Idaho already has a doctor shortage and is losing doctors specializing in obstetrics and gynecology.
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In a presentation Wednesday at the Idaho Statehouse, Idaho health care leaders said doctors are facing confusion over how to practice medicine under Idaho's abortion ban. He said the lack of power is getting worse. Abortion is allowed only when necessary for the mother's life, not for her health.
They appealed to the parliamentarians as follows: health exceptionThis would allow doctors to terminate a pregnancy not only to prevent death, but also to prevent serious harm to the patient. For example, if a patient's waters break prematurely and the infection begins before the fetus is viable, doctors can treat the infection without fear of prosecution, which may include terminating the pregnancy. .
“Idaho is entering a labor shortage that will take years, if not decades, to fill. But before we can stabilize the environment and move forward, we have to stop drilling. And we need to make the law more clear. to help do that,” said Susie Polliot Keller, chief executive officer of the Idaho Medical Association.
The provider Charged under Idaho's abortion law, they could be sentenced to two to five years in prison and have their medical licenses suspended or revoked. Idaho also has a civil enforcement law. Allow doctor to sue for at least $20,000 By the family of the person who underwent the abortion.
But legislation amending Idaho's abortion ban is unlikely to be enacted this year. The Idaho Legislature concluded most of its business on Wednesday and adjourned until April 10 to allow time to address a potential veto from Gov. Brad Little.
Lawmakers postpone introduction of abortion bill in 2024 Meanwhile, the U.S. Supreme Court considers a challenge to Idaho's abortion bansaid Rep. Brent Crane (R-Nampa), chairman of the Idaho House State Affairs Committee, which typically deals with abortion legislation.
After meeting with Treasure Valley doctors about the issue earlier this year, Crane said he believes lawyers are being dishonest about how the abortion ban works. He stressed that no doctors have been charged or prosecuted under Idaho's abortion ban.
“I think there's still an effort to repeal Idaho's abortion law. And they're using doctors and OB doctors as pawns in this political game, and I'm tired of that.” Crane said in an interview with the Idaho Capital Sun. “Be honest with your doctors. Let them know about the regulations enacted by the Idaho Legislature. There are provisions that are clearly spelled out.”
Concerns about the lack of transparency surrounding Idaho's abortion ban are not new. In October, the Washington Post reported on the situation. Doctors begged hospitals for guidance on abortion procedures —Including Idaho.
Most Americans want a health exception to the abortion ban. Political infighting continues to hinder them.
“I don't think there's any way to deny the fact that it's abortion bans that are actually causing this very serious problem,” House Minority Leader Ilana Rubel, D-Boise, told the Idaho Capital Sun. said in an interview. .
The Idaho State Medical Association was working on a draft maternal and child health exception bill, Polliot Keller told The Sun in a statement. But after the U.S. Supreme Court decided to hear the Idaho case, “those conversations stopped,” she said.
“With the Court's decision impending, we find that a path to legislation no longer exists. Regardless of the (Supreme Court's) ruling, the IMA will continue to improve the health of patients facing adverse pregnancy complications. We continue to work to reform the law to protect the United States,” said Polliot Keller.
'Crisis of conscience' for doctors working under Idaho abortion ban
Dr. Megan Kasper, a Canyon County obstetrician-gynecologist who spoke at the Capitol on Wednesday, recently cared for a second-trimester patient who had painful labor and a dilated cervix who was weeks away from survival. he said.
While Idaho's abortion ban didn't change the way Kapsar cared for her patients, she said her behind-the-scenes management did make a difference.
“What did I need to do to keep myself and the entire medical team out of trouble?”
“What will be her baseline health status?”
“If she starts bleeding, how much blood can she withstand?”
“At what point does her bleeding get to the point where I can say, 'Okay, this is life-threatening'?”
Under normal circumstances, the baby “wouldn't survive this process,” Kasper said.
“As a doctor, there's not a lot of room for something to go wrong. I would say, 'Okay, things are starting to go wrong.' We need to step in and intervene and move miles away from anything that threatens life,” she said.
But Kasper said, “We have to think about it now.” And, she said, she has to have parameters that could be upheld in court.
“As we move forward, it has become very clear that the current situation here in Idaho is no longer a pro-life or pro-choice issue…that no one would even have questioned in 1972. These are basic obstetric care issues that we hadn't thought about,” Kasper said. .
Dr. Sarah Thomson, Boise Obstetrician-Gynecologist, Idaho Chapter Representative The American College of Obstetricians and Gynecologists said in a presentation on Capitol Hill. Some obstetricians and gynecologists she knows have quit their jobs because of the “moral conflicts” they experience while treating patients. Additionally, more people are considering leaving the state if the state's laws don't change.
“Many of us have experienced a crisis of conscience about what to do. We feel deeply committed to our patients, but if this is something we personally or our own families do, I’m also concerned about what that means,” Thomson said. “The threat of five years in prison for patient care is a huge burden. And our state has yet to indict a single physician, or we are told that medically necessary cases are unlikely to be prosecuted.” However, it is not reassuring enough.”
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Idaho faces an 'obstetric desert,' says Idaho Hospital Association CEO
Three labor and delivery departments at Idaho hospitals recently closed. Bonner's general health At Sandpoint, courage health in Emmett, and more recently, West Valley Medical Center's Caldwell Facility.
Idaho is seeing a growing “maternity desert,” where “pregnant women may have to travel long distances for prenatal care and delivery,” said Brian, CEO of the Idaho Hospital Association. Whitlock said.
Brad Turpen, CEO of Barrow Health, said in Emmett that the hospital has been unable to consistently staff its delivery program. If the hospital does not make significant changes; Turpen said it was more like “another story of rural hospitals closing.”
Emmett is the county seat of rural Gem County in southwestern Idaho.
Turpen said the hospital still provides prenatal and postnatal care. But he said closed birth services “make it even more difficult for women in Gem County to give birth.”
Steele Memorial Medical Center in Salmon, Idaho, the most remote hospital in the U.S. House of Representatives 48, suspended delivery services because it did not have a doctor to perform labor and delivery, Whitlock said. For pregnant women who live in one of the counties served by that hospital, it will “establish a relationship with a doctor 94 miles or 168 miles away for prenatal care and the delivery of your baby.” “We are currently encouraging that,” he said.
Whitlock said the hospital is actively recruiting.
“For now, if it's an emergency, go to the hospital. They'll stabilize you,” Whitlock said. “But you'll probably be transported to Idaho Falls, 268 miles away, to deliver your baby.”
Idaho is 'digging a workforce hole' that could take decades to fill, health leaders say
Idaho has lost 22% of its active obstetricians. According to a report by the Idaho Physician Well-Being Action Collaborative, since the abortion ban went into effect;
“Hospital administrators say the lack of clarity in Idaho's legal environment regarding maternal care is creating uncertainty and fear, and candidates are now looking for a place to practice.” said Whitlock.
Whitlock said the rate of obstetricians and gynecologists in Idaho is already low: 2.2 per 10,000 women, compared to 14 per 10,000 women nationally. However, Whitlock said hospitals in Idaho have twice and in some cases three times as many openings for obstetricians and gynecologists as usual. Meanwhile, one-third or half of obstetricians and gynecologists at an Idaho hospital are applying for jobs.
Because the state does not have training or fellowships for obstetricians and gynecologists, it is not possible to recruit new obstetricians and gynecologists or maternal-fetal specialists within the state, Thomson said. And out-of-state applications have decreased “dramatically,” she said.
Dr. Lauren Colson, president of the Idaho Safe Healthcare Coalition, calls his pregnant patient for help removing an intrauterine device (IUD), a long-acting contraceptive inserted into the uterus. He said he came there. Dr. Colson said the patient had seen two other health care providers beforehand “because she was concerned that removing the IUD would accidentally terminate her pregnancy.”
And Colson said she has heard similar stories from other doctors, who are worried that “other people might think it's an abortion.”
However, if the IUD is not removed, patients are at increased risk of miscarriage and infection, Colson said.
In Idaho, 55% of high-risk obstetricians lost their jobs, according to a report by the Idaho Physician Welfare Action Collaborative. As a result, the report found, Idaho has fewer than five full-time specialists known as maternal-fetal medicine physicians.
Dr. Jim Souza, chief physician officer at St. Luke's Health System, said these physicians “are the safety net of the health care system from a provider perspective.” “These allow us to manage high-risk pregnancies and safely deliver babies from literally 100 miles away.”
Now that those doctors have left, “family physicians and alumni across the state are asking whether it is still safe to provide obstetric care, both personally and professionally,” Souza said.
“The law is vague regarding the circumstances in which doctors are allowed to practice,” Souza said. “The law treats issues of life and death as if they were black and white, dualistic. Those of us who manage life and death understand that they are two extremes on a spectrum. I know, and there is health in between.”
Why the Idaho Legislature didn't act to ban abortion in Idaho this year
In January, The U.S. Supreme Court has agreed to hear a case challenging Idaho's strict abortion ban. In 2022, the U.S. Department of Justice sued Idaho argued that the state's abortion ban violates federal law that requires hospitals to provide stabilizing care to all patients who present for a medical emergency.
But even after the Supreme Court rules on a challenge to Idaho's abortion ban, Idaho doctors still need clarity on how they provide care, said Ken McClure, lobbyist for the Idaho State Medical Association. he said.
“It's not good for any of us to drive a woman who has a medical emergency and make her wait until the emergency becomes life-threatening,” McClure said.
Crane said lawmakers feel the best path forward is for the Supreme Court to rule in 2024.
“If they make a decision, we can think about 2025,” Crane said.
Crane said he expects the Idaho Legislature to advance a similar bill next year. Recently passed legislation in South Dakotawhich required states to produce information materials about their abortion laws.
Rubel said the full extent of the “disaster” caused by Idaho's abortion ban is likely unknown.
“Of course, the impact of this is going to be devastating for the woman, but it's also going to be devastating for the baby and, frankly, everyone in the state who needs medical assistance. ” Rubel said.
