Senate Bill 97 requires physicians to personally administer the two-drug cocktail that induces a medical abortion, which must be taken 24 hours apart, and to see the patient for a follow-up appointment within 14 days. The bill also requires physicians performing abortions to put existing verbal agreements with back-up physicians into written contracts, so that the state can track the names of doctors with hospital privileges that are willing to treat abortion patients in emergency situations.
"All we're asking is that the abortion clinics follow the federal drug administration guidelines and the manufacturers' guidelines," said Sen. Dan Patrick, R-Houston, the author of SB 97.
The committee left the bill pending for further consideration.
Abortion rights advocates raised several concerns about the bill. For example, they said the in-person physician requirements of SB 97 could present a particular challenge for the roving doctors who treat women in the state's rural counties. And the cost of additional visits to the doctor could be a hardship for poor women, they said, who already have trouble obtaining abortion services because of transportation costs, child care, and lost wages because of existing laws that require multiple appointments for the operation.
"I am 100 percent confident telling you this bill is not in the best interest of Texas women," said Amelia Long, a board member for the Lilith Fund, a statewide non-profit that helps low-income women access abortion services. She said many of the women the organization serves are "heartbroken over fetal anomalies," victims of sexual assaults, and mothers who cannot afford to care for more children.
In 2011, Patrick championed an abortion sonogram law that requires physicians to perform sonograms on women 24 hours before performing abortions, and to describe the development of the fetus and play the fetal heartbeat for the mothers.
Abortion-rights advocates say the restrictions in SB 97, particularly in combination with the physician requirements of the abortion sonogram law, could reduce women's access to abortion services. The measure presents a particular challenge for the roving doctors who treat women in the state's rural counties, they said, as the bill prohibits the use of telemedicine.
Dr. Michael Love, a certified ob/gyn invited by the author to testify in favor of the bill, said the legislation "elevates the standard of care for those who are having medical abortions to the level of current medical practice." He said 20 percent of medical abortions have complications. "We have about 18,000 medical abortions a year, so that would translate into about 3,600 adverse events or complications," he said.
Dr. Al Gros, an ob/gyn testifying on behalf of the American College of Obstetrics and Gynecologists, offered contrasting testimony, and said newer drug regimens that physicians follow have a 98 percent success rate. He called the Food and Drug Administration regimen outlined in Patrick's bill "archaic," because its guidelines were set 13 years ago. "Common practice has advanced beyond that protocol," he said, explaining that in current practice, physicians use only a third of the dosage the F.D.A. guidelines recommend.
Multiple women who testified in favor of SB 97 said they did not believe the procedure is safe and described the physical and emotional pain they experienced while having medical abortions.
"Before I knew it, I was bent over in pain on the side of the bed... At times I was blacking out from the pain," said a woman from Waco.
Mary Robinson, a resource witness from the Texas Medical Board, testified that physicians are currently penalized for not following F.D.A. guidelines for any prescription drug. She said sanctions on physician licenses are complaint driven; Texas physicians could be sanctioned if the board receives complaints that they violated F.D.A. guidelines, and if two other physicians confirm the state's "standard of care" guidelines were violated.
Blake Rocap, representing NARAL Pro-Choice Texas, raised concerns about the requirement that physicians have a written contract with a back-up physician, "given the history of harassment and violence that physicians have suffered in this country." Most physicians already have verbal agreements with back-up physicians, and abortion rights advocates have alleged the requirement for a written contract is intended to discourage doctors with hospital privileges from partnering with physicians who provide abortions.
The Texas Medical Association, which represents 47,000 physicians across the state, has also expressed concerns that the legislation would interfere in the patient-physician relationship.
"Our opposition to Senate Bill 97 is based not on our members' position on abortion, but rather on our concern with any legislative effort that prescribes action and sets a standard of care in statute for the care of any of our patients," said Dr. Michael Speer, president of the Texas Medical Association in a prepared statement. He did not testify in front of the committee. "Regardless of how reasonable legislation requiring certain medical acts may appear, it is a slippery slope that will open the door for future legislation to further direct the practice of medicine."
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