New study on medical care since fall of Roe describes 'a gross violation of common sense'

This story is part of a series on the fallout of the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization that overturned Roe v. Wade and ended the federal constitutional right to abortion.

A joint report released in May by two university programs studying the impact on health care since the U.S. Supreme Court overturned Roe v. Wade uncovered several tragic and horrific findings. The report highlights stories of dozens of patients reported by physicians and providers, including cases in which lives were dangerously at risk due to delays in care or deviations from standard care due to restrictions after the decision Dobbs v. Jackson Women’s Health Organization in June 2022.

Dr. Daniel Grossman is the lead author of the report on the results of the Care Post-Roe Study, conducted by researchers with the Advancing New Standards in Reproductive Health program at the University of California San Francisco and the Population Research Center and Texas Policy Evaluation Project at the University of Texas at Austin. Grossman told the American Independent Foundation that the 50 patient narratives were “sad and frustrating and shocking.”

The report chronicles how clinical care has changed since Roe was overturned in June 2022. According to the report’s executive summary, its authors collected patient stories from health care providers “anonymously and confidentially, at a time when they are being forbidden by their employers or hospital leadership from speaking with the press about these cases.”

“I hope our report will be eye-opening, and I hope they’ll really just listen to hear these stories of these people who were denied care, whose care was delayed and whose health was really harmed,” said Grossman, who heads the Advancing New Standards program at UCSF.

Abortion care has been completely banned in 14 U.S. states. The report highlights how abortion restrictions, particularly in those states, have led to surges in preventable complications, such as severe infection, vaginal bleeding, neurologic impairments, or the risk of death of a developing fetus.

“Some of the stories about the patients who were living in states with bans, who started having unusual symptoms related to pregnancy and were terrified to even go to get care in the state where they live, those were also shocking. Instead, they chose to travel hundreds of miles because they were worried about the possibility of being accused of a crime or being accused of trying to end their pregnancy on their own, which wasn’t the case,” Grossman said.

One story describes how a 15-year-old girl living in a state where abortion is now banned or severely restricted was unable to get an appointment for abortion care in the time she needed, resulting in the need for a more dangerous intervention.

“Because there are far more callers than appointments, it took her mom seven weeks to get into the clinic where we saw her for an abortion [at 16-18 weeks’ gestation]. The procedure was much harder on her than it needed to be—she was hoping for an at-home pill abortion,” one physician wrote.

Another story talks about a patient’s having to travel and the medical dangers of being forced to delay care as a result:

[The] patient had to go out of state for a termination. Once there, imaging was concerning for an accreta [when the placenta attaches too deeply to the wall of the uterus] [at 15-17 weeks’ gestation]. She could not stay for an [ultrasound with a specialist] because she had to make her flight back to [state with abortion ban]. I was contacted by one of our family planning faculty who was in touch with the clinic out of state in order to do a scan for an accreta. It has now been 2 weeks and she has not been able to secure a ride to the ultrasound clinic to get this scan.

The report omits the names of specific states where patients sometimes faced life-threatening medical emergencies, but all the narratives were from people living in or traveling away from states with restrictive abortion laws.

“Any clinician who cares for people during pregnancy knew that this was going to happen. It’s very clear to all of us that abortion care is a component of comprehensive health care. And when you take it away as an option, people’s health will be harmed, ” Grossman said.

Grossman said that several doctors who submitted narratives talked about the extra work they do to get their patients the help they need.

“They were using secure messaging apps to try to contact everybody that they knew in the surrounding states where abortion is still legal to see who could accept this patient and provide the care that the patient needed. That just took time, it was work, it took away from the rest of the work that they were doing caring for their other patients. And it’s just kind of shocking that the quality of your health care might depend on who your doctor knows in another state and how fast they can get you to that other state to be cared for by them,” Grossman said.

Another example from the report discusses a case of a patient being sent home and told to return when their labor started or when they began experiencing severe infections.

One physician described a patient who had been diagnosed with PPROM, or preterm premature rupture of membranes, at around 16 to 18 weeks of pregnancy and who was sent home after receiving the diagnosis.

On her fourth day of [her membranes] being ruptured, we received a text about this patient and accepted the request. However, she was asked by her [sending] hospital to self-transfer with her mother, driving almost four hours through [another state] to get to our facility. This transfer was not initiated until five days after she had ruptured. In [the intervening state], she noticed there was umbilical cord in her vagina and some vaginal spotting. They hurried to our hospital.

Grossman says care in abortion-restrictive states can compromise a doctor’s ability to do their best for patients and even may lead to legal issues eventually.

“It’s certainly conceivable that a clinician or a hospital could be accused of malpractice for providing this kind of substandard care that isn’t in line with national standards and guidelines,” Grossman said. “But how does that work when it’s required under state law?”

Published with permission of The American Independent Foundation.