ACOGJune 20, 2013Uncategorized

The Texas District of the American Congress of Obstetricians and Gynecologists (ACOG) represents more than 3,600 physicians and partners in women’s health. Texas-ACOG opposes CSSB 5 by Senator Hegar. CSSB 5 is an accumulation of all the measures we opposed during the 83rd Regular session and remain opposed to in this special session.

The Texas District of the American Congress of Obstetricians and Gynecologists (ACOG) opposes CSSB 5 and other legislative proposals that are not based on sound science or that attempt to prescribe how physicians should care for their individual patients. As a District of the Nation’s leading authority in women’s health, our role is to ensure that policy proposals accurately reflect the best available medical knowledge.

CSSB 5 will not enhance patient safety or improve the quality of care that women receive. This bill does not promote women’s health, but erodes it by denying women in Texas the benefits of well-researched, safe, and proven protocols.

Texas-ACOG opposes provisions that treat women as if they cannot make their own medical decisions

  • CSSB 5 would require a woman to come to an Ambulatory Surgical Center (ASC) to take a pill for a medical abortion. She would then have to return a second time to the ASC to be watched taking the 2nd pill within the next 24-48 hours.
  • Requiring a woman to physically come in to take a 2nd dose increases the risk of her not being able to return—this increases the chance for hemorrhage, blood transfusion, and emergent D&C.
  • Women outside of Dallas, Houston, San Antonio, and Austin will have to travel long distances to find a clinic that meets ASC regulations.
  • These burdensome requirements will make these services harder to access as well as make these services more costly.

Texas-ACOG opposes provisions dictating protocol for physicians to follow when prescribing certain drugs

CSSB 5 weakens standards of care and patient safety

  • CSSB 5 requires providers to follow a protocol that has been proven to be less effective, more costly and causes more detrimental side effects for women than care that is currently available and widely used.
  • CSSB 5 has permissive language allowing dosage amounts that follow the ACOG Practice Bulletin guidelines as they existed on January 1, 2013. However, this is still codifying standard of care and is dangerous in the long term. Science and medicine evolve quicker than our laws.
  • Under CSSB 5, physicians can be punished for striving to provide the highest quality of care for their patients, the women of Texas.

CSSB 5 threatens the doctor-patient relationship

  • CSSB 5 places an unacceptable level of control over the doctor-patient relationship in the hands of the legislature, essentially allowing the legislature to practice medicine.
  • CSSB 5 creates medical protocol for physicians—dictates what to document, what tests to perform, what medications to prescribe and when to schedule follow-up appointments.
  • CSSB 5 interferes with a doctor’s ability to use his or her professional judgment to determine the appropriate medical care in each individual patient’s unique circumstance. It undermines the standard of care and restricts the ability of physicians to prescribe and direct medication use.
  • CSSB 5 interferes with physicians’ ability to establish an individual care plan.

Texas-ACOG opposes over-reaching requirements for abortion facilities
CSSB 5 requires additional standards that are unnecessary and unsupported by scientific evidence.

  • CSSB 5 does not promote the public health objective it claims to enhance; in fact it harms public health by restricting access to safe, legal, and accessible abortion services.
    • Late term abortions (16 weeks and later) are already required to be provided at a facility licensed as an Ambulatory Surgical Center (ASC)
  • CSSB 5 will require women to go to an ASC to take a pill for a medical abortion
  • CSSB 5 has unintended consequences that make the treatment of certain conditions (ex. Ectopic pregnancies) more difficult and expensive.
    • Ectopic pregnancies are frequently treated in outpatient facilities and physician office settings—SB 5 could prevent doctors from treating cases as they normally would.
    • Ectopic pregnancies must be reported to DSHS as emergency abortions; this could result in physicians losing exemption from abortion facility licensing requirement.
    • Positive patient outcomes will decrease, medical costs will increase
    • Affects more providers and facilities than just Planned Parenthood or traditional abortion facilities

Texas-ACOG opposes unnecessary requirements that may be extremely difficult and in some cases impossible to meet, without a basis in public health or safety.

  • CSSB 5 requires hospital admitting privileges for physicians performing an outpatient procedure that bears low risk. No other outpatient procedure requires a physician to have active admitting privileges in a hospital within a specific distance.
  • Requirements for admitting privileges vary from hospital to hospital. Some hospitals bar physicians that perform terminations from being awarded hospital privileges.
  • Processes for approval of admitting privileges can take a lengthy amount of time—sometimes as long as licensure and board certification.
  • A physician may have active admitting privileges, but not within a 30 mile radius. This is especially problematic for rural areas where hospitals are scarce.
  • Not all hospitals may meet the requirement of providing “obstetrical or gynecological health care service.” There is not a special designation for hospitals providing OB/GYN services. This provision is vague and could have extensive consequences.
  • Criminally penalizing physicians for performing a legal procedure is inappropriate and prevents physicians from exercising medical judgment in order to treat their patient as they see fit.

ACOG opposes CSSB 5 and strongly urges the Legislature to closely examine and follow scientific facts and medical evidence in its consideration of this and other health care legislation. We stand ready to provide you with factual information on medical issues that come before the Legislature, and hope you will contact us at any time.


Lisa M. Hollier, MD, MPH, FACOG
Chair, Texas District American Congress of Obstetricians and Gynecologists

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