POSTED IN GILEAD: WHAT TO DO ABOUT THE END OF ROE V. WADE
EDIT: This was written at the time of the leaked draft opinion of the Supreme Court. The official decision was released today.
We weren’t supposed to find out. The decision was supposed to be out at the end of the term, and leaks from the Supreme Court are unheard of. But for some reason, someone wanted this to get out, and the fallout has been nothing short of earth-shattering.
Protests and finger-pointing are everywhere, and battle lines are being drawn for a fight that’s been brewing for 50 years.
If this decision holds, and all indications are that it will, 23 states of this country will be immediately banned from providing health care in the form of medical or surgical abortion. The penalties vary, but for people who perform the procedure, there can be criminal penalties, even felony-level.
In most of these states, there is no exception for the health and safety of the mother, or victims of sexual assault or trafficking. None. Many of these states have huge swaths of land making travel difficult for anyone who doesn’t have the money to go to a state where it is legal.
As when anything is made illegal, the result is going to be that people will still get what they need, they just do it illegally. And there’s where the problem is going to start. Unsafe medical care has huge potential for harm and infertility to patients.
The impact on EMS in a large part of the USA is going to be potentially big. In states where the procedure is legal, not much will change for you. Even so, we may be faced with some situations that even we never could have imagined in today’s world.
My goal here isn’t to change your mind on what you believe. I want you to think of the role you will play in a very vulnerable patient population, and give you some ideas on what you’re going to do when the time comes. In the end, we deal with human beings, and the trouble starts when we start thinking in the abstract.
And if this isn’t your thing, then feel free to stop here and move on to another topic. But for now, let’s look at this from three angles: medical, legal, and social.
The first is the medical side. I think one of the issues that we have with learning about OB/GYN in EMT and paramedic training is the fact that we just don’t see these things. Placental tissues are found early with basic prenatal care; stillbirths are rare because the patients have them addressed in the hospital and the same with many of the other issues. But with the laws that are sure to be put in place; we are going to start seeing these things again in the field. I’m personally brushing up on pelvic anatomy and pathology of OB/GYN emergencies, and I think we should all give it a look-see.
Know what “child-bearing age” really is; you’re going to be surprised. Know your first-line care for abdominal pain and sepsis, how to manage uterine bleeding, and brush up on your childbirth emergencies and neonatal resuscitation. This way you’re ready for all the possibilities.
What about the legal implications? Are we heading toward a Margaret Atwood-type spin-off situation? Probably not for now, although some of us may have to start thinking about our patients and their interaction with the police. And we need to think about what we are going to do and what we should do for our patients. Again, your belief system may vary. But if you’ve come this far; you’re at least willing to listen to this opinion.
Legally, our disclosures about patient care are listed by the Health Insurance Portability and Accountability Act (HIPAA-NOT HIPPA). HIPAA tells healthcare what they can and cannot release about their patients.
Generally speaking, EMS cannot disclose anything about patient care unless you are participating in treatment, payment, or operations. We can share protected health information (PHI) with providers and facilities involved in taking care of the patient. We can share it with the people and firms who do our billing and coders, for example, and we can share PHI for making our systems better (QA/QI).
So, does this mean you can and should share every piece of information with the local cops about your patient who may be having a GYN emergency secondary to a botched illegal abortion? Maybe not.
Law enforcement is allowed to get limited information to further the performance of their duties. One of the interesting things is that you cannot release PHI about incriminating activity if you are treating a patient who may be incapacitated for any reason; and it cannot be used against the patient.
Think about this: Ever comment on the scene of a motor vehicle collision along the lines of, “Hey guys! This guy is drunk as a skunk!”, or “I smell booze/weed/whatever!” That can be a violation under HIPAA (45 CFR 164.512(j)(1)(ii)(A), (j)(2)-(3)). While it’s probably a non-zero event that happens; it doesn’t make it legal.
There are certain laws in states that mandate that we report information to police about things like child abuse, firearms injuries, sexual assault, etc., and in areas where these laws exist, you may have to disclose information.
But that does not mean you have to do it right then and there. You need to check with your organization's compliance officer and look at the policy your agency has for releasing information. Depending on the agency, law enforcement may have to be notified through the compliance officer or a formal channel. This isn’t you. Your job here is to go through your chain of command for these instances and let the system work. Bottom line: you don’t have to be that person. And you have the law to back you up.
This doesn’t mean you have to go full protest mode and loudly refuse to cooperate. But you should follow your agency’s guidelines on releasing PHI. A simple, “I don’t know” goes a long, long way here. A good general rule: Provide what you are required to under the law and your policy, and nothing more.
Officer: “Hey, did she have an abortion?”
Me: “I don’t know. She’s sick.”
(DOORS close, AMBULANCE pulls away)
Easy peasy.
It’s not our job to do the police’s job. We take care of our patients. We report what we are legally obligated to, and they investigate and charge violations.
Remember, the more you get involved, the greater the chance you get called to court, where a defense attorney will pick apart every possible detail of your “investigative wisdom” to make you look stupid. Stick to what you know, and stay off the hot seat.
Socially, I think we have to realize that how we are regarded as clinicians will weigh in a large part of how well our patients trust us and will talk to us. If people don’t tell us the truth; we can’t do our job well. And if they think we will be on the phone with the police after patient contact; we risk a loss of confidence and trust that will be damaging at best, and unsafe at worst. I’ve worked in areas where EMS was regarded differently than the police, and it kept us safer. Because we didn’t judge, or at least the smart clinicians didn’t. We stuck to our role, treated everyone the same, and didn’t call out random violations for the police to handle.
Because it wasn’t our job. And in the end, it's not yours.
