After Supreme Court abortion decision, hospitals grapple with uncertain legal landscape

With the Supreme Court's reversal of Roe v. Wade, hospitals and health systems are reviewing the decision and potential effects it may have on their reproductive health services.

The nation's highest court overturned the constitutional protection for abortion June 24, returning the authority to regulate abortion to states. 

Without Roe v. Wade, 26 states are certain or likely to ban abortion to the fullest extent possible, including 13 states that have "trigger" laws that will be set in motion to ban abortions, according to the Guttmacher Institute, a pro-choice research organization.

The states with "trigger" laws — Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah and Wyoming — have different implementation mechanisms, timelines and details. As of June 30, judges in Kentucky, Louisiana, Texas and Utah have temporarily halted the implementation of trigger laws pending the resolution of lawsuits filed against them, according to legal news source ABA Journal. There are also pending lawsuits in Idaho and Mississippi.

As of June 28, 10 states were already enforcing abortion bans with very limited exceptions, and three had stopped offering abortion care, according to the Guttmacher Institute. 

The patchwork of rules has created confusion for hospitals and health systems, which say they are working to understand the legal landscape.

St. Luke's Health System in Boise, Idaho, is among the organizations working to understand the details of the Supreme Court decision as well as how it could affect pregnancy care services in Idaho.  

"The situation has understandably created confusion for patients and providers alike," Chris Roth, president and CEO of St. Luke's, said in a statement shared with Becker's. "We are staying in close communication with medical leaders and care teams to ensure that our committed professional colleagues have support and are equipped with accurate information regarding current policies and procedures having to do with all aspects of care, including pregnancy care." 

Mr. Roth added: "St. Luke's is committed to helping its teams and patients navigate the changes ahead while continuing to live our health system's values, support each other, and continue to provide safe, high-quality and compassionate healthcare to all in our communities."

Chattanooga, Tenn.-based Erlanger Health System is also examining the issue. 

Chief Administrative Officer Gregg Gentry told Becker's: "Tennessee is a state in which abortion access will change. As this ruling will affect hospitals throughout Tennessee, Erlanger Health System is working to determine the best path forward in order to adapt to these changes and to comply with the law. We are currently planning the creation of a working group at Erlanger that will be available to offer guidance and continue to update the staff as we go forward. As leaders in reproductive healthcare and as the essential health system of our region, it is our duty and honor to continue to provide exceptional, evidence-based care, and that mission will not change. We will continue to be leaders in our region, compassionately caring for our patients."

Troy Wells, president and CEO of Little Rock, Ark.-based Baptist Health, told Becker's: "We always abide by federal and state laws and the new decision will not change our practice. Baptist Health does not perform abortions, with the limited exception of life-threatening medical emergencies which require therapeutic intervention consistent with current state law." 

Cheyenne (Wyo.) Health told Becker's that given the state's conservative view on the matter, it has previously prepared for the ruling and that not much will change going forward. Wyoming was one of the states that had drafted a trigger law in preparation for the ruling. 

"Wyoming, as one of the more conservative states, has had limited access to elective abortions for some time. There were very few providers within the state and most were located in the state's western side," said Jeffrey D. Storey, MD, co-chief medical officer at Cheyenne Regional Medical Center. "Providers throughout Wyoming who had patients requesting access have developed connections out of state to provide resources for those patients. In practice, most patients from this region travel to Colorado if they are seeking abortion services." 

The 2,000-plus-employee strong system will not significantly change any current practice and will follow the law outlined by the state.

The University of Utah, via their public announcement through their website, said that it will "carefully monitor judicial and legislative developments in this area to ensure its practices conform to applicable law." Utah is one of the states that has a trigger law banning abortion excpet in the case of rape, incest or preserving the mother's life. On June 27, a judge put the law on hold for 14 days pending the outcome of a lawsuit by Planned Parenthood and the ACLU.

They also stated: "Delivering compassionate care is what we are about at University of Utah Health. We will continue to provide all appropriate referrals to our patients, while following state law."

Sanford Health, headquartered in Sioux Falls, S.D., also does not offer elective abortions as a matter of policy, but told Becker's that it is closely evaluating the impact of the Supreme Court ruling.

"Our focus remains on ensuring our providers, alongside our patients and their families, can continue to make the best clinical decisions for the health and safety of those we serve. Our primary objective is to ensure our patients have access to the care they need, and our providers retain the ability to practice evidence-based medicine without interference," Jeremy Cauwels, MD, chief physician, told Becker's

The system is also engaging its ethics committee with physician leadership to look into the need for additional clinical care guidelines in specific situations.

BHSH System, the 22-hospital organization formed by the February merger of Grand Rapids, Mich.-based Spectrum Health with Southfield, Mich.-based Beaumont Health, said it has evolved its approach on abortion since the Supreme Court decision.

In a news release posted June 26, the health system cited an unclear and uncertain legal landscape regarding abortion in Michigan as well as a 1931 state law. The law makes abortion a felony unless necessary to preserve the life of a woman.

Although the Supreme Court overturned Roe v. Wade, there is an injunction in place prohibiting enforcement of the state law, according to Michigan Radio.

"At present, the current legal landscape regarding abortion in our state is unclear and uncertain. We are aware of the 1931 Michigan law. However, given the uncertainties and confusion surrounding its enforcement, until there is clarity, we will continue our practice of providing abortions when medically necessary," the health system said in its news release.

The health system went on to say that it "continue[s] to believe that these decisions are both personal and private and best made between a woman and her physician." Last year, the BHSH System performed about 60 therapeutic, medically necessary abortions that required hospital-level care, the health system reported.

"We have not and will not perform elective abortions," the health system said. "We continue to provide care for women's health, including reproductive needs. We will support our physicians and patients through a multidisciplinary, local committee as they navigate this challenging landscape."

The health system posted the June 26 news release after it told staff June 24 that it would restrict abortions to cases where it's deemed "necessary to preserve the life of the woman," according to the Detroit Free Press.  

Both Houston-based Harris Health and Lexington-based University of Kentucky Healthcare told Becker's that their legal teams are analyzing and reviewing the ruling to understand how it will affect future operations, and until then, they couldn't give a clear comment for the article. 

After reviewing the responses from multiple systems based in states that are most affected by the Supreme Court ruling, it is clear that the current situation is one of flux. Many systems are huddling down to evaluate how exactly the law will affect them, and for many others, the law does not represent a major change to existing state law. It remains to be seen how the picture will evolve once health system legal teams fully grasp the law, and if there will be further changes to the law, as suggested by President Joe Biden.

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