It’s an emotional and legal dilemma that potentially faces not just obstetricians and midwives, but also family physicians, emergency physicians, pharmacists, and anyone else who might become involved with pregnancy care. And Ogburn, who noted that he was speaking personally and not for the medical school, worries that fears about the Texas laws have already delayed care.
“I wouldn’t say this is true for our practice,” he said. “But I have certainly heard discussion among physicians that they’re very hesitant to do any kind of intervention until they’re absolutely certain that this is not possibly a viable pregnancy — even though the amount of bleeding would warrant intervening because it’s a threat to the mother’s life.”
John Seago, legislative director for Texas Right to Life, described this type of hesitation as “an awful misunderstanding of the law.” Even before the passage of the two bills, existing Texas law stated that the act is not an abortion if it involves the treatment of an ectopic pregnancy — which most commonly occurs when the pregnancy grows in the fallopian tube — or to “remove a dead, unborn child whose death was caused by spontaneous abortion,” he said, pointing to the statute. Another area of Texas law that Seago cited provides an exception to the state’s abortion restrictions if the mother’s life is in danger or she’s at “serious risk of substantial impairment of a major bodily function” unless an abortion is performed.
“It is a pro-life position to allow physicians to make those life-and-death decisions,” Seago said. “And that may mean in certain circumstances protecting the mother in this situation and the child passing away.”
But interpretation of the laws is still causing challenges to care. At least several OB-GYNs in the Austin area received a letter from a pharmacy in late 2021 saying it would no longer fill the drug methotrexate in the case of ectopic pregnancy, citing the recent Texas laws, said Dr. Charlie Brown, an Austin-based obstetrician-gynecologist who provided a copy to KHN. Methotrexate also is listed in the Texas law passed last year.
Ectopic pregnancy develops in an estimated 2% of reported pregnancies. Methotrexate or surgery are the only two options listed in the medical guidelines to prevent the fallopian tubes from rupturing and causing dangerous bleeding.
“Ectopic pregnancies can kill people,” said Brown, a district chair for the American College of Obstetricians and Gynecologists, representing Texas.
Tom Mayo, a professor of law at Southern Methodist University’s Dedman School of Law in Dallas, understands why some in Texas’ pharmacy community might be nervous. “The penalties are quite draconian,” he said, noting that someone could be convicted of a felony.
However, Mayo said that his reading of the law allows for the use of methotrexate to treat an ectopic pregnancy. In addition, he said, other Texas laws and the Roe v. Wade decision provide an exception to permit abortion if a pregnant person’s life is in danger.
Since the Texas laws include a stipulation that there must be intent to induce an abortion, Mayo said that he’d advise physicians and other clinicians to closely document the rationale for medical care, whether it’s to treat a miscarriage or an ectopic pregnancy.
But Prager believes that the laws in Texas — and perhaps elsewhere soon — could boost physicians’ vulnerability to medical malpractice lawsuits. Consider the patient whose miscarriage care is delayed and develops a serious infection and other complications, Prager said. “And they decide to sue for malpractice,” she said. “They can absolutely do that.”
Texas providers are still adjusting to other ripple effects that affect patient care. Dr. Jennifer Liedtke, a family physician in Sweetwater, Texas, who delivers about 175 babies annually, no longer sends misoprostol prescriptions to the local Walmart. Since the new laws took effect, Liedtke said, the pharmacist a handful of times declined to provide the medication, citing the new law — despite Liedtke writing the prescription to treat a miscarriage. Walmart officials did not respond to multiple requests for comment.
Since pharmacists rotate through that Walmart, Liedtke decided to send those prescriptions to other pharmacies rather than attempt to sort out the misunderstanding anew each time.
“It’s hard to form a relationship to say, ‘Hey look, I’m not using this for an elective abortion,’” she said. “‘I’m just using this because this is not a viable pregnancy.’”©2022 Kaiser Health News. Distributed by Tribune Content Agency, LLC.