Impact: Since the June 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, Texas physicians and many of their patients have been in a medical limbo.
The decision set in motion or “triggered” state law that imposes additional abortion restrictions. The vague and sometimes inconsistent requirements laid out in Texas law make it difficult for physicians to work with patients when complications arise before birth, says Houston obstetrician-gynecologist Rakhi Dimino, MD, chair of the Texas Medical Association’s Committee on Reproductive, Women’s, and Perinatal Health.
“When I’m in a room with a patient who has a complication in pregnancy, I have to think about what the legislation says before I can counsel my patient,” she said. “Some of the clinical options that I could counsel her about are no longer available until her life is at dire risk. The legislation puts the onus on the physician and patient to prove that she is so sick that she qualifies for the full gamut of clinical options for her health care.”
Physicians are looking to Texas lawmakers to provide clarity on how they can safely treat pregnant women while protecting the patient-physician relationship from criminal consequences under such laws, says TMA President Gary Floyd, MD.
“We need to create a health care environment where any patient can choose any physician they like and discuss any concern with that physician without fear of criminal or civil penalty,” he said.
Without clarity, many women cannot be treated adequately for pregnancy complications.
Waiting too long means a prospective mother may already be too sick to help, Dr. Dimino says. Or, she may face irreparable damage to her reproductive organs. “Even if she does not lose her life, she could lose her ability to have babies in the future.”
That immediate problem is compounded by additional unintended consequences that could deeply affect all of Texas medicine long term, she adds. The lack of clarity about how to treat patients has made it more difficult for medical practices and institutions to recruit OB-gyns to fill open positions. Even many locum tenens physicians now decline to provide stop-gap relief.
“Now, physicians don’t necessarily want to come to Texas,” Dr. Dimino said. “We have a harder time trying to get people to cover even in emergency situations when we need physician coverage.”
TMA experts say that problem will likely grow in any specialty that deals frequently with pregnant women, including family medicine, internal medicine, emergency medicine, and oncology – at a time when Texas already faces workforce shortages in some of these areas.
And since most new physicians are of childbearing age, Texas’ legal landscape on the matter is likely to impact where medical students and residents choose to practice, Dr. Dimino says.
“Younger physicians starting their families – men and women – may not want to start their families here in Texas. That means they’ll settle somewhere that has more favorable legislation that protects the pregnant person in the family and allows the clinical options to keep her safe.”