TESTIMONY SUBMITTED IN SUPPORT OF SB 2305
This proposed legislation should be supported by all who put the health and wellbeing of women who are patients seeking elective termination of a pregnancy above all else.
The safety of abortion is touted by it’s advocates using statistics and terms indicating infrequency of problems. The number of procedures does, though, result in significant incidents of harm to actual human beings as a result of procedures executed by itinerate physicians.
This is a preemptive measure intended to avoid as much as is practicable unintended consequences of itinerate surgery.
Medical Privileges is a BIG DEAL for both physicians and the hospitals extending such privileges. The process has significant correlation with risk management and legal exposure. It is undertaken very, very thoroughly. For a REASON.
A more rigorous vetting of itinerant physicians by hospitals done by their professional peers WILL improve the care of women patients and thus the outcomes of their surgery or medically induced termination.
The constitutionality of a state’s duty to protect it’s citizens by establishing pre-emptive measures in general, and in this manner itinerate physician scrutiny specifically, is well established in case law.
Abortion practitioners and academics concur that establishment of medical privileges will result in improved outcomes following elective pregnancy termination.
ABORTION COMPLICATIONS – IN THEIR OWN WORDS
Red River Women’s Clinic Website
It can take anywhere from about a day to 3-4 weeks from the time a woman takes the first medication until the medical abortion is completed. The length of time depends in part on the medications taken and when the misoprostol is used. The majority of women who take mifepristone will abort within four hours of using misoprostol. About 95% of women will have a complete abortion within a week.
Possible Complications: About 95-98% of women will have a successful medical abortion. Complications are rare. However, a small percentage of women (approximately 0.5-2%) will need a suction aspiration (similar to a surgical abortion) because of heavy or prolonged bleeding. Rarely, in approximately 0.1-0.2% of cases, a blood transfusion might be required to treat very heavy bleeding.
In about 1% of cases or fewer, the medications do not work and the embryo continues to grow. In these cases, a suction procedure (surgical abortion) must be done to empty the uterus and complete the abortion. Deciding to continue the pregnancy to term is not an option after taking the first medication because the medications can cause birth defects in the pregnancy.
SAFETY OF ABORTION
• Medication abortion accounted for 17% of all nonhospital abortions, and about one-quarter of abortions before nine weeks’ gestation, in 2008.
• Fewer than 0.3% of abortion patients experience a complication that requires hospitalization.
North Dakota Abortion Numbers and Statistical Probabilities by Year
2011 2010 2009 2008 2007 2006 2005 2004 2003 2002
1,247 1,291 1,290 1,386 1,235 1,298 1,231 1,357 1,354 1,219 = 9 yr total = 12,3908
12,908 X 0.003 38.24 (9 year estimate) or 4.3 per year requiring hospitalization
How many are complicated but do not require hospitalization?
Medical termination does not work…who finishes in the case of critical need?
What about the conscience of medical professionals that would have to complete the procedure should there be horrific problems as a result of an abortion?
A Google search of the two words “Ambulance Abortion” will yield insightful results.
ITINERANT PHYSICIANS – A SPECIAL CASE
“Itinerant surgery is defined in this inspection as the practice by a physician (normally residing in another city) of traveling to small rural hospitals to perform surgery. The surgeon tpically is not available for follow-up care, having traveled to another rural hospital or returned to his or her home base all in the same day. The American College of Surgeons will and have excluded physicians from fellowship for performing itinerate surgery”. United States Department of Human Services, Office of Inspector General report (1988).
“The American College of Surgeons has long condemned the practice of "itinerant surgery," where doctors operate on patients and leave follow-up care to a family physician. But it has refrained from issuing guidelines on locum tenens. Paul Collicott, a director of the ACS, says it's "a necessary part of surgical practice today," given the overall shortage in the field. He says it's the responsibility of each temporary surgeon to make sure patients are handed off to another surgeon for postoperative care.” - Wall Street Journal, January 13, 2009
“I pledge myself to pursue the practice of surgery with honesty and to place the welfare and rights of my patient above all else. I promise to deal with each patient as I would wish to be dealt with if I were in the patient’s position, and I will set my fees commensurate with the services rendered. I will take no part in any arrangement, such as fee splitting or itinerant surgery, which induces referral or treatment for reason other than the patient’s best welfare”. Portion of the Fellowship Pledge – American College of Surgeons, International Fellowship Requirements
ABORTION PROVIDERS CLAIM SIGNIFICANCE OF LEVEL OF CARE
Termination of pregnancy is not a benign medical procedure. In some cases, serious complications, even life-threatening ones, arise and necessitate optimal and evidence-based treatment.
According to John Thorp, Jr., an abortion provider who is the author of a leading abortion textbook and who is as well as a physician is a professor of obstetrics and gynecology at the University of North Carolina (Chapel Hill) School of Medicine:
“there are few surgical procedures given so little attention and so underrated in its potential hazard as abortion.”
W.M. Hern, in ABORTION PRACTICE 101 (1990):
“Serious complications can only be evaluated in full service hospitals and often occur after regular business hours. Given the frequency of short-term complications from abortion (2-10%), follow-up medical care is often needed on an urgent basis to treat infection, bleeding, or organ damage. If recognized and attended to promptly, long-term consequences can be minimized. Often, though, abortion procedures are performed in freestanding clinics during weekday hours and complications are managed in urgent care centers or emergency departments after hours or on weekends.”
Dr. Thorp also asserts that:
“When the [abortion] provider is an ob-gyn and has admitting and treating privileges at a local hospital, he or she is more likely to effectively manage patient complications by providing continuity of care and decrease the likelihood of medical errors.”
Nationally, 73% of emergency departments report inadequate on-call coverage by specialist physicians, including obstetricians/gynecologists who are particularly difficult to secure. According to O’Malley, A., Draper, D. & Felland, L. in their publication Hospital Emergency On-Call Coverage: Is There a Doctor in the House?
AMERICAN COLLEGE OF SURGEONS
II. RELATION OF THE SURGEON TO THE PATIENT
E. Postoperative Care
The responsibility for the patient's postoperative care rests primarily with the operating surgeon. The emergence of critical care specialists has provided important support in the management of patients with complicated systemic problems. It is important, however, that the operating surgeon maintain a critical role in directing the care of the patient. When the patient's postoperative course necessitates the involvement of other specialists, it may be necessary to transfer the primary responsibility for the patient's care to another physician. In such cases, the operating surgeon continues to be involved in the care of the patient until surgical issues have resolved. Except in unusual circumstances, it is unethical for a surgeon to relinquish the responsibility for the postoperative surgical care to any other physician who is not qualified to provide similar surgical care.
F. Continuity of Care of the Surgical Patient
The surgeon will ensure appropriate continuity of care of the surgical patient. An ethical surgeon should not perform elective surgery at a distance from the usual location where he or she operates without personal determination of the diagnosis and of the adequacy of preoperative preparation. Postoperative care should be rendered by the operating surgeon unless it is delegated to another physician who is as well qualified to continue this essential aspect of total surgical care.
It is recognized that for many operations performed in an ambulatory setting, the pattern of the patient's postoperative visits to the surgeon may vary considerably; it is, however, the responsibility of the operating surgeon to establish communication to maintain proper continuity of care.
MEDICAL PRIVILEGES – HIGH LEVEL PEER REVIEW – BIG DEAL
An entire legal specialty field
William and Mary Law Review [Vol. 29:609
A hospital with a respected staff and a reputation for high-quality care will be attractive to skilled physicians, who want access to the broad patient base and desire the prestige of membership on the hospital staff.
Staff privileges are one of the most important assets of a physician's practice.
Although specific procedures for review of staff privilege applications may differ at various hospitals, some general similarities exist. Several groups within the hospital structure participate in the process of considering an application for privileges. The medical staff plays a significant role in that process by evaluating the professional capabilities of the applicant. The physicians on the hospital's credentialing committee investigate the applicant's background to determine the extent of his past medical training and performance, whether he is licensed and board certified, whether he carries malpractice insurance, and any other information that they believe is relevant. The committee may report to the staff as a whole, to its executive committee, or directly to the governing board. The board is responsible for making the final decision, although many boards may give great weight to the findings of the committee. If the decision is unfavorable to the physician, the hospital generally provides an internal procedure for appeal and review.
Burdensome V. Life-Impacting Consequences
Abortionist Dr. Thorp acknowledges that “[a]ll competent physicians endure the ‘burdensome’ nature of applying for hospital privileges for the safety and well-being of their patients.”
Dr. James Anderson, a board-certified emergency medicine physician who serves as clinical professor at the Medical College of Virginia, opines regarding requiring physicians associated with abortion clinics to have hospital privileges, “s consistent with the time-honored practice of requiring training and credentialing of physicians who are making decisions and doing procedures that have life-impacting consequences. If a physician cannot obtain privileges for the specific requested procedures at his or her local hospital, then in my expert opinion, the physician is not qualified to do the surgical procedures that have life-changing or life-threatening impact.”
Constitutionality of Proposed SB 2305
This proposed law would likely prove to be of no unconstitutional purpose. As Casey held, a regulation serves a “valid purpose” if it is “not designed to strike at the right [to abortion] itself” and furthers the State’s “legitimate interests…in protecting the health of the woman and the life of the fetus that may become a child.” 505 U.S. at 846.
Simopolous v. Virginia, 462 U.S. 506, 511 (1983) affirms that “[t]he State has a legitimate interest in seeing to it that abortion, like any other medical procedure, is performed under circumstances that insure maximum safety for the patient”.
Simopoulos, 462 U.S. at 516 affirms that , “In view of its interest in protecting the health of its citizens, the State necessarily has considerable discretion in determining standards for the licensing of medical facilities”.
Greenville Women's Clinic v. Bryant, 222 F.3d 157, 172 (4th Cir.2000), cert. denied, 531 U.S. 1191 (2001) (“Greenville I”), held that a “valid purpose” was served by a regulation requiring abortion clinics to be associated with a physician who has admitting privileges at a local hospital.
Gonzales, supra, 550 U.S. at 163 (“The Court has given state and federal legislatures wide discretion in areas where there is medical and scientific uncertainty.”); id., at 157
Washington v. Glucksberg, 521 U.S. 702, 731 (1997) (“[t]here can be no doubt that the government ‘has an interest in protecting the integrity and ethics of the medical profession’”).
The Supreme Court has upheld health-related abortion-clinic rules that merely “may be helpful” and “can be useful.” Planned Parenthood of Central Mo. v. Danforth, 428 U.S. 52, 80, 81 (1976).
Two federal circuit courts have expressly found that “admitting privileges at local hospitals and referral arrangements with local experts” are “so obviously beneficial to patients” undergoing abortions as to easily withstand a facial constitutional challenge alleging them to be undue burdens.
Greenville Women's Clinic v. Commissioner, South Carolina Dept. of Health and 317 F.3d 357, 363 (4th Cir. 2002) (“Greenville II); Women’s Health Ctr. of West County, Inc. v. Webster, 871 F.2d 1377, 1382 (8th Cir. 1989).
Accord Tucson Woman's Clinic v. Eden, 379 F.3d 531, 547 (9th Cir. 2004) (holding that Arizona statute requiring only abortionists who performed a certain number of abortions per month to obtain admitting privileges did not violate equal protection because it was rationally related to achieving a legitimate end).