Stroke, hemorrhage, sepsis: Idaho doctors detail ways abortion ban risks patients' health

Boise OB-GYNs say transfers add more risk

The emergency obstetrics cases outlined by the amicus briefs aren’t isolated incidents. In a panel hosted by the American Civil Liberties Union last week, Dr. Jim Souza, chief physician executive for St. Luke’s, at a news conference said the hospital system last year saw 54 cases of previable preterm rupture of membranes.

“That’s one a week,” he said. “There’s a lot of second-guessing and hand-wringing. When the guessing game gets too uncomfortable, we transfer the patient out of state at great cost.”

In 2023, when the injunction was still in place, St. Luke’s transferred a single patient out of state for obstetric emergency, Souza said. Since January, six such patients have been transferred to other states for care.

Doctors said their patients are getting worse medical care as a result of the reinstated ban on emergency health-preserving abortion. Since the law allows abortion when a patient’s life is at risk, some doctors said they feel they have to let their patients’ condition decline to a point where the life-saving exception is more certain.

“It’s not good medicine to wait till someone’s at death’s doorstep and then try to pull them back,” Dr. Stacy Seyb, a maternal-fetal medicine specialist at St. Luke’s in Boise, told the Statesman.

Seyb and others noted that even when they transfer a patient out of state, they’re causing care delays and risking potential accidents or other problems. Many now advise their pregnant patients to carry insurance for air ambulance transports, which can cost tens of thousands of dollars.

Before the abortion ban, physicians were able to proactively prevent serious illness, whereas “now we are delaying care,” Schneider said. “So patients are becoming sick, or we’re delaying their care by transferring them out of state. And that causes just a tremendous potential for harm — maternal health harm, emotional harm and financial harm — to these patients and their families.”

Potential criminal charges worry physicians

Doctors told the Statesman their first concern is for their patients. Their second is for themselves and their careers.

Idaho’s abortion ban doesn’t just outlaw the procedure, it criminalizes it. Health care providers face two to five years in prison and the revocation of their medical license if they perform an abortion that doesn’t fit the law’s few exceptions.

In an interview with the Statesman, Souza said the line between preserving someone’s health and preserving their life is never clear. That makes for uncertainty over which emergency abortions may be legal.

Souza said in a patient’s “hour of greatest need,” a doctor may not feel comfortable making the right medical choice because they have to fear for themselves. He called it a “very dangerous mix in medicine.”

“Your doctor has to worry about their own profession and their own interests,” Souza said. “It runs 100% counter to the fiduciary relationship we commit to in our profession.”

St. Luke’s amicus brief called such situations “an impossible choice.” In its own brief, the Idaho Coalition for Safe Healthcare — a group formed in the wake of the Dobbs decision — said its members “have been at a loss for what to do” since January.

“At nearly every turn, Idaho’s doctors have been warned that they are being tracked and scrutinized and they should fear prosecution for providing an abortion under any circumstances — even when medically necessary,” the group’s brief said.

Dr. Sara Thomson, a Boise OB-GYN, told the Statesman in a written statement that she and her colleagues are facing a crisis of conscience.

“The threat of incarceration for five years for patient care is a heavy burden, and being told that no physician has been prosecuted in our state yet or that a case of medical necessity is unlikely to be prosecuted is not adequately reassuring,” Thomson said.

‘I have to be hopeful’ about SCOTUS decision

Since August 2022, Idaho doctors have rallied in support of abortion access. More than 600 physicians joined the newly formed Idaho Coalition for Safe Healthcare. Doctors have contacted their patients to explain the potential impacts of the state’s laws. They’ve testified about their concerns in front of the Idaho Legislature and now the U.S. Supreme Court.

It’s been hard work, they said. And many feel like no one is listening.

Souza said that’s why it was important for St. Luke’s to weigh in on the EMTALA case.

“Very early on this issue, we asked ourselves how loudly we were going to speak up about this as a health care system,” Souza told the Statesman. “And very quickly, when we saw what the language of the law that was going to be implemented, we recognized that it was going to be in conflict with health care.”

Souza said the brief was a chance for St. Luke’s to show its doctors that it stands with them, hears their concerns and will continue to push for an abortion law exception to preserve patients’ health.

Seyb, who works for St. Luke’s, lent his voice and experience to the hospital’s brief. He said it felt important to advocate for patients and their right to get adequate care at home.

“I see patients in these moments that make me feel like somebody’s got to help them,” Seyb said. “And to not speak up, it would be a failure on my part.”

Wednesday’s oral arguments won’t give physicians the answers they need. The Supreme Court is expected to issue its decision in the case in June or July. That leaves doctors and their patients in a holding pattern, and the justices could ultimately rule that this is the state of Idaho health care.

“Six months of hoping is better than nothing,” Uranga said. “I choose to feel hopeful. I have to be hopeful; otherwise, I wouldn’t be able to see patients.”

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