KY doctors say GOP lawmakers' attempt to clarify abortion ban confuses instead

Yahoo

24-03-2025

House Majority Whip Jason Nemes, R-Middletown, presents House Bill 90, which was amended to make changes in Kentucky's abortion law, March 13, 2025. (LRC Public Information)
Kentucky doctors say the legislature's effort to clarify the abortion ban is 'junk language' that, overall, confuses them even more than current law.
With a few days left in the 2025 session, Republican lawmakers pushed through legislation they said should reassure doctors they can rely on their medical judgement when treating pregnancy complications despite the state's abortion ban.
According to House Bill 90, 'there is a need to clarify the distinction between an elective abortion and illegal termination of the life of an unborn child protected under Kentucky law and medically necessary interventions.'
But obstetricians and other medical providers have slammed the move as more restrictive than the law under which they currently work. Dozens of health care providers signed onto a letter from Planned Parenthood asking Gov. Andy Beshear to veto it.
Doctors can sometimes see complications coming and work to avoid them, but Kentucky's abortion law — and the proposed clarification to it — require them to wait until their patient's life is in jeopardy before intervening to end a pregnancy, explained Dr. Janet Wygal, a retired Louisville OB-GYN.
'We have cared for enough patients over the years that we know what the likely outcome will be in certain situations,' she told the Lantern.
Without the abortion ban, Wygal said, 'we would intervene well before we thought her life was at risk.'
'We would not wait — absolutely not wait — until the mother was in any kind of threat of permanent illness, permanent destruction of her gynecologic capabilities, obstetrical capabilities,' Wygal said.
But Kentucky's near-total ban on abortion raises barriers to timely care, Wygal said, forcing doctors to delay treatment to first consult with lawyers and colleagues.
The clarification move followed reports from across the country, including in Kentucky, of women who did not receive medical care and medications to treat miscarriages and other dangerous complications because of state abortion bans, leading in some cases to preventable deaths. Kentucky OB-GYNs have said the state's abortion ban is forcing them to violate their oath as physicians and causing 'devastating consequences' for patients.
'Patients who have hemorrhage from a spontaneous abortion, or who have ectopic pregnancies, it's a matter of time,' Wygal explained. 'They can bleed out and die quickly if appropriate intervention is not taken. So … it's important to move quickly and not have to rely on legal counsel.'
Dr. Caitlin Thomas, a Louisville OB-GYN, agreed. She also worries the vagueness in the law and subsequent 'clarification' language will result in delays and deferred care for patients.
'These things can evolve very quickly, especially in the case of sepsis or hemorrhage,' Thomas told the Lantern. 'Sometimes when people start getting sick, they can get sick and decompensate very quickly.'
The addition, meant to offer clarity, does nothing to speed up the process or comfort providers, Wygal said, calling it 'junk language.'
'It absolutely does not provide clarity,' she said. 'The wording is totally … inappropriate. It's not scientific. There's a clear intention to create personhood for the fetus,' which 'makes the practitioner and the patient have more angst.'
Two House Republicans brought forth the language, which was supported largely along party lines. A spokesperson for House Republicans did not respond to a Lantern inquiry about the allegations of vagueness in the language.
Speaking to a legislative committee, Dr. Jeffrey M. Goldberg, the legislative advocacy chair for the Kentucky chapter of the American College of Obstetricians and Gynecologists (ACOG), said the language isn't perfect and will need more work.
But, he said, physicians in Kentucky are working under such uncertainty that something has to be done. 'We already work within statutory restrictions that are, from a medical perspective, very ambiguous.'
'There's a great deal of work to be done. This is not perfect. I don't want to give anybody the illusion that we all think this is great,' he said. 'We think it's an acceptable short-term solution for dealing with a really serious problem that's in front of us.'
Thomas, who signed Planned Parenthood's veto request letter, said she appreciated the bill saying, specifically, that doctors can treat molar and ectopic pregnancies.
But she said the 'clarification' has muddied the legal picture. 'When dealing with miscarriage treatment and … medically indicated abortions, it does not make it clear,' Thomas said. 'And, I think, in some ways, makes it less clear for me.'
It's also 'impossible to definitively identify all situations that would be life threatening,' Thomas said.
The legislation's new details for when a provider can intervene to end a pregnancy follow this statement: 'No action that requires separating a pregnant woman from her unborn child shall be performed, except the following when performed by a physician based upon his or her reasonable medical judgment.'
Dr. Nicole King, a Kentucky-licensed and Cincinnati-based anesthesiologist with experience in high-risk obstetrics, said the use of 'reasonable medical judgement' still doesn't protect providers from legal action.
Physicians accused of violating Kentucky's abortion ban can be charged with a Class D felony and imprisoned if convicted.
'You're opening up the opportunity for them to be judged by somebody who wasn't in the situation at that time,' King said. 'The problem here is that if you are found not to have used best medical judgment to provide a termination, you still are at risk of criminal suit, not civil suit, and that's the concern. Nothing there has changed.'
Wygal also found it 'sad' that the new language was introduced and passed so quickly, which she said eliminated the chance for open review.
'There was no transparency,' she said.
Dr. April Halleron, a family medicine physician in Louisville, is among those who signed Planned Parenthood's letter. She called the bill 'an insult to the medical community and a direct threat to the health of pregnant Kentuckians.'
It also, she said, 'adds to the confusion, the fear, and the chilling effect that is already forcing physicians to hesitate when every second matters.'
'As a physician, I have dedicated years of my life — years of rigorous education, training, and real-world experience — to providing the best possible care for my patients,' Halleron said in a statement. 'Yet with HB 90, politicians who have never stepped foot in a medical school classroom are once again inserting themselves into the exam room, overriding science, medical ethics and common sense.'
Louisville anesthesiologist Dr. Dana Settles echoed those concerns and also signed the Planned Parenthood letter.
'Freedom of religion is a fundamental right in this country, and with it comes the responsibility to uphold the separation of church and state,' Settles said. 'When politicians invent terms such as 'fetal maternal separation' in pursuit of personal beliefs that have no basis in medicine, the problem of gender disparity in health care is exacerbated, reinforced and redefined in many ways, but the most evident is that no other area of health is as politicized as when it pertains to women.'
Rep. Nancy Tate, R-Brandenburg, who helped introduce the new abortion language, said previously that 'under no circumstances is this language expected or intended to be prescriptive.'
'Within this language, it says that 'reasonable medical judgment' means the range of conclusions or recommendations that licensed medical practitioners with similar sufficient training and experience may communicate to a patient based upon current and available medical evidence,' Tate said. 'There's also a clause within this language that says that in cases of emergencies, that the reasonable medical judgment can be used.'
That change, Tate said, will 'save lives.'
King, the Cincinnati doctor, doesn't agree with Tate's interpretation.
'You can't say 'it's not prescriptive,' but then it's written in black and white in a bill that can be used to then criminally prosecute somebody,' King said.
Doctors also take issue with the categorization of some abortions as 'separating a pregnant woman from her unborn child,' which they said is not medical terminology.
'The whole 'my abortion was an okay abortion;' 'my abortion was the good abortion, the reasonable one, the one that made sense, versus someone else's was done for the wrong reasons.' I think that that language has been here for a really long time,' Thomas said. 'And when you have situations where it's only legal to have an abortion in a life threatening situation, it kind of further stigmatizes and 'others' abortion care, because at the end of the day, all of this is abortion care.'
King agreed, saying these differentiations don't exist.
'The problem with subcategorizing it is that you are determining some abortions as good and some abortions as bad. You're clarifying some abortions as medical procedures and some as a crime,' she said. 'And the problem with that is none of those differentiations exist in the medical terminology, because none of those differentiations exist in medical education or in medical reality. It is an abortion.'
Doctors are also concerned about the abortion ban's lack of consideration for future fertility, which can be jeopardized with some pregnancy complications and treatments, such as when a pregnant patient's condition is allowed to deteriorate to the point of requiring a hysterectomy.
The law's supporters, Thomas said, are 'granularly focused on this … one situation with this one fetus, and don't take into account the patient's previous history or future desires.'
'That's where a lot of nuance in plan of care really arises. If somebody is to get septic … they may have to have their uterus removed, which would prevent the ability to have future children,' she explained. 'Their medical conditions — if they have pre-existing conditions — pregnancy could cause them to worsen to where any future pregnancies would not be recommended. And so there is little thought about the future in these bills.'
Kentucky legislature approves late-breaking 'clarification' of state abortion law
While many doctors and health care providers publicly denounced HB 90's new abortion language, 15 who signed the Planned Parenthood letter did so anonymously 'for fear of retribution' or because they did not have employer approval.
The doctors who spoke out publicly said they felt it was the right thing to do.
'I'm a born and raised Kentuckian,' Thomas said. 'I'm from Louisville, and I feel very strongly about continuing to advocate for Kentuckians in this situation, and helping them to know that there is somebody here who wants to advocate for their reproductive rights.'
Wygal is motivated by her belief that 'women's decisions about their health, their fertility, their pregnancy, should be between the doctor and the patient.'
'I know it's going to be very difficult to overturn the current laws,' she said. 'But I want to do everything I can to make as many people as I can aware of what this does.'
King, a Navy veteran, said she felt more supported in treating women in the military than she's felt as a civilian provider.
'Because I've always been vocal, I've been very clear with my employers, all of them, that I'm not out there representing them,' King said. 'But I am representing me, and I will not be silent.'
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