Doctors refusing potentially life-saving abortion treatment over legal fears, Indiana doctor says

Indiana’s new abortion law will go into effect on Sept. 15, which would ban abortion in nearly all cases with limited exceptions including rape and incest.

Indiana was the first state to pass new legislation restricting reproductive rights after Roe v. Wade was overturned on June 24.

Dr. Katherine McHugh, a practicing doctor who provides abortion services in Indiana, spoke with ABC News’ podcast “Start Here” about how her practice has been shifting following the overturning of Roe v. Wade and how the new state law will impact her practice.

START HERE: Dr. McHugh, can you just tell me about where you work and what the last couple months have been like?

MCHUGH: Yeah, absolutely. Thanks so much for having me and for taking on this issue. I am primarily in Indianapolis, although I travel all over the state of Indiana providing abortion care. And over the last two months, we have seen a real change in our patient demographic. We've seen an influx of patients from outside of the state, they are coming to us from other states that have already banned abortion.

And this has all been in the setting of anticipating an abortion ban in Indiana as well. So we've been able to increase access over the last few months and been very fortunate that we have been able to take care of a lot of people that needed healthcare and at the same time, working with collaborative networks and strengthening those referral places because we know that we will be sending our own patients away in just a few short weeks.

The patients that we're seeing are the ones that can afford childcare, that can afford the gas money, they can afford to take time off of work. We're also seeing much earlier patients, patients whose pregnancies are much earlier in their gestation. People are scared. People are nervous about what it means to be pregnant in a place or in a time when all of their options are not available to them. So that is probably the most common thing that I talked about with patients, is how scared they are to be pregnant.

START HERE: That makes me curious, if there's this fear of pregnancy from women seeking abortions, I'm wondering about the fears of women who are pregnant who aren't seeking abortions or don't know if they want an abortion. Is it getting more complicated, for example, for women I was mentioning earlier, who are suffering miscarriages or other abnormalities early on?

MCHUGH: That has been a complicated topic for physicians and certainly a very challenging experience for patients. Patients who have a miscarriage that is diagnosed, but the fetus still has a heartbeat– that is very complicated in states like Kentucky and Ohio that have what they're called heartbeat bans, which means that they can't have an abortion after the time that you can see fetal cardiac activity. So that means that even if the patient is bleeding, even if the cervix is open, and there is no way that the pregnancy is able to continue, they cannot interfere, the physicians cannot interact.

START HERE: Oh, there's still technically a heartbeat.

MCHUGH: There is a heartbeat even though there is not a viable pregnancy. I've seen several people coming from surrounding states where the physicians in those states are unclear enough about the legality of interfering in what is, in the legal sense, a continuing pregnancy even though medically speaking it is not a viable pregnancy, that the patients have to come to Indiana where that doesn't exist yet. It doesn't have that same legal impact here in Indiana.

I saw a patient recently who came to me from out-of-state and she had a situation where she was pregnant, and she was bleeding so she went to an emergency room and had an ultrasound to evaluate what was going on. What the doctors there saw was that her pregnancy was inside the uterus, so it wasn't an ectopic pregnancy, but she had significant bleeding and the cervix had started to open. The pregnancy already had and still had a heartbeat. She was about seven weeks pregnant.

So at this point the doctors were faced with a really challenging moment where they didn't know what they were allowed to do legally. Could they offer what is standard of care, which would be to offer some sort of termination of this pregnancy? And they decided they could not. The reason that this situation would warrant terminating a pregnancy is called an inevitable abortion or a pregnancy that is not able to be continued. And in the intervening time, the woman or the pregnant person can lose a lot of blood and become infected, can get very very sick and can even die from this.

START HERE: So it feels like you’re sentencing this woman to, best-case scenario, a very painful miscarriage, worst-case scenario is much worse than that. And those are the two options.

MCHUGH: Exactly right. And so this is a very common scenario we diagnose inevitable abortion all the time. For this particular patient, she was able to come to Indiana, she saw me in one of my clinics, and we were able to provide that pregnancy termination for her, save her uterus and potentially save her life. But in her home, state physicians did not feel that they were legally able to do that. So they sent her away.

START HERE: Wow, I see and then they come to you because right now it's legal where you are. But on September 15th, I believe, this new law goes into effect in Indiana. It outlaws virtually all abortions that are not the result of rape or incest or that endanger the life of the mother. Even in those circumstances, though, there are timelines to deal with. And I found this interesting, there are also timelines for fetal abnormalities, right, what happens in those situations?

MCHUGH: Yeah, great question. That part of the new law echoes our previous laws, where we had the ability to terminate a pregnancy up to 22 weeks. However, what's different is under the new law, if the government doesn't agree with the medical opinion that this was a lethal anomaly, suddenly instead of it just you know, quote unquote being a medical decision that is controversial, now it's a felony. So this becomes much more complicated to navigate from a medical perspective. You know, it's already very complicated and very emotional to tell a patient with a desired pregnancy that the baby they're carrying is not going to live, that they are carrying a baby with profound anomalies that is not able to live outside. That is a devastating day for everyone involved.

And now we are also faced with telling patients that offering them their options which include abortion, which is a compassionate way to treat this pregnancy and this fetal anomaly, and yet if the government does not agree with our medical diagnosis or medical plan of care, treatment plan, then we have the threat of a felony charge which carries six years in jail.

START HERE: So if the stakes are that high for someone like you all of a sudden, what are you going to do starting September 15th?

MCHUGH: After this ban goes into effect, I will no longer be able to provide abortion care in Indiana. This is an integral part of my practice and reason for going into obstetrics and gynecology and so I will move that part of my practice out of state.

START HERE: Oh, you're gonna have to like move your practice because of this?

MCHUGH: Yeah, the closest state to me is Illinois, so I will work to find a place in Illinois where I can work. The rest of my career will also adjust, to accommodate for the travel and so forth.

START HERE: It’s the moment that your state becomes one of the states that you have been helping up until now.

MCHUGH: Exactly right.

START HERE: Dr. Katie McHugh in Indiana, for now, thank you so much.

MCHUGH: Thanks so much for having me.