Clinical implications of the Kate Cox Texas abortion case

Contemporary OB/GYN:

Hi, I'm Celeste Krewson with Contemporary OBGYN and I'm here with Dr. Kumar to discuss the clinical implications of the Kate Cox abortion case. Do want to introduce yourself, Dr. Kumar?

Bhavik Kumar, MD, MPH:

Yeah, sure. My name is Dr. Bhavik Kumar. I'm a family medicine doctor in Houston, Texas, and abortion provider.

Contemporary OB/GYN:

So, for viewers who aren't aware, can you provide a brief summary of the Kate Cox abortion case in Texas?

Kumar:

Sure. Kate Cox is somebody who lives in Texas and recently had a diagnosis of Trisomy 18. Given her history of 2 C-sections and desiring future fertility, after consultation with her medical providers who know her full medical history and any other concerns that might have been discussed, Kate needed an abortion for her non-viable pregnancy. Now unfortunately in Texas, we have 3 statewide abortion bans along with some local travel bans within some counties. The first abortion ban is the pre-Roe ban from 1857, which is difficult to understand how it would apply today in 2023, given how it was written over 160 plus years ago, but it could result in 2 to 5 years in jail for the provider and anyone else involved in the care. There's also Senate Bill 8 or SB 8. This bans abortion after cardiac motion can be detected and allows for anyone in the country to bring a lawsuit forward for anyone who aided or abetted that abortion, including the provider and anyone else that's part of the care team except for the pregnant person themselves. The person suing can choose any county in the state for that lawsuit, they don't have to have any connection to the person who had an abortion or have any harm that was caused to them, and it can be up to 3 years after the abortion takes place. And then lastly, there's a trigger band that went into effect after Roe fell, and that only allows for abortion in cases that could prevent a life-threatening physical condition, aggravated by, caused by, or rising from a pregnancy. This law is also quite vague and unclear for medical providers and has left a lot of providers and people seeking care in sort of a legal limbo. The penalties for violating this law could include loss of your medical license, monetary fines, and also life in prison.

So, Kate Cox sought legal protections to move forward with the time sensitive care that she needed, and the case was heard by a judge in Texas who granted her permission to move forward and offered protections for the person who would be providing her with care. However, the Attorney General in Texas appealed that decision to the Supreme Court of Texas, who eventually ruled to prevent Kate from being able to get the care she needed in Texas, forcing her to travel out of state for the same care that she and everyone else who needs it should be able to get within their own communities. The Attorney General also included threats to anyone involved in the care should it take place in Texas, as well as the 3 hospitals where the named provider had admitting privileges. And it's important to remember that Kate Cox should never have had to expose her personal private medical history and decision making in a lawsuit in order for her to get the care she and her family needed, that while this is one person's story, abortion providers like me hear countless stories just like this in Texas and so many other states, especially throughout the South. And people continue to be forced to travel out of state for care if they are able or they're being forced to carry these pregnancies to term when they know they can't do that.

Contemporary OB/GYN:

And given this case and the barriers that clinicians in Texas face, what advice do you have for clinicians in Texas whose patients are seeking abortion? How can they help their patients without worrying about legal recourse?

Kumar:

Yeah, navigating the several abortion bans in Texas takes abortion out of the health care space and into a legal world. And that means all of us have to have a good relationship with our legal counsel. More specifically, our own personal counsel and the attorneys that represent the places where we work. People seeking abortion and states are likely to be faced with misinformation, and clinicians can serve as an important resource for sound, medically accurate information which is so important for folks right now. From my understanding of the law, providers are allowed to discuss abortion even in Texas, including medication abortion. We're allowed to provide factual information and provide resources for that care as long as it takes place outside of Texas, meaning the care itself or the abortion part takes place outside of Texas. The Texas laws only apply for abortion care within the state. So, we're still allowed to provide any useful information for a patient prior to an abortion, perhaps an ultrasound for gestational aging or for folks that went out of state and had an abortion and are requiring post abortion care often to confirm completion of their abortion, we can still provide that care and any answer any questions that they may have as well. I think the most important point I would want to make for clinicians and for every person on any health care team is that you're never obligated to report any pregnancy outcome to law enforcement, and that involving law enforcement can be extremely damaging for the pregnant person and their family. So, we shouldn't be suspicious of our patients who present with pregnancy related concerns that may be suggestive of a miscarriage or early pregnancy loss. Our job as health care providers is to provide them with the care that they need and to ensure their safety while they're under our care.

Contemporary OB/GYN:

And what resources can clinicians in Texas or other states where abortion is restricted provide to their patients?

Kumar:

Yeah, there's a number of great resources available for patients seeking care. So, if they're looking for a health center out of state that provides abortion care, you can go to abortionfinder.org. Or another website is ineedana.com or ineedanabortion.com, both websites will get you to the same place. If your patient needs legal resources or to access an abortion and pregnancy legal defense fund, they can go to ifwhenhow.org And then lastly, many patients will also need financial assistance to help pay for the cost of their care or perhaps logistical support such as travel lodging, and they can access the national network of abortion funds or NNAF at abortionfunds.org, and that can take them to their local abortion funds or a number of different abortion funds that can help with some of that financial support.