August 23, 2016 — Physicians working at the Medical University of South Carolina (MUSC) have been forced to send patients seeking abortion care to other states because of a new South Carolina law (Act 183) banning the procedure at or after 20 weeks of pregnancy, the Charleston Post and Courier reports (Sausser/Prabhu, Charleston Post and Courier, 8/20).
The law, signed in May, requires physicians to determine the length of gestation prior to providing abortion care, except in cases of endangerment to a woman's life. The legislation also includes an exception if the physician determines that the fetus is nonviable. It does not include exceptions for cases of severe fetal anomalies, rape or incest.
The law calculates gestation as weeks post fertilization. Physicians convicted of violating the law could face fines of up to $10,000 and/or potential prison time of up to three years.
The legislation affects abortion care provided only at hospitals in the state. The three abortion clinics in the state do not provide abortion care after 15 weeks of pregnancy (Women's Health Policy Report, 5/26).
Law deters physicians from providing needed care
Scott Sullivan, director of maternal-fetal medicine at MUSC and chair of the South Carolina chapter of the American College of Obstetricians and Gynecologists, said MUSC is sending women to out-of-state providers, even in instances of life endangerment or a nonviable fetus, because the hospital's legal team cannot determine how to ensure providers offer care in compliance with the law. Prior to the law's implementation, MUSC provided abortion care only in instances of life endangerment or fatal fetal anomalies.
Sullivan explained that providers only in very rare instances can tell a patient with complete certainty that a fetus is not viable. He noted that in certain situations, an infant with a fatal fetal anomaly may live for a short time after birth.
Similarly, Sullivan said the law complicates care for a woman who becomes ill during pregnancy. For example, he said pregnancy could induce organ failure in a woman diagnosed with cancer, but that providers would be unable to provide abortion care if the woman was more than 20 weeks pregnant.
Sullivan said, "We've had [women seeking abortion care] go to Georgia, New Jersey and Colorado ... And of course we've had some women who don't have the money for that. They just can't access the service."
Noting that at least 13 other states have enacted similar bans, Sullivan added that providers in other regions are tackling the same issues. "That happens all the time, unfortunately," he said.
Separately, a spokesperson for MUSC's legal team said the law's language was unclear. "There is some debate about how the 'post-fertilization age' is calculated," the legal team said, adding, "Further, based on the plain language of the statute, exceptions are extremely rare both as they relate to a fetal anomaly and as they relate to medical emergencies for the [pregnant women]. As a result, the physician's ability to provide appropriate care to the [woman] and [fetus] may be compromised."
State House Minority Leader Todd Rutherford (D), who opposed the ban when it was proposed, reiterated his concerns about the legislation. "Part of the reason why (MUSC's) in-house attorneys would be having problems is because that's what happens when the Legislature tries to play God." He added, "Supporters of the bill demonstrate a total disrespect for women and their health care, and believe 170 people sitting in Columbia know better than a physician in a room" (Charleston Post and Courier, 8/20).