Testimony of the Texas Medical Association on House Bill 215
House State Affairs Committee
July 26, 2017
The Texas Medical Association (TMA), representing more than 50,000 physicians and medical students, appreciates the opportunity to voice our concerns with House Bill 215 relating to requirements for reporting on certain abortions.
As we have stated numerous times, our members’ opinions fall on both sides of the abortion issue, and our comments do not address that personal and private matter. Our comments relate to the components of this legislation that create additional reporting requirements on abortion — requirements that call for details on deeply personal decisions and on medical care, and reporting that does not contribute to public health.
The reporting and tracking of newborns with developmental abnormalities or other birth defects is indeed a longstanding public health responsibility. Decades ago, the Texas Legislature developed a robust birth defects monitoring program, and Texas now conducts active surveillance for newborns with birth defects in concert with physicians and health care facilities to ensure appropriate follow-up and care for infants, and equally, to identify opportunities for prevention. This Texas reporting and surveillance system is an example of how public health reporting systems contribute to improving our understanding of maternal, fetal, and perinatal care, and the prevention and management of fetal anomalies and birth defects.
HB 215 will require additional reporting related to third trimester abortions, which are extremely rare in Texas and the United States, and take place because of life-threatening medical conditions of the pregnant woman and/or her fetus. The most recent reports showed that a fraction of one-tenth of 1 percent of the abortions in Texas were at 27 weeks or more of gestation. It is evident that this is an extremely rare event, yet physicians will be required to certify and provide details to the state on a medical procedure intended to protect health and prevent disability. The purpose of this reporting is not at all clear, nor does it appear to be based on addressing a current public health issue in Texas.
Specifically, HB 215 specifies that if the physician certifies that a particular third-trimester abortion was authorized because the fetus has a severe and irreversible abnormality, the physician is required to certify in writing on the department’s form the fetal abnormality identified by the physician.
Fetal abnormalities that prevent the normal development of a fetus are complex clinical situations. The pregnant woman carrying a fetus with a severe abnormality requires the clinical care of a physician and a team of caregivers. The addition of more reporting on the details of the fetal abnormality are of unknown value and add to the burden of care in these rare events.
The extensive reporting requirements outlined in HB 215 also call on physicians to provide extensive details related to consent for an abortion for a minor, a minor’s participation in the state’s judicial bypass process, and on emergency abortions performed on minors.
Particularly troublesome is the bill’s requirement for a physician performing an emergency abortion to document that in the physician’s good faith clinical judgment that: (1) a condition existed that complicated the medical condition of the woman and necessitated the immediate abortion of the woman’s pregnancy to avert the woman’s death or to avoid a serious risk of substantial impairment of a major bodily function and (2) there was insufficient time to obtain the consent of the woman’s parent, managing conservator, or legal guardian.
Currently, the Medical Practice Act allows an abortion of a minor if “the abortion is necessary due to a medical emergency….” Thus, this bill’s new reporting requirement appears to impose a more restrictive requirement and force the physician, in an emergency situation, to think first about whether there is sufficient time to talk to the patient’s parents prior to performing an abortion. When time is of the essence, even a short delay could negatively impact patient care.
The reporting of details of medical abortions performed in the third trimester and of consent for minors seeking an abortion or requiring an emergency abortion do not address a public health need and purpose. These are extremely rare events, and this new requirement will only lead to more reporting and requirements for physicians. These measures build on the existing intrusive foundation already established by lawmakers to further interfere in the sacred relationship between patients and their physicians.
TMA was founded with the mission of supporting the education of the public on medicine and public health. We will continue our work in this area so that public health policy is based on sound scientific evidence that supports the health of the residents of our state. We look forward to working with the committee to address our concerns with HB 215.