A couple of days ago, I read a story in The Guardian about how, as of May 2023, Bonner General Health, a hospital in Sandpoint, Idaho is no longer going to offer labor, delivery and other obstetrical services. Hospital officials cite the state’s new draconian laws against abortion as the main reason why they must stop offering care to pregnant women. New pregnant patients are no longer being referred to Bonner Health for obstetrics care, and existing patients are being offered alternatives to Bonner for their obstetrics needs. According to a statement put out by the hospital:
Highly respected, talented physicians are leaving. Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care. Consequences for Idaho Physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.
Idaho does not allow abortions after six weeks gestation except in documented cases of rape, incest, or threat to the mother’s life. It is also one of six states that prosecutes physicians for providing abortions. Consequently, a lot of OB-GYNs are leaving the state, as are many pediatricians. According to the same statement:
Without pediatrician coverage to manage neonatal resuscitations and perinatal care, it is unsafe and unethical to offer routine Labor and Delivery services; despite our best efforts over months of negotiations. Our inpatient pediatric services will no longer be consistent and reliable in May. BGH has reached out to other active and retired providers in the community requesting assistance with pediatric call coverage with no long-term sustainable solutions. Our low patient volume is insufficient to attract candidates for pediatric hospitalists, and we cannot afford to continue having locum tenens physicians.
The statement also indicated that besides the political climate in Idaho, the number of births in the Sandpoint community were steadily dropping. Only 265 babies were born at Bonner General Health in 2022, and fewer than ten pediatric patients were admitted for other reasons. The demographics of the area where the hospital is located are changing, with fewer people giving birth, and more older people living in the community. There is also an updated facility at Kootenai Health, which has staffing 24/7. However… I just did a calculation of the distance between Bonner General Health and Kootenai Health:
Doctors in Idaho have found themselves having to choose between violating state law or providing competent care to their patients. Last year, a federal lawsuit was filed by twenty states and medical groups against Idaho’s extreme abortion bans. According to AP News:
“[Idaho’s abortion ban laws] will really place physicians in a lose-lose situation,” said Jeff Dubner, the deputy legal director for Democracy Forward, the legal team representing the coalition of medical associations.
Physicians who follow the federal law will be at risk of criminal prosecution and the loss of their medical license, said Dubner, and those who follow state law could damage patients’ health and place themselves and their hospitals at risk of federal fines or loss of funding.
Naturally, there were some really stupid comments from “pro-life types” about this development. I saw a number of ignorant statements from men about how, if OB-GYNs want to provide abortion care, they shouldn’t be in the healthcare business. Some people were trying to dismiss the news as scare tactics, or even as “woke” journalism. Below is one egregiously ignorant comment made by a man named Mark:
They’re not dedicated to their patients. If they cared, it wouldn’t make a difference as the new mothers need care.They want to perform abortions which are more frequent and makes them easy money. Why would you want to be under the care of an MD that only cares about how much money he makes.
I decided to respond to Mark’s comment. This was what I wrote:
Sometimes abortions are medically necessary. OB-GYNs already pay huge malpractice insurance premiums. Banning abortion is DANGEROUS to women! Threatening the doctors with arrest or losing their license if they need to provide abortion care is too much of a liability for them.
Women will die because of these laws!
I hope more doctors move to states where they are allowed to practice their professions without interference from ignorant politicians and their equally ignorant constituents. Maybe when some red state’s legislator’s wife is in dire need of immediate competent care from a qualified OB-GYN, and they can’t find one, they will rethink their extreme policies regarding abortion.
More than a few simply stated that this is just a “business decision”. I agree, Bonner General Health’s decision is a “business decision”, however, the decision isn’t just being made by hospital administrators. It’s also being made by highly trained, very talented and capable physicians, who have spent many years and many thousands of dollars to become experts in their fields. And they want to be able to practice their professions without being hamstrung by ignorant MALE legislators and their equally ignorant constituents. OB-GYNs already pay huge malpractice insurance premiums.
As someone who has a master’s degree in public health-health administration, this story is kind of in my wheelhouse. I just don’t think most rank and file Americans even consider how much doctors have to pay for malpractice insurance. The actual costs vary by state and speciality, but OB-GYNs typically pay among the very highest annual premiums for this protection, because the stakes are simply that high. Guess what. The costs are not going down, especially in the wake of these new abortion bans. While doctors in some specialties pay a few thousand dollars a year for malpractice insurance, according to Physicians Thrive:
Average annual malpractice insurance premiums range from $4k to $12k, though surgeons in some states pay as high as $50k and OB/GYNS may pay in excess of $200,000.
According to Cunningham Group, a medical malpractice insurer:
Obstetrician/Gynecologists (OB/Gyns) pay among the highest premiums for medical professional liability insurance coverage in all of medicine. An OB/Gyn who practices in a major metropolitan area can expect to pay an annual premium in the neighborhood of $100,000 to $200,000, and this burdensome cost of doing business—coupled with an omnipresent fear of lawsuits—has influenced many to see fewer high-risk obstetric patients, reduce the number of gynecological surgeries they perform, exit private practice in favor of hospital employment or move their practice to an area with a more favorable liability climate. Our historic med-mal rates shows the cost that an OB/Gyn pays for their insurance in every state.
Granted, the same article states that claims are going down, and tort reform is making lawsuits less of a risk for providers. But my guess is that the new abortion ban laws are going to lead to some catastrophic OB-GYN cases. Not enough have happened yet to raise widespread awareness, but they inevitably will. And then, the risks will either increase again, or more people will opt out of having children. That may seem like a good thing, until you realize that if people stop reproducing, the population will age more, and there will be more need for other medical services, and fewer human beings to provide them. You may one day find yourself having your medication dispensed in a hospital by a robot nurse, instead of a live human being.
An article in The Washington Post from August 2022 discussed the dilemma doctors in Texas are facing. Olgert Bardhi, a primary care physician in training, will probably be a full fledged doctor with highly sought after skills as of 2025. But Dr. Bardhi, who is currently getting his highly valuable training in Dallas, said that the new laws regarding abortion really bother him. According to the article:
Although [Bardhi] doesn’t provide abortion care right now, laws limiting the procedure have created confusion and uncertainty over what treatments are legal for miscarriage and keep him from even advising pregnant patients on the option of abortion, he said. Aiding and abetting an abortion in Texas also exposes doctors to civil lawsuits and criminal prosecution.
The article continued:
“It definitely does bother me,” Bardhi said. “If a patient comes in, and you can’t provide them the care that you are supposed to for their well-being, maybe I shouldn’t practice here. The thought has crossed my mind.”
There is now a “chilling effect” for OB-GYNs trying to provide care to their patients in states where abortion is suddenly practically banned. The end result is that doctors are scared, and it’s causing them to go to places where they can relax and do their jobs without so much fear. After all of the money, time, and effort expended for their training, can you blame them?
Don’t think this scenario is realistic? Consider this. Back in 2019, I wrote a blog post titled “Whatever you think is best, doctor.” It was inspired by a piece written by Dr. Jen Gunter, a rather famous OB-GYN who has written some pretty awesome books about women’s healthcare. Here’s a lengthy passage from my 2019 post about Dr. Gunter and a case she encountered back in 1998:
[Dr. Gunter] was called in to perform an abortion on a woman who was very sick and in her first trimester of pregnancy. The woman’s condition was rapidly deteriorating and the pregnancy was making her situation worse. Although her life was not in immediate danger, her caregivers feared that if she continued her pregnancy, her condition would quickly decompensate and she would need dialysis due to kidney failure.
The problem was, this was happening in Kansas, where a new restrictive abortion law was enacted that forbade abortions from being done on state government property, unless the mother’s life was in danger. The medical center where Dr. Gunter worked was on state property. While it’s very possible to manage kidney failure on dialysis, it’s not the ideal course of action. It’s better to prevent kidney damage, which would then prevent a host of other serious medical problems that would put the patient’s life in danger. The patient was not about to die, but her condition might eventually cause death if the doctor didn’t act. On the other hand, thanks to the law, if Dr. Gunter made the “wrong” decision, she could be fired or wind up in legal trouble. She could even be arrested, which would be a real problem, since malpractice insurance does not cover criminal prosecution.
The law was vague regarding what Dr. Gunter should do. She spoke to the hospital’s attorneys, who advised her to call the legislator who had written the law. So, instead of prepping her patient for surgery and taking care of her patient’s private medical issues, Dr. Gunter was forced to call up a legislator who had absolutely no clue about this wrinkle in the law because he wasn’t a medical professional. Moreover, Dr. Gunter was about to talk about this lady’s private medical situation with a man who was completely uninvolved, except for the fact that he’d written the law that was holding up Gunter’s ability to take action. To add insult to injury, he didn’t even seem to care! As Gunter launched into a description of the woman’s medical issues necessitating an abortion, the legislator interrupted her and said, “Whatever you think is best, doctor.”
The woman got her abortion and her medical condition improved. But Dr. Gunter was left fuming, since she’d had to waste precious time calling up a legislator who obviously didn’t actually care that much about this law. He hadn’t even listened to her speak for more than a minute before he basically said “whatever”. Meanwhile, this lady’s health– her very life– was in danger. What would have happened if Dr. Gunter had not taken the time to cover her ass by calling the lawmaker? What if she’d simply done the abortion and gotten arrested for breaking the law, even though she’d made the correct medical decision? What if she’d not done the abortion and her patient died? Then she might be on the hook for medical malpractice. She’d also have to deal with the guilt of knowing that she has the training to help women in these dire medical situations, but can’t act due to restrictive, misguided legislation like the “heartbeat” bills being considered and passed in places like Georgia, Ohio, and Alabama.
Of course, in 2023, the “heartbeat bills” have now become laws in a number of states, and doctors are now encountering the same problems Dr. Gunter ran into in Kansas back in 1998. Ironically, Kansas voters made it very clear last year that they want to maintain access to legal abortion services. Today, Dr. Gunter probably wouldn’t have that problem in Kansas. But she would definitely encounter it in Idaho or Texas, or many places in the Deep South.
I hate the thought of women and babies having to pay for the ignorant and misguided policies mostly being made by Republican men in conservative states. I especially hate the fact that the people who will likely suffer the most will be the poorest citizens. However, I think what’s going to have to happen in abortion banning areas is that a lot of women will have to die or get very sick. Some of the folks in power are going to have to be personally confronted by a lack of competent healthcare providers available to take care of them, or their loved ones, before they will understand why it’s so important to let OB-GYNs do their jobs without their interference.
Too many people assume that abortions are always due to a woman being irresponsible or wanting convenience. They never stop to realize that putting that spin on it endangers the lives of everyone… including men. Because I’ll bet some of the OB-GYNs who are deciding to relocate are married to doctors in other specialties, who will choose to move with them. Think about it.
5 thoughts on “I hope more OB-GYNs leave red states…”
“When and if fascism comes to America it will not be labeled ‘made in Germany’; it will not be marked with a swastika; it will not even be called fascism; it will be called, of course, ‘Americanism.'” – Halford E. Luccock, “Keeping Life Out of Confusion” (1938).
I am glad to be 50 and childless.
I know that you miss home at times, my dear friend, but the U.S. is becoming a dystopian nightmare. I don’t think you’ll be happy if you must return in the future.
What kind of a country have we become where members of Congress show contempt for the visiting head of state of a European nation under attack by our biggest adversary and disparage him for not wearing a suit and tie while addressing Congress? Or make excuses for Vladimir Putin and his depredations in Ukraine?
Extreme conservatives are undermining American democracy every day. They’re trampling on the rights and freedoms that your dad and Bill devoted so many years of their lives to defend as commissioned officers in the United States military. And it’s something that they’ve been striving to accomplish since at least the 1930s.
I only hope Western Europe manages to resist this trend of rising fascism/white nationalism, otherwise we might yet live to see the end of democracy as we knew it in our younger days.
Fine piece, by the by. It certainly is thought-provoking.
Thanks for reading and commenting, Alex. I think a lot of civilizations go through uncivilized times. This period happens to be one of our times, unfortunately.