MO: Every abortion must be reported and prosecutors will decide whether to file charges [View all]

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Mark Joseph Stern
@mjs_DC
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When Missouri doctors terminate a pregnancy because of a medical emergency, they must report their decision to the state. Then prosecutors review it and decide whether or not to charge them with a criminal violation of the state's abortion ban. https://statnews.com/2022/07/05/a-scary-time-fear-of-prosecution-forces-doctors-to-choose-between-protecting-themselves-or-their-patients/…

Missouri residents with ectopic pregnancies must persuade a hospital ethics committee that their condition is sufficiently life-threatening to justify an abortion, even if their fallopian tubes are about to burst. https://statnews.com/2022/07/05/a-scary-time-fear-of-prosecution-forces-doctors-to-choose-between-protecting-themselves-or-their-patients/…

Last Wednesday, a patient walked into Julie Rhee’s fertility clinic in St. Louis with pelvic pain that was getting steadily worse. She had a history of ectopic pregnancies and, following months of IVF treatment, was showing all the signs of another one. A recently implanted embryo was growing inside the fragile walls of her fallopian tube, threatening to burst them open and cause internal bleeding at any moment. She needed surgery, and fast.

For the first time, though, Rhee discovered her clinical judgment wasn’t enough. She would have to present her case to a hospital ethics committee.

Some Missouri hospitals are instructing doctors not to treat patients with an ectopic pregnancy until they are "unstable" or experiencing blood loss. Only at that point can they terminate the pregnancy (which is unviable by definition). https://statnews.com/2022/07/05/a-scary-time-fear-of-prosecution-forces-doctors-to-choose-between-protecting-themselves-or-their-patients/…

Although Rhee’s patient was able to get surgery in time, physicians are worried that delays could imperil other patients. The lack of specificity over what counts as a threat to the mother’s life means some doctors feel pressure to sit and watch patients’ health deteriorate until they’re able to intervene.

Serena H. Chen, a fertility doctor in private practice in New Jersey, said a friend in Missouri had been told by her hospital to wait until patients with ectopic pregnancies are unstable before taking them to the operating room.

Jane van Dis, professor of obstetrics and gynecology at University of Rochester Medical Center in New York, also tweeted that colleagues in Missouri were now waiting to treat ectopic pregnancies until their patients had falling hemoglobin levels — an indication of blood loss — or unstable vital signs.
1:00 PM · Jul 27, 2022

https://www.statnews.com/2022/07/05/a-scary-time-fear-of-prosecution-forces-doctors-to-choose-between-protecting-themselves-or-their-patients/

Last Wednesday, a patient walked into Julie Rhee’s fertility clinic in St. Louis with pelvic pain that was getting steadily worse. She had a history of ectopic pregnancies and, following months of IVF treatment, was showing all the signs of another one. A recently implanted embryo was growing inside the fragile walls of her fallopian tube, threatening to burst them open and cause internal bleeding at any moment. She needed surgery, and fast. For the first time, though, Rhee discovered her clinical judgment wasn’t enough. She would have to present her case to a hospital ethics committee.

In the days after the U.S. Supreme Court overturned Roe v. Wade, Missouri was one of several states that rushed to pass legislation that bans physicians from terminating a pregnancy unless the mother’s life is in immediate danger. Physicians like Rhee risk losing their medical license and more than a decade of prison time if they violate these laws, so doctors and hospitals are taking no chances.

Though an ectopic pregnancy will never result in childbirth, and can cause massive internal bleeding and death if left untreated, the ethics team at Mercy Hospital had to determine that Rhee was exercising appropriate judgment and her patient was in danger before she could be rushed to the operating room. The added bureaucracy took more than half a day of work, and Rhee felt the oversight was intended to protect her and the hospital, at the expense of her patient.

“When we graduate medical school and take the Hippocratic oath, we vow to first do no harm to the patient, and to keep the patient’s best interests in mind,” said Rhee, an OB-GYN and a reproductive endocrinology and infertility specialist who noted she was speaking only for herself, not a medical practice or hospital. Seeking approval from ethics committee members with no clinical expertise can help document that physicians are acting within the law, she added, but puts patients’ lives at risk: “I can’t think of another situation where we’re feeling cornered to choose between the two.”

*snip*