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Texas-ACOG STATEMENT OPPOSING SB 5 (Hegar)/ HB 60 (Laubenberg)

Texas District American Congress of Obstetricians and GynecologistsJuly 1, 2013Articles

Texas-ACOG opposes SB 5 by Senator Hegar and HB 60 by Representative Laubenberg. SB 5/HB 60 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 SB 5/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.

SB 5/HB 60 sets a dangerous precedent by legislating the practice of medicine and places women at risk by denying access to safe, legal reproductive health services.

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 appropriate substitute.

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

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) implying high survival rates among neonates that are overwhelmingly pre-viable.

Fetal Anomalies
Many fetal anomalies can be diagnosed before 20 weeks; others are not diagnosed until around 20 weeks. CSSB 5 provides an inadequate exception for “severe fetal abnormalities.” This exception and is overly vague and puts into statute how a doctor should exercise medical judgment

Life of the Mother
SB 5/HB 60 fails to entirely protect women for whom pregnancy poses serious health risks. Requiring doctors to wait until a woman faces immediate injury or death, indefensibly jeopardizes a patient’s health and places physicians in a difficult position. Physicians facing the legal penalties may be less likely to intervene early and instead compromise a patient’s 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

  • 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 for 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, jeopardizing their access to safe, legal reproductive health services.

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

SB 5/HB 60 weakens standards of care and patient safety

  • 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.
  • Should newer, safer treatment regimens be developed, under SB 5/HB 60, physicians could be punished for striving to provide the highest quality of care for their patients, the women of Texas.

SB 5/HB 60 threatens the doctor-patient relationship

  • SB 5/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.
  • SB 5/HB 60 legislates a medical protocol for physicians—dictates what to document, what tests to perform, what medications to prescribe and when to schedule follow-up appointments.
  • SB 5/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.
  • SB 5/HB 60 interferes with physicians’ ability to establish an individual care plan.

Texas-ACOG opposes over-reaching requirements for abortion facilities

  • SB 5/HB 60 requires that all abortion facilities meet the minimum standards for ambulatory surgical centers. Texas-ACOG opposes additional standards that single out abortion services from other outpatient procedures. We oppose facility regulations that are more stringent for abortion than for other surgical procedures of similar low risk.
  • Abortions at 16 weeks and later are already required to be provided at a facility licensed as an Ambulatory Surgical Center

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.

  • SB 5/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.
  • Many specialties, including Obstetrics & Gynecology, have begun to stratify the primary practice location for providers: some providers work exclusively in the outpatient setting and others work exclusively in the hospital.
  • Processes for approval of admitting privileges can take a lengthy amount of time.
  • 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 and jeopardizes access for rural women.
  • SB 5/HB 60 requires that the physician or other health care provider be available by phone 24 hours a day indefinitely. This regulation is overly broad and could require 24/7 access for years.
  • SB 5/HB 60 requires access to medical records 24 hours daily, which is unprecedented and unnecessarily broad.
  • Criminally penalizing physicians for performing a legal procedure is inappropriate and prevents physicians from treating their patients based on the best clinical judgment.

ACOG opposes SB 5/HB 60 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.

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

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