ST. LOUIS — Missouri’s week-old abortion ban provides an exception for medical emergencies affecting the life of a pregnant woman, but some health care providers and the lawyers who advise them say the law’s definition of emergency is narrow and worrisome.
Missouri is among five states that have so far imposed total abortion bans in response to the U.S. Supreme Court ruling last Friday that ended the constitutional right to an abortion.
, passed by the Republican-led Legislature in 2019 and triggered by the high court’s ruling overturning Roe v. Wade, defines a medical emergency as “a condition which, based on reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman.”
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That statutory language is “incredibly narrow” and has physicians concerned that they can’t intervene until a pregnant woman is close to certain death, said , a Kansas City area health care regulatory attorney.
“This is a really serious issue,” Larson-Bunnell said. “This is something that physicians and attorneys all throughout the state are trying to wrap their minds around.”
Trying to decide whether there is a serious risk of “substantial and irreversible physical impairment” also is not as simple as it may sound.
“When you are in the moment, it is not always easy to tell if something is irreversible, because of the wonders of modern medicine, we have treatments for lots of things, and some of those treatments work and sometimes they don’t,” she said.
Rep. , D-Shrewsbury, on Wednesday sent a letter to Missouri Attorney General Eric Schmitt, urging him to release a statement defining what he will not prosecute because it is a medical emergency.
Unsicker asked him to at least address ectopic pregnancies (when a fertilized egg implants outside the womb), miscarriage management, septic pregnancies, pregnancies of children under the age of 16, cancer patients and patients with a medical condition that makes pregnancy dangerous.
“These cases are true emergencies even before they get to an emergent point,” Unsicker said.
The attorney general’s office did not respond to a request for comment.
Unsicker said she was prompted to write the letter after having a conversation with a worried emergency room physician who sometimes faces having to provide life-saving abortions, and after seeing reports on social media of delayed treatment of an ectopic pregnancy that was allowed to rupture and pregnant women from Missouri being denied radiation therapy for cancer.
Under the law, providers who violate the abortion ban can be charged with a class B felony, punishable by five to 15 years in prison, and lose their medical license. It’s up to local prosecutors or Schmitt, a Republican running for U.S. Senate, to prosecute abortion violations.
Unsicker said she’s concerned doctors and hospitals will have to spend time defending medical decisions, could face losing their malpractice insurance or the insurance could become unaffordable.
“I am afraid doctors are going to leave the state because of this, and that is going to harm everybody,” she said.
Dave Dillon, spokesman for the , said hospital officials are concerned about the medical emergency exception will play out.
“It has potential to create second-guessing of clinical judgment and expose caregivers to evaluation of that judgment by non-clinicians,” Dillon said.
Jeff Howell, an attorney who serves as the executive vice president for the , said doctors are concerned that they have to withhold care for pregnant women until a situation is dire.
“In real life, you shouldn’t have to make a patient wait to do that if it’s going to be inevitable,” Howell said.
Reproductive care and emergencies can be very nuanced and nearly impossible to regulate every scenario, he said.
“They don’t fit into a nice convenient box,” he said. “All patients are different. All pregnancies are different. It’s not cookie-cutter and you can’t really treat them all the same, and that’s an issue.”
Howell said he does not have enough feedback yet to make a specific request to Schmitt or other legislators, but he was glad to hear about Unsicker’s letter.
“It will be interesting to hear what comes from that,” he said.
Rep. , R-Arnold, who helped pass Missouri’s abortion ban that was written in 2019 and triggered to go into effect after the Supreme Court ruling, said, the law is clear.
“It’s a really dangerous game that the Left is playing regarding women’s health and what is and what isn’t allowed,” Coleman said. “I am really calling on the Left to stop this dangerous rhetoric and information because women are going to be really hurt.”
Earlier this week, a Kansas City-area hospital system stopped providing emergency contraception to sexual assault patients because of questions over the of abortion, an unborn child and when pregnancy begins.
After Schmitt and Gov. Mike Parson stated the law does not ban the use of emergency contraception, the hospital system changed course.
But some of those same questions over when pregnancy begins also complicates treatment for “medical emergencies” under the law, such as whether ectopic pregnancies are considered pregnancies or what to do when a miscarriage dangerously stalls and an embryo is still in tact, Larson-Bunnell said.
Coleman again insists there’s no ambiguity in the law.
“The definition of abortion in our state is clear, it’s about ending the life of unborn child intentionally in the mother’s womb …,” she said. “As long as they don’t kill the child they won’t lose their license.”
But Larson-Bunnell said there’s a lot of gray area in the law.
“Human reproduction is messy … and it’s lay people that draft these laws, and they don’t understand the real implications,” she said. Even attorneys are not in agreement.
“That is how you get facilities operating in different ways, and you have physicians operating in different ways; and it’s because we have received very little support or insight from the state at this point,” she said.
Providers are unsure and wary of how an overzealous local prosecutor might interpret the law, Larson-Bunnell said. After performing an abortion, she said, physicians are required to send records to the state health department, which also shares the records with law enforcement agencies.
“I think this is a really dangerous time,” she said. “Every single one of these has the potential to be scrutinized, and who knows who going to pick it up and be a like a dog with a bone.”
Posted at 7:30 a.m. Friday, July 1.