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AHLA's Speaking of Health Law
The Political Practice of Medicine: The Impact of the Dobbs Decision on Emergency Medical Care
Ramona Thomas, General Counsel, Planned Parenthood of Orange and San Bernardino Counties, Inc., Louise M. Joy, Partner, Joy & Young LLP, and Dr. Sangeeta Sakaria, Medical Director, Emergency Department, UC Irvine, discuss some of the recent changes and updates they have seen in the reproductive health care space, particularly at the state level, and how practitioners of emergency medical care are responding. They cover the Zurawski case in Texas, legal battles over mifepristone and travel, and the impact on access to care. Ramona, Louise, and Sangeeta spoke about this topic at AHLA’s 2023 Annual Meeting in San Francisco, CA.
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Speaker 2:For more information,
Speaker 1:Visit american health law.org.
Speaker 3:Hi, my name is Ramona Thomas. I am the General Counsel for Planned Parenthood of Orange and San Bernardino Counties. We are located in Southern California, and we're one of the larger planned plan Planned Parenthood affiliates across the nation. We see about 200,000 patients a year, and a small but important part of our services are abortion services. So we're obviously very attentive to the issues that have arisen nationwide with regard to abortion access, post the US Supreme Court's decision in Dobbs last June. Uh, I'm joined today by a couple of , uh, people that I consider to be experts in this field , uh, Louise Joy and Dr. Sanita Saria . Uh , and they're joining us from across the country, and I'd like to turn it over to them to introduce themselves. Louise .
Speaker 2:Hi, I'm Louise Joy, and I'm from Austin, Texas. So we've had a lot of experience here, <laugh> with issues going on, starting with our heartbeat bill in September, 2021. Um, my background is all administrative and regulatory healthcare law in Texas and across the country when it comes to federal issues. So appreciate being able to speak on this.
Speaker 1:Hi everybody. My name is Sanita Zachary . I'm an emergency physician. I work at Brigham and Women's Hospital in Boston, Massachusetts. Um, have a big interest in women's health and , um, you know, definitely been , had a lot of changes since the Dobbs decision , um, in trying to keep up with those.
Speaker 2:Uh, I'm gonna be
Speaker 1:Bringing the clinical perspective today. And just to clarify, I'm not speaking on behalf of the views of my hospital, the MGB organization or any emergency medicine organization just representing my own views.
Speaker 3:Yeah, I'd echo those comments. I'm here today in my own capacity, not as a representative of Planned Parenthood, despite our ongoing interest in these issues. But I think one of the things that we wanted to talk about today was just , uh, an overview of some of the changes that have happened and some of the updates that we've seen since the three of us presented at the A H L A annual meeting in San Francisco last June. A couple of the state ban updates that we've seen, you know, North Carolina and South Carolina both saw some changes to their state law. North Carolina had a 12 week ban go into effect on July 1st, and South Carolina's bounced around a lot. They had a six week ban that was overturned by their Supreme Court. Then they had a new six week ban that was basically enjoined. But then in August, late August, actually, the Supreme Court upheld that ban and basically recognized that even though it infringed on a , on a woman's right of bodily autonomy of six week fetus, the the right of that six week fetus to use the woman's body kind of overrode of the woman's right to control the access to , to her body. Um, and then I think there have been a couple of other really significant updates. Uh , uh, Louise , I think you've seen some stuff happening outta Texas, right?
Speaker 2:Yeah. Um, in Texas, we ended up having , um, house Bill 30 58 that got filed with very little fanfare and went into effect on September 1st. And it's provided a affirmative defense for previable, premature rupture of membranes treatment, and , um, also an affirmative defense of for individuals treating an ectopic pregnancy. We already had an exception for the removal of ectopic pregnancy from our definition of what is an abortion under Texas law. Um, I think we ended up talking at the, our presentation, and I think we remind people , um, health lawyers have a hard time with affirmative defense and what it is and how it applies and what kind of protection it gives you. It's not a great protection. Um, it puts the burden of proof on the person defending themselves against the charge for the <laugh> , um, alleged crime. And so it's a little bit of cold comfort there. Um, we also ended up with no legislative history of this particular change. It was passed , um, maybe related to the Roski case, and we'll talk more about that in a bit. But , um, we have no definition of Previable <laugh> . We , um, uh, some recent research that I did was just on , um, the Guinness Book of World Records has the shortest gestation of a child, and that child was born in Alabama and was 21 weeks and five days . But we have no idea what is Previable. Um, so , um, we also,
Speaker 1:You know , I think from the, from the clinical perspective that kind of fits , uh, I have seen and taken care of , um, babies that were born , uh, around 23 weeks. Um, the outcomes were, were typically not good. And , um, even if whether they survived more than just a couple of days, usually have significant health issues , um, let alone the limited , uh, limited lifespan. Um, but yeah , I'm not surprised to hear about the 21 week five days. So it's, it's interesting when we don't have a definition for previable, because I think from the clinical perspective, we all do kind of have a general idea of what is viable versus what is not. In a lot of hospital policies, for example, in the emergency department, if a patient comes in , uh, who's pregnant, there's usually a policy in the emergency department of, at a certain number of weeks that patient can be sent up to labor and delivery triage , um, for pregnancy related concerns. Because before that cutoff, and it varies with different hospitals before that cutoff, they're considered pretty viable . Um, so I think even though there's, there's no legal definition there from a clinical perspective, we certainly have a little bit more of one.
Speaker 3:And that's something we've seen just consistently with the challenges created by this lack of clarity, is the difference between like a lay person's definition and a lawyer's definition and a clinician's definition. You can be talking about the same general concept, but have such different frameworks and such different , um, indicators of what should and should not be considered in meeting that definition. It's just one of the ongoing challenges, like you were saying, Louise , it's the fire hose we're all trying to drink from.
Speaker 1:Absolutely. You know, I , there I've learned so much just from working with the two of you about the differences between, you know, my definition of things from a clinical perspective versus the legal definition. It gets very, very confusing.
Speaker 3:Yeah, I think one of the places we saw a lot of that was in some of the discussion that came out of that Center for Reproductive Rights in Zaki case. Uh, you know, when you look at the actual care that was provided, or in some cases denied to the individual plaintiffs who were presenting to Texas emergency Departments with, you know, what we would classically identify as a previable premature rupture of membranes, you know, what are you supposed to do in that situation? And when there's so much confusion on the legal front, it really impacts the overall ability to deliver care and the quality of the care that is provided.
Speaker 1:Absolutely. And
Speaker 2:It has continued to lead to chaos. And I think one of the things that we've noted , um, at our presentation in , uh, June, we went through just kind of really briefly, the fact that there's exceptions in the ban states , um, whether there are , um, full bans , whether there's ge gestational limit bands , um, so we go on the gestational limits anywhere from six weeks, which , um, Georgia and South Carolina has , uh, Arizona is 15 weeks, Utah currently is 18 weeks, but they've got bands that are enjoined . Um, and then we end up , um, looking at different varieties of , um, legal protections that are some of the , um, the states that , um, are trying to allow for , um, abortion protection. Um, we've got different ways that those , um, protections have been put in place. And then we also have , um, and I, we can't even begin to, I don't think, get into this kind of protection, but there are HIPAA rules that have been proposed that are very complex, and many states are for those bans, and many are for those HIPAA changes, and many are against 'em . And they're really, they're almost kind of along the lines of what are the chemical dependency , um, protections that we have under , um, I think title , uh, 45 C f r , um, chapter two protections for substance abuse treatment. And it's even broader because when you talk about reproductive , um, health records, the category of what qualifies as reproductive health records, whether it is for , um, women and men, I mean, there's male reproductive health records as well, <laugh> . And , um, so , um, so it , these will be interesting areas for us to see lots of changes. So
Speaker 3:Yeah, so much legislation. I mean, you know, one of the, one of the areas we talked about in June was , uh, the current Ohio law at the time, and now we know that Ohio's actually got a proposed constitutional amendment on the ballot in November to enshrine reproductive healthcare access and the right to abortion in the Ohio State Constitution, which could conceivably make Ohio's six week trigger ban unconstitutional , uh, if that is passed by a majority of the Ohio voters , uh, at that, at, at that election. So it's just, you know, it , it's so hard to continue to predict and , um, you know, on , on any given day, I think we had another conversation , uh, offline sanita where you, you described like you don't have time in the emergency department to try to like Google what the current law is. Uh , so like the, the healthcare, the hospital attorneys are trying to keep these policies up to date , but, you know, how do you, how do you do that and how do you make medical decisions when you've got that kind of specter of potential enforcement hanging over your head?
Speaker 1:Absolutely. It's, it gets really confusing, keeping up with all of the changes, and it's state by state . And then, you know, as you guys were mentioning, there have been multiple changes within the same state , um, where things are proposed and then they're struck down and then , um, and then they're allowed. So it gets really confusing from a physician perspective to keep up with, what am I allowed to do versus what am I not allowed to do? And when you're in that state of confusion, I can absolutely see how people, people are scared , um, and they're, they're worried about, you know, being able to keep their license. Are they gonna get in trouble? Are they gonna have legal action against themselves? But at the same time, there's this big conflict because you have a patient in front of you who is sick and could be, you know, critically ill and, and you wanna do right by the patient. And when they're in front of me, that's my, that's my main priority. Um, as you were saying, if luckily I, I practice in a state where there is no confusion at this point , um, hopefully there won't be in the future either, but I, I can't imagine what it's like for my colleagues who are living in Texas or Alabama or any of these states that have had so many changes recently. You have a patient who comes in who's , you know, unstable and crashing in front of you, like you said, you don't have time to , uh, to Google what is the latest update in the law. And every hospital has legal teams. We have a wonderful , um, access to legal consult 24 hours a day, which I really appreciate. They're, they're really helpful to us in , um, in tough cases. Um, but when you have somebody that's , you know, crashing in front of you, I don't always have the luxury of time to, to even page them or, or get on the phone with them. I just need to take care of my patient right then.
Speaker 2:And one of the other things that has come up that I'm gonna say give , because I'm from Texas <laugh> , one of the issues is when the federal government tried to use Tala to give some clarification that we can at least rely on the Tala definition of what is an emergency medical condition, which would trigger responsibilities to protect the health of the patient. The attorney general Ken Paxton was very aggressive about fighting the federal government as has been his , um, style for a long time in Texas. And so he fought these emergency guidelines by fighting the emergency guidelines. He created the very confusion that doctors have in Texas. And from there, the Texas Attorney General's office continues to challenge any rulings that come down in favor of protecting physician decision making in emergency settings. And I think the confusion that we have in all the states, because Texas consumes so much of the news cycle leads to confusion around the country too, that that is other states, the , the situation for other states bans because , um, just in looking at recent work that I've done , um, putting the , uh, working with people in Alabama, there are some actually better exceptions in Alabama, but I would bet many alabamian physicians do not know that those exceptions are in place because they're affected by what they hear in the news and the fact that they are one of the reddest estate . And so they must have one of these stripped as bands , which isn't the case
Speaker 3:That that makes , uh, that makes perfect sense. I mean, and you know, circling back to that idea of the Zuki case, you know, just as a brief kind of overview, for anyone who hasn't had an opportunity to review it, you know, it was basically 15 plaintiffs who challenged the scope of the medical emergency , uh, definition under Texas law with regard to abortion access. And, you know, that's, this is exactly what you're talking about, Louise . On August 4th, the Texas State District judge issued an injunction blocking the bans as they applied to dangerous pregnancy complications, and basically saying that doctors could use medical judgment to determine when to provide abortion care and emergency situations. But then immediately the state appealed it and blocked that injunction from taking effect. So essentially it took the decision back out of the doctor's hands. And, you know, we, we talk about the reason that we had named our , uh, session at the annual meeting, the political practice of medicine, because most states recognize that it's improper for corporations to try to practice medicine. So why are we allowing politicians to do it? I was just wondering, Dr. Dr. Zakaria , did you see anything in those , um, in the descriptions of the care provided or denied to the plaintiffs in the Zaki case that, you know, you would've, you , you know, you , you, you kind of reacted to in any way? Um,
Speaker 1:I had very strong reactions when I read through them. Um, I would , it was just so surprising to me because when I read through all of the cases, none of them were ambiguous in my mind. All of them had very clear reasons for why they needed emergency care and very clear reasons as to why , um, a person would be seeking a termination of that pregnancy. Everything had to do with either a prema , a , a very premature ruptured membranes, pre the point of what we would clinically consider to be viability or such severe , um, congenital abnormalities that the fetus would either even not s survive the pregnancy, perhaps be born stillborn or have a very high chance of , uh, of not surviving more than a few days or shortly after birth. Um, so each of those cases I was, when I read through them, I kept waiting to find a case that was a little bit more, you know, ambiguous or a little bit more where I could try to reason out why they would be denied care. Um, and I couldn't, they were just such clear cases in my mind. Absolutely. It's terrifying.
Speaker 2:One of the things that is worth drawing people's attention to is, you know, as we talked about the different definitions of what is in a medical emergency, Texas's definition of medical emergency qualifies every condition for which you could have an exception to go ahead and provide the care. It has to be a life threatening physical condition, aggravated by, caused by, or arising from a pregnancy that as certified by a physician, places the woman in danger of death, or a serious risk of substantial impairment of a bodily major bodily function. It doesn't say just, you know, what does, what a medical , um, physician's medical reasonable medical judgment, they determine poses a risk to the health of the woman, poses a risk to loss of fertility in the future. Because many of the things that we're talking about are not allowing the termination of a pregnancy now for someone who desperately wants to have a healthy child.
Speaker 3:Yeah . And
Speaker 2:They're not able to do that because they have , they're carrying this pregnancy longer with more risks associated with it,
Speaker 3:And they
Speaker 2:Actually are risking the fact that they could never have children again in the future because they could lose their fertility due to scarring, due to infection, due to the fact they may have to undergo a hysterectomy. And that is not contemplated in our definition. And I think that's part of our problem and our fatal fetal anomaly, we did have that exception, and it was horrific to work through with individuals who needed that. But we had a mechanism to do that. We don't have that mechanism now. And there's quite a number of states that also don't have that exception.
Speaker 3:Yeah. And it's, it , it , it's both interesting and, and, you know, disheartening to see the difference between the Texas definition and the definition of medical emergency under tala , which is what everybody's experience with everybody's used to. Everybody's, you know, familiar with the application of medical judgment and decision making in those situations. And it was, you know, it was a, a relatively challenging standard. You had to be very clear. You had to, you know, evaluate for the condition. You had to understand what the condition was that necessitated screening or stabilization , uh, you know, so there was already this legal analysis that was going into it. Uh , but then you see these changes in Texas that , uh, that just make it that much harder to make these calls. And, and now you're even seeing in Idaho, they appealed , uh, you know, essentially they had had a , uh, an internal finding on the m Tala preemption question from Idaho , uh, that the court essentially determined that their criminal abortion statute conflicted with a small but important corner of federal legislation. And the us , you know, the federal case was gonna succeed, and then like Idaho waited until literally the last day, it could appeal that decision and appealed it this past July 3rd. So, you know, you're seeing these states who want to impose their own definition of these medical exceptions that limit providers flexibility and discretion, and you're seeing it not just in Texas, but in other states as well. Well, I mean, I , I know that , uh, you know, in addition to some of these recent updates , uh, on topics that we discussed at the A H L A annual meeting, there were also a couple of things we didn't even get to talk about , uh, at that meeting. One of which really is the , uh, the challenge to the availability of Mitrione . Uh , back in April, you know, originally Judge Kame out of the Northern District of Texas , uh, ruled that the FDA's approval, you know, 23 year old approval of Mifepristone was essentially invalid, and the drug would effectively have to come off the market. That went through an initial appeal to the fifth, and then all , all the way up to the Supreme Court, which essentially stayed the , uh, imposition of cosmetic's ruling. And then it came back to the fifth. And I mean, there's just so much litigation , uh, you know, happening in this space, but it's really interesting to talk about what the impact would be , um, if Miry Stone either had to come off the market entirely or had to be rolled back and , um, considered within the context of the earlier REMS that had been issued by the F D A , you know, imposing follow-up visits limiting the pregnancy gestational age , uh, you know, limiting which providers could actually provide the drugs. And , uh, Dr. Sicario , I was just kind of wondering from your perspective in terms of what, you know, medication abortion as a methodology and as a modality of providing abortion services. What do you see the impact of , uh, miry , you know, its availability on the availability of abortion access, period?
Speaker 1:You know, it's an incredibly important drug. It's something that's used all the time , um, in , in medically induced abortions. Uh, and so obviously those numbers would be affected dramatically if it's taken off the market. Um, it's just one less tool that we have to work with when we need to take care of women that need an abortion , uh, for whatever reason. Um, also, you know, even if we take that off the table, there are other uses of MPA Bristol . So for example, it can be used to treat , um, Cushing syndrome. It can be used to treat uterine fibroids. It can be used to treat , uh, a number of different things. And so you're taking a drug off the market because of this, you know, this sort of political perception of it , um, when it has to do with abortion services, but at the same time, you're not taking the account the fact that it's being used for other things. And then if you try to, to limit it with the wording of saying, oh, it can only be, it's taken off the market when it's being used for medically indicated abortions, people are going, you know, that's, again, it's confusing because when can I use this drug and when can I not use this drug? But also , um, people will try to find ways around that because they'll , they need to use that drug for, for medically medical reasons that are legitimate. Um, like I said, it's, it's a good medication. It does what it needs, what we need it to do, and it's helpful in so many cases, whether that's pregnancy related or not pregnancy related . So it would be a huge disservice for our patients if that were taken off the market.
Speaker 3:You know, when we were talking about the legislation , um, that's being proposed and implemented in these various states, it's really about abortion itself. It's about the actual termination of the pregnancy induced by the decision of the woman , um, or the Medica Medical, you know , decision making of the physician. And then in this case, it's really unrelated to any of that. It tries to be kind of like an administrative challenge to the FDA's approval based upon, you know, essentially this I , what what you could, what someone may call junk science , uh, you know, articles talking about the, the impact of it on certain people who regretted their decision. Um, you know, the , the concept of picking and choosing the research that you're going to utilize to make these decisions and not leaving it up to the expert advice that we have of the physicians and the clinicians who are trained in this area. One
Speaker 2:Of the things I think people also, you know, we, I wanna make clear for all of us who's all the people who are listening the drug mitrione , it can be used for treating miscarriages. So miscarriages, and we've brought this up before, miscarriages come up with spontaneous abortion, missed abortion, incomplete abortion, other, those are medical conditions that can occur for pregnant individuals losing a pregnancy. Miry stone can be the best miry stone and misoprostol, while they are used for elective termination of pregnancy, they are used for treatment of miscarriage. You are losing the ability to have a treatment available to you and your family members who need it and could result in a much more difficult way to have miscarriage treatment if this drug is not available to them. And I think that that is lost in the litigation.
Speaker 1:Absolutely . And I think that , that , for clarifying that , Luis , 'cause I think you just highlighted a , a prime example of what we were saying earlier when , um, we, we all use terms differently because in my mind when I was saying that, when I say abortion, I don't think just elective , uh, termination. I think miscarriage to me is an abortion. It's a spontaneous abortion. So you're absolutely right. Thanks for clarifying that.
Speaker 2:And I think one of the terminologies that people that we probably should be using as a framing of this topic, it's induced termination of pregnancy or I T O P as opposed to abortion. Because abortion in itself is the end of the pregnancy. It's the loss of the pregnancy. It's not how it , uh, how the result was obtained, even though we as laypeople tend to use the term to mean the elective termination, someone's decision to , to choose to end a pregnancy that they have.
Speaker 3:Yeah, that's a great, that's a great point, Louise. I know one of the other areas that we didn't really get a chance to talk about at the, the H l A annual meeting is some of the, the law and the changes that we've seen relate related to travel. I know that that's one of the things that you specifically have seen some of Louise in terms of some of the Texas , uh, lawsuits and stuff. I don't know if you could share some information about that area.
Speaker 2:Yeah, one of the biggest cases that we have is , uh, the fund Texas Choice v Paxton . That one was filed last August in , uh, Austin, and that was by the abortion funds and nonprofit groups who help out paying for procedures in, I mean, they paid in-state, they pay out of state , they will help with expenses getting to other states , um, provide childcare services. I mean , a range of support for individuals who are seeking to terminate their pregnancy. And , um, they looked at, they were looking at the har , our Texas heartbeat bill with our bounties and our trigger law, our pre-ROE statute that has our pre-roe statute has most of the aiding and embedding provisions in it. And , um, basically we do have a court decision in the Western district of Texas that had said that the pre-roe laws could not have been interpreted as reaching travel, but at the same time, so that was useful. I don't know , um, the current status of that case, but we do know in another state in Alabama, their tex , their , the Alabama Attorney General is also making, speaking out directly and saying that Alabama conspiracy law would allow them to prosecute for crimes those who helped individuals leave the state. So they again, wouldn't be necessarily prosecuting the individual who was trying to leave the state, but those who were helping the individual leave the state and receive , um, a termination of pregnancy outside the state. And that's the yellow hammer , uh, fund versus Attorney General of Alabama. Um, I think that also gets into , um, you know, looking at , um, we had, we also had in Texas , um, legislatures who sent out threat letters to , uh, including a law firm saying that that law firm that was willing to pay for services outside the state of Texas and to pay for the costs for their employees of the law firm to leave the state and , um, seek , um, an elective termination of pregnancy, they were threat . They were being threatened with , um, enforcement under Texas law. And so it , it , this isn't just a words being said to the media. These letters actually were sent out and , um, received as threats to employers. So it, it really has , um, caused a lot of fear about what can you do and what is safe, and are you going to be a target?
Speaker 3:Yeah. And it's, it's not just the south either. I know , uh, Idaho , uh, recently made it a crime for an adult to help a minor obtain an abortion without parental consent, including travel to a state where abortion is legal. And also the , uh, uh, the Idaho Attorney General had basically issued an opinion back in March , um, talking about how medical professionals licensed in Ohio could be subject to criminal penalties for referring patients for pregnancy terminations across state lines. Now that's being challenged by , uh, a different Planned Parenthood affiliate, actually a Planned Parenthood Greater Northwest, Hawaii, Alaska, Indiana, Kentucky, and Labrador, or versus Labrador. Um, and they filed that back in April. Um , basically asserting that, you know, this is not, this is not proper, this is a constitutional violation on multiple grounds. Um, but essentially just, you know, it , you do see this in a , a variety of states where they're not just trying to limit what, what people are doing within their own state lines, but they're actually trying to limit what people can do outside of the state. And that's just such an interesting extraterritorial constitutional, you know, question , um, that we just as a nation really haven't had to deal with much in a , a very, very long time. But we're starting to see those issues come up again now because we've got this, this significant difference , uh, you know, five miles apart just across state lines, what you can do in one state and , and you can't do in the other.
Speaker 2:And one of the travel things that's going on as well, we've got two versions of this. One is local ordinances that are trying to prevent the roads in a town from being used as transit points to travel out of the state. I mean, how those would even be enforced, I don't know. But the same individuals who are behind the Heartbeat Bill are promoting local legislation or local ordinances to be adopted in various towns and especially , um, towns that happen to have , uh, major thorough affairs going out of them .
Speaker 3:And , and, you know, going back to the idea that, that you're seeing these actions at an individual state level that's having, that's having broader impacts than just the law itself. It's having impacts on things like , um, you know, professional organizations , uh, physician recruiting , um, you know, seeing, like I know , uh, Dr. Sakari , you had mentioned that, you know, personally, you , you'd even make decisions about where you were interested in practicing based upon the laws of that individual state, because you don't wanna be subject to a state that's got those sorts of restrictions in place.
Speaker 1:Absolutely. Um, it's, you know, it's really tough and that's not something that we can really, we can't really track those numbers. We can , uh, you know , we were talking the other day that you can, you can try to track other numbers about people who leave the state or , um, you can't really count the number of people who won't even consider working in those states. I was born and raised in Indiana, I went to undergrad and medical school there. Um, and with the current political landscape, I will not return there , uh, to work as an emergency physician because I, I would be too worried that I wouldn't be able to practice the way that I think ethically I should be able to take care of my patients. So it, it absolutely has a big impact. And, and not just for emergency physicians, that's, you know, every specialty. And one thing that's concerning is , um, when you have these states that have these different bands, it's, if it's restricting the people who are going to want to go there to practice, there are already so many healthcare disparities, whether those are racial or socioeconomic healthcare disparities that we see. Um, and, and maternal health and maternal mortality, those are already numbers in the US where we have the , the highest maternal mortality of any industrialized nation in the world. Um, it's an embarrassing statistic and it's something that we need to be much better at. Um, but this is not helping currently. We already have states where, for example, in Georgia, more than half of Georgia counties don't have o ob enough OB G y n access for patients. That means patients are going into pregnancy with undiagnosed health conditions. They could have higher life-threatening complications. Um, we see that in many states even where people can access an OB G Y N typically in the past, you would always expect your first prenatal appointment to be somewhere around eight weeks , um, of pregnancy. And now we're seeing people push that out because providers don't want to be responsible for those complications that may happen in, you know, in those early stages of pregnancy. And, and that's very common in pregnancy to have complications that early. Um, and people don't wanna be associated with that because they're unsure of the legal implications, which means higher rates of complications for patients. Um, and it's, it's just going to increase , um, maternal mortality in the US that data's very hard to track, could be take years for us to collect or analyze it. It's so inconsistent from state to state. There are lots of delays in reporting currently. Many states have only reported through 2019, let alone, you know, trying to get numbers for post-ops. Um, so it's really tough. And , and , and my concern is that when we have these increasing rates of maternal morbidity and maternal mortality, it's going to really increase the healthcare disparities that specifically affect , um, people of certain racial groups or socioeconomic status. Uh, it's, it's very concerning to me that there seems to be quite a bit of overlap between states with abortion bans and the same states where there you have even more significant racial and socioeconomic healthcare disparities. Um, these already exist in every state, but they're gonna be exacerbated to an even greater degree in those states.
Speaker 3:Yeah . And seeing that impacts on the different communities and kind of what that means for the, the state of morbidity and mortality and maternal patients in the US overall, I think we had talked about the fact that, you know, comparing this to international standards , uh, one of the things maybe we could kind of conclude our, our discussion on the Supreme Court of Mexico , uh, who recently issued its decision decriminalizing abortion access, and had a beautiful quote in that , uh, in that opinion saying that the criminalization of abortion constitutes an act of violence and discrimination based on gender as it perpetuates the stereotype that women in pregnant individuals can only exercise their sexuality for procreation and reinforces the gender role that imposes motherhood as an a compulsory destiny. Well, thank you both so much for, for this conversation. I think we got through a lot of of interesting topics, but there will obviously be so much more to come on this , uh, as we continue to see developments over the next few years probably.
Speaker 1:Thank you so much.
Speaker 3:Thank you.
Speaker 4:Thank you.
Speaker 5:Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L A speaking of health law wherever you get your podcasts . To learn more about a H L A and the educational resources available to the health law community, visit American health law.org.