For five hours on Monday, the Texas Medical Association heard from doctors, lawyers and patients about the department’s proposed guidance on the state’s abortion ban, and the resounding message was clear: Nearly three years after Texas began making abortion civilly and criminally illegal, no one is happy with the rules that are in place.
Commenters at the stakeholder meeting said the rules would, at best, provide no clarification to doctors and, at worst, make it even harder for them to operate under the abortion ban. The draft guidelines include provisions for how doctors should record abortion cases, including indicating whether there was “sufficient time to transfer the patient to another hospital” to avoid the procedure.
“We are very concerned that the proposed rule’s documentation and administrative requirements could interfere with the Hippocratic Oath, restrict the exercise of rational medical judgment and delay much-needed life-saving and fertility-saving care,” said Dr. Joseph Valenti, an obstetrician-gynecologist in Denton and president of the Texas Board of Regents of the Medical Association, which is unaffiliated with the state medical association.
The commission is responsible for regulating the practice of medicine in the state, but until earlier this year it had been conspicuously silent on the issue of abortion. In its Kate Cox decision, the Texas Supreme Court called directly on a panel of physicians appointed by the governor and local officials to provide guidance to doctors operating under three overlapping abortion bans.
Lobbyists Amy and Steve Bresnan filed a petition with the agency in January, asking for clarification for doctors, patients and lawyers. The agency released its proposed rules in March, but they are broad and rely heavily on language from the abortion ban itself.
There are no conditions listed that may qualify for an exception to the ban to protect the life of the mother, except for ectopic pregnancies, in which a fertilized egg implants in a place where it should not, which are not viable and can be fatal to the mother if left untreated.
Current rules define an ectopic pregnancy as one that exists solely outside the uterus, a rule that doctors challenged at Monday’s meeting.
Dr. Karin Fox, a professor of maternal-fetal medicine at the University of Texas Medical School at Galveston, explained that there are two types of ectopic pregnancy — those that occur in the scar from a previous C-section and those that occur in the uterine muscle — and said they can be difficult to address under current guidelines.
“It’s even contradictory to what’s written in the law,” Fox said. “What’s the definition of an ectopic pregnancy and what are the symptoms that can be treated?”
Fox and Valenti, the Denton obstetrician-gynecologist, were among several doctors who raised concerns about the added documentation requirements, saying they would add undue burden to an already complicated situation and could delay needed care in emergency situations.
Dr. Sherif Zaafran, president of the Texas Medical Association, said the proposed documentation guidelines are not intended to make doctors’ jobs harder and that documentation may occur after treatment has been performed, which is common practice.
Doctors on both sides of the abortion debate took to the virtual microphone to stress the importance of getting proper guidance. Dr. Ingrid Skop, a San Antonio obstetrician-gynecologist and anti-abortion activist, recounted treating a woman whose treatment after a miscarriage was delayed for weeks because her doctor insisted she get a follow-up ultrasound.
“The irrational fear that this will lead to doctors failing to intervene in a timely manner for Texas women is unnecessary,” Scopp said. “The board needs to remind doctors that no doctor has ever been prosecuted in Texas for performing an abortion to save the mother’s life.”
The repercussions of Texas’ anti-abortion law could be career-ending for medical professionals, including heavy fines, prison time and loss of licenses.
Elizabeth Weller, one of more than 20 plaintiffs in Zulawski v. Texas, said she was asked to file a complaint by lawyers for the Texas Medical Association after she was denied a life-saving abortion. Weller said the association’s website doesn’t allow complaints to be filed if the doctor isn’t named.
“In my communications with the committee, I made it very clear that I did not intend to file a complaint against my doctor,” Weller said. “He was adamant that I receive treatment, but ultimately the hospital informed me that, based on the letter of the law, I was not eligible for an abortion.”
No decisions were made during or after Monday’s meeting. The board plans to consider public comments when deciding whether to edit the guidelines or put the rules to a vote at its next meeting in June.
