'We will be in uncharted territory:' 4 leaders on the potential implications of Roe v. Wade reversal

Editor's note: This article was posted on June 23. The Supreme Court overturned Roe v. Wade June 24.

The effects of the Supreme Court's proposed overrule of Roe v. Wade would touch health systems nationwide — leading some clinicians to urge industry leaders to start preparing for potential fallout prior to the decision. 

"Health systems that view abortion exclusively as a political or partisan issue, perhaps one they'd like to avoid, will soon bear witness to the reality that abortion care, or lack thereof, is a healthcare and health equity issue," Lisa Harris, MD, PhD, wrote in a May 11 article for The New England Journal of Medicine. "Avoiding the issue will not be possible, short of abandoning care and equity missions altogether. Thoughtful preparation is needed now."

This compilation features guidance from four leaders at three systems who shared insights with Becker's via email. 

Question: What will hospitals need to know and get ahead of if Roe v. Wade is overturned?

Editor's note: Responses were lightly edited for clarity and length.

Dee Fenner, MD. Chair of the Department of Obstetrics and Gynecology at Michigan Medicine (Ann Arbor): Hospitals and health systems will need to know the laws in their state, as there are many different restrictions being placed. At Michigan Medicine, we have been working for the past six months on a comprehensive plan to ensure our patients will be able to receive the care they need, whether in Michigan or a state that will allow abortion care. We are considering the impact on medical and surgical abortions, the risk of the life of the mother, our education programs, and the workforce demands of our university and community.

Adam Jacobs, MD. System Director of the Complex Family Planning Division in the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai (New York City): A Roe v. Wade reversal could change the national landscape regarding patient care and access to abortion, so it is vital that hospitals take a position that can inform their community, healthcare providers and staff. In this situation, hospitals will need to be prepared for an influx of patients seeking abortion services from bordering states with restrictive bans. Furthermore, healthcare providers will need to work in collaboration with their governance and legal colleagues to ensure the SCOTUS opinion is both fully understood and that any future state legislation is reviewed to protect the entire health system and continue high-quality, equitable patient care.

Melissa Simon, MD. Vice Chair for Research in the Department of Obstetrics and Gynecology and Director of the Center for Health Equity Transformation at Northwestern University Feinberg School of Medicine and Cassing Hammond, MD. Associate Professor of Obstetrics and Gynecology and Director of the Section and Fellowship in Complex Family Planning at Northwestern University Feinberg School of Medicine (Chicago): If Roe is overturned, we will be in uncharted territory. Overturning Roe is going to impact every sector of society. At the state level, Illinois will likely experience a surge in abortion volume, though the extent of the surge remains unclear. Illinois will also receive increased requests to train residents and fellows from states where abortion is restricted. Most patients will be able to undergo procedures within the community, but some will have medical issues that require hospital-based care — care that is often less accessible and prohibitively expensive for those lacking insurance coverage. While community providers will bear the brunt of the surge, navigating patients between community and hospital-based providers will present an acute and novel challenge. 

Beyond women and their providers, health systems will undoubtedly shoulder a high portion of this burden. The surge will impact medical service lines traditionally less focused on abortion such as emergency departments and labor floors. Some individuals will be forced to carry pregnancies that may substantially harm the pregnant person themself, which will increase high-level, complex health system care. The increase in acuity of care will undoubtedly drive potential for increased poor outcomes and will drive up healthcare costs. Consequently, maternal mortality rates will also mirror this rise in complex and emergency care. Regardless of the ruling, abortions will not stop, and thus there will be a potential rise in complications if abortions are performed in unsafe spaces.

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