This is a statement signed by Louisiana physicians to provide clarity that Louisiana Pro-Life Laws protect physicians’ ability to care for their patients.
This is a statement signed by Louisiana physicians to provide clarity that Louisiana Pro-Life Laws protect physicians’ ability to care for their patients.
Over the past few months, we, the undersigned Obstetricians, Gynecologists, Obstetrician-Gynecologists, family medicine doctors, and other physicians who specialize in caring for women and babies, have noted increasing misinformation about the impact of abortion laws on Louisiana physicians. Some statements have suggested that physicians would not be able to provide necessary care for their patients under the pro-life laws of Louisiana which went into effect with the reversal of Roe v. Wade. We feel compelled to address these misconceptions for our fellow physicians and the public.
Before we delve into details, let us be clear on two points: First, elective abortions are not necessary healthcare for patients. The abortions now prohibited under law are elective procedures. Second, Louisiana law in a post-Roe world protects physicians’ ability to care for their patients in emergencies.
It is key to note that medical definitions of abortion and legal definitions of abortion are different, and that legal definitions typically make room for this difference. Because the conversation has been focused on what Louisiana law does and does not allow, we will discuss Louisiana law on abortion in reference to the practice of medicine.
The Louisiana 2022 Reaffirmation of Human Life Protection Act (Act 545 / La. R.S. § 14.87.7) distinctly makes elective abortions illegal and defines those abortions as the “performance of any act with the intent to terminate a clinically diagnosable pregnancy with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child.” Thankfully, Louisiana law now protects the lives of innocent, living babies from elective abortion.
These illegal elective abortions are not to be conflated with proportionate pregnancy care for the mother and the unborn child that occurs in our hospitals and doctor’s offices. The Human Life Protection Act clearly defines those actions which are not considered abortions under the legal definition of elective abortion. Concerning ectopic pregnancy, miscarriage, life and health-threatening circumstances, and contraception, Louisiana law presently provides the following:
Ectopic Pregnancy
Louisiana law is clear that Louisiana physicians should provide the necessary care when a mother is diagnosed with an ectopic pregnancy. Our ability to care for women in these medical emergencies has not changed.
La. R.S. § 14.87.1(1)(b) says, “Abortion shall not mean any one or more of the following acts, if performed by a physician:
The Mayo Clinic explains ectopic pregnancy as follows, “Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina. An ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may cause life-threatening bleeding, if left untreated.” And “if the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture.” (1) Louisiana physicians should not hesitate to act in the event of an ectopic pregnancy.
Miscarriage
Louisiana law is clear that Louisiana physicians can provide the necessary care when a mother has miscarried her unborn child.
La. R.S. § 14.87.1(1)(b) says, “Abortion shall not mean any one or more of the following acts, if performed by a physician:
When a woman’s body does not naturally pass a child’s remains, she may need the remains removed in order to preserve her health. Some medications or procedures used for illegal elective abortions are also used for removing the remains of a dead unborn child. The law clearly allows physicians to use these medications and procedures when removing a dead unborn child. Furthermore, the law is clear that illegal elective abortions are committed only when there is a specific intent to cause the death of an unborn child.
Life-Threatening Circumstances
Louisiana law is clear that Louisiana physicians can provide the necessary care when a mother’s life is in danger.
La. R.S. § 14.87.1(1)(b) says, “Abortion shall not mean any one or more of the following acts, if performed by a physician:”
And, La. R.S. § 14.87.1(1)(b) says the following about the termination of pregnancy to save an unborn child, “Abortion shall not mean any one or more of the following acts, if performed by a physician:”
If a pregnancy must end because of a condition endangering the mother, or even endangering her unborn child, Louisiana law allows physicians to proceed with actions they deem necessary to save lives. It is impossible for Louisiana law to list every possible complication or emergency or to provide step-by-step guidelines for how physicians can handle these situations. Because of this, the law quoted above repeatedly makes reference to these decisions being made with the “good faith medical judgment” of physicians consistent with “reasonable medical practice.” These terms are defined under the same section as “a physician’s use of reasonable care and diligence, along with his best judgment, in the application of his skill. The standard of care required of every healthcare provider, in rendering professional services or health care to a patient, shall be to exercise that degree of skill ordinarily employed, under similar circumstances, by the members of his profession in good standing in the same community or locality.” Louisiana law defers to a physician’s expertise to resolve complex medical situations, as long as the physician is acting with the intent to save the life of the mother and under medical necessity.
Louisiana law allows physicians to practice good medicine and care for patients in emergencies. Our practice of helping our patients has not changed in a post-Roe landscape.
Emergency Contraception
Louisiana law clearly does not include any form of contraception within its definition of abortion.
La. R.S. § 14.87.1(2)(b) says, “Abortion-inducing drug shall not mean a contraceptive, an emergency contraceptive, or the use of methotrexate to treat an ectopic pregnancy.”
The terms “contraceptive” and “emergency contraceptive” are further defined in La. R.S. § 14.87.6 and La. R.S. § 14.87.8 respectively:
“Contraceptive” means any device, measure, drug, chemical, or product, including single-ingredient levonorgestrel, that has been approved by the United States Food and Drug Administration for the purpose of preventing pregnancy and is intended to be administered prior to the time when a clinically diagnosable pregnancy can be determined, provided that the contraceptive is sold, prescribed, or administered in accordance with manufacturer’s instructions.”
(8) “Emergency contraceptive” means a drug, chemical, or product, including but not limited to single-ingredient levonorgestrel or ulipristal, that has been approved by the United States Food and Drug Administration designed or intended to be taken after sexual intercourse but prior to the time when a clinically diagnosable pregnancy can be determined, provided that the emergency contraceptive is sold, prescribed, or administered in accordance with manufacturer’s instructions or is prescribed in accordance with the standard of care that generally accepted by the American College of Obstetricians and Gynecologists.
While there are varying medical opinions on the abortifacient nature of certain contraceptives, Louisiana law does not define contraceptives or emergency contraceptives as abortion.
Addressing Recent Stories
We would like to address a few stories which have circulated since the overturning of Roe v. Wade and which have contributed to a false narrative. It is important to keep in mind that the only information we have to review on these situations is what is publicly available.
Situation #1: Cytotec for Purposes Other Than Elective Abortion
On June 10, an article (2) was published in the NOLA.com / Advocate newspaper about Louisiana law and its alleged “chilling effect” on the work of physicians to care for women. The article described a situation in which a physician sought to use Cytotec for a purpose other than elective abortion, but a Walgreens pharmacy refused to fill a prescription he wrote for the drug. For the reasons explained above, Louisiana law did not prohibit the pharmacy from filling the prescription. The problem in this case was a Walgreens pharmacist’s misunderstanding of Louisiana law. Walgreens legal counsel should provide to its pharmacists the information clearly found within the law.
Louisiana law is clear: When these medications are used for purposes other than elective abortion, they are legal and permitted to be used while practicing medicine. La. R.S. § 14:87.9 (2022 Act 548) reads, “None of the following shall be construed to create the crime of criminal abortion by means of an abortion-inducing drug: Lawfully prescribing, dispensing, or distributing a drug, medicine, or other substance for a bona fide medical reason that is not intended to cause an abortion in violation of this Section”
The same law provides that when a physician prescribes misoprostol, Cytotec, and other drugs for uses other than elective abortion, the physician is to include the diagnostic code on the prescription to provide information alerting the pharmacist that the drug is being used for a purpose other than abortion. The practice of including the diagnostic code is consistent with standard Medicaid and Medicare practices. In fact, the Louisiana Department of Health published a lengthy list (3) of medications that require diagnostic codes under Medicaid on its website. Again, Louisiana law is clear: When these medications are used for purposes other than elective abortion, they are legal and permitted to be used while practicing medicine.
Situation #2: Physician Care in the event of PPROM
The same article references a “preterm premature rupture of membranes (PPROM).” Dr. Cecilia Gambala claimed this condition could lead to a prematurely-induced delivery of a child not old enough to survive outside the womb. Louisiana law clearly permits physicians to induce delivery to save the life of a mother in such medical emergencies.
Similarly, Dr. Valerie Williams submitted an affidavit on Monday, June 18, 2022 to Judge Don Johnson of the 19th Judicial District Court in Baton Rouge telling the story of a patient whose water broke at 16 weeks. According to the affidavit, Dr. Williams offered the patient a D&E procedure but was told by the hospital’s lawyer that she could not perform this procedure. Dr. Williams described the D&E as the patient’s preferred option due to the patient’s emotional trauma. It is unclear from the document if there were medical reasons that would have required a D&E. If Dr. Williams determined that there were any factors medically necessitating a D&E procedure in order to save the life of the mother, it is likely that Louisiana law would have deferred to the expertise of the physician and allowed it.
However, performing the D&E procedure because of the patient’s emotional trauma, according to Dr. Williams’ affidavit, and not because of medical necessity reasoning, could be a violation of Louisiana law and the hospital’s attorney was possibly correct in their advice. According to our medical consensus, a D&E procedure would rarely be justified as a necessary procedure other than a situation that calls for the removal of the remains of a dead child. In fact, numerous OB/GYNs, including some physicians who have signed this letter, assert that a D&E procedure is never necessary with a living child to save the life of the mother. With such an early PPROM diagnosis in Dr. William’s case, immediate delivery of a living child, by induction for vaginal delivery or Cesarean section if at a more advanced gestational age, would certainly be considered necessary in the event of maternal hemorrhage, sepsis, organ failure, or other situations that pose a more immediate grave danger to the mother. Furthermore, at 16 weeks, whether the child is alive or not, a D&E procedure is associated with a much higher rate of complications such as hemorrhage, infection, and uterine perforation than a first trimester D&C that is commonly done for miscarriages. For this reason, most OB/GYNs would not consider a D&E to be the preferred method, even for removing the remains of a deceased child.
While we do not know all the details of the situation, our first analysis would be to determine if antibiotics and pregnancy management in a hospital situation could continue a pregnancy for long enough to allow the child to develop for a premature delivery when the child is old enough to potentially live outside the womb. If the analysis shows that this is not possible, inducing delivery would be an appropriate solution, even though the previable baby would die in the process. The intention of this action is to save the life of the mother.
Regardless of the consensus of the physicians signing this letter, if Dr. Williams determined that there were any factors medically necessitating a D&E procedure in order to save the life of the mother, it is likely that Louisiana law would have deferred to the expertise of the physician and allowed it.
After delivery of the child, according to the affidavit, the patient experienced a complication with the delivery of the placenta and hemorrhaged nearly a liter of blood. While this complication is devastating, postpartum hemorrhage is a potential complication in natural and induced labor, c-section, and D&E procedures. Physicians are trained to handle these complications. An emergency surgical procedure to remove a retained placenta in the setting of a postpartum hemorrhage would in no way be prohibited by Louisiana law.
Louisiana law protects the ability of physicians to serve women and unborn babies with compassion and skill. The requirement simply is that the physician is making reasonable efforts under the circumstances consistent with reasonable medical practices to preserve the life of mother and the child. But as we know in medicine, reasonable medical efforts cannot always save everyone. Instead of defending their practice of aborting healthy babies, abortion advocates are resorting to misinformation to confuse the public.
It is time for media and abortion advocates to stop spreading the lie that necessary medical treatment would be at risk. This fear mongering puts lives at risk, as it may cause physicians to hesitate in emergency situations, make pharmacists unwilling to prescribe necessary medication, and cause patients to not give honest explanations of their conditions.
Together, let’s ensure the public knows that women’s necessary healthcare is not at stake and move forward with protecting unborn babies and their mothers.
Sincerely,
Angela Parise, M.D., Obstetrician-Gynecologist, New Orleans
Bennie Nobles, M.D., Obstetrician-Gynecologist, Metairie
Bradley Fossier, M.D., Family Medicine and Internal Medicine, St. Francisville
Brett Lewis, M.D., Emergency Medicine, Greenwell Springs
Charles Aycock, M.D., Obstetrician-Gynecologist, Baton Rouge
Damon Cudihy, M.D., Obstetrician-Gynecologist, Lafayette
Diane E. Pierce, M.D., Emergency Medicine, New Orleans
Evelyn Griffin, M.D., Obstetrician-Gynecologist, Baton Rouge
Jack Andonie, M.D., Obstetrician-Gynecologist, Metairie
Kim Hardy, M.D., Obstetrician-Gynecologist, Lafayette
Lauren McCalmont, M.D., Obstetrician-Gynecologist, Shreveport
Scott Bergstedt, M.D., Obstetrician-Gynecologist, Sulphur
Tara Berner, M.D., Family Medicine, Metairie
