News Health Systems

Raped In Oklahoma? Better Know Your Hospitals

Robin Marty

A rape victim is turned away because there is no one on staff able to examine her.

Imagine being the victim of a sexual assault, or a parent who learns their daughter was  sexually assaulted. You arrive at a hospital, looking for assistance — someone to do a physical exam, tests, collect evidence, offer emergency contraception so the rape isn’t compounded by pregnancy.

Imagine being turned away.

This is what happened to a young woman who arrived at Integris Canadian Valley Hospital with her mother. There, the doctor that met with her told her that the hospital was unable to examine her or provide emergency contraception due to a lack of Sexual Assault Nurse Examiners (SANE). The specially trained nurses are rotated from hospital to hospital, and there were none at the hospital that the victim chose.

Hospital spokes-people argued that the doctor made the right call, and that SANE nurses were specially trained to collect and preserve evidence without “re-traumatizing” the victim.

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However, the real question is whether the doctor behaved ethically when she refused to provide emergency contraception, which is much more effective the sooner it is taken after unprotected sexual intercourse. The doctor stated that she was unable to provide it until she had received an exam, but the victim’s mother thinks that may have just been an excuse.

The mother said she and her daughter did file a police report about the rape. She’s angry that she brought her 24-year-old daughter to the Integris Canadian Valley Hospital emergency room on Sunday, and that the doctor who came in and saw them refused to do any sort of exam or to provide them with any emergency contraceptives.

Not only that, she says the doctor was less than sympathetic when dealing with her daughter, even though she was told she was a victim of a rape.

Oklahoma is one of a handful of states that allow doctors to refuse to provide emergency contraception due to conscience clause laws, and that very well may have been the contributing factor in this case.

However, as Jessica Pieklo writes over at Care2, this isn’t just an issue of a doctor refusing treatment.  It’s also a sign of how budget cuts and austerity programs are decimating both medical programs and public safety programs that especially help women. 

[P]rograms like that can only work when there’s the resources behind them and in support of the mission. When that doesn’t happen, rape kits go uncollected, languish in processing, and evidence stales. Perpetrators go free and victims are left without any justice. Thanks to Republicans continued assault on sexual assault prevention and victim support services, SANE nurses must rotate time at different hospitals around the Oklahoma City metro-area. Which means when this victim needed one she had to transfer hospitals, further delaying the processing of her claim and any evidence that could be used in prosecution.

There is no reason why a person isn’t trained in each hospital to be able to conduct an exam, other than a mentality that believes that regardless of the circumstances, women and girls should continue to jump through hoops to get proper care, and that it’s up to them to bear any inconvenience.

SANE nurse exams are meant to “not retraumatize” the victim, but how is searching for and being denied care the first time not in itself traumatizing?  Being denied the tools to best prosecute the perpetrator or to protect her from pregnancy after the assault?

Oklahoma balances the budget on a rape victim’s back, then victimizes her again by allowing doctors to refuse her needed and compassionate care and her basic human rights.

News Law and Policy

Purvi Patel Could Be Released From Jail by September

Jessica Mason Pieklo

In 2013, investigators charged Patel with both feticide and felony neglect of a dependent, based on the theory that Patel had self-induced an abortion and delivered a live infant, which then almost immediately died post-delivery.

The State of Indiana will not appeal a decision vacating the feticide conviction of Purvi Patel, the Granger woman who had previously faced 20 years in prison for what state attorneys described as an illegal self-induced abortion.

Patel was arrested in 2013 after she sought treatment at a hospital emergency room for heavy vaginal bleeding. While being examined by medical personnel, Patel told doctors she’d had a miscarriage and had disposed of the remains. Investigators located those remains and eventually charged Patel with both feticide and felony neglect of a dependent, based on the theory that Patel had self-induced an abortion and delivered a live infant, which then almost immediately died post-delivery. In February 2015, a jury convicted Patel of both counts.

But in July, the Indiana Court of Appeals vacated Patel’s feticide conviction, holding the statute was not designed to be used to criminally charge people for their own failed pregnancies. However, the court largely upheld Patel’s felony neglect of a dependent conviction, deferring to controversial medical testimony offered by the state that claimed Patel’s fetus was on the cusp of viability and had taken a breath outside her post-delivery.

Patel had initially been sentenced to serve a total of 20 years. But because attorneys for the state failed to appeal the July decision, she could be available for re-sentencing as soon as the court can schedule a hearing—which could mean a possible release as early as September, depending on her new sentence and credit for time served.

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Commentary Contraception

Hillary Clinton Played a Critical Role in Making Emergency Contraception More Accessible

Susan Wood

Today, women are able to access emergency contraception, a safe, second-chance option for preventing unintended pregnancy in a timely manner without a prescription. Clinton helped make this happen, and I can tell the story from having watched it unfold.

In the midst of election-year talk and debates about political controversies, we often forget examples of candidates’ past leadership. But we must not overlook the ways in which Hillary Clinton demonstrated her commitment to women’s health before she became the Democratic presidential nominee. In early 2008, I wrote the following article for Rewirewhich has been lightly edited—from my perspective as a former official at the U.S. Food and Drug Administration (FDA) about the critical role that Clinton, then a senator, had played in making the emergency contraception method Plan B available over the counter. She demanded that reproductive health benefits and the best available science drive decisions at the FDA, not politics. She challenged the Bush administration and pushed the Democratic-controlled Senate to protect the FDA’s decision making from political interference in order to help women get access to EC.

Since that time, Plan B and other emergency contraception pills have become fully over the counter with no age or ID requirements. Despite all the controversy, women at risk of unintended pregnancy finally can get timely access to another method of contraception if they need it—such as in cases of condom failure or sexual assault. By 2010, according to National Center for Health Statistics data, 11 percent of all sexually experienced women ages 15 to 44 had ever used EC, compared with only 4 percent in 2002. Indeed, nearly one-quarter of all women ages 20 to 24 had used emergency contraception by 2010.

As I stated in 2008, “All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.”

Now, there are new emergency contraceptive pills (Ella) available by prescription, women have access to insurance coverage of contraception without cost-sharing, and there is progress in making some regular contraceptive pills available over the counter, without prescription. Yet extreme calls for defunding Planned Parenthood, the costs and lack of coverage of over-the-counter EC, and refusals by some pharmacies to stock emergency contraception clearly demonstrate that politicization of science and limits to our access to contraception remain a serious problem.

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Today, women are able to access emergency contraception, a safe, second chance option for preventing unintended pregnancy in a timely manner without a prescription. Sen. Hillary Clinton (D-NY) helped make this happen, and I can tell the story from having watched it unfold.

Although stories about reproductive health and politicization of science have made headlines recently, stories of how these problems are solved are less often told. On August 31, 2005 I resigned my position as assistant commissioner for women’s health at the Food and Drug Administration (FDA) because the agency was not allowed to make its decisions based on the science or in the best interests of the public’s health. While my resignation was widely covered by the media, it would have been a hollow gesture were there not leaders in Congress who stepped in and demanded more accountability from the FDA.

I have been working to improve health care for women and families in the United States for nearly 20 years. In 2000, I became the director of women’s health for the FDA. I was rather quietly doing my job when the debate began in 2003 over whether or not emergency contraception should be provided over the counter (OTC). As a scientist, I knew the facts showed that this medication, which can be used after a rape or other emergency situations, prevents an unwanted pregnancy. It does not cause an abortion, but can help prevent the need for one. But it only works if used within 72 hours, and sooner is even better. Since it is completely safe, and many women find it impossible to get a doctor’s appointment within two to three days, making emergency contraception available to women without a prescription was simply the right thing to do. As an FDA employee, I knew it should have been a routine approval within the agency.

Plan B emergency contraception is just like birth control pills—it is not the “abortion pill,” RU-486, and most people in the United States don’t think access to safe and effective contraception is controversial. Sadly, in Congress and in the White House, there are many people who do oppose birth control. And although this may surprise you, this false “controversy” not only has affected emergency contraception, but also caused the recent dramatic increase in the cost of birth control pills on college campuses, and limited family planning services across the country.  The reality is that having more options for contraception helps each of us make our own decisions in planning our families and preventing unwanted pregnancies. This is something we can all agree on.

Meanwhile, inside the walls of the FDA in 2003 and 2004, the Bush administration continued to throw roadblocks at efforts to approve emergency contraception over the counter. When this struggle became public, I was struck by the leadership that Hillary Clinton displayed. She used the tools of a U.S. senator and fought ardently to preserve the FDA’s independent scientific decision-making authority. Many other senators and congressmen agreed, but she was the one who took the lead, saying she simply wanted the FDA to be able to make decisions based on its public health mission and on the medical evidence.

When it became clear that FDA scientists would continue to be overruled for non-scientific reasons, I resigned in protest in late 2005. I was interviewed by news media for months and traveled around the country hoping that many would stand up and demand that FDA do its job properly. But, although it can help, all the media in the world can’t make Congress or a president do the right thing.

Sen. Clinton made the difference. The FDA suddenly announced it would approve emergency contraception for use without a prescription for women ages 18 and older—one day before FDA officials were to face a determined Sen. Clinton and her colleague Sen. Murray (D-WA) at a Senate hearing in 2006. No one was more surprised than I was. All those who benefited from this decision should know it may not have happened were it not for Hillary Clinton.

Sometimes these success stories get lost in the “horse-race stories” about political campaigns and the exposes of taxpayer-funded bridges to nowhere, and who said what to whom. This story of emergency contraception at the FDA is just one story of many. Sen. Clinton saw a problem that affected people’s lives. She then stood up to the challenge and worked to solve it.

The challenges we face in health care, our economy, global climate change, and issues of war and peace, need to be tackled with experience, skills and the commitment to using the best available science and evidence to make the best possible policy.  This will benefit us all.

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