disasters, healthcare, law, politics, slut shamers

I hope more OB-GYNs leave red states…

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:

This could be a real problem in an emergency situation…

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.

Standard
politicians, stupid people

Once again with feeling– YOU CANNOT RE-IMPLANT AN ECTOPIC PREGNANCY!

Yesterday, as I was waking up on my last day in Poland, I read an article a friend of mine shared about Ohio’s relentless push to end abortion. The article, which came from a site called Insider.com, was based on a news item that was in The Columbus Dispatch. Since I am in Europe, I can’t read the original article without a VPN. Fortunately, I have a VPN, and am now reading the article. I know I have at least one regular reader in Ohio who has commented to me about how frightening the pro-life agenda is in Ohio right now. The article I just read is not very comforting.

House Bill 413 proposes that “a fetus would be legally considered a person, and those performing an abortion could be charged with aggravated murder.” Furthermore, anyone providing an abortion “shall suffer death or be imprisoned for life.” I hasten to add that at least this bill doesn’t subject women who seek abortions to the death penalty, unlike recently proposed legislation in Texas. I guess the lawmakers figure the poor pregnant people are “misguided” and need a firm hand to help them make decisions more in line with their way of thinking.

My first reaction to this? Wow! It seems very strange to want to impose the death penalty on abortion providers when one is arguing for the pro-life movement. After all, every abortion provider was once someone’s unborn fetus, too. Why kill competent healthcare professionals for helping their patients? Why put them in prisons, where their skills will erode and they will cost taxpayers money while potentially enriching shareholders at privately run corrections facilities? It makes no sense to me at all.

I have come to understand that this kind of extreme language is par for the course when it comes to pro-life wingnuts. However, one thing that I cannot wrap my head around is the insistence that ectopic pregnancies can be made viable. In the Columbus Dispatch article dated November 15, 2019, it is stated:

Exceptions for saving the life of the mother are limited — including a requirement to attempt to implant an ectopic pregnancy into the woman’s uterus. Critics say the procedure is not supported by science and puts the woman’s life at even greater risk.

Now… I distinctly remember back in May 2019, writing a post about this very same ludicrous argument that ectopic pregnancies can somehow be salvaged by technology that doesn’t yet exist. At that time, idiot lawmaker John Becker, who apparently has zero knowledge about pregnancy, anatomy, or physiology, proposed House Bill 182, which would prohibit most private insurance coverage for abortion. The bill included language addressing treating ectopic pregnancies (when the fertilized egg attaches outside of the womb, usually in one of the fallopian tubes). When this was big news, Becker said:

“Part of that treatment would be removing that embryo from the fallopian tube and reinserting it in the uterus so that is defined as not an abortion under this bill,”

Back then, I wrote that no ectopic pregnancy I have ever heard of could be salvaged. Indeed, ectopic pregnancies are true medical emergencies, and they almost always end with the termination of the pregnancy and possibly a significant downgrade in the woman’s fertility, since there is a good chance the affected fallopian tube might also have to be removed. More importantly, there does not currently exist any medical procedure that would allow a physician to “re-implant” an embryo into a woman’s uterus. The technology simply isn’t there yet. If it was there, a lot of women who have ectopic pregnancies would be all for getting the procedure done. Contrary to what the pro-lifers in Ohio seem to believe, most pregnant women look forward to being mothers and don’t plan to terminate their pregnancies. I fail to see why ectopic pregnancies need to be addressed by the pro-life crowd.

As I recall, Becker got a pretty good backlash for his ignorant and tone deaf comments on the ectopic pregnancy issue. I thought maybe his fellow lawmakers would get a clue and at least consult someone in the maternal healthcare field who knows more about pregnancy than they do. But no… they’re still discussing requiring physicians to re-implant non-viable embryos resulting from ectopic pregnancies into the uteri of women who surely have enough trauma to deal with. Under this bill, if the physicians don’t try to save the ectopic pregnancies by using currently non-existent technology, they could wind up facing the death penalty.

All I can do is just shake my head at the sheer cruelty and lunacy of the right wing nutjobs in Ohio who keep pushing this UNCONSTITUTIONAL legislation. They really should be ashamed of themselves, not just for trying to deny reproductive freedom to Ohioans, but for being just plain stupid and ignorant on the topic for which they claim to be so passionate. Ectopic pregnancies are not viable and they have nothing to do with abortion. Pro-lifers need to get a clue and stop pushing this nonsense before more innocent people die. Then, they need to take it a step further and realize that there are situations in which an abortion is the appropriate medical decision and sometimes should be allowed for the health of the mother. And then they need to butt the hell out of other people’s private healthcare decisions.

And… just to bring Donald Trump into this– I just read that he’s been trying to push a rule that would allow healthcare professionals to refuse to treat people on religious grounds. The measure, which would have gone into effect yesterday, was struck down a federal judge who, thank GOD, realized the chilling effect that could have on our already horrendous healthcare system. U.S. District Court Judge William Alsup was the third judge to reject the measure, writing “When a rule is so saturated with error, as here, there is no point in trying to sever the problematic provisions. The whole rule must go.”

Alsup continues, ” [the Trump administration rule] upsets the balance drawn by Congress between protecting conscientious objections versus protecting the uninterrupted effective flow of health care to Americans.” Then he cites a scary hypothetical scenario, quoted below, in which “ambulance drivers” (who really should be referred to as EMTs or paramedics), could legally abandon a pregnant person en route to the hospital needing an emergency abortion. I would assume an ectopic pregnancy would be one of those situations, although I sure would hope that anyone choosing to work as an EMT or paramedic would know better, and understand that without surgery that will effectively terminate the pregnancy, someone with an ectopic pregnancy will likely DIE without medical intervention. Those who are truly pro-life should recognize that the person who is growing the fetus deserves care and protection, too.

“Under the new rule, to preview just one example, an ambulance driver would be free, on religious or moral grounds, to eject a patient en route to a hospital upon learning that the patient needed an emergency abortion,” wrote Alsup. “Such harsh treatment would be blessed by the new rule.”

I really think we’re seeing a lot of these ridiculous, extreme, church sponsored pro-life rules being proposed because we have an incompetent jackass in the White House who will champion and embolden these people into pushing their sick and intrusive agendas. Extreme Christians have gained too much power and are trying to force their religious views on the entire country. I really hope that people will open their eyes and vote against Trump in the next election. He’s destroying lives, and that will, in turn, destroy the country. We need to get him out of power, pronto, and elect someone decent who will restore humanity to our government before it’s too late. Trump admires dictators, disrespects women, non-whites, and the poor, and cozies up to the ignorant simply to win their votes. This anti-woman legislation that punishes women who are pregnant and threatens healthcare providers with the death penalty is a huge step backwards into the Dark Ages. We simply must elect more competent and compassionate people.

For more on Ohio’s House Bill 413 and all the craziness it proposes in its over 700 pages, have a look at this link.

Standard