“Abortion for *lethal* fetal anomalies is now *illegal* in Ohio. I’m a high-risk obstetrician here. I diagnose birth defects. So some point soon I may look someone in the eyes & say that they, against their will, will carry to term, undergo delivery & then have their child die.”
Pittsburgh native Dr. David Hackney’s tweet on June 27 gained the attention of a nation.
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Hackney is a Cleveland-based maternal-fetal medicine specialist and chair of the Ohio section of the American College of Obstetricians and Gynecologists, and since then he has been doing much more than providing medical care. He’s advocating for patient rights on social media, through published op-eds, through media interviews and by pushing back against laws that are not working for his patients.
But there are no easy answers, and Hackney is among doctors in Ohio who are having to send their patients to Pennsylvania and other states for abortion care. That new role stems from the U.S. Supreme Court’s decision to nix Roe v. Wade, allowing states to enact a shifting patchwork of restrictions and bans that is nearly as disorienting and wrenching to many providers as it is to patients.
“I feel like the news cycle is ending and we still don’t know what to do,” Hackney told PublicSource.
In an Aug. 7 MSNBC interview, Hackney confirmed that his prediction had become a reality for his colleagues.
“We the doctors, especially the high-risk obstetricians in the state of Ohio, have now gone through the lived experience of having to have this happen, having to see patients with serious birth defects, lethal birth defects in some cases, who have not been able to receive abortion care and it is hard to express how tremendously sad it is.”
Where the laws stand
In Ohio, abortions are restricted after 6 weeks’ gestation except in cases with risk of severe harm or death to the pregnant person. West Virginia’s lone abortion clinic ceased performing abortions in June, in anticipation of pending legislation – still embroiled in legal machinations – that would make abortion a felony within the state.
Abortion in Pennsylvania is legal up to the 24th week of pregnancy; late-term abortions in medically necessary situations are also allowed.
Pittsburgh, the closest major city for many patients in those states, is quickly becoming an abortion destination with two abortion clinics in the region and two major hospital systems.
The Allegheny Reproductive Health Center told TribLive in early July that they had seen a threefold increase in abortions since Ohio and West Virginia further restricted abortion access, but told PublicSource in an email they are no longer sharing that information in an attempt to protect their staff, volunteers and patients.
Both of Pittsburgh’s major hospital systems told PublicSource in email statements that anyone from out of state who is experiencing a medical event related to pregnancy such as incomplete miscarriage, ectopic pregnancy, septic pregnancy or other issues, can show up at their emergency departments without legal risk. This commitment relates to the Emergency Medical Treatment and Labor Act, or EMTALA, which requires hospitals to provide medical screening exams and prohibits hospitals with ERs from refusing treatment.
UPMC Vice President of Media Relations Gloria Kreps responded to PublicSource’s outreach with confirmation that all of its emergency departments adhere to the EMTALA.
Dominique Buccina, strategic communications advisor for Allegheny Health Network, assured people they can show up and receive care. “AHN continues to provide the full spectrum of women’s health services to all who seek our care, as the law allows, including those who travel from other states, and particularly in cases where a patient with a life-threatening circumstance presents in one of our emergency departments.”
Barriers to care
Ohioans, and other residents in nearby states with strict abortion laws, may think they can simply call or drive to Pennsylvania to access an abortion. But it’s not nearly that easy.
Telehealth options exist for people who want abortion pills, but those are only effective until around 11 weeks of pregnancy.
Pennsylvania’s abortion law is more expansive than its neighbors, but numerous barriers stand in the way, including a major backlog in provider availability given the rising numbers.
Here are some of the roadblocks one may encounter:
A logistical — and ethical —mess
If one of Hackney’s Ohio-based patients needs an abortion, such as when the baby they are carrying has a fetal anomaly that will result in suffering or death right after birth, he starts making calls to Pennsylvania and Michigan providers.
“We don’t have a singular pathway at the moment,” he said. “We are in conversations … with different abortion providers in different states. And we are definitely grateful for all of the colleagues out of state that we’ve been talking to and making good-faith efforts to facilitate our patients.”
Hackney added that he faces the ethical dilemma of whether he should “pull strings” to connect an abortion-seeker with a fetal anomaly who may potentially end up ahead of a “21-year-old who doesn’t want to be pregnant or maybe an adult who was raped but is in good physical health.” He questions if any one case is more “meaningful” than the others.
Deadlines and ‘bad actors’
Another issue some face is that delays can put them past the 24-week cutoff in Pennsylvania.
Dr. Cindy Duke, a Las Vegas OB-GYN and fertility specialist, said anyone seeking an out-of-state abortion, especially in a medical emergency such as an ectopic pregnancy, shouldn’t just get into their car and start driving to an emergency room. Instead, reach out to Planned Parenthood for connections to providers.
Hackney said patients are generally directed to the National Abortion Federation to find a provider.
Duke said knowing your rights under EMTALA helps control for “bad actors” in hospitals who may not agree with your decision and try to withhold care.
Some Ohioans and other out-of-state pregnant people may be trying to reach out to individual OB-GYN offices in Pennsylvania, but Duke explained that they are often advised not to reveal if they provide abortions over the phone. Patients may ask to schedule a virtual consultation to determine this.
The 24-hour rule and its ‘gray zone’
In many states, including Pennsylvania, abortion-seekers must wait 24 hours after counseling with a provider to actually begin treatment. Hackney said this barrier “has never served a medical need” and is causing issues for those seeking care.
“Now that patients are having to travel out of state, the impact of the 24-hour waiting period is more severe,” he said, calling it a “hassle.”
Watch Dr. David Hackney testify against Ohio’s abortion law, House Bill 598
Hackney explained that most surgical abortions after the first trimester require a period of cervical preparation before the surgery can be performed. This usually consists of placing laminaria or Dilapan in the cervix for 24 hours before going to the operating room.
“There is varying opinion if the placement of laminaria constitutes ‘starting’ the abortion with regards to the 24-hour waiting period or if the 24-hour waiting period just applies to the surgery itself,” he said. “If a patient is out of state and needs cervical preparation and the law is interpreted at its most conservative, then they would need to arrive in an outside state, initiate the 24-hour waiting period, then at the end of the 24-hour waiting period have the laminaria/Dilapan placement and then wait another 24 hours.” It leads to additional time and cost for travel, from longer hotel stays to more days off of work, sometimes without pay.
In the case of patients crossing state lines, Hackney said being able to start that 24-hour waiting period over the phone would make more sense, though it’s his opinion that no 24-hour period would be best.
For now, he said, this is a “gray zone” that isn’t well defined.
“Though [abortion is] always safer than having to carry a pregnancy all the way to term … the risk does go up every week,” he said, adding that this makes reducing barriers within the Ohio to Pennsylvania abortion pipeline all the more necessary, especially for those whose health is at risk.
Providers are risking their livelihoods
Duke is a Hopkins and Yale-trained specialist who has taken to social media to educate the country about how abortion restrictions are impacting pregnant patients and endangering lives and livelihoods.
Some laws, she said, such as those in Ohio, require “waiting until [an ectopic pregnancy] is a direct threat to people’s lives. … It means you have to wait until her blood pressure is so low, you’re concerned, that her heart rate is so concerning, that’s called hemodynamic instability,” she said.
She said that across the country, doctors are asking legal teams the same question: How long do they have to wait to help someone without risking their careers and facing legal penalties?
Hackney takes issue with Ohio’s unclear guidelines on when an abortion is essential for a pregnant person, noting that certain medical conditions like multiple sclerosis are clearly identified as reasons an abortion might be considered, but other conditions like cancer aren’t clearly defined.
Doctors, he said, are left confused about when they can treat patients with serious conditions who may need an abortion.
“I would presume cancer would always be a threat to maternal health, but again, you have criminal penalties, and it’s not spelled out,” Hackney said. “Are you at risk of some sort of legal jeopardy?
“A whole universe of potential indications, including cancer and kidney disease, are unaddressed and thus unclear.”
Meg St-Esprit is a freelance journalist based in Bellevue. She can be reached at megstesprit@gmail.com or on Twitter @MegStEsprit.
Alex Frost is a freelance journalist based in Cincinnati. She can be reached at alexfrost@frost-freelance.com, or Twitter @alexfrostwrites
This story was fact-checked by Ladimir Garcia.
The Jewish Healthcare Foundation has contributed funding to PublicSource’s healthcare reporting.
