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Louisiana Doctors: We’re Choosing Between Saving a Life or Going to Jail

“Frankly, I am worried that I could go to prison just for handling a miscarriage as I always have.”

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As the fate of several states’ abortion bans hang in the balance, more than a dozen Louisiana doctors filed sworn affidavits on Tuesday asking that the state not impose legislation that leaves them potentially choosing between saving a pregnant person’s life and going to jail.

The physicians argued in their testimony that Louisiana, which already has one of the highest maternal mortality rates in the nation, will suffer extremely harmful consequences as a result of a statewide abortion ban. Dr. Eric Siegel, an OBGYN in the state, said he’s concerned about the provision requiring a second doctor that needs to sign off on an abortion in an emergency situation.

“Decisions in emergency situations may need to be made in the moment—including the middle of the night and weekends, when legal counsel may not be available,” wrote Dr. Siegel, who frequently treats low-income Black and Latina women, “and hesitating due to fear of prosecution is not safe for our patients.”

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“Does it have to be another OB/GYN? Can an anesthesiologist be the one to agree?” he asked in his affidavit. “What about a resident, who is an M.D. but performing under my supervision and not yet board-certified?”

Emergency physician Elisa Arrillaga wrote, “The Trigger Bans leave me and my colleagues at a loss for how to do our job.”

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Another emergency doctor, Nina Breakstone, wrote to the state government, “The reality is pregnancy is not usually nine months of smooth sailing. Complications from pregnancy not only exist, but pregnancy-related complications present to the emergency department very often. Frankly, I am worried that I could go to prison just for handling a miscarriage as I always have.”

Abortion is temporarily legal in Louisiana, following a lawsuit alleging the the state’s multiple trigger bans are “unconstitutionally vague.” Yesterday, Attorney General Jeff Landry asked the state Supreme Court to reinstate the abortion ban, saying that those who filed the suit “are willfully misreading clear terms in the law in an attempt to manufacture arguments.”

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But the doctors who filed the affidavits say that the trigger bans are anything but clear. Dr. Jennifer Avegno, the New Orleans health director, called the language “confusing, at times contradictory, and unclear from a medical perspective.”

Former Secretary of Louisiana’s Department of Health Rebekah Gee, a gynecologist, pointed out that Black women are disproportionately more likely to die from pregnancy and face pregnancy complications. She posed hypotheticals about decisions clinicians will have to make. “A woman comes in with sepsis (infection in her blood) in pregnancy. At what point does a clinician feel comfortable intervening to disrupt a pregnancy that could lead to multi-organ failure?” asked Gee. “To satisfy these laws–does it have to be her heart that fails, what about her lungs, her kidneys, and so on, what organs would this law decide are necessary to protect her life?”

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Gee also spoke to the lack of exceptions Louisiana’s trigger bans have for survivors of rape or incest. “These are complications that can happen when a body is too small to carry a pregnancy,” wrote Gee, detailing what could happen to the body of a 10-year-old girl forced to give birth. She said these complications “sadly may become more common in Louisiana because physicians will be unable to provide abortion care for children and adolescents even in the case of rape or incest.”

The physicians’ concerns went beyond abortion and miscarriage management. Avegno said oncologists are unclear whether they should “withhold potentially life-saving chemotherapy treatments when treating pregnant patients for fear they could be criminally charged” if the pregnancy is terminated as a result. A family medicine physician who treats patients living with diabetes, lupus, rheumatoid arthritis and seizure disorders said she’s scared of being imprisoned for prescribing life-saving medications that can cause pregnancy complications or miscarriage. One drug, methotrexate, is proving difficult to obtain in states like Texas, Tennessee and Virginia.

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Gynecologist Alexandra Band said her patients have been “terrified” and asking her questions about abortion, miscarriage, and whether they’ll have to wait to be sick and bleeding enough to get sufficient care. (Disclosure: Band is my doctor, but I did not speak to her for this story.)

Band wrote in her affidavit that she prescribed Cytotec (misoprostol) to a patient just after the Dobbs decision. She said Walgreens called her office and asked if the prescription was for an abortion. “When the response was, ‘No, it’s prescribed for IUD insertion to make it less painful,’ the response from Walgreens was that it would still not be filling the prescription, because it could not be sure we weren’t prescribing this for an abortion,” said Band.

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Avegno’s affidavit also referenced how in the wake of Dobbs, multiple pharmacies began refusing to dispense misoprostol because they were unsure what criminal penalties they would face.

Like many states, Louisiana is experiencing a shortage of healthcare providers. Avegno and other physicians said the trigger bans could make this situation even worse, which in turn would increase maternal mortality rates, especially in rural areas.

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Even current doctors in Louisiana admitted they have thought about leaving. “The thought of having to choose between my patients and my liberty is so acute that it is making me start considering relocating to another state,” wrote Dr. Anna White.

The physicians paint a grim picture for the future of healthcare in Louisiana should the trigger bans be imposed.

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“One of the main reasons pregnant women are more likely to die in Louisiana is because they are forced to travel long distances for care in many areas of the state due to the lack of health care providers,” wrote Avegno. “Any confusion, and any resulting decrease in access to care, will mean that more women are likely to die.”