Beyond the Byline: Roe v. Wade ruling compromises patient safety

Senior Operations Reporter Alex Kacik and Safety & Quality Reporter Mari Devereaux talk about how the healthcare industry will adapt to a post-Roe world.

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Music Credit: Coffee by Cambo

Alex Kacik: The healthcare industry is trying to navigate a new normal as 26 states are primed to restrict or ban abortion services after the Supreme Court overturned Roe v. Wade, the 1973 law that protected a woman's right to an abortion. It poses an array of ethical, financial and legal consequences for healthcare providers. How will the industry adapt to a post-Roe world?

Welcome to Modern Healthcare's Beyond the Byline, which offers a behind the scenes look into our reporting. My name is Alex Kacik. I'm a senior operations reporter for Modern Healthcare and I'm joined by.Mari Devereaux, our safety and quality reporter. Thanks for coming on Mari.

Mari Devereaux: Glad to be here. Thanks for having me.

Alex Kacik: All right Mari. We've been trying to unpack all the potential consequences about bending the federal law and leaving abortion laws up to the states. You had a great breakdown of the varying state laws that are set to go in effect after Roe was overturned last week. What does that patchwork of state laws look like?

Mari Devereaux: Post-Roe landscape is already looking similar to more or less similar to what we expected. Abortion is now completely prohibited in seven states and another seven are likely to ban abortion soon. In Louisiana and Utah courts have temporarily blocked the state's existing abortion bans which were supposed to go into effect after Roe was overturned. So abortion is still more or less legal in those states. Several states have gestational limits in place restricting how far into pregnancy patients can receive an abortion. For nine states mostly located in the Midwest and the East Coast. The legality of abortion is undecided at the moment and in the hands of courts and lawmakers. Laws in 20 states and D.C. protect the right to abortion services. And many individuals from around the country will likely flocked to the states once abortion rights are restricted in their home state.

Alex, physicians will grapple with some ethical and legal dilemmas if they operate in a state that restricts or outlaws abortion services. What's their legal liability?

Alex Kacik: So nearly all the lawyers and law professors I spoke with said the doctors will have minimal legal protection. So state courts are going to grapple a variety of civil administrative involving their licensure and criminal charges related to providing abortions and restrictive states. So some of it depends on their malpractice coverage and health systems are talking with their carriers right now to determine what's covered and what isn't under this landscape. But ultimately, it really depends on how much risk physicians and their employers are willing to shoulder. Some attorneys will advise physicians to run the risk if they terminate an ectopic pregnancy, while others will tell clients to avoid them altogether. You know, even if a doctor performs an abortion in a state that allows it post-Roe, they could be prosecuted if they're licensed in a state that has banned those services, one lawyer told me. It depends really how aggressive the licensing boards and state prosecutors are some hospitals and clinics reportedly have resorted to sending encrypted messages and calling patients via phone to avoid a paper trail. So we're already seeing some defensive strategies implemented.

Mari, you talked to one of the executives at the American Medical Women's Association and they went through a hypothetical scenario where eventually the Texas resident may have an OB-GYN that has never done an abortion. Take us through some of the potential impacts on training when it comes to abortion services and how that could impact health outcomes.

Mari Devereaux: Yeah, so several doctors and healthcare executives I spoke with have expressed concerns about what could now be a real possibility. According to the American College of Obstetricians and Gynecologists, nearly half of OBGYN residency programs and residents are located in states that have outlawed or are likely to outlaw abortions. This means that medical trainees in many of those states may no longer be able to learn how to perform abortion related procedures in a hands on training setting with licensed doctors. And in many cases of severe miscarriages, preeclampsia, or other high risk conditions. These types of services are essential and often even life saving. If physicians aren't fully educated on performing abortions, or emptying the uterus, experts say it could lead to lower care quality and potentially life threatening health outcomes for patients.

Alex, we're already seeing some legal challenges to states that have implemented trigger laws banning abortion. What have we seen so far?

Alex Kacik: On Monday, we already seen some legal movement where the Center for Reproductive Rights filed a petition and asked for an injunction halting Louisiana's trigger laws on behalf of the family planning clinics. The state court granted them the injunction until the hearing set for July so they're gonna have a waiting period over the next couple of weeks. That will still preserve access to these services. But at the same time this is going to factor in to patient care this is going to be in the back of their minds. So you have these outside influences that could potentially impact care.

And on the other side of things, we're already seeing some legal moves from more aggressive "pro-life states." Indiana Attorney General Todd Rokita filed a request Monday to stop expansion plans for abortion providers in Evansville and South Bend. The Attorney General is also asking the courts to lift injunctions against several state abortion laws following the Supreme Court's decision.

So we've got a while until these state courts grapple with these legal claims and challenges, and it will take some time for precedent to be set. But that being said, patients and physicians oftentimes are in the middle. So it's unclear how they'll adjust in the short-term.

One of your sources told you that clinics in New Jersey and New York were already seeing more patients coming for abortion care from states like Texas, Ohio and Pennsylvania. How are they preparing for an influx of patients and what could be the potential consequences of having to travel further for care?

Mari Devereaux: In states where abortion is legal clinics are gearing up to hire more healthcare staff and gather resources in order to offer a higher number of abortion services. Some clinics and healthcare systems are looking for ways to partner with other facilities and states that outlaw abortion to help educate their patients on various options and provide them with easier care access. Others are looking into expanding telemedicine options for version services, or developing legal strategies to protect against certain restrictions in certain states. Still, even with all these efforts, the need to travel is a significant barrier to care for many individuals, depending on their socioeconomic background, and it disproportionately impacts communities of color.

Read more: With Roe v. Wade overturned, telehealth providers brace for impact

Traveling for abortion services can be expensive, and it's hard for those with work or childcare responsibilities. The lack of immediate access to an abortion may also mean that patients won't be able to undergo the procedure before it becomes illegal in nearly every state at field viability or at a determined number of weeks of pregnancy. Physicians say that waiting for an abortion leads patients to show up at clinics with more severe complications and high risk pregnancies than they normally would have.

Alex, you spoke with a law professor who has done some work in El Salvador, where abortion is outlawed. What was her experience?

Alex Kacik:So Michelle Oberman, she's a law professor at Santa Clara University. She was working in El Salvador and doctors, she would describe trying to work around the country strict abortion ban. A doctor in El Salvador couldn't recommend an abortion for instance, if a breast cancer patient was pregnant, instead, they would give the patient small amounts of radiation treatment they didn't have much if any data to support. Michelle describing it was kind of exploratory, hoping that it would eliminate the cancer without harming the fetus. She said that as many as one in three pregnancies end in abortion in Latin America, even though it's banned, so that does not mean abortions are going to stop. Emergency department visits to may ris, she warned if complications arise from taking the abortion pill too late in a pregnancy.

I think her most salient point was that just because it's outlawed, you know, this abortions aren't going to stop, they're going to find other ways to do so. And I know, telemedicine has come a long way and other avenues of care. But at the same time, people are going to have to come into the ER for emergency care related to you know, their pregnancy. And then you're going to have some real time discussions between the providers, the health system, you know, the legal counsel and what they're allowed to do what they have pledged an oath to do in terms of keeping people safe. What federal law under EMTALA dictates that they have to do. So right now it's just, it's a really risky gray area.

Mari, have you heard anything about how providers are preparing to address or work around any training gaps in reproductive healthcare?

Mari Devereaux:Yeah, so recently, the Association of American Medical Colleges published an article on how physicians and educators expect there to be a steeper climb for residents seeking training on abortion and related OB-GYN issues. Although requirements set by the Accreditation Council for Graduate Medicine Education dictate that every resident at an accredited OB-GYN program must have access to abortion training that will become difficult for schools to provide as states increasingly begin to ban abortion services. As a result, various organizations have been contemplating ways for residents to be able to fulfill their training requirements. This might look like colleges finding a partnering institution that can take on additional trainees and temporarily relocating residents to states that allow abortions in order for them to complete their education. Some physicians and educators are considering creating new curricular content to address this learning gap. And others are looking to train residents on abortion related services using virtual or real life simulations. However, much of this planning is a ways off for being implemented, because it will take medical educators time to assess the full extent of the fallout from the court's decision.

Alex Kacik: On the backdrop of this, too, we have the staffing shortages that are already hitting healthcare systems hard. And so I imagine, as you said, some of these providers are trying to staff up. I imagine they're hindered by just a lack of number of licensed caregivers that could step in here. I know telehealth is gonna help because they can cover more ground theoretically, but also, the laws are pretty sweeping at this point when it comes to the restrictive trigger bans. So that's also kind of a legal gray area. But yeah, imagine through all this, too, you have to keep in mind that there aren't enough caregivers right now to go around and to service the demand. So I imagine that could be a hindrance when it comes to even finding folks. Especially if it's like located within a certain state that people are traveling to enough in that area to fill that demand.

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Mari Devereaux: It's going to be difficult for sure some of the providers that I talked with are already, you know, getting overwhelmed from patients coming in from different states to access abortion care as their home states already have restrictions in place that make it difficult to access that kind of care.

Alex Kacik: All right Mari. Well, hey, thank you so much for your time sharing your reporting and expertise with us.

Mari Devereaux: Thanks, Alex. Anytime.

Alex Kacik: All right. And thank you all for listening. You can subscribe to Beyond the Byline on Spotify, Apple podcasts or wherever you choose to listen. You can support the reporting of Mari, myself and our team of reporters by subscribing to Modern Healthcare and giving us a follow on Twitter and LinkedIn. Thank you for your support.

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*Alex Kacik forgot to mention: This will grow care deserts when it comes to obstetrics care. Hospitals, particularly rural ones, had been cutting obstetrics services for years since it is often a loss-leader. So something to keep track of.