The Opinions - My Patients Are Children. Dobbs Forced Me to Leave Them Behind.

Episode Date: October 17, 2024

In the wake of the Dobbs decision, South Carolina banned abortion after around six weeks of pregnancy. The law does have a few exceptions, including rape and incest. Dr. Kristl Tomlin, a pediatric and adolescent gynecologist, saw what those exceptions look like in practice for young victims of rape — and she decided to leave the state. In this episode, Dr. Tomlin describes how having to involve the sheriff’s department and lawyers in her work hurt her patients, and pushed her to leave the community she loved. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This is The Opinions, a show that brings you a mix of voices from New York Times Opinion. You've heard the news. Here's what to make of it. I'm Jillian Weinberger, and I'm a producer for New York Times Opinion. Over the past five months, I've been reporting on the effects of the Dobbs decision, which ended the constitutional right to abortion. And I've talked to dozens of people, patients, doctors, advocates. All of their lives have changed because of this ruling. One woman's story in particular really struck me.

Her name is Dr. Crystal Tomlin. Sorry, our house is normally beautiful, but now it's empty. I mean, it's lovely. And over the summer, I flew down to South Carolina to spend some time with her. I stole some boxes from the deli under my office, but I don't know that this freedom legist box is going to be strong enough to hold all the things. Dr. Tomlin was packing up for a big move, out of state. She's lived in this house with her husband and two daughters for the last seven years.

But they only have a few weeks left. So maybe I'll need to do some culling. I mean, do I really need this textbook called Basic Sciences and Obstetrics and Gynecology? Dr. Tomlin is wrapping framed photos. My daughter came to visit me in the office the other day, and she literally counted how many pictures I had up by her and how many pictures I had up by her sister to make sure that they were even. As a sister, I understand the impulse. She's sad to be leaving her life down here.

In a lot of ways, she loves her neighborhood and her community. With this wraparound front porch and people swing by and drink wine on the front porch or you'll just get a text and it'll just say, porch drop. And someone's left you a little gift, something handmade. You know, it's just, it's really lovely. My husband's Irish, we throw a St. Patrick's party every year that has just gotten out of control. And every year, people are like, oh, the Tomlin's the St. Patrick's Day Party. Dr. Tomlin is a pediatric and adolescent gynaecologist.

She cares for kids who have everything from painful periods to children who need surgery to repair birth defects. She also provides abortions to children and teenagers. It's a small but meaningful part of her practice. After the Dobbs decision, South Carolina passed a bill that bans abortion once there is a fetal heartbeat, which usually happens around six weeks, before many people realize they're pregnant. The law includes exceptions for the life of the mother, fatal fetal anomalies, rape, and incest. People who qualify can get an abortion up to 12 weeks of pregnancy, and in cases of rape or incest, the doctor doing the abortion has to report it to the shift.

sheriff within 24 hours. Abortion providers who don't follow the letter of the law can have their licenses revoked. They can face felony charges and be sentenced to prison. The new law sent hospitals in South Carolina scrambling. Suddenly, they needed to train up their staff. My institution, they had a big meeting, and they said, we are going to support the OBGYNs, and I went, okay, this is awesome, like great. You had that meeting?

It was like a big team's meeting with all the OBGYNs from all across. the state. And so at this meeting, they had said we have criminal defense attorneys that we have hired. They're going to be on retainer. And I was like, great. They're paying attention. They understand this is going to be now very dangerous for us to provide abortion care, but that abortion care is health care. And this is going to be really great. Given that the abortions Dr. Tomlin would provide would fall under the exceptions provision and the fact that she had her institution's support, at first it seemed like things might be okay, kind of scary, but okay. But then the law came into practice.

Last November, I had a kid come through my doors. This was a 12-year-old kid who had been in a party and had been raped by a 15-year-old boy. And as part of her medical follow-up was found to be pregnant. And so she was sent to me. And they decided that they wanted a termination of pregnancy. And so that was the first time I was like, okay, we're going to have to like navigate this new reality. In my notes, I have all these bold

statements, patient extremely tearful, will not meet my eyes, has chosen a seat in the corner, is picking at her shoes, like just wouldn't talk to me because, of course, let's not forget that early pregnancy for many people is not comfortable, right? So not only am I yet another doctor in the parade of doctors, in the parade of law enforcement that she has been going through over the last number of weeks, her boobs hurt, and she's got morning sickness, and she feels awful. We talked about all of our options. They made their decision, and we signed their paperwork. So I came in, and I did it, and then I was like, okay, now I've got to call the sheriff's department.

and I called him on speaker in my nurse's office. So she heard the whole thing. And I said, I'm Dr. Tomlin, and I'm just calling to report that I just performed an abortion for a victim of rape. He starts asking me all these questions. He said, and how old is the mother? And I said, by mother, do you mean the pregnant child who was raped? And he goes, yeah, yeah, yeah, you know what I mean, that. And I said, well, this victimized child is 12.

And he asked me all sorts of questions about her. And then he said, all right, ma'am. And how old are you? And I was like, what? What does it matter how old I am? And he was like, ma'am, I'm asking you a question. How old are you? So I gave him my age.

And he goes, and what is your ethnicity? And my nurse is like on edge. Like, she's like staring at me and she's mouthing, like, are you okay? And I said, sir, I'm really uncomfortable answering that question, and I don't really see why I need to answer what my ethnicity is. And he goes, ma'am, I asked you a question. I'm telling you what the computer is asking me to ask you. Can you please just answer the question? Dr. Tomlin is biracial, which made this question particularly anxiety provoking. So I answered the question, and he asked me a couple things more. And then we ended the conversation

and I said, officer, is there a report number? And he goes, nope, there is. is no report number, and then I left, and I got home, and he had left a message while I was driving on my cell phone. Yes, this is the University of County Sheriff's Department. I forget to give you the case number for this report. It is 2-3. If you have any other question, you can call us back at 803-576, 3,000. Thank you. Bye-bye. Except I never gave him my cell phone. I never gave him my cell phone. I didn't call him for my cell phone, I never gave it myself, and I called from the office. That nurse who was in the room

confirmed Dr. Tomlin's version of what happened. I also spoke with the sheriff's department about this. A spokeswoman told me that Dr. Tomlin called from her cell phone. That was why the deputy had her number. They said they have a transcript of this conversation, but they couldn't provide it to me because it included information about a crime against a minor. When I reached the deputy who left the message, he declined to comment. Either way, Dr. Tomlin let the weird message go. Everyone was getting used to how to navigate exceptions under the new law. I saw it.

I must be just reading too much into it. It's been an emotional number of days, and I was willing to say, gosh, that was real weird. But, you know, we're all still figuring it out. It's fine. We're all still figuring it out. The most important thing always is that this kid, got the termination that she desired,

and I saw the kid two weeks later, and she looked at me and made eye contact with me for the very first time, and she was better. And that's the most important thing, right? But then, Dr. Tomlin had another experience, one that made her feel even worse about that first interaction with law enforcement, and one that made her realize

that this new law complicated her relationship with her own employer. We'll be right back. Dr. Tomlin doesn't perform abortions on kids often. It's two, maybe three a year. But she told me that when these cases come up, they tend to come in waves. That was true this time, too. This kid came in, and she was a 13-year-old kid, and she had been walking down the street, and this guy pulled up in the car, and he said, hey, you want to get in the car, I'll buy you some food. And she went, okay. She got in his car.

and he took her to her his apartment where he locked her in and he raped her in every available orifice. And then the neighbors heard her screaming and they called the police and the police battered down the door and caught this guy in the act and arrested him, thankfully, and took her to the emergency room. And then as part of her follow-up, she had a positive pregnancy test a couple weeks later. and when she came to my office, she'd had an ultrasound because this is part of this law, right? There's a huge emphasis on ultrasound. There has to be because this emphasis is on fetal heart rate, right? And you can only assess that through ultrasound. Except through ultrasound, at small gestational ages like that, you typically need to do a transvaginal ultrasound.

So if you've never had that before, that is a probe. that has stuck up your vagina and moved around until we can get the images that we need. So not amazing at the best of times, but definitely not amazing when you're a child who's just been abducted and raped. And the kid had an ultrasound, and there was no heart rate yet. And the gestational age corresponded exactly to the day of the day this kid was rescued by the police. So there is like no ambiguity here, zero, zero ambiguity that this is a pregnancy as a result of rape. And I just remember the kid would not talk to me.

She just sat there and her tears would drip down her face and like just fall on her lap. And the mom was like, I don't believe in abortion. I believe in adoption. But then a few weeks after that first appointment, the girl came back with her mom and wanted to get an abortion. And remember, the clock is ticking. I had everything ready to go. I called the lawyers, and the lawyers went, I don't think so.

And I was like, what? What do you mean? And they were like, Dr. Tomlin, it's been weeks since she got her ultrasound. She needs another ultrasound. And I was like, why? We're still within the 12 weeks. There's no medical reason for me to get an ultrasound. And they went, but we need to know whether or not there's a heartbeat. I was like, but we don't, right?

Oh, and then she said, not only does she need an ultrasound, you need to wait 24 hours before you can give her her medicine. And I said, that's not what the law says. Like, what? And she said, Dr. Tomlin, you called me for advice. You make the decision about whether or not you follow it. But that's my advice. And I said, you have no idea what you're asking. And it's interesting because the advice you got was not necessarily following the letter of the law.

But what the law does is create this culture of anxiety around what is supposed to be done at this very critical moment. I think this is part of where the problem is these laws are so ambiguous. This isn't necessarily a criticism of the lawyers who are having. helping me, they were being hugely conservative in their advice to me. They were trying to help me. But the issue is what a lawyer interprets as conservative and what I then have to live on the ground when I'm telling this to a family, they're just different things. We reached out to Dr. Tomlin's former employer, a hospital in Columbia, South Carolina. They did not respond to requests for comment. Dr. Tomlin continued to follow the lawyer's

advice. Now she has to give the kid another ultrasound. Weeks after that first appointment, even though there's no medical reason to do it. At least this time, they were able to do it over her abdomen. So I had to go back into this room and tell this family, and I took the kid and her mom to the ultrasound suite, and it was without a doubt one of the worst experiences of my life. Because this kid just sobbed through the whole thing, and her mom sobbed through the whole thing, and my nurse sobbed through the whole thing. And of course, now it's been three weeks,

and now there's a heartbeat. And I have to say all this junk, I'm obligated to inform you that there's a heartbeat. And this kid just can't even get words out. She's just shaking her head. I'm obligated to let you know that you may have pictures, of this old, would you like your picture? I mean, just, I didn't, it was just so hard because I'm a doctor.

I'm a doctor. And in doctor world, none of that was necessary. Dr. Tomlin asked them to come back the next day, following the lawyer's advice. They did, and she gave the patient abortion medication. And so we did it. Great. Now I have to call the sheriff. There ends up being this whole back and forth with the sheriff's office.

Someone else picks up the phone this time. Their computer system is down and they want to send a uniformed officer to Dr. Tomlin's location. Dr. Tomlin does not want this. It's late, it's dark out, and frankly, she's scared after her interaction with the other deputy. She finally gets the sheriff's department to agree to talk the following day. So I went home. And my girls were just going to scouts. We were like ships in the night.

Like we're passing in the front yard. My husband's got the girls. And he was like, what happened? Like, are you okay? She told him that the sheriff's department had wanted to send an officer to her so she could make a report. And my older daughter, she would have been 10 at the time. She overheard me. And she started crying.

And she said, Mommy, are police coming to the house? Are they coming to arrest you? And I was like, no, they're not coming to arrest me. But maybe they were. I don't know. And so all of a sudden, as I started sifting through all of it, I suddenly realized, you know what? No one's got my back. The next morning, Dr. Tomlin gets on the phone with the sheriff's department's lawyer, and she asked Dr. Tomlin for her name, the patient's name, and the date the abortion was performed. And that's all.

And I went, what? She goes, I mean, what else do we need? And I said, you don't want to know my. name and my ethnicity, and there's silence. And she goes, yeah, we did hear about that officer, and we're investigating that. What were you thinking at that moment? I just, I felt like a fool. Like, I'd been trying to believe in the best in people, that people were just confused and frightened and misunderstanding of this law, but that everyone was continuing to try to work in their best interest in what I realized was I'd had these encounters with the police who had felt completely emboldened

to treat me like dirt because now their legislators had made it seem like I was some sort of criminal for providing an abortion. I wanted to understand why Dr. Tomlin might have been asked about her age and ethnicity during that first call to the sheriff's office. A law professor in South Carolina told me that according to the new law, doctors have to report the crime, rap or incest, that allowed for the abortion. And in South Carolina,

law enforcement often asks for the age and ethnicity of a person calling to report a crime. But Dr. Tomlin thought she was calling to report the procedure. She says that's what her hospital told her. The law professor told me, it matters how that call is perceived by doctors.

If they feel threatened when they call to make a report, maybe they won't want to ask. exercise the exception. Maybe they'll stop performing abortions. Asking for personal details can have a chilling effect. That still leaves me with the question. If asking for age and ethnicity is a common practice, why did the sheriff's office say that the deputy was being investigated? It's not clear. The sheriff's office told me they couldn't comment on personnel matters. When I reached the deputy himself, he declined to comment.

Whatever the case, having to involve the sheriff's department in her work, with the threat of possibly losing her license or going to prison, it all cast a shadow of fear over Dr. Tomlin's interactions with them. Her hospital's attorney seemed to feel this too. That's likely why they told her to do the extra ultrasound. After this experience, Dr. Tomlin's relationship with the police, her sense of safety, just fundamentally changed in a way she couldn't come back from. Even the smallest things.

One night a car alarm went off outside her house. She didn't even want to call the cops about that. I just thought, oh my God, what? I live in a world where now I think the police are scary, where I don't think the police are actually there to defend me or care for me or the people I care about that the police are out to get me. What world am I living in now? She's living in the world of restrictive abortion law.

Nothing here is going to change that's going to make this better. This isn't a blip. This is the new reality. And I don't know that Dobbs is ever going to be changed in my career. I may retire in a world where restrictive abortion access is still the law of the land. It's not going to get better here. So when a friend of Dr. Tomlens reached out to her about a job in Virginia, she went back and forth, but she ultimately decided to take it.

Can you talk a little bit about what it means to move your family? Yeah, it sucks. It's awful. They're not happy. And it doesn't matter how much I try and tell them it's going to be an adventure. It doesn't feel like it. And my 11-year-old, as 11-year-olds are wont-to-do, has definitely called me selfish on more than one occasion, right? We wouldn't be moving mommy if it weren't.

weren't for you. And she knows better. She's just doing it to be 11, right? I know that. Yeah, it's been really hard. But I suddenly felt like I had this vision. Me doing what I want to do, taking care of kids, just the way I need to. And coming home and like getting to go to scouts instead of being a curmudgeon all the time and stressed.

horrible. Like, my girls deserve to see their mom and look back and think, yeah, I loved being at home. My parents were great. Dubs happened and everyone said it, right? You're going to have this, like, brain drain and you're going to have this flight. And when you have people like me who are happy here and have loved being here and would really rather not leave here, but I feel like I have to, I cannot be the only one who is leaving a community I love, but feels forced out of the this community because I'm not able to practice medicine the way that I need to practice medicine. I can't be the only one. Since Dobbs, a number of doctors like Dr. Tomlin have left states with strict abortion bans.

There are no national statistics yet on this, but the president of the American College of obstetrics and gynecology told me she's heard a lot of stories like Dr. Tomlans. In the one state where there is data, Idaho, a recent survey found that more than 20% of obstetricians have left the state. Dr. Tomlin now lives and works in Virginia, which has not changed its abortion laws since the Dobbs decision. If you like this show, follow it on Spotify, Apple, or wherever you get your podcasts. This show is produced by Derek Arthur, Sophia Alvarez Boyd, Bischaca, Phoebe, Feebillette, Christina Samuoski, and Jillian Wen. It's edited by Kari Pitkin, Alison Bruzek, and Annie Rose Strasser. Engineering, mixing, and original music by Isaac Jones, Sonia Herrero, Pat McCusker, Carol Saburo, and Afim Shapiro.

Additional music by Amin Sojota. The fact check team is Kate Sinclair, Mary Marge Locker, and Michelle Harris. Audience Strategy by Shannon Busta, Christina Samuelski, and Adrian Rivera. The executive producer of Times Opinion Audio is Annie Rose Stresser. So,