The Dobbs Health Scare

By John McCormack

Thursday, July 28, 2022

 

Leftists resort to scaremongering about abortion

 

Ingrid Skop, a pro-life obstetrician based in San Antonio who has delivered more than 5,000 babies in her career, thought in the wake of the Dobbs decision that media fearmongering amounted to little more than idle, if shameful, talk. But it’s begun to look a little more like a self-fulfilling prophecy.

 

“Unfortunately, I see it is affecting what’s happening on the ground,” Dr. Skop told me in a phone interview on July 22, a month after the Dobbs decision. “The media misrepresentation of the law has been taken as truth by many doctors. They have not looked at what the law actually says.” For example, Texas law explicitly excludes treatment of a miscarriage from the definition of abortion, but Skop says her trusted colleagues have “seen and heard from women who have been told by emergency rooms that there is no other option for their miscarriage except to pass it on their own,” she said. “It’s just not good care.”

 

One of the most important pro-life battles in the states right now is clearing up misinformation and disinformation about what abortion laws mean for women with life-threatening conditions. One blatantly false claim that has been spread in the media is that pro-life laws may prohibit treatment of ectopic pregnancies.

 

“‘Do I abort this ectopic pregnancy to literally save my life or do I go to jail?’” Daily Beast columnist Wajahat Ali wrote on Twitter the day of the Dobbs decision, adding that it’s a “question women in America now have to ask.” Representative Alexandria Ocasio-Cortez wrote in a July 8 tweet that abortion laws mean that women in “half the country should risk death if they have an ectopic pregnancy within the wrong state lines.” 

 

But every state abortion law before Roe included an exception to save the life of the mother, and that is true of every abortion law that has taken effect following the Dobbs decision. Before Roe, ectopic pregnancies were routinely treated as soon as they were detected. Many states, including Texas, explicitly exclude treatment of ectopic pregnancies from the definition of abortion. An ectopic pregnancy is a life-threatening condition in which the embryo implants outside the womb, and lifesaving treatment always results in the death of the embryo. Skop said she hasn’t personally heard of any doctors who have delayed treatment for an ectopic pregnancy, but a small number of such stories (which are seemingly impossible to confirm) have cropped up in the press. 

 

On July 14, the Dallas Morning News reported that the Texas Medical Association sent a letter asking state regulators at the Texas Board of Medical Examiners to clarify the law. The News reported that one hospital “in Central Texas allegedly told a physician not to treat an ectopic pregnancy until it ruptured, which puts patient health at serious risk, according to the letter.” The letter and article didn’t name the hospital or person who “allegedly” gave the physician this terrible advice — and do not suggest that the physician acted on it — but if the story is true, the advice would appear to amount to malpractice. “Every ER doctor and every ob-gyn knows that an ectopic is a big deal, so I don’t think anyone has been willing to wait on those,” Skop said.

 

What is to be done to clear up the misinformation and disinformation about abortion laws? Pro-life doctors, advocates, and journalists have been trying to correct the record. To that end, in her capacity as senior fellow and director of medical affairs at the pro-life Charlotte Lozier Institute, Skop has produced a pair of papers (one in May and another in July) on treatments to save the life of the mother. Ultimately, it’s going to fall to those in positions of authority to correct the record. In Skop’s view, both the Texas Medical Association, which represents doctors, and the Texas Medical Board, which has the power to discipline doctors, have the authority and responsibility to clear up the misinformation. “I do blame the medical organizations,” she said. “That’s what they’re there for — to help the doctors understand these situations.” 

 

It was a matter of weeks following the Dobbs decision before the hospital system where Skop has worked sent out an email in which a lawyer “cut and pasted the text of the Texas law and basically outlined, this does not include miscarriages, does not include ectopic pregnancies.” Skop said she “asked the attorney who sent me the email if I can share it with other friends outside of the system. And she said no, this was only for the doctors in our system.”

 

Ideally, Skop said, there needs to be an “all of the above” approach from medical organizations and government lawyers in clearing up misinformation. At the very least, attorneys general and medical organizations should say that doctors operating in hospitals should continue to exercise the same standards of medical judgment and care when treating women with life-threatening conditions as they did before Dobbs. Such conditions include, but are not limited to, cases of severe hypertension and times when a pregnant woman’s water breaks before the baby can survive outside the womb — when the baby is delivered before viability to save the mother’s life. 

 

Some advocates of a right to abortion and doctors have said that the law leaves unclear whether they need to wait until a woman’s condition becomes dire before delivering, but that was not a requirement of abortion laws before Roe, and it is not a requirement of abortion laws after Dobbs. Paul Linton, a constitutional lawyer who formerly served as general counsel for Americans United for Life, told me in a phone interview that life-of-the-mother exceptions in laws banning abortion “do not have any requirement of imminency or immediacy” of a threat to the mother’s life.

 

Skop gave the example of a woman whose membranes rupture — her water breaks — before viability, when it is appropriate to offer immediately to deliver the baby. “I say this as a pro-life physician: It is appropriate to deliver at that point. Because we know that likelihood that four days, six days [later], she’s going to be clinically infected,” and that infection can lead to potentially fatal sepsis. She added: “We know that the likelihood this child was going to make it to be born alive, to stay alive, not die in the neonatal period, is super low.” There is no need to wait until day four or day six; the delivery may occur on day one. 

 

Yet there was a troubling American Journal of Obstetrics and Gynecology pre-proof article released at the end of June that reported two major hospitals in Dallas had stopped offering the option of immediate delivery in these circumstances following the enactment of the Texas Heartbeat Act in September 2021. Those hospitals offered only “expectant management” of the mother’s condition, which is associated with greater risks to the mother. (Expectant mothers will sometimes choose to take these risks — rather than deliver immediately — despite the very low odds that the baby will survive.) 

 

National Review contacted both Dallas hospitals, seeking comment about how and why they had concluded that the law prohibited offering immediate delivery in these circumstances. A spokesperson for Parkland Health told NR in an email: “We do not have anyone available” for an interview. The other hospital, UT Southwestern, also declined an interview request, but the hospital’s media-relations department sent an email to NR that said: “UT Southwestern continues to review the U.S. Supreme Court opinion in conjunction with Texas laws and will not be commenting at this time. The findings speak for themselves. UTSW followed the appropriate guidelines on the provision of care reflected in this retrospective review.”

 

But it was legal to offer lifesaving treatment before Roe, and Skop says there is no good reason to believe it is illegal to offer such lifesaving treatment after Dobbs: “If [the mother] wants delivery at the time of initial diagnosis, it is the standard of care to do so and is allowed by all state pro-life laws.”

 

In the intervening five decades, of course, a whole army of risk-averse lawyers have encouraged doctors to practice defensive medicine — always keeping an eye on protecting themselves from liability. Some hospital administrators may be taking “measures thinking they’re protecting themselves from the law. But if they’re not following the standard of medical care, and people get hurt, the flip side” is that the hospital or doctor “can be sued for medical malpractice,” said Skop. “So it’s very important that the medical societies set ideology aside and make sure that the members who rely on them for advice are given appropriate advice and that they can care for women well.”

 

Abortion-rights activists would surely like to turn a life-of-the-mother exception into a loophole to perform any abortion. But that risk is very low because almost all women with life-threatening conditions would already be in hospitals, and it would be very rare for a doctor to diagnose a woman with a life-threatening condition that didn’t exist. Statistics show that only a very small percentage of abortions are performed to save the life of the mother. For example, last year in the State of Florida, 0.15 percent of all abortions were performed “due to a life endangering physical condition,” according to Florida’s Agency for Health Care Administration. If Planned Parenthood tried to reopen a clinic doing abortions only to “save the life of the mother,” it would be obvious what was going on.

 

Why medical organizations and attorneys general haven’t done more to clear up the disinformation isn’t entirely clear. Many state pro-life laws are being challenged in court, and attorneys general could worry that any statement could be used against them in a trial. But if that’s what is holding them back, they are behaving like lawyers concerned only about representing their client (the government) when they should be taking a broader view of themselves as statesmen dedicated to protecting women, babies, and the law. In short, when Dr. Skop speaks, they should listen.