The Iowa Board of Medicine met Friday to discuss standard rules for abortion in Iowa under the six-week abortion ban passed by Iowa Republicans in a July special session.
No rules were adopted at this meeting.
On its face, the ban would require physicians to perform an abdominal ultrasound to confirm whether any electrical pulses were happening in the embryo. This is commonly called a heartbeat, but no physical heart has developed that early in pregnancy. If pulses are detected, abortion is prohibited, except for a few exceptions.
Iowa Republicans in July said the Board of Medicine would have the responsibility to establish guidelines for when and how physicians are allowed to perform abortions within those exceptions. The board is also required to handle discipline for physicians who perform abortions outside of those guidelines.
Enforcement of the six-week ban is currently blocked by the courts, but not the rule-making requirement.
The six-week abortion ban has exceptions for rape, incest, and medical emergencies, but exceptions are narrow, and the rape and incest exceptions have reporting requirements (45 and 140 days, respectively).
The proposed rules require physicians to gather information from patients to determine whether the pregnancy was the result of rape or incest. Physicians have to ask patients the date of the act that led to pregnancy and the date of the initial reporting—if the patient isn’t reporting it to the person who means to perform the abortion.
The rules include an option for physicians to have patients sign a document certifying they’re telling the truth, which would then be added to their medical records. The documentation would be meant to protect the physicians if their decisions were called into question.
The proposed rules also define incest, rape, standard medical practice, and private and public health agencies, which appear in the law.
The text of Iowa’s six-week abortion ban allows abortion for medical emergencies. Those are defined as situations where abortion is performed to save the life of a pregnant woman if her life is endangered by a physical disorder, illness, or injury. That includes a life-endangering physical condition that is caused by the pregnancy.
Abortion can also be performed if continuing the pregnancy will create a “serious risk of substantial and irreversible impairment of a major bodily function.”
The rules say physicians must certify the fetus or embryo does have an abnormality and include the diagnosis, the tests and procedures and their results that were used to determine the diagnosis of the abnormality, and a description of why the abnormality is “incompatible with life.” The certification must be signed and included in the patient’s medical records.
The law and proposed rules don’t say when a doctor is allowed to act in situations where the patient’s life or physical health is in danger.
A few physicians offered comments on the proposed rules, largely criticizing what they required physicians to do and pointing out where they fall short. Since the law passed, OB-GYNs have said the exceptions won’t help Iowans. Nationwide, exceptions are largely unused because physicians worry about breaking their laws.
Dr. Deborah Turner, an Iowa physician and national president of the League of Women Voters of the United States, talked about the times she’s worked with pregnant patients who were 11-13 years old. She said it’s unrealistic to expect them to talk about what happened to them.
“Many times they are not sure how they got pregnant. Most don’t know what it means to be pregnant, and they don’t understand what lies ahead,” Turner said. “To require them to, for example, give a specific date when a given event took place and for us as physicians to figure it out, is unrealistic and traumatizing.”
One 11-year-old patient Turner treated had no idea she’d had forced sex and, “thought having a baby is going to be like having a little brother or sister to play with.”
Dr. Francesca Turner, an OB-GYN at Broadlawns Medical Center in Des Moines, who represents Iowans for Health Liberty spoke on behalf of other OBGYNs in Iowa. She said physicians should not be required to determine legal questions of rape or incest, and interrogating patients will hurt their physician/patient relationship.
“There are several sections of this legislation which put physicians into an unreasonable position of having to interpret complex legal scenarios, rather than focusing attention on diagnosis, care, and treatment of a patient,” she said.
“The law puts an undue burden on medical professionals to seek details of an assault which are not pertinent to medical care, and to practice medicine in such a way that the legal jeopardy of documentation exceeds the responsibility of the patient physician relationship,” Turner continued.
Turner also pointed out the rules don’t address medical emergencies, which have brought dozens of women in other states close to death.
“Every patient in every pregnancy, regardless of age, medical history, fetal status, psychological background, may be moments away from becoming a life-threatening medical emergency,” she said. “Physicians in Iowa seek to care for their patients, not document minutia of assault or jeopardize the physician-patient relationship by demanding horrifying details.”
Dr. Deborah Turner said she knows politics are being used to influence health care decisions and health care providers.
“It is clear that these rules are written to assure that most women and those who can become pregnant, and certainly girls who are victim of incest and rape, are prevented from access to abortion and choice,” she said.
What happens now
The proposed rules will be published Dec. 13, which will also open them for public comment until Jan. 2. All of those comments—including those provided at Friday’s meeting—will be collected and presented to the board for its Jan. 4 meeting.
At that point, the board will discuss whether to make changes and decide what the final form of the rules should be. The public will then have a chance to view the final draft and offer comments. At the same time, the draft will go before the Legislative Administrative Rules Review Committee for legislators to weigh in on.
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