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View Diary: Mich GOP introduces bill mandating invasive transvaginal ultrasound probe for women seeking abortion (113 comments)

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  •  You're right about all of that (4+ / 0-)

    Since 2011, we've had essentially the same law in Texas, where I am on staff at a clinic providing abortion care. It goes without saying that I have a big problem with bills lke this one. However . . .

    Despite viral propaganda to the contrary -- and yes, "we" do that, too -- a skilled practitioner usually does not need a vaginal probe to perform the required scan. Even if it does make a great headline.

    And it makes no difference to a woman's decision, anyway. The sponsors of these bills really do seem to think that women will run screaming out of a clinic after a sonogram, but of course they are completely delusional. As one of our own patients said shortly after implementation of the Texas law, "I've got four little boys. Does that dumbass Rick Perry really think I don't know what a sonogram looks like?"

    Complaints about mandated "medically unnecessary" sonograms just leave me shaking my head. It would be extremely foolhardy and irresponsible for any provider of abortion care to perform that procedure -- by any method -- without a preliminary ultrasound. It does not increase the cost of care. it's already included in the overall fee because it has been the accepted standard of care for over 20 years.

    The part of the law that is truly difficult for women to deal with is the imposition of a waiting period after the sonogram is performed. It means two (sometimes lengthy and expensive) trips to the clinic, two days off work, two days of child care, etc. How high does the mountain have to be before she just can't climb it anymore?

    These more sensational measures will continue to be titled and marketed to the public by "them" as sonogram laws designed to protect women, and will continue to be objected to by "us" based mostly on inaccurately focused exaggerations. Some will succeed, and some will not.

    In the meantime, woman-controlling laws limiting access to safe abortion care by other means are now in effect in every state except Oregon.

    I'm waiting for the day when we say "Hell NO!" without sensational claims and titillating imagery from the carnival barkers on both sides -- "Hell NO!" just because it's wrong.

    I should live so long.

    "Texas is going to shrink government until it fits into a woman's uterus." -- Texas State Sen. Leticia Van de Putte

    by moiv on Wed Feb 06, 2013 at 11:24:05 AM PST

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    •  This law... (4+ / 0-)
      Despite viral propaganda to the contrary -- and yes, "we" do that, too -- a skilled practitioner usually does not need a vaginal probe to perform the required scan.
      This law specifies that the ultrasound technique used be the one that 'provides the best possible image'. Not 'provides an adequate image' or anything like that, but 'the best possible'. If (I'm not a medical professional) the average quality of a transvaginal ultrasound really is better than that of an abdominal ultrasound, then a physician who uses the latter really is breaking this law.

      May not be the case in Texas, but if the law is being read correctly, it certainly does seem to be true here.

      •  The average quality of the image (2+ / 0-)
        Recommended by:
        MichiganGirl, SneakySnu

        most often depends on the average quality of the machine and the operator. Our law also specifies that we use best practice in all aspects of the scan--in both sound and image quality.

        If no sac is visible on abdominal scan, a vaginal scan may be indicated -- and that was the case even when these laws were still nothing but some jeebatollah's pregnancy porn fantasy -- but in a patient with normal anatomy, experienced ultrasound operators usually can identify and measure a sac at 5mm. That's only a few days after a missed period.

        Ultrasound images are part of a patient's record. In addition to observing our practices in real time, state inspectors have access to all records. And please believe that the Texas state government licensing inspectors cut us no slack at all.

        "Texas is going to shrink government until it fits into a woman's uterus." -- Texas State Sen. Leticia Van de Putte

        by moiv on Wed Feb 06, 2013 at 12:56:16 PM PST

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      •  Actually, the best possible scan would come from (1+ / 0-)
        Recommended by:
        moiv

        cutting open her belly and sticking the probe directly in the opening as there would be no cervix to get in the way.  Of course, the woman would not be allowed any sedation (though an epidural should be fine) as that would interfere with her ability to fully understand the scan.

        Yes, those people are that evil that they would probably try to argue exactly that in court.

        You have watched Faux News, now lose 2d10 SAN.

        by Throw The Bums Out on Wed Feb 06, 2013 at 01:37:22 PM PST

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        •  Anything that scares a woman (1+ / 0-)
          Recommended by:
          Throw The Bums Out

          so much that she's afraid to even think about having an abortion would probably appeal to way too many of them.

          And if they had their way, then they'd say it was her own fault if she ended up like this:

          God Forbid.

          "Texas is going to shrink government until it fits into a woman's uterus." -- Texas State Sen. Leticia Van de Putte

          by moiv on Wed Feb 06, 2013 at 02:46:29 PM PST

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    •  Yes they do, the law says that it has to provide (0+ / 0-)

      the best possible scan.

      You have watched Faux News, now lose 2d10 SAN.

      by Throw The Bums Out on Wed Feb 06, 2013 at 01:33:10 PM PST

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      •  All I can honestly tell you (2+ / 0-)
        Recommended by:
        Throw The Bums Out, SneakySnu

        is what I know from 20 years of providing care while complying with legal restrictions in my own state, and from intensive and ongoing communication with colleagues across the country.

        These laws have been implemented in several states, and their sponsors deliberately use the same wording, so that once a federal court has upheld the law in one state, all the others in a given federal district are unable to challenge the law in their own. For example, if Mississippi wins a case before the Fifth Circuit, Texas and Louisiana lawmakers introduce legislation with identical language, right down to the last comma.

        And until now, no state compliance agency has required a physician to employ a vaginal probe when s/he can obtain a high-quality image without it.

        Like anything else, that could change. But it hasn't happened yet.

        "Texas is going to shrink government until it fits into a woman's uterus." -- Texas State Sen. Leticia Van de Putte

        by moiv on Wed Feb 06, 2013 at 03:00:40 PM PST

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        •  Well nobody has challenged it yet but you can (0+ / 0-)

          bet that they will.  Also, what makes you think it will be a state compliance agency that would be enforcing it?  All it would take is a single police officer to go in and arrest the doctors on murder charges (because due to fetal homicide laws an illegal abortion is murder) for not using a vaginal ultrasound.

          You have watched Faux News, now lose 2d10 SAN.

          by Throw The Bums Out on Wed Feb 06, 2013 at 04:58:38 PM PST

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          •  The way it really is (0+ / 0-)
            Also, what makes you think it will be a state compliance agency that would be enforcing it?
            What makes me think that is 20 years of full-time experience in the provision of abortion care in an extremely hostile medicolegal environment. It's something that I arguably know as much about as anyone else who has ever posted here. You don't have to accept that statement if you'd rather not, but it is nevertheless true.

            I think that because of how state enforcement systems are set up for health care licensing and compliance. That structure has been in place for decades, in all states. That is simply how it works.

            Similar TRAP laws have been on the books in some states for years now, and of course various anti groups have made complaints, and tried to have clinics closed for alleged failure to comply. Clinics and physicians know this and prepare for it. After all, we have been dealing not only with threats of legal persecution and prosecution -- and of outright violence and other forms of terrorism -- for many years. We wade through protesters just to get into the office in the morning. They try to question patients before they enter the clinic, and again when they leave.

            For that reason, among many, everything we do as providers is meticulously documented to ensure compliance, from the time of the first phone call to the final follow-up exam. After all, any prospective patient could be an undercover antiabortion operative. In fact, that happens all the time.

            All that being said, there is no reason to suppose that any doctor or clinic will be legally harmed by these sonogram/waiting period laws. They serve only to intimidate and inconvenience women, and to make doctors do more paperwork. And, of course, to drive people on both sides of the divide into a frenzy.

            It's simple to close down clinics. All a state has to do is pass laws mandating requirements that are impossible to comply with. When states really get ready to shut clinics down, that is what they do. That ploy already has succeeded almost entirely in several states, and it well may happen in Texas this year.

            All the rest of it is theater.  

            "Texas is going to shrink government until it fits into a woman's uterus." -- Texas State Sen. Leticia Van de Putte

            by moiv on Thu Feb 07, 2013 at 06:25:15 PM PST

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          •  Here's an example of a clinic-closing bill (0+ / 0-)

            Alabama Lawmakers Fast-Track Bill to Shut Down Clinics While Yawning Through Testimony

            Wednesday's most pressing issue, however, was a House hearing on a Targeted Regulation of Abortion Provider (TRAP) law that could close down every clinic in the state by requiring changes to buildings that are not necessary, and a requirement that all abortions be performed only by physicians with both an Alabama state license and with admitting privileges to a local hospital.
            Simply mandating that all facilities qualify for ambulatory surgical center (ASC) licensing will close most clinics. The necessary modifications (and in most cases, new construction) usually cost at least $1million. Abortion is a low-cost procedure, and clinics don't have that kind of capital. In a state where the entire power structure is trying to close you down, obtaining such a high-risk loan is next to impossible. Even if you do have the money to rebuild, operation of an ASC is highly expensive, and the cost of the procedure would have to be increased to the point that almost no one could afford it anyway.

            Requiring doctors to have both an in-state license and admitting privileges in a nearby hospital is another way to shut a clinic down. In most states, doctors who provide abortion care are not admitted into the mainstream medical community. Many clinics even have to have their doctors fly in from out of state. While those physicians might obtain a state license to practice, there's absolutely no way that they can obtain admitting privileges at any area hospital -- especially since religious institutions have become such active shareholders in the hospital infrastructure. They raise the drawbridge, and that's the end of it.

            If a state passes both those measures, and if they then survive legal challenges, safe and professional care will disappear within its borders. It doesn't make for sexy headlines, but it works.

            "Texas is going to shrink government until it fits into a woman's uterus." -- Texas State Sen. Leticia Van de Putte

            by moiv on Thu Feb 07, 2013 at 06:57:11 PM PST

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