Consider This from NPR - How Abortion Bans—Even With Medical Emergency Exemptions—Impact Healthcare

Episode Date: November 28, 2022

Christina Zielke went to an ER in Ohio bleeding profusely while experiencing a miscarriage. This was in early September, before the state's 6-week abortion ban was put on hold by a judge. What happened to her next is an example of how new state abortion laws can affect medical care in emergency situations.Doctors who run afoul of these laws face the threat of felony charges, prison time and the loss of their medical license. NPR's Selena Simmons-Duffin reports that some doctors are asking themselves a tough question: when they are forced to choose between their ethical obligations to patients and the law, should they defy the law?Selena's story about Zielke is part of NPR's series, Days & Weeks, documenting how new abortion laws are affecting people's lives.In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Indiana University. Indiana University performs breakthrough research every year, making discoveries that improve human health, combat climate change, and move society forward. More at iu.edu forward. Hey listeners, just a heads up before we get started on today's episode. The story we're about to hear includes a description of a miscarriage that involves a lot of bleeding. Christina Zilke's medical nightmare started on a drive from her home in Washington, D.C. to Northeast Ohio. She and her husband were going to celebrate her brother's wedding. I had some really heavy bleeding.

It was to the point like we had to like stop and clean out the car and like change all the clothes. At this point, Zilke wasn't worried. She already knew that she was having a miscarriage. At her first prenatal checkup eight weeks into her pregnancy, there was no heartbeat. Laboratory tests confirmed it was a miscarriage. Weeks went by. She thought her body was just taking a while. When she had bleeding on the drive to Ohio, she assumed she had finally passed the pregnancy tissue. But two days later, she started to bleed again. A lot. She climbed into an empty bathtub at her dad and stepmom's house so it wouldn't make a mess. I was passing blood clots like the size of golf balls. And at that point, I woke up my husband,

and I was like, please bring a phone. We need to call. The nurse on the advice line told them to go to the emergency room. They arrived at University Hospital's TriPoint Medical Center in Painesville, Ohio, at around 6 a.m. She got an ultrasound, which again found no fetal heartbeat. But Zilke says she didn't receive any treatment, not even IV fluids or pain medicine. Meanwhile, she kept bleeding heavily. So about two and a half hours into this slew of tests, finally a nurse comes in and tells me that I'm being discharged.

They said they needed to prove there was no fetal development and was told that I could come back in two days for a repeat hormone test to confirm I was miscarrying. Zilke had already had these tests at home in Washington. She tried to show the staff the records on her phone, gave them her doctor's contact information, but she says she got no response. Her husband, Greg Holyman, said that, to him, the hospital staff seemed hesitant. We kind of knew it was like, okay, it's Ohio, this is a delicate subject. The standard care to stop heavy bleeding from an incomplete miscarriage is a dilation and curatage procedure, a DNC, to remove any remaining pregnancy tissue. That's because the tissue can interfere with the normal contractions of the uterus,

which help shut down small blood vessels and control bleeding. A DNC is exactly the same procedure that's used for an abortion. Ohio had a ban on abortions after six weeks. It's been put on hold by a judge in the state, but when Zilke was in the ER on September 2nd, it was in effect. People who violate that law face felony charges, prison time, fines, the loss of their medical license. Zilke and her husband wonder if that law is the reason she wasn't offered a DNC on that emergency room visit. I wish someone had come and said, hey, this is the state law. This is what we're afraid of.

And was a little more frank. Zilke didn't want to leave the ER, but didn't know how to object. She says she wrote, I disagree on her discharge papers. At 10 a.m., four hours after she arrived, she drove back to her dad's house. But her scary experience wasn't over. I didn't make it back to the door again until there was blood running down into my shoes. Consider this. It's been five months since Roe v. Wade was overturned. And now 14 states have laws banning abortion with limited exceptions for medical emergencies. Christina Zilke's story is just one example of how, despite those exceptions,

the laws can still cause problems for patients. From NPR, I'm Juana Summers. Send, spend, or receive money internationally, and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit WISE.com. T's and C's apply. It's Consider This from NPR. The national legal landscape around abortion has changed radically and chaotically since the Supreme Court overturned Roe v. Wade. Doctors are now in the position of having to parse untested laws to decide what sorts of care for pregnant people may now be illegal. I think we're in a moment of tremendous

fear, and we're working with hospitals and doctors who are not fans of liability. Katie Watson, a bioethicist at Northwestern University, says that has led to situations. With physicians or staff saying, only if I think I'm a thousand percent safe will I do necessary, potentially life-saving medical care. NPR's Selena Simmons-Duffin has been reporting on how changing state laws are affecting patients around the country, including Christina Zilke, who we last heard from just after she'd been discharged from the ER without getting a DNC procedure for her miscarriage. Selena picks up the story from here. Back at the house, Christina Zilke was still bleeding. She climbed back into the empty bathtub. About another hour of bleeding passes, and I say, I don't think this is right. I don't think we should have come home.

By this point, she'd been bleeding heavily for seven hours. They called an advice line again, and a nurse said they needed to go back to the hospital right away. And so I tell my husband, all right, I just need a minute or two to like wash off, get myself clean enough to get out of this tub. And that's when I started to feel the world slip away. I looked at him and I said, I don't think I'm okay. She'd lost so much blood so quickly, her blood pressure had plummeted. Her eyes rolled back. Her body went limp.

She stopped breathing. She stopped moving. She's not responding at all. For like 30 seconds, I thought she was like a goner. Her husband yelled to call 911. Then her eyes opened again, and he told her that an ambulance was coming. They'll be here soon. Just keep breathing. Stay calm.

When the paramedics arrived, they had to use a sheet to pull her out of the bathtub and onto a stretcher. Just hours after being discharged, she was back in the very same ER. This time, she was admitted to the OBGYN department at the hospital and had the DNC. She had the option to stay overnight, but chose to go home that evening. It wasn't a place I felt safe or wanted to stay overnight but chose to go home that evening. It wasn't a place I felt safe or wanted to stay in. University hospitals declined NPR's request for an interview, citing patient privacy. They sent a written statement saying, quote, University hospitals complies with Ohio laws. Our position is always that health care decisions are best made between the patient and her

physician. Zilke filed a complaint with the hospital. She also got bills for two separate ER visits, totaling more than $10,000. She still doesn't understand why they didn't treat her the first time. Knowing Ohio's laws and knowing I was close to 12 weeks and them needing to have that two-part confirmation, I think could have cost me my life that day. That thought still haunts her. NPR's Selena Simmons-Duffin.

Her series on how changing abortion laws are affecting individual Americans and their families is called Days and Weeks. There's a link in our episode notes. Selena has also been reporting on how doctors are dealing with new state abortion laws. And there's a lot of evidence, surveys, news reports, court affidavits, that fear of violating these laws has caused some doctors to delay or deny abortions, including in emergencies. Some doctors are asking themselves a tough question. When they are forced to choose between their ethical obligations to patients and the law, should they defy the law? Here's an example of how the exceptions in abortion bans for emergencies can still cause problems for patients.

The Texas Policy Evaluation Project conducted a survey of clinicians operating under that state's restrictions. It found that sometimes providers avoided doing DNCs, opting instead for, quote, a surgical incision into the uterus because it might not be construed as an abortion. That's just nuts. Dr. Matthew Winnia directs the Center for Bioethics and Humanities at the University of Colorado. Much more dangerous, much more risky. The woman may never have another pregnancy now because you're trying to avoid being accused of having conducted an abortion.

Not all doctors agree that the abortion restrictions are responsible for harming patients. The American Association of Pro-Life OBGYNs calls that idea absurd, arguing OBGYNs have many years of training to know when to intervene before a condition becomes life-threatening. But many doctors and groups, like the American Medical Association, are concerned. Winnia published an editorial in the New England Journal of Medicine in September, calling for physicians to take a stand against these laws when necessary using civil disobedience. I have seen some very disturbing

quotes from health professionals essentially saying, well, look, it's the law. We have to live within the law. And if the law is wrong and causing you to be involved in harming patients, you do not have to live to that law. There's actually a long history of civil disobedience around abortion. Mary Ziegler, a legal historian at UC Davis, says for many decades, starting in the 1900s, there was kind of a don't ask, don't tell silence around abortion. By the 40s, you get more of a crackdown on abortion, and it's more framed as a vice or a racket, the same language you'd be using against organized crime. Lots of abortion providers got arrested and prosecuted. Then hospitals began forming committees to authorize certain abortions in

certain circumstances, like emergencies, but some doctors felt that wasn't enough. Allowing abortion when someone's death is imminent may be straightforward, but what about when someone has a heart condition and pregnancy makes that condition worse? Or if a patient tells their doctor, if I can't get an abortion, I'm going to harm myself. Ziegler says doctors wanted more leeway to follow their conscience and provide abortions in more situations. And in the 1960s, in the period leading up to Roe v. Wade, some doctors began to openly defy abortion laws. Not just getting arrested because they happened to get caught, but trying to get arrested. Dr. Millen-Vuic is one example, she says. He was arrested 16 times for providing abortions

in Washington, D.C. Dr. Leon Belus was arrested in California for just referring someone for an abortion. He fought back in the courts. And in Canada, Dr. Henry Morgenthaler was actually imprisoned for violating abortion laws. He used the legal cases brought against him to progressively legalize abortion across that country. One interesting question is like, well, why is it that we don't have more, you know, Dr. Morgenthaler's now? For one, she says the penalties now are very different. In the pre-Roe era, often if you violated an abortion line and you could lose your license to practice medicine, most people didn't really face much real prison time.

Some state laws now treat doing an abortion as like life in prison. That's the penalty for violating the abortion ban in Texas. Dr. Louise King raises another reason why there haven't been more people openly defying these new abortion laws. She directs reproductive bioethics at Harvard University and is an OBGYN surgeon. She says if she were to purposefully get arrested in Texas, for example, where she went to medical school and did her residency, she doesn't think it would actually be effective in getting laws changed. It's probable in Texas I'd lose the case. It's going to go up, wait, through the Fifth Circuit? I'm not going to win in the Fifth Circuit. And then am I going to win it in the Supreme Court? No.

She adds another consideration is how few OBGYNs there are who provide abortions. Any doctor who's sitting in jail or fighting felony charges will never work again, and that's one fewer person who's able to take care of patients. So what's the point? I don't even see the point. So far in the five months since Roe v. Wade was overturned and state bans began to take effect, there have been no reported prosecutions of health care workers. But Winnia says charges against doctors will certainly come. There will be individual doctors who will get, presumably, will end up in court.

And then, you know, the question will arise, were they supported? Can they be supported? He says this is a leadership issue. He wants organized medicine, accrediting organizations, and medical facilities like hospitals to unite in saying clearly that they will support clinicians who decide to follow the standard of care for a patient, even when that violates state abortion laws. This month, at the American Medical Association meeting, the legislative body directed a task force to develop a legal defense fund and strategy to help physicians who do face prosecution. Winnia says that's a good first step.

NPR's Selena Simmons-Duffin. It's Consider This from NPR. I'm Juana Somers.