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House Republicans defeat bills to clarify pregnancy care under Louisiana abortion ban

Alex C. Balla

House Republicans voted down two bills that would have given physicians greater autonomy to care for pregnancy complications amid Louisiana’s near-total abortion ban, after opposition from Louisiana Right to Life in a committee hearing Tuesday.

Over the last year, physicians have said the ban has created fear and ambiguity for some OBGYN and emergency room doctors tasked with treating miscarriages and other pregnancy complications, especially in cases where they might normally provide treatment, but the patient’s condition doesn’t rise to the standard of a medical emergency or meet the ban’s specific language.

The ban allows abortions in a few narrow circumstances: for ectopic pregnancies, for miscarriages, in cases when the woman’s life or a life-sustaining organ is at risk, or when the fetus is deemed medically futile and unable to survive outside the womb. The law carries maximum penalties of 15 to 20 years in jail and $100,000 to $200,000 fines for anyone who provides an abortion outside of the ban’s narrow exceptions.

Testimony on Tuesday mirrored ongoing debate over the law since it took effect, with supporters arguing the law’s language is clear and unambiguous, despite claims from physicians and patients to the contrary.

Louisiana Right to Life, the state’s leading anti-abortion group, and Attorney General Jeff Landry’s office forcefully opposed the bills.

Dorinda Bordlee, a lawyer who’s worked alongside Louisiana Right to Life to draft anti-abortion legislation, argued both bills were written in service to the “abortion industry.”

Benjamin Clapper, executive director of Louisiana Right to Life, called them “pro-abortion.” He argued that Rep. Mary DuBuisson’s bill would “legalize elective abortions before 23 weeks.”

DuBuisson (R-Slidell) flatly rejected that claim. “This bill is not to allow access to abortions,” she said. DuBuisson said she is pro-life; she voted against Louisiana’s abortion ban last year.

DuBuisson’s bill would have eased access to abortions to treat miscarriages. It removed the requirement for an ultrasound that definitively proves a pregnancy “has ended or is in the unavoidable and untreatable process of ending” and replaced the ban’s current language with more general language to allow abortions when a physician deems the patient is miscarrying.

In an interview, Clapper said that the bill added language allowing abortions when a physician deems the pregnancy is nonviable — which the American College of Obstetricians and Gynecologists (ACOG) says starts at around 23 to 24 weeks gestation.

But the bill only allowed for abortions in those cases if the patient has been given a diagnosis that renders the pregnancy nonviable.

DuBuisson said her bill was supported by both ACOG and the Louisiana State Medical Society, an organization not known for wading into the abortion debate.

The committee heard testimony in support of the bill from women who experienced pregnancy complications over the last 20 years and worried about the law’s impact on cases like their own, including cases of water breaking in early pregnancy, complications with twins, and miscarriages.

Dr. Jennifer Avegno and Dr. Nicole Freehill, testifying in support of DuBuisson’s bill, said the law was written with legal terminology that doesn’t easily translate to medical terminology. Both said that issue is causing delays as physicians either wait to decide how to act or for the patient’s health to deteriorate.

“We’ve seen a significant increase in transfers to our urban specialty centers” from more rural parts of the state, said Avegno, an emergency physician and the director of the New Orleans Health Department.

“Those in areas without robust physician coverage are afraid their decisions will be second-guessed or ‘the patient wasn't quite too sick enough.’ And so they'll transfer them, and that delay worsens care,” she said. “This is not good medicine. And it puts local doctors in a terrible position.”

Freehill, a New Orleans OBGYN, said applications to OBGYN resident programs in Louisiana have dropped 10% since the ban took effect.

Rep. Tony Bacala (R-Prairieville) and other Republicans on the committee said the law seemed clear to them, and they haven’t heard complaints from doctors in their regions.

“We wouldn't be at this table if it was so clear,” DuBuisson said.

Republicans voted to involuntarily defer the bill, essentially killing it, by a vote of 8 to 5.

The second bill, from Rep. Candace Newell (D-New Orleans), would have expanded treatments for ectopic pregnancies, clarified that molar pregnancies can be treated, and explicitly allowed abortions for cancer patients. She said Louisiana’s ban had “oversimplified the reality of obstetric care.”

Newell said she’d been told of a case in which a woman was diagnosed with a molar pregnancy – when cells that are not an embryo or fetus grow inside the uterus, which can lead to cancer, hemorrhaging, and other complications.

In that case, the woman was told “she had to wait until all her vitals crashed, and her blood pressure was so high that she was on the verge of a heart attack before the doctor could perform the removal of that molar pregnancy,” Newell said.

“If we keep forcing doctors to work in near-miss conditions, one time they are going to miss. And not only will one life be lost, two lives will be lost,” Newell said.

Avegno and Freehill supported Newell’s bill, arguing that it added clarity for ectopic pregnancies and molar pregnancies. Freehill said that could especially aid rural OBGYNs who might be 45 minutes to 1.5 hours away from the next OBGYN.

Newell’s bill was involuntarily deferred by a vote of 7 to 5.

Bordlee, the lawyer who’s worked with Louisiana Right to Life, suggested that DuBuisson’s bill was deliberately written to try and provide elective abortions in Louisiana because it was supported by Lift Louisiana, a group that advocates for abortion rights and reproductive health more broadly. Planned Parenthood Gulf Coast also supported the bills.

Bordlee also said the bills were designed to aid the ongoing legal battle over Louisiana’s ban in state court.

“If the abortion industry can prove to the court that this is confusing, such that doctors don't know what to do, then the court would strike this down,” she said.

In a statement, Lift Louisiana said it was “shocked” by those statements. It said Louisiana Right to Life had “disparaged” its motivations to create “a reasonable and modest proposal to amend the existing abortion laws to allow patients experiencing a miscarriage or other serious pregnancy complication to access timely and appropriate health care.”

Clapper, of Louisiana Right to Life, reiterated that the law is clear and allows for physicians to make good faith judgment calls. He said any physicians with questions about the law should be given more education, adding that could come from the State Board of Medical Examiners, the Louisiana State Medical Society, or the Attorney General’s Office.

In fact, physicians have asked for that clarity. Members of a Louisiana Department of Health infant mortality commission meeting in October, including two leading maternal-fetal medicine specialists, asked for clarification from the Louisiana Department of Health, which referred those questions to Attorney General Jeff Landry’s office. Landry’s office has not released public clarification or guidance on the law since then.

Republicans also voted down bills that would add rape and incest exceptions to Louisiana’s abortion ban last week. With those defeats, the state’s near-total abortion ban is all but guaranteed to remain unchanged this session.

Rosemary Westwood is the public and reproductive health reporter for WWNO/WRKF. She was previously a freelance writer specializing in gender and reproductive rights, a radio producer, columnist, magazine writer and podcast host.

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