortions. There are medical causes where they are needed.

“And scare the doctors – the guy who took care of your grandma and delivered your baby and he or she is on call at 2am and a patient comes in with severe bleeding partial placental abruption and a decision is made in the middle of the night that we need to take this to stop the bleeding and save the mother, this doctor shouldn’t have to worry about going to jail for three to ten years .”

West Virginia’s New Politics

The bill that passed this week was about licensing, not jail.

HB 302 would put medical providers’ licenses at risk if the board that oversees their professions finds they have “knowingly and willfully” exceeded the bounds of the law. People who are not licensed to perform abortions could still face criminal penalties if they attempt the procedure.

The bill allows exceptions for a non-medically viable fetus, an ectopic pregnancy, which is when a fertilized egg implants and grows outside the main cavity of the uterus, or a medical emergency, excluding psychological or mental health situations.

The gray areas of life make some of them a challenge to define, but West Virginia law tries.

For example, a “non-medically viable fetus” means containing enough lethal abnormalities that the fetus is medically futile or incompatible with life outside the womb in the reasonable medical judgment of a prudent physician.

A “medical emergency” is defined as a condition that complicates a patient’s medical condition to such an extent that an abortion is necessary to avert a serious risk of death to the patient or a serious risk of life-threatening physical harm to a major bodily function.

The law specifies that no condition can be considered a medical emergency if it is based on an allegation or a diagnosis that the woman will engage in a behavior that she intends to lead to her death or to a substantial and irreversible physical alteration of her life. a major bodily function.

Medical treatment isn’t always so black and white, Artrip said.

If a patient’s water were to rupture at 18 weeks, too early to be considered viable, doctors and patients would have a difficult decision. One option would be an abortion to avoid the possibility of infection and potentially losing the uterus. The other option would be to watch and keep making progress.

“It’s one option or the other and you have that option taken away; you have to wait until she gets incredibly sick and she could lose her womb or her life,” Artrip said of what would happen under West Virginia’s new policy.

“The whole question becomes the risk to mum’s life at that point. The answer could be no. But is it going to be three weeks before she gets a major infection? The answer is yes. So you potentially delay care,” he said.

A physician could assess that a medical professional licensing board would be leaning towards latitude, Artrip agreed, but the doubt could affect the advice provided by the physician.

“Ultimately, our goal is always to respect patient autonomy and provide them with the best possible care,” he said. “It puts roadblocks in the way.”

West Virginia lawmakers passed the abortion bill in one day this week without a committee, just debate in floor sessions. A few weeks ago, House committees reviewed abortion legislation and heard testimony from one particular obstetrician-gynecologist, Joe Ellington, who himself is a delegate and chairman of the House Education Committee.

Otherwise, there was no invitation for doctors who tend to pregnancies to speak publicly about ways the law might affect their treatment. “I volunteered personally. There have also been several physicians in Charleston. We all volunteered to go talk if they let us,” Artrip said.

The American Association of Obstetricians and Gynecologists “strongly opposes any effort that impedes access to abortion care and interferes with the relationship between a person and their healthcare provider,” a statement that was adopted and reaffirmed several times over the years, most recently this year. .

Legislative considerations

Tom Takubo

Takubo, the Senate Majority Leader and pulmonologist, led the discussion on the bill during this week’s session and described it as carefully balanced.

“We’ve expanded the language a bit to say that you don’t have to wait until organ damage or something has happened to a patient. If it is in the careful decision of a doctor that there is a higher probability, act before it happens, and we will put it in the bill,” said Takubo, R-Kanawha.

“Then there is language that says that to be in violation of this law, a doctor would have to knowingly and voluntarily perform an abortion with the intent to break the law. It can’t get more black and white than that. Finally, if there was a gray area, the doctor would be brought before the board of medicine.

Stephen Baldwin

Senator Stephen Baldwin, D-Greenbrier, expressed concern about how this would all work in practice.

“If you just have an allowance for a medical emergency, then the doctor has to make the decision,” he said. “If you have politicians saying ‘This is what a medical emergency is and under these circumstances the doctor has to make a decision’, that takes away from the doctor the ability to really make that decision.”

He said doctors are likely to ask themselves, “Am I providing treatment and I risk breaking the law, or am I not providing treatment and I risk being sued?”

So, Baldwin said, some of the state’s obstetricians and gynecologists are likely to leave. “They don’t want to be put in that position. So why practice medicine here when they don’t feel like they have the ability to actually practice medicine and not be put in these difficult circumstances? »

Politics and Medicine

Anita Stewart

Dr. Anita Stewart practiced women’s health and worked in the labor and delivery unit at Summersville Regional Medical Center until it closed just a few years ago. Now she provides family planning services in Fayette County.

She expressed concern about the cross-factors of high maternal morbidity and mortality in West Virginia, poor health outcomes and high-risk behaviors, and the ongoing challenges of recruiting doctors and encouraging young residents of the state to stay. “I think that adds another layer of complexity and another barrier to not only recruiting doctors, but also retaining doctors,” she said.

“Any time politics and medicine are intertwined in this capacity and providers and doctors are excluded from this decision-making process, you will have bad results. You train for a long time to become a doctor and practice medicine, and it’s not black or white.”

For example, Stewart said, some patients in rural parts of the state may experience placental abruption. “If it happens at any time during pregnancy, it can become an emergency quite quickly. Women can bleed very quickly,” she said.

Now is not the time to have to consider the possibility of appearing before the licensing board, she said.

“In this situation, we make decisions in seconds and minutes. So to throw in consultation with law or ethics or legislative rule in a situation that may take a few seconds that you need to make that decision, you’re going to have bad results,” Stewart said.

“This is going to potentially lead to the loss of both mother and baby. We would have to act quickly. Being able to quantify the amount of blood lost is a challenge.

These situations could force doctors to consider what’s right for the patient rather than have their medical license at stake. Or, be overly cautious and be sued for a poor outcome.

“To even have to think about it as a doctor,” she said, “if you were looking to potentially move here and had to think about it, you’d choose somewhere else to practice.”

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