(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . Texas hospitals are now forcing patients with high-risk pregnancies to get sicker 'by design' [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.', 'Backgroundurl Avatar_Large', 'Nickname', 'Joined', 'Created_At', 'Story Count', 'N_Stories', 'Comment Count', 'N_Comments', 'Popular Tags'] Date: 2023-05-12 As reported by Stephania Taladrid, writing for the New Yorker, this dystopian scenario is now playing out daily in Dallas’ Parkland hospital, and other medical facilities in Texas. In states with liberal abortion laws, such as New Mexico, California, and Massachusetts, the decision about treatment for such dangerous conditions is usually left to the patient and her family, and abortion is an option. But, in 2021, when the Texas legislature passed a law known as S.B. 8, that option was largely ruled out. Once a fetal heartbeat could be detected, typically around the sixth week of pregnancy, doctors could propose abortion as a treatment only when a woman’s life was at risk. So doctors trained to prevent disease and avert emergencies had to set aside the principles they’d learned in medical school. Instead, they had to let patients’ conditions deteriorate before informing them that their fetuses weren’t viable and an abortion might save their lives. An ob-gyn at Parkland told me, “We essentially watched those patients in labor and delivery until they became infected. As long as there was a heartbeat, we couldn’t do anything.” An OB-GYN physician interviewed by Taladrid cogently explains the dilemma faced by Texas doctors challenged by such situations: “It would be like if all of a sudden an orthopedic surgeon was told, ‘You have a patient with an open fracture, the bone is sticking out of their arm.’ The suffering goes without saying. But the government is telling you that you’re not allowed to repair that until the patient develops an infection.” As noted by Taladrid, the penalty in Texas for a doctor who makes the wrong decision in such circumstances is life in prison. As Taladrid reports, doctors have to make these decisions in a very short period of time, as a patient facing a potentially fatal sepsis or other other life-threatening condition can deteriorate in a matter of hours. The problem faced by doctors is also exacerbated by the fact that they operate in tandem (and under observation by) nursing and other staff who may disagree with their assessment. One OB-GYN cited by Taladrid was reminded by an ostensibly “pro-life” RN under his supervision that she felt she “could sue” him for his decision. Since the Texas law provides a fulsome $10,000 reward, allowing any private citizen to sue someone who “aid[s] or abet[s]” an abortion, Texas hospitals have now become potential havens for an abortion “Stasi,” in which physicians must navigate among both staff and patients who might later challenge their medical judgment. This naturally forces Texas doctors to seek legal counsel before terminating a pregnancy in just about any conceivable situation, and to restrict (or hide) their communications to patients from their staff, keeping their opinions to themselves. away from even their colleagues’ hearing. Taladrid’s report is replete with instances of this occurring, several provided by OB-GYNs who asked to remain anonymous. Earlier this year, at a large hospital in Houston, a pregnant woman came into the emergency room. She had severe preeclampsia, the ob-gyn who treated her told me, and it had evolved into something called hellp syndrome—a condition that can cause liver and kidney failure in the mother. To the doctor, it was obvious that the patient needed to have the choice to have an abortion to stay alive. However, under the new hospital rules, the patient had to wait until a perinatologist and a maternal fetal expert reviewed her case, attested to her level of medical extremity, and offered their clearance. In another instance, a doctor in Houston was presented with a patient who’d undergone three prior Caesarian sections and had been warned by her personal physician that a fourth pregnancy could be fatal. Prohibited by law from recommending that the woman terminate her pregnancy, the OB-GYN chose to slip her a note bearing the names of some out-of-state clinics who could abort the pregnancy, telling her “This conversation never happened.” Taladrid also interviewed Texas patients for her article. One thirty-five year-old Dallas woman, pregnant with twins, had the misfortunate of learning that one of the two fetuses had Trisomy, a rare condition that left the fetus with “two large fluid-filled sacs near the brain.” That condition has an estimated five percent survival rate, and all of the physicians the mother spoke to agreed that the fetus would “very likely die.” Every day that fetus continued to develop placed both the twin fetus and the mother at further risk. But despite the obvious necessity that the sick fetus be terminated, the doctors she spoke to felt compelled to speak in code to her, studiously avoiding the word “abortion.” As Taladrid reports: “[W]ith virtually every doctor’s appointment she attended, she remembers encountering hesitancy and fear. Doctors found themselves stopping midsentence, careful to avoid the word “abortion,” she recalled. It wasn’t until a doctor tore his gloves off, sourly threw them away, and spoke his mind that Miller confirmed what she had feared all along. “I can’t help you,” the doctor told her. “You need to leave the state.” As Taladrid reports, other OB-GYNs have been even less forthcoming to their patients about going to a “safe” state, obliquely suggesting, for example, that the weather in Colorado was “fabulous” and the patient could “get a second opinion there.” And in fact, as Taladrid emphasizes, Colorado has been inundated with pregnant, high-risk patients fleeing from Texas. But many patients do not have the resources to do that and instead must endure the “Russian roulette” system that has been foisted on the medical system by Texas’ forced-birth legislature. As Taladrid observes, the statistics in Texas documenting patients with high-risk pregnancies who have been forced to try to survive potentially fatal complications, or those who actually die as a result of their doctors’ reluctance or refusal to perform or recommend an abortion, are still “years away.” Taladrid reports that doctors currently practicing in Texas have considered leaving the state, but fear for those patients who do not have the means to travel elsewhere. But as pointed out by one Dallas doctor, that concern does not yet apply to young medical school graduates aspiring to be OB-GYNs. New data from the Association of American Medical Colleges shows that states that banned abortion have seen a drop in applications for obstetrics-and-gynecology residencies. Naturally, students considering coming to Texas are asking, How has the hospital responded to the bans? What does ob-gyn training look like these days? And what are you able to offer patients? “When nobody wants to train in Texas, as the physicians get older and retire, there will be no ob-gyns in the state,” the doctor told me. “And that’s when you’ll really see maternal mortality go up.” As Taladrid reports, the problem for pregnant citizens of Texas is further aggravated by the fact that “Half of the counties in Texas, according to state data, lack a single specialist in women’s health: no ob-gyn, no nurse, no midwife who can treat mothers and their babies.” Since the right-wing Supreme Court issued its edict, prospective OB-GYNs are increasingly unable to even receive training in Texas on performing the procedure. This requires them to receive training for their accreditation out-of-state. And abortion laws such as those in Texas, which effectively dangle a potential criminal sentence over the doctor's own ability to exercise their medical judgment, have begun to impact where young medical school graduates apply for their residencies. What is happening in Texas is the natural, predictable outcome of a political party that has chosen to disregard the interests of the majority of American citizens and instead bow to the dictates of a radicalized, implacable religious minority, one unwilling to acknowledge or even see the harmfulness of its blind dogma. The tragedy is that many people will almost certainly die as a result, for no other reason than becoming pregnant at the wrong time, and in the wrong place. 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