Keeping doomed fetuses alive: How doctors say Idaho’s abortion law disrupts care
Abortion care in Idaho is changing. But how, specifically, and to what degree, will the state’s near-total ban affect pregnant women?
Health care providers say the new law has negative short-term and long-term implications.
The Idaho Legislature in 2020 passed a “trigger law” that imposed criminal penalties for doctors or others who perform abortions except for pregnancies caused by rape or incest or that threaten the mother’s life.
The ban was triggered by the Supreme Court’s ruling in June overturning Roe v. Wade. It took effect Thursday, Aug. 25, although a federal judge barred the prosecution of anyone who aborts a fetus in a medical emergency.
Dr. Frank Johnson, a physician at St. Luke’s Health System, Idaho’s largest hospital and clinic operator, said the injunction gives health care providers more time to navigate the state’s restrictive abortion law and determine how patient care will change.
Johnson said health care providers are bound by the federal Emergency Medical Treatment and Labor Act to provide stabilizing treatments to patients in medical emergencies, including abortion. Idaho’s abortion ban, which has narrow exemptions for rape, incest and the life of the mother, conflicts with EMTALA.
The injunction issued allows St. Luke’s and other hospitals a chance to seek clarity from the courts on what can legally be done to save the life of a pregnant woman suffering from complications.
Women with complicated pregnancies ‘ill and need care’
“We were struggling, frankly, to figure out how we could follow the total abortion ban law, which criminalizes all abortions,” Johnson said. “That was going to be challenging for women who presented to our hospital who had a medical emergency, who had complications of a pregnancy, and whose life or well-being was put at grave risk, in part because of their pregnancy.”
He said women who come to St Luke’s for abortion care have complicated pregnancies. The health system generally doesn’t perform abortions otherwise.
“We’re really focused on those complications of pregnancy that arrive here,” he said. “They’re sick. They’re ill and need care in that setting.”
Typically, these situations involve a conversation between a patient and a physician or health care team to talk through options and risks to determine the best course of treatment.
Idaho’s abortion ban makes those conversations significantly more challenging.
“How much risk is too much risk is something that each individual has always had the ability to help decide for themselves and have a conversation with their doctor,” Johnson said. “With the total abortion ban, that decision-making is no longer part of the equation.”
Mothers’ bodies keep fetuses facing certain death alive
Scott Tucker, practice administrator at Women’s Health Associates, says the law disrupts certain aspects of care for pregnant women.
Women’s Health Associates provides gynecology services to women in the Treasure Valley. The most common procedure it performs is for miscarriages.
“Those aren’t even viable pregnancies anymore,” Tucker said. “There’s no heartbeat, there’s no fetal pole, there’s no nothing. We’re still going to treat those.” A fetal pole is an embryo, one of the first stages of pregnancy, according to the Cleveland Clinic.
Tucker said his office does not perform elective abortions and refers women with unwanted pregnancies to Planned Parenthood or other local providers.
Idaho’s trigger law will affect pregnancies where the fetus has an anomaly that’s not compatible with life. These situations are not uncommon, he said.
“For example, they’re born without a head or they’re born without a face or they’re born with a severe heart defect,” he said. “Basically, mom’s keeping them alive, but as soon as they come out, they’re not going to live.”
Clinic staffers worry about ectopic pregnancies
At St. Luke’s hospital in Boise, Johnson said he’s been involved in the care of three women with ectopic pregnancies just this week.
An ectopic pregnancy is a clinically diagnosable pregnancy, except instead of being located in the uterus where it should be, the pregnancy is somewhere else, perhaps in the fallopian tube, attached to an ovary or even in the abdominal cavity.
“It’s a common thing that comes into our emergency department requiring hospitalization,” he said. “Ordinarily, that would not be an issue.”
But now, when women with ectopic pregnancies come in, staff members become worried.
“The teams are asking for input, feedback, and they’re reaching out to our legal team to help make sure they’re compliant with the law as it’s currently written,” Johnson said. “And that’s creating stress, anxiety and potential for delay that wasn’t there previously.”
The outcome? Increased risk and mortality for pregnant women.
Chemotherapy, radiation for mom’s cancer could kill fetus
There are also situations where the mother’s long-term health is at risk.
Tucker said cancer screenings are a routine part of the initial workup for pregnant women. “If somebody has cervical cancer, and they need to go through chemotherapy or radiation, the discussion is had with them about what they want to do,” he said. Chemotherapy or radiation could kill the fetus.
“Those are the situations that, under the new law, are technically outlawed right now,” he said. “We would have to seek other options for these patients.”
Tucker said the office has dealt with other patients who have had non-Hodgkin’s lymphoma or other types of cancers.
Under the new law, the threat to the mother’s life must be immediate. Tucker calls this a gray area.
He said his office often deals with situations that don’t necessarily pose an immediate threat to the life of the mother but can become dangerous the longer the woman stays pregnant. Based on the new law, providers would be subject to criminal penalties for providing such care.
“Part of our role in health care and part of our role as an OB-GYN is helping patients make an educated decision on what is going to be their best choice given their situation and supporting them in whatever that is,” Tucker said.
At the end of last year, he said, his office helped a patient whose baby had no face, half a head and only part of a brain. Tucker said they consulted with maternal-fetal medicine and determined there was no chance it would survive, even for a second, outside the womb.
“That’s not compatible with life, and there’s no surgical correction for that,” he said. “She opted to terminate the pregnancy, rather than put her body through continuing a pregnancy that is going to be nonviable.”
The state’s abortion ban will also affect routine health services for healthy women and women with healthy pregnancies, said Johnson, the St. Luke’s physician.
Nurses, physicians leave or won’t come to Idaho
“We have already seen nurses and physicians, either leaving St. Luke’s or leaving our area because of the restrictions that this law puts in place and the concern and stress that the law causes,” he said. “We’ve also had providers and nurses choose not to come to St. Luke’s and Idaho because of that law.”
Still, he encourages pregnant women suffering from complications to get help, whether that be at St. Luke’s or elsewhere. Johnson said his teams are working diligently to provide the best possible care under the circumstances.
“Please continue to come and continue to seek care when you need it,” he said. “Don’t delay. We’ll certainly treat you with care and compassion.”
Providers may send women out of state
There’s an added financial burden for women forced to get care in another state such as Oregon, where abortion remains legal. Insurance may not cover out-of-network benefits, Tucker said. If an insured patient does have out-of-network benefits, it might involve a high deductible.
Johnson said St. Luke’s has always sent patients elsewhere when needed.
“We would continue to follow that same principle, and if a treating physician felt that a woman’s care could not be provided here at St. Luke’s, then certainly we would be looking at transferring to a different location where care could be provided,” he said.
Tucker said Women’s Health Associates is ready to do the same.
”We’ll be working with a full interdisciplinary team, internal fetal medicine, internal medicine, cardiology, you know, just getting all of the specialists involved, and then coordinating and figuring out, where’s the best care if it’s something that would be illegal to do in Idaho?” he said.
Mack Smith, communications manager for Planned Parenthood Great Northwest Hawaii, Alaska, Indiana and Kentucky, told the Statesman via email that Idaho’s abortion ban places the most burden on people of color, people with low incomes and people living in rural areas.
“Before the bans, people in Idaho traveled an average of 21 miles each way to access abortion care,” Smith said. “However, with the total abortion ban in place, Idahoans will have to drive at least 250 miles on average each way to get the care they need.”
No elective abortions at Saint Alphonsus
Saint Alphonsus Health System, the Treasure Valley’s second-largest system of hospitals and clinics, does not provide elective abortions, a spokesperson said.
The hospital is part of Trinity Health, a Catholic health care system. The Catholic Church considers abortion a moral evil and demands that human life be protected from conception.
“In the event a pregnant woman has an emergency medical condition which requires the termination of her pregnancy in order to stabilize her condition, Saint Alphonsus provides such medical care as required under the Emergency Medical Treatment and Labor Act and consistent with the ERDs (Ethical and Religious Directives for Catholic Health Care Services),” spokesperson Mark Snider said in an email to the Statesman.
This story was originally published August 27, 2022 at 4:00 AM.
