Texas hospitals are putting pregnant patients at risk by refusing care over fears of abortion laws, medical group says

AUSTIN (Texas Tribune) – The Texas Medical Association is asking state regulators to intervene after saying that several hospitals fearful of violating the state’s abortion ban have turned away pregnant patients or delayed care resulting in complications, reported the Dallas Morning News.

In a letter to the Texas Medical Board — the state agency that regulates the practice of medicine — TMA officials said Wednesday they had received complaints that hospital administrators and their legal teams were preventing physicians to provide medically appropriate care to patients with certain pregnancy complications. They ask the council “to act quickly to prevent any unwarranted intrusion into the practice of medicine”.

TMA is a nonprofit professional organization that represents more than 55,000 healthcare professionals in the state.

The request comes as confusion and concerns abound among Texas medical professionals about what they can and cannot do under Texas’ abortion ban.

Beyond elective abortions, there are several situations in which a doctor may advise an abortion for the patient’s safety – including ectopic pregnancies, in which a fertilized egg develops outside the uterus, making it nonviable – or provide other stabilizing treatments during hypertension and preeclampsia. Delays in treatment can lead to serious health complications.

But in a post-Roe world, doctors in states where abortion has been banned must weigh the legal implications of their actions, instead of making decisions based on what the prevailing medical literature recommends. In Texas, doctors can face six-figure fines and jail time for any unauthorized abortions.

According to the Morning News, the TMA included in its letter examples of cases in which treatment was denied or delayed, but did not name specific hospitals. In central Texas, a doctor is said to have been instructed not to treat an ectopic pregnancy until a rupture occurs, which seriously endangers the patient’s health, the letter says.

“Care delayed or prevented in this scenario creates a substantial risk to the patient’s future reproductive capacity and poses a serious risk to the patient’s immediate physical well-being,” the letter states.

The TMA letter also accuses two other hospitals of telling doctors to turn away pregnant patients and send them home to ‘expel the fetus’ if their waters break too soon, which may put them at risk of death. ‘infection.

Not only are patients at risk of serious injury, but doctors could face lawsuits or the loss of their medical licenses for failing to provide adequate care, the TMA letter says. Failure to do so could violate the state’s prohibition on practicing medicine in business, which generally prohibits corporations or non-physicians from practicing medicine.

The TMA’s plea comes a day after Texas sued the Biden administration for blocking new federal guidelines reiterating to doctors across the country that they are protected by federal law to terminate a pregnancy as part of treatment for pregnancy. ’emergency.

The Biden administration has warned that federal dollars could be taken from institutions that don’t provide care.

Texas abortion restrictions – a ban that bans most abortions after around six weeks of pregnancy, as well as a law passed last year that will ban almost all abortions, as well as older laws that banned the procedure before Roe — have made caring for pregnant women harder than ever, health care providers say.

Without medical assistance during a miscarriage, especially later in pregnancy, patients face risks such as life-threatening bleeding and sepsis. Texas abortion laws provide exceptions for the procedure if the mother’s life is in danger, but even that is fraught with uncertainty, doctors say.

Some medical providers say they are forced to delay or reconsider treatment options they may prescribe because of laws, especially for those with high-risk pregnancies.

Many doctors, legal experts and anti-abortion groups have said the state abortion ban should not apply to miscarriages and life-threatening complications.

Texas laws against abortions — including the 1925 law that the Texas Supreme Court has allowed to come back into effect while the U.S. Supreme Court hands down the judgment that will formally end Roe v. Wade and the trigger law that will then come into effect – make exceptions in cases where an abortion is necessary to save a mother’s life.

The trigger law, which will take effect 30 days after the Supreme Court ruling, also adds an exception where a person is at risk of “substantial impairment of a major bodily function.”

The state’s definition of abortion, clarified by state lawmakers in recent years, explicitly states that treatments for miscarriages, called “spontaneous abortions” in medicine, and ectopic pregnancies do not count as abortions.

Texas law defines abortion as “the act of using or prescribing any instrument, drug, medicine, or other substance, device, or means with intent to cause the death of an unborn child of ‘a woman known to be pregnant’.

Abortions do not include “birth control devices or oral contraceptives”, according to the statutes, and treatments to “remove a dead and unborn child whose death has been caused by spontaneous abortion” or to “remove ectopic pregnancy” or to “save life”. or preserve the health of an unborn child.

Some Texas doctors have already run into trouble since a law last fall banned most abortions for the past six weeks. And others in the health care industry have steered clear of anything that could be construed as violating state abortion laws.

“We’ve seen pharmacists unwilling to fill certain medications,” said Dr. Natalie Crawford, co-founder of Fora Fertility in Austin, who also sees patients in their first trimester.

Abortion-inducing drugs are the most common method used by Texans to terminate a pregnancy, according to Texas Health and Human Services. But it also has a wide range of other uses in obstetrics and gynecology, according to the U.S. National Institutes of Health, including the medical management of miscarriages, induction of labor, cervical dilation before surgical procedures and the treatment of postpartum hemorrhage.

For example, an incomplete miscarriage may require the use of abortion-inducing drugs to prevent infection of any remaining tissue. Other times, a patient may not realize that she has lost her pregnancy until she has a medical examination, and she may not want to wait for her body to begin the process of natural release, a a Texas doctor told NPR.

Medicines are also used beyond reproductive care. Misoprostol helps prevent stomach ulcers, but it can cause abortions if taken with mifepristone.

Methotrexate, another abortion-inducing drug, is used to treat ectopic pregnancies as well as rheumatic diseases, inflammatory bowel disease, psoriasis and cancer.

Another Texas law enacted last year prohibits the distribution and shipment of abortion-inducing drugs for the past seven weeks, but provides exceptions when used for “other medical reasons.”

Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said doctors typically note a diagnosis when prescribing medications and prescription rejections don’t appear to be widespread.

If patients are having trouble filling their prescriptions, Thoppil and Crawford say they should try to find another pharmacy or talk to their healthcare provider.

“We haven’t seen a big problem, but there are definitely some anecdotes,” Thoppil said. “Fortunately, I think there are still plenty of pharmacies that understand the proper use of some of the drugs that we use for non-elective care. [pregnancy] terminations. »

He said the Texas Association of Obstetricians and Gynecologists is in communication with some pharmacy executives to “help clarify the proper interpretation of the rules.”

And on Wednesday, the Biden administration also warned retail pharmacies to fill prescriptions for pills that could cause abortion or risk violating federal civil rights law.

Still, Crawford said doctors are concerned about delays in care, especially for first-trimester conditions such as bleeding, hemorrhaging, septic miscarriages and ectopic pregnancies.

“These can be acute, life-threatening emergencies,” she said.

That’s why Crawford said it’s important for patients to seek help quickly if they notice that their pregnancy isn’t progressing normally.

“Please go see a doctor if you have any bleeding during pregnancy. If you are in severe pain, if you have a fever, you need to let your medical team know,” she said. “We want to keep you safe.”

Karen Harper of the Texas Tribune contributed to this story.

Disclosure: The Texas Medical Association financially supported The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and sponsors. Financial supporters play no role in the journalism of the Tribune. Find a full list here.

This article originally appeared in The Texas Tribune at www.texatribune.org. The Texas Tribune is a nonprofit, nonpartisan media organization that educates — and engages with — Texans about public policy, politics, government, and statewide issues.

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