Dear Chairwoman Vukmir and Senate Health Committee Members:
I provide abortion care to patients in hospital settings as well as in outpatient clinics. A significant number of these patients undergo medically indicated abortions for lethal fetal anomalies or to preserve their life or health. Often, patients have significant medical problems (as cancer, diabetes, heart failure) which require expertise and care in addition to a safe abortion procedure. Many of the patients I treat are referred to me by their primary care physician in Wisconsin, often from a significant distance. I have described examples of the care I provide in the attached article I wrote for the Capitol Times a few months ago.
I oppose SB 306 since it interferes with the ability of myself and other physicians to practice sound evidence-based medicine. This bill interferes with my ability to provide care to patients in need of my expertise and it limits patient choice and autonomy.
1) SB 306 creates an unacceptable barrier in the doctor patient relationship, harming the continuity of care providers strive for in Wisconsin.
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Under current law, Wisconsin Statute Sec. 253.10, any qualified physician in the state of Wisconsin can provide informed consent counseling, make the voluntariness determination and obtain the state required 24-hour consent form from a patient. Oftentimes these primary care physicians refer the patient to an abortion provider, who provides counseling and again obtains consent for the procedure. This bill would require that the abortion provider obtains the initial consent. This new and additional requirement delays care and interferes in the patients existing relationship with her primary care physician. In addition, the referring physicians know their patients and are often the best informed regarding the patients’ medical condition. Certainly any licensed physician is qualified to obtain the initial consent. The physician performing the abortion will verify that consent and provide counseling prior to a procedure. This bill will greatly impede the continuity of care and put up obstacles between a woman and her primary care physician.
2) SB 306 is an unacceptable intrusion into the doctor-patient relationship because it requires abortion providers to give patients inaccurate post-procedure instructions.
This bill requires that patients be told that they must return to the same clinic where they received their abortion for a follow up visit with the abortion clinic within a specific time frame written into the law. I absolutely agree and best practice requires that women undergoing an abortion have a follow up exam to ensure a successful termination with no complications. Frequently this follow up care is better and more conveniently provided in a continuity of care setting by a primary care provider or referring physician in their own community. There is a medical necessity for follow up care, but no medical rationale that this follow up care must be provided by the abortion provider. This requirement can create a distance and access barrier for patients with no medical rationale or benefit. In addition, it is not the role of the legislature to practice medicine. This level of control over the doctor-patient setting is unacceptable and amounts to the legislature practicing medicine—without a license or any medical expertise.
3) SB 306 interferes with a doctor’s ability to use his or her professional judgment to determine the appropriate medical care in each individual patient’s unique circumstance.
The safe use of abortion medication, including proper dosage and administration, is extensively studied in the medical literature and established in evidence-based practice guidelines that are available for medical professionals. The timing, administration and dosing of legal medications is a practice which should not be legislated but left to the physician and patient to decide based on individual circumstances, as is the standard for all medical care. SB 306 undermines this standard of care and restricts the ability of physicians to prescribe and direct medication use in a location of choice. Currently FDA rules and guidelines are followed for medication abortions and in hospital settings medications are often used off-label based on evidence based literature. This bill interferes with physicians’ ability to establish an individual care plan.
There is no need for this bill. The bill will not enhance public safety. This bill will not improve the counseling or informed consent. The medical community is not asking for this bill—in fact, many of my colleagues are mobilizing against its unacceptable intrusion into medical practice. What this bill does is create barriers for patients to obtain abortion care in a timely fashion within a continuity of care context. This bill interferes negatively with continuity of care which is important for patients after an abortion procedure, especially when medically indicated.