News Abortion

Missouri Attempts To Combine RU-486 Rules With TRAP Law To Create SuperTRAP

Robin Marty

What do you get when you cross legislation on who can provide an exam before administering RU-486 with new rules on admitting privileges and other standards for doctors who provide abortions?  SuperTRAP.

In Mississippi, the state passed a TRAP law so onerous that the only clinic that provides abortions may have to shut down.

Now Missouri has decided to join the fight by creating so many regulations around a medical abortion that no doctor may be able to meet all of the criteria.

Yes, it’s a superTRAP.

Via NECN.com:

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The bill endorsed by the House would require a doctor — not a nurse or other medical professional — to perform a physical examination of the woman at least 24 hours before prescribing the abortion-inducing drug mifepristone, commonly known as RU-486.

The legislation would require the physician administering RU-486 to have clinical privileges at a nearby hospital, as well as privileges to intervene with surgery if necessary at a hospital or the abortion clinic where the drug was given. It also would require physicians who prescribe abortion-inducing drugs to carry an additional medical malpractice insurance policy of at least $1 million per occurrence and $3 million annually for injury or death of a child born alive after an attempted abortion.

Apparently the amendment requiring that the doctor wear rainbow-striped underwear when administering the drug was voted down.

That’s a joke.  For now.

The new law isn’t likely to immediately effect the cost of a first trimester abortion, as the procedure costs the same regardless of whether it is done with medication or surgery.  But by cutting down the number of doctors who can provide medical abortions, as well as slowing down the process by creating a rule restricting who can do the initial exam for a medical abortion, the bill could force more women to wait until later in their pregnancies to terminate, then increasing both the costs and risks.

“It’s essentially setting up a two-tiered system for abortions,” said Michelle Trupiano, statewide lobbyist for Planned Parenthood Kansas and Mid-Missouri.  According to Trupiano, all abortions currently have the same set of pre-procedure requirements, including who does the initial exam, regardless of what procedure is being employed.  By requiring the doctor to perform the exam for a patient who is going to use RU-486, the legislature is placing additional burdens on women seeking medical abortions rather than surgical. The legislature is actually putting more restrictions on providing medical abortions than on providing surgical terminations.

As for requiring any doctor who gives RU-486 to have surgical privileges? “There is absolutely no need for someone following the medical procedures to need surgical privileges in a hospital within 30 miles,” said Trupiano. “Not all of our doctors would be able to get them. It’s an absolutely burdensome regulation.”

The obvious intention is to put in so many rules, regulations and requirements that a doctor will be unable to provide a woman with RU-486 without putting his or her career in jeopardy, and to make it too expensive for a doctor to provide medical abortions at all.  This new law has the potential to in essence ban medical abortions all together.

Legislators are writing the right to a legal, safe and non-bankrupting abortion out of law.  This is just the first superTRAP law, and if it goes unopposed, it will not be the last.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Abortion

Abortion Providers Could Recoup Millions From Wisconsin After Fighting Unconstitutional Anti-Choice Law

Michelle D. Anderson

The providers seeking money include Planned Parenthood of Wisconsin, Inc., Planned Parenthood Federation of America, and Milwaukee Women's Medical Services, which conducts business as Affiliated Medical Services.

Abortion providers serving Wisconsin residents could recoup nearly $1.8 million in legal fees they amassed while fighting an anti-choice law that was first blocked in 2013. However, spokespeople for the State of Wisconsin have raised the possibility of an undisclosed settlement.

In a U.S. District Court filing dated July 28, the providers requested an award of “attorneys’ fees, costs and expenses” that could be recouped under the Civil Rights Attorneys’ Fee Awards Act of 1976. On Wednesday in response, Wisconsin Attorney General Brad Schimel asked the court to extend the due date for the state to respond from August 18 to September 1. The request was granted, according to court documents.

“The parties are currently discussing settlement of the plaintiffs’ motion. An extension of the briefing schedule would allow the parties the opportunity to explore the possibility of a settlement of this issue,” Schimel said in the court filing.

The providers seeking money include Planned Parenthood of Wisconsin, Inc., Planned Parenthood Federation of America, and Milwaukee Women’s Medical Services, which conducts business as Affiliated Medical Services. The sum requested includes $1.7 million in attorneys’ fees, $44,253 in billable costs and $22,545 in out-of-pocket expenses, according to the court filing.

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The providers amassed the fees fighting Wisconsin Act 37 of 2013, a Republican-initiated law that required doctors to have hospital admitting privileges within 30 miles of the location where an abortion was to be performed.

U.S. District Judge William Conley of the Western District of Wisconsin blocked the law’s enforcement soon after Republican Gov. Scott Walker signed it in 2013.

The state attorney general twice appealed to the Seventh Circuit U.S. Court of Appeals, which affirmed the lower court’s decision both times; the U.S. Supreme Court also declined to take the case a day after overturning a similar provision in Whole Woman’s Health v. Hellerstedt.

In a Court of Appeals opinion issued in November 2015, the court said there was no evidence that “transfer agreements provide inferior protection to the health of women undergoing abortion compared to admitting privileges.” The opinion concluded by saying the unconstitutional statute was burdensome and curtailed citizens’ constitutional right to an abortion.

“The statute may not be irrational, yet may still impose an undue burden—a burden excessive in relation to the aims of the statute and the benefits likely to be conferred by it— and if so it is unconstitutional,” the court said.

If not blocked, the law would have forced pregnant people in various parts of the state to travel at least an extra 200 miles round trip to access legal abortion, according to a previous Rewire report.

Johnny Koremenos, a spokesperson for Schimel, had indicated in statements to the Journal Sentinel and the Wisconsin State Journal earlier this month that the state would fight the charges for legal fees. He said Schimel would challenge the providers’ request “to ensure that the state is not paying more than it should be for those fees,” according to local news reports.

Koremenos did not respond to Rewire’s request for comment.

Walker also supported fighting the fees, his spokesperson told the Journal Sentinel.

Ismael Ozanne, the district attorney for Dane County, was also named as a defendant in the providers’ lawsuit, along with several state medical examining board members.

Planned Parenthood of Wisconsin spokeswoman Iris Riis told Rewire the money Planned Parenthood is seeking in this case is only a recoup of the legal fees already spent fighting the unconstitutional admitting privileges law.

“There would not be any leftover money to allocate to services or any fund. It would just cover what was already spent. Governor Walker’s administration appealed multiple definitive rulings, wasting countless taxpayer dollars in the process. That action also drove up our legal costs,” Riis said.

Riis said the plaintiffs do not know when Conley will issue the ruling that will determine whether Schimel will have to compensate them for legal fees.

Andrew Wiseman, a deputy clerk in the U.S. District Court, Western District of Wisconsin, told Rewire the court could not offer a prediction about the date of Conley’s ruling.

Affiliated Medical Services, which operates a clinic in Milwaukee, is being represented by the American Civil Liberties Union of Wisconsin, while private attorneys are representing Planned Parenthood.

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