- Thank you very much
for speaking with us today on this topic.
I wanna start by asking
what was your reaction and the reaction
of some of your patients when this news came down?
- So this is something because of the draft leak
that we, at Wisconsin ACOG, have been preparing for.
We've been having conversations within our state,
amongst other physician groups,
trying to anticipate this moment
and prepare the best we can
to take the best and safest care
of our patients given the current political landscape
or the current change in Wisconsin law reflected,
based on the judicial decision.
American College of OBGYN's views abortion as healthcare,
as essential healthcare for our patients.
And so knowing that our colleagues
who are caring for patients every day
who are needing these services, it's devastating.
And I think each of us, individually, as OBGYNs,
has met or interacted with a patient
who's needed an abortion.
And I'm sure really everyone has.
But maybe they don't know about it, right?
And so we have heard stories about patients
who have just devastating fetal birth defects
that aren't consistent with life,
that have made the really hard decision
to end their pregnancies, knowing what the outcome would be.
We have had patients who, for whatever reason,
pregnancy did not fit into their life plan,
whether it was due to medical conditions they had
or social factor, any number of different things.
And those stories touch you as a provider. They impact you.
And it is hard to not see compassion
for the patient who is sitting next to you
across the exam table.
And so I think for that reason,
many patients and providers were very upset
by this decision, yet still wanting to, again,
take the best and safest care for our patients possible,
given the circumstances.
- So now that the right to access an abortion
has been overturned,
where does that leave physicians in terms of patient care?
- Yeah, so I would say number one,
we are following very closely the legal landscape
in the state of Wisconsin.
I'm sure you're aware of the lawsuit
that was placed yesterday by Governor Evers
and Attorney General Kaul.
So I think all of us are watching
to see how that may impact our ability to care for patients.
For patients wanting to access abortion services
in the state of Wisconsin,
we are then needing to sort of help patients understand
where they could access those services,
which at this point, is outside of the state of Wisconsin,
until we get further clarification,
again, likely through some of these lawsuits
that have been placed,
whether or not the 1849 law that would prohibit abortion
in the state of Wisconsin,
whether that is enforceable.
So at the current moment,
abortion services are not being provided
in the state of Wisconsin.
And patients then need to sort of work with their providers
and understand the best way
to get to access those services out of state.
The conditions in the law include one
for an exemption for the life of the mother-
or the life of the pregnant person, rather.
And the challenge is that this law,
which was written in 1849,
before ultrasound, before any of the diagnostic tools
that we have today,
doesn't give us clarification of what that means.
And so the challenge for us as providers
is trying to interpret what the life of the mother means.
How sick does a patient have to get
before I can provide services
that I know are safe and effective?
And so I think that is where we are at
in terms of our state professional society of OBGYNs
is trying to figure out how to best provide the safest care
for our patients so that we aren't waiting
until a patient cannot be pulled back.
You know, I think there may be this misconception that,
"Oh, the life of the mother.
Well, we can just decide at some point
that she's sick enough
and then provide treatment and all is well."
Patients that are allowed to get sick enough are in the ICU.
They may have to have their uterus removed
for life-saving care.
So it isn't so easy in terms of medical decision making
to provide a quick fix
once a person has gotten that far ill.
And prior to this decision, if it got to that point,
it was because a patient chose to be there.
It was because a patient felt strong enough
about that pregnancy and continuing
that they accepted the risk
of severe illness or potential death.
And now with this law, that won't be the case.
And so we, again, as providers within the state,
are working with our state partners
to try to develop guidance
within our own institutions
and communicating with each other about how to make sure
that we're not letting patients go so far
that we lose pregnant people, mothers,
wives, sisters, daughters in our state,
knowing that right now in the country,
there is already a rising rate of maternal death.
And we're adding fuel to the fire here.
And that's scary.
As a patient myself, I've given birth twice.
As a doctor, as a friend, a mother,
a colleague, a sister, that's scary.
- Does that make timing of the essence
when there's the potential of,
okay, this person, if they needed
to terminate the pregnancy, would have to travel
versus how quickly they could get care
in a circumstance that continues to deteriorate
and then it's more serious.
- Honestly, I think that depends on a lot of factors.
Number one being where is that patient to start with?
So if you have a patient who is in a rural hospital
who doesn't have access immediately
to two other physicians to sort of qualify
for this maternal exemption,
the reason being the law states
that the person providing the abortion would have
to get sort of a approval or agreement
with two other physicians in order to perform the procedure.
So the time could be of the essence, right?
In terms of does
that provider feel comfortable proceeding again knowing
the potential outcome?
Or would that patient have to be transferred
to a different hospital with more tertiary care services?
You mentioned out of state.
I think there's some questions about,
again, how sick is sick enough, right?
So if a person has severe heart disease
in an early pregnancy,
and we know that that pregnancy
would then later put her life-
or that pregnant person's life, rather- at risk,
can the abortion be performed
at that time with consent of two physicians,
knowing that that continuing the pregnancy
may risk that life?
Or is that something that that person then
would have to travel or wait until they get sicker?
So these are some of the things that as doctors,
we're struggling with in terms of trying to, again,
make the best decisions for providing safe care
within the framework of this law,
which is hamstringing us
and our ability to provide necessary
and evidence-based treatment for our patients.
- If a situation right now,
without the law being cleared up,
presented itself that a pregnancy
would need to be terminated,
is that something that physicians,
like yourself, are going to do if needed for the mother?
- Yeah, I think honestly right now,
we're still sorting that out.
So the answer is, I hope, yes, right?
Because if the life of the mother is at risk,
I hope any OBGYN would recognize that
and quickly reach out to partners at other hospitals
to get approval so that this can move forward
so patients' lives are saved.
That said, I would imagine given
the criminal penalties for physicians
that any doctor in that situation would feel scared.
You know, it's a felony conviction.
I got kids at home, right?
I'm doing your pap smears. I'm not a felon.
And so that's scary.
And I can imagine, especially in a place where
this isn't quite as common,
where maybe people aren't in big tertiary care centers
where they're not as familiar
with the law or moving forward,
that this could be a harder decision or scarier
and that getting some of that legal-
you know, this is a legal framework that is a barrier
to providing safe care.
And so anytime you're putting barriers, that adds time.
And so if patients are getting sick quickly,
yes, I would be concerned
for that patient's health or safety.
- Do you foresee more deaths among pregnant people
and any disproportionate impacts?
- This is a tough question because for 50 years,
we have had access to-
More than 50 years. I don't remember the exact number.
But we've had access to the safe care, right?
I do think there are medical jour-
The medical journals are looking at Texas
in terms of what's happening in other states
where this has been going on longer
that are seeing some of these effects.
Certainly we can-
was literally just on the radio on the way here-
that the World Health Organization stated
that countries that limit or restrict access
to abortion don't necessarily change the numbers
of abortions that are happening,
but do, you know, present increases in maternal mortality.
And absolutely we already are seeing disparities
in terms of health outcomes for patients of color.
And particularly in Wisconsin, the ratio of maternal death,
the risk of maternal death is much greater
and, you know, unfortunately one
of the worst in the country, our state,
for Black women compared to white women.
So while we at the American College of OBGYNs
and partner institutions are dedicated
to working to make that better,
I am terrified that this is going
to disproportionately affect those patients
in the same way that other health inequities have presented.
- If a patient is considering traveling
at this moment in time,
is there fear that there could be legal ramifications
for the patient?
- Currently, my understanding of Wisconsin law,
and I am not a lawyer,
is that there are no criminal penalties
for patients at this time.
And there is also no criminal penalty for physicians
for helping advise patients on how to access care safely
outside of the state of Wisconsin.
So I would hope that if patients are needing services,
they feel comfortable talking to their healthcare providers
and communicating so that we can make sure, again,
that if care is being accessed out of the state,
that it's done in a way that's safe for the patient
and provides access in a timely way.
And then, again, hopefully we're not seeing some
of the more devastating effects that could happen
if patients are not using safe methods
to induce an abortion.
- When the law is cleared up or attempted to be cleared up,
are there laws that can capture
what used to be a conversation
between a patient and a physician?
- I mean, I think in general, as doctors, as OBGYNs,
we are very resistant to government intrusion
on doctor-patient relationships.
And so legislating medical care presents a danger
in us being able to provide, again,
the best and safest care for our patients.
There are many other sort of areas where-
that's what we call legislative interference, right?
Where there are laws being placed to limit patients'
and doctors' abilities to talk to each other freely
and to discuss, freely,
options which are known to be safe and effective.
And this is not limited to abortion care.
Recently, the American Medical Association passed
a resolution in their house of delegates unanimously,
again, that reaffirmed this position.
And the American Medical Association
is all physician specialties, not just OBGYN,
but reaffirmed this position that we are not interested
in legislative interference in us providing safe
and evidence-based care for our patients.
And they also reaffirmed that abortion is-
there should be a human right to receiving abortion care
and that's the American Medical Association.
So again, this sort of house of medicine in general,
as represented by this large physician body,
is in favor of allowing patients to make that decision
with their doctors
and without lawmakers interfering in that.
- All right, we're gonna leave it there for today.
Dr. Domeyer, thank you so much for joining us.
- Thank you so much for having me.