Idaho's strict abortion laws create uncertainty for OB-GYNs in the state
At a brewery in this northern Idaho city, hundreds of people recently held a wake of sorts to mourn the closure of Sandpoint's only labor and delivery ward, collateral damage from the state's Republican-led effort to criminalize nearly all abortions.
Jen Quintano, the event's organizer and a Sandpoint resident who runs a tree service, called to the crowd, packed shoulder to shoulder as children ran underfoot, "Raise your hand if you were born at Bonner General! Raise your hand if you gave birth at Bonner General!" Nearly everyone raised their hand.
Later this month, the hospital, founded in 1949 near the shores of Lake Pend Oreille, will stop providing services for expectant mothers, forcing patients across northern Idaho to travel at least an additional hour for care. In June, a second Idaho hospital, Valor Health, in the rural city of Emmett, will also halt labor and delivery services.
Those decisions came within months of Idaho's abortion ban, one of the nation’s strictest, going into effect in August 2022. Physicians can now perform the medical procedure only to stop the death of a pregnant woman or in the case of rape or incest reported to the police.
In March, Bonner General Health officials said the law was a driving force in the closure, noting Idaho's legal and political climate.
“Highly respected, talented physicians are leaving," the hospital wrote in a statement. "Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care."
OB-GYNs face dangerous dilemmas
Amelia Huntsberger, an OB-GYN, has delivered babies and treated miscarriages at Bonner General for more than a decade. Soon after abortion became illegal here, she saw a patient with a ruptured ectopic pregnancy — where a fertilized egg grows outside the uterus — and faced a dangerous dilemma. The state law did not allow physicians to terminate ectopic pregnancies, which are never viable.
"I went to the emergency room and evaluated the patient," Huntsberger said. "Her vital signs were stable at the time of my evaluation, but I knew based on her imaging we needed to move quickly to stabilize her."
Huntsberger said her duty as a doctor was clear — to prioritize the safety of her patient — but added that she "also knew that I was putting myself potentially at risk of felony charges, which would have a minimum of two years in jail, [and] loss of my medical license for six months."
She added, "I took care of multiple cases of ruptured ectopic pregnancy in the first weeks following that law going into effect."
The Idaho Supreme Court has since ruled that the law does not apply to ectopic or molar pregnancies, a rare complication caused by an unusual growth of cells. But physicians say that limited change does not account for many common pregnancy complications that can escalate rapidly.
That has led to deep frustration and turmoil in hospital emergency rooms.
"When is it OK for me to act?" Huntsberger said. "Do I wait until she bleeds out? Do I wait until we do CPR? When is it that I can intervene? How close to death does she need to be before I take care of her?"
State Rep. Mark Sauter, a Republican from this lakeside community 60 miles northeast of Spokane, Washington, said he hadn't thought much about the state abortion ban.
"It really wasn't high on my radar other than I'm a pro-life guy, and I ran that way," he said during an interview at his home overlooking the lake and forested mountains. "I didn't see it as having a real big community impact."
Then in December, Sauter had dinner with Huntsberger, whose husband is an emergency physician at Bonner General. "They started explaining all the details of what’s going on and how it was uncomfortable for them," Sauter said.
Those conversations proved revelatory. "You get exposed to something, all of a sudden you go, 'Wow, there’s a different way to look at this,'" he said. "'What are we going to do about all this?'"
With Sandpoint’s maternity ward closing, Sauter supported a bill that would have allowed doctors to terminate pregnancies to protect a woman’s health, not just prevent her death. But that effort was shot down by other Republicans during a committee hearing in late March.
"The list was endless when we began considering the conditions that could fall under that language," said Rep. Julianne Young, a Republican from Blackfoot. "We want to make sure that health of the mother doesn’t become so broad that everything becomes an exception to take the life of a potential child."
The effects of the ban are being felt statewide. In Boise, the state capital, Lauren Miller, an OB-GYN, resigned earlier this month from her position at one of the state’s largest hospitals, St. Luke's Health System, further shrinking the state's already minuscule corps of maternal fetal medicine specialists.
As a doctor who cares for complex and high-risk cases, Miller said, she's had to send patients out of state to end dangerous pregnancies, including a woman with a serious kidney disease.
"I could very easily have taken care of that patient along with my partners," she said, noting that the Boise-based medical center has kidney specialists and an intensive care unit. "Instead, she had to leave her family and fly several more hours away to receive care in an expeditious time frame. It’s just not what we signed up to do."
Miller said the abortion ban and threat of prosecution were not the only factors that drove her to resign. She cited lawmakers' failure to extend postpartum Medicaid coverage beyond two months and to renew the Maternal Mortality Review Committee. The state panel investigates deaths of pregnant patients and new mothers and whether they could have been prevented.
During a hearing before the House Health and Welfare Committee, Rep. Mike Kingsley, a Republican, said the maternal mortality reports "all seem to identify the same thing: substance abuse, mental health. So, I think this has served its purpose."
The start of an exodus
Directors of women's health care services at Idaho hospitals are bracing for what's next: 75 of 117 Idaho OB-GYNs recently surveyed by the Idaho Coalition for Safe Reproductive Health Care said they were considering leaving the state. Of those, nearly 100% — 73 of 75 — cited Idaho's restrictive abortion laws.
An exodus could affect broader medical coverage for women who rely on OB-GYNs for routine and urgent gynecological care unrelated to pregnancy, like menstrual disorders, endometriosis, and pelvic pain.
Idaho is one of 15 states that have implemented strict abortion laws since last year's Supreme Court decision overturning Roe v. Wade. And while there is no official nationwide count yet, anecdotal evidence shows that women's health specialists from states where abortion is criminalized are beginning to relocate to places like Washington state, which has strong abortion rights laws.
In Seattle, for example, about 270 miles west of Sandpoint, Sarah Villareal, an OB-GYN, is now practicing medicine without fear of prosecution after moving from Texas, where performing an abortion is a felony punishable by up to life in prison. In Texas, private citizens can file civil lawsuits against anyone who “aids or abets” an abortion, earning a minimum of $10,000 for cases prosecuted successfully.
The difference between Texas and Washington is stark, said Villareal, noting an atmosphere of fear and distrust at many Texas hospitals. She recalled caring for a patient in a Gulf Coast emergency room who was having a miscarriage, though the fetus still had a heartbeat. The patient, already in physical and emotional crisis, had to navigate a legal issue, too.
"She was trying to figure out if me as the provider was going to report her if she did decide that she wanted to do a procedure to save her life over the life of her fetus," Villareal recalled. "And the worst part was I could assure her that I’m going to try to do everything that I can for her, but I could not assure her that someone else in the emergency room or someone else in the operating room was not going to report her."
Sarah Prager, an obstetrics and gynecology professor at the University of Washington School of Medicine, who has been recruiting OB-GYNs from states with abortion bans, including Texas and Tennessee, says physicians believe deeply that they are failing their patients.
"There’s really a moral and an ethical injury that happens when you are unable to do the job that you want to do," Prager said. "Being unable to take care of our patients is what makes doctors stressed out. And when you add that we are legally unable now to prevent harm to patients, it leads to incredible rates of burnout."
Even medical students are beginning to change their plans.
Kathryn Tiger and Allie Ward, first-year medical students in Moscow, Idaho, are both planning to become surgeons, though both say they intend not to practice in Idaho.
"I wouldn’t feel safe here as a provider, and I wouldn’t feel safe here as a patient," said Tiger, 25.
Ward said the new laws criminalizing abortion in the state are constricting the ability of physicians to provide comprehensive care.
"You have to be able to refer and collaborate with not only just your care team and nurses and everyone that’s involved there, but also with other physicians," Ward said. "It’s terrifying to think that I wouldn’t be able to refer a patient who was seeking care or even just education to a colleague of mine that I trusted because of the laws in place."
Back in Sandpoint, Huntsberger and her family are saying their goodbyes to Idaho, saddened by the idea that some patients left behind may be in medical peril.
"It’s heartbreaking to me to think about what it will mean for a woman experiencing a pregnancy crisis," the doctor said.
But, she added, "This isn’t a safe place to practice medicine anymore."
This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.