TMA Condemns Women's Health Rules

Proposed rules for the state's Women's Health Program (WHP) would interfere with the patient-physician relationship and set a dangerous precedent "based upon the political agenda of the day," a representative of organized medicine warned the Texas Department of State Health Services (DSHS) earlier this month.

If implemented, said Austin family physician Celia Neavel, MD, "the rules would interfere in the patient-physician relationship by restricting physicians' ability to provide candid and confidential information about elective abortions to any woman in the practice, even if the physician felt that this information was in the clinical interest of the patient or if the patient asked about the procedure." Dr. Neavel, who practices at People's Community Clinic in Austin, testified at the Sept. 4 hearing on behalf of TMA, the Texas Academy of Family Physicians, the American Congress of Obstetricians and Gynecologists, the Texas Association of Obstetricians and Gynecologists, and the Texas Pediatric Society.

Adoption of the rules would force the clinic to resign from the program, she added.

DSHS held the hearing to discuss how WHP will function without federal funding. The Texas Legislature approved a plan last year that would ban Planned Parenthood and other abortion affiliate programs from the federal Women's Health Program. That move led the Obama administration to cut off federal funding for WHP. Since then, the Texas Health and Human Services Commission (HHSC) proposed rules affecting the program that concern many Texas physicians. At the hearing, physicians spoke in favor of the program and opposed proposed rules that would not only forego 90 percent of federal funding for the program, but also bar physicians in it from discussing abortion with patients.

Janet Realini, MD, president of Healthy Futures Alliance, a coalition working to reduce teen and unplanned pregnancy, stressed that Texas is experiencing a "crisis in access to women's preventive care." She says further reduction of participating physicians in WHP "will only make things worse." (See "A Steep Price" in the July 2012 issue of Texas Medicine.)

TMA sent a letter to DSHS in early August opposing the proposed rules. TMA President Michael E. Speer, MD, wrote that the rules would impose a "gag order" on physicians who participate in the Texas WHP. "If the state indeed wants doctors to participate in the program, this is a step in the opposite direction," Dr. Speer wrote.

Rep. Donna Howard (D-Austin), Rep. Sarah Davis (R-Houston), and Sen. Kirk Watson (D-Austin) attended the hearing and encouraged state officials to protect the patient-physician relationship and work in the best interest of Texas women.


Action, Sept. 17, 2012


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    Thank you for your comments and for taking the time to respond to the survey. The Women's Health Program (WHP) covers annual well-woman exams, contraception, and basic preventive health screenings for eligible low-income, uninsured adult women. WHP does not cover abortions. Indeed, the Texas legisalation enacting WHP specifically prohibited the state from contracting with clinics or physician practices that "perform or promote" elective abortions. TMA's concern with the proposed rules, among others, is that they interfere with the ability of physicians to have candid conversations with their patients about an issue that may affect their health. As drafted, the rules would preclude physicians who participate in WHP from discussing elective abortions with any of their patients, even if the patient directly asked about the procedure or the physician felt a discussion was clinically indicated. The proposed rules apply to all patients in a physician's practice, not just those enrolled in WHP. As noted in the letter on the proposed WHP rules, TMA does not take a position on abortion, but leaves the decision on whether to support or oppose the procedure to individual physicians. However, the association does strongly oppose government interference into what physicians can discuss with their patients in the context of confidential patient-physician relationship. In regards to the results of the survey that you answered, you can find that information here: http://www.texmed.org/template.aspx?id=16236 under "NEW: TMA July 2012 Survey". Page 8 of the report summarizes the findings pertaining to this issue. Eighty-four percent of respondents indicated that they somewhat or strongly agree that "TMA should advocate against any legislation that could limit physicians' ability to frankly discuss all reproductive choices." TMA received 1,177 responses. Best regards, Helen Kent Davis, Director, Governmental Affairs

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    TMA asks us to participate in surveys, and I think I responded to one on this issue. Contrary to the comment in the article stating that "TMA sent a letter ... opposing the proposed rules," I said in the survey that I supported the proposed rules, which, as I recall, were to decrease taxpayer-funding of abortion. I suspect that is the majority opinion of Texas doctors if they were polled without slanted questions. If that was not the main intent of the proposed rules, enlighten us. Or give us feedback on the surveys and the number of responses.
    Paul Boone, M.D. Pasadena

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