‘Complete disregard for human life’: Doctors reflect on NC’s abortion ban

Abortion Ban

Dr. Rachel Jensen, center, joined Democrats and reproductive rights advocates last week for a press conference assailing the state's 12-week abortion ban on the anniversary of its passage. (Michael McElroy/Cardinal & Pine.)

By Michael McElroy

May 21, 2024

In interviews with Cardinal & Pine, doctors laid out the ban’s impact in North Carolina, describing a landscape of delays, backlogs, and hesitancy that forces doctors to consult lawyers before saving patients’ lives.

The Greek princess Cassandra was cursed with the power of prophecy: Though she could predict the future, no one ever believed her.

North Carolina’s doctors know what that’s like.

It’s been a year since the Republican-controlled General Assembly passed a 12-week abortion ban over warnings from nearly every doctor and medical association that the law would create cruel burdens, tangle doctors in legal uncertainty, and put women in danger.

And this, doctors and reproductive rights groups say now, is exactly what happened.

On Thursday, the anniversary of the vote, doctors and reproductive rights advocates returned to the site of a large protest a year earlier to offer a defiant “I told you so,” and to issue new warnings that the 12-week ban, also known as Senate Bill 20, was only the beginning.

“Just one year ago, thousands stood right here advocating and fighting and chanting and crying and begging the legislative majority to listen to the majority of people in North Carolina and reject SB 20 for what it is—an extreme abortion ban,” Jillian Riley, the North Carolina director of public affairs for Planned Parenthood South Atlantic, said at a press conference across from the General Assembly.

“But they didn’t listen,” she said.

“Many North Carolinians have been forced to travel out of state for care, and those who have been unable to travel have been forced to carry pregnancies to term against their will.”

She continued: “We have seen the impacts that we expected to see.”

In several interviews with Cardinal & Pine over the last few months, doctors laid out the ban’s impact in North Carolina, describing a new landscape of delays, backlogs, and hesitancy that forces doctors to consult lawyers before saving patients’ lives.

And medical experts are issuing more warnings of what’s to come— sounding the alarm of the possibility of Mark Robinson becoming the state’s next governor. Robinson, a Republican, has referred to abortion as “murder” and “genocide” and said that if he wins, he will call for a full ban.

“We are in a public health crisis that is not being recognized by a large plurality of the people in charge,” Dr. Robin Wallace, a family medicine doctor and abortion provider in the Triangle, told Cardinal & Pine.

Republican lawmakers are “completely gaslighting those of us that know the devastation that has already happened and will continue to happen,” she said. “And it’s with complete disregard for human life.”

‘Intentional chaos’

Cassandra tried to warn the city of Troy that the Trojan horse outside their gate was full of assassins, not treats. And doctors tried to warn lawmakers that the bill they presented as a compromise, was instead an extreme ban in disguise.

The ban on abortions after 12 weeks of pregnancy, for example, wasn’t the worst part.

The bill also included new barriers in those 12 weeks, including medically unnecessary doctor’s visits that put undue burdens on patients, especially those in rural areas. And though the ban contained exceptions for rape, incest, and the life of the mother, the language was vague, doctors say, leaving medical providers scrambling to assess the legal risks of saving the life of a woman who prosecutors may later say was not sick enough.

“It has been pretty devastating,” Wallace said. “It should come as no surprise to anyone that’s paying attention that any kind of restrictions on healthcare are going to have really negative effects.”

The law allows abortions to save the life of the mother for the duration of pregnancy, but the language is vague. Medical complications qualify for this exception, the law says, if “reasonable medical judgment” determines that an “immediate abortion” is needed to “avert her death.”

There is a lot of room for judgment calls under that language, doctors say, noting that the law does not clarify who has to agree a threat is reasonable or whether someone else’s judgment after the fact can put doctors at risk.

And doctors now have to fill out a detailed report after any abortion that lists all the patient’s pre-existing conditions, opening the door for a prosecutor’s second-guessing for those that come after 12-weeks.

This is far from the clarity lawmakers insisted they were providing, Wallace said, and has led to confusion and hesitancy among doctors. The combination can be as effective in denying abortion care as an outright ban, she said.

And it is deliberate.

“We’ve always known this is one of the tactics of the opposition to create confusion with the end goal of fewer abortions provided,” Wallace said.

“It creates intentional chaos and it’s designed to create as much of a delay as possible.”

‘It’s just crazy’

Dr. Erica Pettigrew, a family medicine doctor in Hillsborough, was among the many physicians who met with lawmakers before the vote and implored them to reconsider.

She said that even with the law’s supposed protections for the mother’s life, doctors in North Carolina have been unsure if, or when, they can intervene when patients are experiencing serious complications.

Doctors in emergency rooms often have to second-guess their own expertise, call for a second opinion, or seek advice from lawyers, all while the patient gets “sicker and sicker,” Pettigrew said.

“When the doctor has a patient in their clinic or in the emergency room and a certain clinical scenario comes up and maybe one of the nurses says to the doctor, ‘is this one of those scenarios that’s now illegal? And the doctor says, ‘Oh, crap, I have no idea.’ And then they scramble to figure out, ‘Who am I supposed to call? What am I supposed to do? I’ve never had to call the attorney on call before.’ And so who do they call? How do they reach them? How quickly do they hear back? And is that legal person going to be well-versed in such a highly specialized, sort of bizarre part of the law?”

These questions are taking place when the patient often doesn’t have a lot of time to spare.

“Let’s say someone has placenta previa,” she said. “It can be minutes where they can bleed out because their placenta is lying over their cervix. And if the doctors in that moment hesitate because they’re not sure that this is legal, that can be deadly.”

The law’s vagueness puts patients and doctors in impossible situations, she said.

It means that when a patient gets a life-threatening infection, they may not be infected enough, that high fevers may be too low, and that imminent death may not be close enough to protect the doctors from losing their medical license if a prosecutor later thinks they intervened too soon.

“As physicians, we went through all of this training because we want to save people’s lives,” Pettigrew said. “There are no other areas of medicine where a doctor has to interrupt the standard, evidence-based, widely-accepted level of care to ask, ‘wait a second, could I be put in jail for doing the right thing for the patient?’

“It’s just crazy.”

One of the longest waiting periods in the country

The abortion ban adds barriers to pre-existing barriers.

North Carolina law now requires that a patient visit the doctor for an in-person consultation before scheduling a surgical abortion, a mandate which is often medically unnecessary, doctors say. The obstacles to obtaining a medication abortion are even more significant. A patient now has to go to the doctor three times to complete a medication abortion, when in many cases, the pills could be prescribed over the phone or by a pharmacist.

Additionally, North Carolina’s 72-hour waiting period, which was first passed in 2015, is one of the longest in the country. Most abortions take place before 12 weeks, but the restrictions, waiting periods, and extra burdens often push women past that deadline, even when they jump through all the hoops, Dr. Rachel Jensen, a family planning doctor in the Triangle, told Cardinal & Pine.

“I’ve certainly seen patients who are able to come in for their initial appointment, but they can’t make it back for their next appointment,” she said.

In many ways, the math of abortion bans is simple. The longer the waiting period, the more people miss the deadline, which, she reiterates, has nothing to do with medicine.

And even if patients are able to ultimately get the abortion care they need, the extra office visits and waiting period between them create financial, childcare, and travel burdens that are especially harmful for lower-income and rural patients, who may have to travel hundreds of miles to the nearest provider, miss work, and pay for lodging.

And in one of the big contradictions in the bill, while the 72-hour waiting period pretends to give women more time to choose, the 12-week ban provides far less. Women are having to rush their decision, Jensen said.

“They are actually being forced to make a decision more quickly than they feel like they would otherwise want to.”

Dangerous burdens

In practice, the waiting period can often wind up even longer than 72 hours, the doctors said.

“It’s a huge disruption to a family’s life for the pregnant person to have to make these multiple in-person visits,” Wallace said. “If someone presents on a Wednesday, right, or Thursday, no one’s open on Sunday. So often the three day delay becomes a five or six day delay.”

These kinds of delays aren’t just burdensome, they can be dangerous, Wallace said.

One patient started bleeding heavily during the three-day waiting period after the mandatory ultrasound, Wallace said, but didn’t tell anyone because she didn’t want to risk losing her appointment.

Wallace didn’t know the patient had been bleeding until just before the procedure.

“She had miscarried between the time when she had her ultrasound and [when she] came back,” Wallace said. “She had gotten so far through the process without telling us because she was worried that if she told us that she wouldn’t get the abortion she needed. She was fearful of bringing up anything that might get in the way.”

It’s a common occurrence, she said.

And as dangerous as abortion bans for overall maternal health, they are even worse for women of color, studies show.

“Some people, especially those from a marginalized community, are not going to be forthcoming when they are afraid of either losing access to care or legal consequences,” Wallace said.

‘Why are you making me do this?’

Those barriers also heap undue stigma and shame onto the patient, Wallace said. Patients internalize the scorn intentionally hidden just below the surface of all these new restrictions.

“We are all internalizing this dehumanization, this rhetoric that women are there to be vessels for a pregnancy and that pregnancy is more important than the person that is living and breathing in front of us,” she said.

“These patients are exhausted and they’re made to feel terrible about themselves,” Wallace said. “And when they come to see us and we provide the most compassionate care we can, they are just so grateful.”

But all those hurdles take a toll, she said. Patients feel isolated, she said, and they don’t understand.

“The landscape is constantly changing and it has just fostered this sense of powerlessness,” Wallace said.

“When a new restriction has been put in place, [patients have] often been like, ‘why are you making me do this?’

“It breaks my heart every time,” Wallace said.

And it makes her angry.

“I love going in to work. I love being able to provide that care. It fills my cup,” she said. “But the relentless, pejorative, over-legislating of reproductive healthcare specifically is so infuriating.”

She added: “I always feel like the legislators are trying to tell me that they know more than I do despite my long years of training.”

‘A mere political whim’

House speaker Tim Moore said that while he does not anticipate new abortion restrictions before the election, he most certainly does in 2025 if Republicans keep their supermajority.

Republicans may not believe doctors, but medical providers believe lawmakers when they say more restrictions are coming.

“Let’s be clear, the current legislative majority will not stop until abortion is completely inaccessible in North Carolina,” Jillian Riley of Planned Parenthood Southeast said at the press conference last week.

And if Mark Robinson becomes governor, there will be no one left to stand in the way of a complete ban with no exceptions.

“We are a mere political whim away from harsher restrictions,” Jensen said at the press conference. “We’ve seen it in neighboring states and it could happen here.”

Even after watching their dire predictions come true in the ban’s wake and knowing what will happen if their warnings are ignored again, doctors are still left with questions they can’t answer and a political reality that has nothing to do with medicine.

“Why in the world is this a law in the first place?” Pettigrew said. “Why are doctors being kept from providing the standard of care that is exactly what is necessary to save someone’s life?”

Author

  • Michael McElroy

    Michael McElroy is Cardinal & Pine's political correspondent. He is an adjunct instructor at UNC-Chapel Hill's Hussman School of Journalism and Media, and a former editor at The New York Times.

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