ACOGJune 20, 2013Articles

The Texas District of the American Congress of Obstetricians and Gynecologists (Texas-ACOG) opposes HB 60 by Representative Laubenberg. HB 60 is an accumulation of all the measures we opposed during the 83rd Regular session and remain opposed to in this special session. 

Texas-ACOG opposes HB 60 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.

HB 60 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 20 week ban/‘Fetal Pain’ provisions

Terminology:  The use of appropriate, standard terminology is essential.

  • “Embryo” is the proper term to use for the 2nd-8th week of pregnancy; “fetus” is the correct term to use until birth.
  • “Post-fertilization” is rarely used outside of in vitro fertilization. The medical community uses the first day of the last menstrual period (LMP) to date pregnancies. Post-fertilization is not an accurate substitute. 

Fetal Pain:  No credible scientific evidence exists of fetal pain perception pre-viability. The medical profession produced a rigorous scientific review of evidence on fetal pain in the Journal of the American Medical Association (JAMA), 2005. Fetal perception of pain is not confirmed prior to the 3rd trimester. Perception of pain is only confirmed after viability.

Fetal Viability:  Most obstetrician-gynecologists understand fetal viability as occurring near 24 weeks gestation utilizing LMP dating. Supporters of fetal pain present misleading evidence about fetal viability (especially in using post-fertilization age, instead of LMP dating) and falsely implying high survival rates among neonates that are overwhelmingly pre-viable.

Fetal Anomalies:  Many fetal anomalies can be diagnosed before 20 weeks; others not until around 20 weeks. HB 60 makes a shallow attempt at providing an exception for “profound and irremediable congenital” fetal anomalies, however, the exception for such an anomaly is based upon the amount of time believed the infant will live after birth—minutes to hours. Physicians cannot know when death will occur with that kind of certainty.

Life of the Mother:  HB 60 fails to entirely protect women for whom pregnancy poses serious health risks. By requiring doctors to wait until a woman faces immediate injury or death, indefensibly jeopardizes a patient’s health. Instead doctors are forced to compromise patient health by waiting until a woman’s condition deteriorates and becomes life threatening or severely debilitating.

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

  • HB 60 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

HB 60 weakens standards of care and patient safety

  • HB 60 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.
  • HB 60 prohibits the act of prescribing a medication regimen that has, in the simplest of terms, simply been proven to be far superior to the FDA-approved regimen required by HB 60.
  • Under HB 60, physicians can be punished for striving to provide the highest quality of care for their patients, the women of Texas.

HB 60 threatens the doctor-patient relationship

  • HB 60 places an unacceptable level of control over the doctor-patient relationship in the hands of the legislature, essentially allowing the legislature to practice medicine.
  • HB 60 creates medical protocol for physicians—dictates what to document, what tests to perform, what medications to prescribe and when to schedule follow-up appointments.
  • HB 60 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.
  • HB 60 interferes with physicians’ ability to establish an individual care plan.

Texas-ACOG opposes over-reaching requirements for abortion facilities

HB 60 requires additional standards that are unnecessary and unsupported by scientific evidence.

  • HB 60 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
  • HB 60 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—HB 60 may 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.

  • HB 60 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 HB 60 and strongly urges the committee 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.

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