Why doctors are decrying Tennessee's 'dangerous' abortion ban as lawmakers debate change

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Dr. Michael DeRoche’s patient was already a mother to four when her fifth pregnancy went wrong.

The patient’s embryo implanted in her cesarean section scar, a form of ectopic pregnancy that is rarely viable and can cause life-threatening complications, including severe hemorrhage and death.

“My patient was frightened, did not have the resources for a prolonged hospital admission, had no support to care for her children, and did not want to die and abandon her children,” DeRoche said.

DeRoche, formerly a Franklin-based maternal fetal medicine specialist who now consults on high-risk pregnancies across Tennessee, knew what was needed — termination of the ectopic pregnancy.

But under Tennessee’s total abortion ban, which requires physicians to knowingly commit a felony when performing an abortion to prevent the death or severe injury of a pregnant patient, hospitals and physicians are wary of making what were once routine, if heartbreaking, decisions.

The patient ultimately was treated in Mississippi, a state with staunch anti-abortion leadership which drove the U.S. Supreme Court case last summer that ultimately overturned the landmark Roe v. Wade decision. But even there, doctors can legally perform abortions for certain medical emergencies.

"The state has chosen zero lives over one life right now, in the cases where we know the baby won’t survive,” DeRoche said. “That’s not a pro-life position. But that’s what the state is doing with these lives.”

Tennessee is one of only three anti-abortion states without legal exceptions to protect a patient’s life. Six months in to the total abortion ban, state lawmakers are now deep into negotiations over adding certain medical exceptions to the law.

Exception push in legislature

The exceptions push has shown momentum in the House, where Speaker Cameron Sexton, R-Crossville, has openly backed the effort and provided cover for members of his Republican caucus supportive of changes.

But the effort faces an uphill battle in the Senate amid an opposition campaign from Tennessee Right to Life and reticence from Lt. Gov. Randy McNally, R-Oak Ridge, to add changes to the law. Gov. Bill Lee, a fellow Republican, also says he's comfortable with the current law, which provides an affirmative defense for doctors who might be charged for abortions performed to save a patient's life.

The bill with the most momentum rose from the House, where Sexton publicly chastised Right to Life’s lobbyist in an early committee meeting over what some saw as “political threats” to lawmakers’ anti-abortion bona fides.

The Senate version, SB 745, was supposed to be heard in the crucial Senate Judiciary Committee on Tuesday but sponsor Sen. Richard Briggs, R-Knoxville, delayed it for two weeks amid rumblings it didn’t yet have the votes to advance.

Briggs, a physician, has been among the most outspoken of his colleagues about the critical implications of the state’s current law, pushing Right to Life to disendorse him last fall.

The Senate delay has also slowed HB 833, which was delayed in a full House Health committee on Wednesday despite overwhelming, bipartisan support at its initial subcommittee hearing last month. Democrats have called the narrow legal exceptions outline in the bill the "minimum" action needed on the issue but have pledged to support the Republican-sponsored bill.

Related legislation:Tennessee bill to add rape, incest exceptions to abortion ban falters

In email blasts in recent weeks, Right to Life has urged its supporters to actively oppose the exceptions bill through emails and calls to lawmakers.

"The current law has been in effect for nearly six months and is working as the legislature intended,” Tennessee Right to Life said in a statement. "An estimated 900 unborn children are being saved each month from abortion in our state and no doctors have been charged for saving a woman’s life. This law should be allowed to remain strong in order to save our most vulnerable citizens."

Trying to avoid 'catastrophe'

Dr. Laura Andreson, an obstetrician-gynecologist from Franklin, didn’t consider herself particularly politically active until last year, when she began speaking out about the potential implications of limited abortion access on women’s health care and her job, which treats high-risk patients and pregnancies.

She’s since joined a coalition of physicians lobbying lawmakers for changes, traveling to Nashville when she’s not on call and trying to learn the ropes of legislative politics while juggling her caseload.

‘When it's your person that's in the ER for 10 hours waiting for the lawyers to decide if they can treat an ectopic pregnancy, it's a very different situation than when you're sitting up here talking about it in a committee hearing,” Andreson said.

Andreson outlined the case of a recent patient diagnosed with cervical insufficiency. Before Tennessee’s ban, Andreson would have presented the options to her patient, which included pregnancy termination or stitching the cervix, which has risks of infection and other complications.

The cervical issue eventually led to the patient’s amniotic fluid slowly leaking, a condition Andreson said presented a significant risk of bleeding or infection if care is delayed.

In depth:How Gov. Bill Lee's push for $100M in grants is putting pregnancy centers in the spotlight

“It's not patient abandonment, but it feels like you're washing your hands (of the situation.) That's just a really ugly feeling because you're used to helping your patients through the hard times. You're not used to just saying, ‘Okay, well, I hope things work out,’" Andreson said. “And that's kind of where we're stuck right now."

Another recent patient, who Andreson had seen through other previous pregnancies, began experiencing bleeding issues. She ultimately came in with what Andreson called an "inevitable abortion," when irreversible symptoms will eventually result in a miscarriage, but the fetus still had a heartbeat.

"If we had just watched her bleed, she wouldn't have lived," Andreson said.

Right to Life currently opposes proposed exceptions to the law as they would allow doctors to make "subjective" calls on what constitutes a medical emergency, lobbyist Will Brewer told a House subcommittee in February.

"The Human Life Protection Act that was passed by the General Assembly in 2019 is the preferred language. It protects the right to life of all unborn children in our state with a provision for those situations when the mother’s life is in danger," Right to Life said. "Although Tennessee Right to Life has made it clear that we would not oppose efforts to simply clarify language in the current law, HB 883 does much more than clarify."

Some high-risk conditions will "work themselves out," Brewer said, and anti-abortion advocates worry changes to the law would allow doctors to proactively terminate pregnancies for conditions that could be waited out to "see how it goes."

Doctors say this is a fundamental misunderstanding of how medical practice works, with Andreson arguing she needs the ability to prevent issues from developing into full-blown crises.

DeRoche compares the conflict to that of air traffic controllers. It isn't sound policy to wait until two planes are about to collide before taking action, DeRoche said, but instead to move them out of the way "before there's a problem to prevent a catastrophe."

Would you criminalize air traffic controllers for moving a plane out of the way too early, DeRoche asks?

"If you think in those terms, you’d say this is the stupidest thing you’ve ever heard," DeRoche said. "We’re trying to avoid that same catastrophe.”

It’s not a perfect metaphor when you have two or more lives at stake, DeRoche said, but doctors must be allowed to head off disaster when the mother’s life is threatened.

"In pregnancy, it’s the only branch of medicine where you can potentially have a second life come out of it, but it’s not guaranteed,” DeRoche said. “The only guaranteed life we have is mom's."

'I'm not pro-abortion, I’m pro-woman'

Allie Phillips, a Clarksville resident, describes herself as an avowed abortion rights defender, but she never thought she'd seek an abortion herself. Phillips, who already has one daughter, began trying to conceive with her husband Bryan last fall.

The couple quickly became pregnant in November. Though they had some early concerns about the pregnancy due to Phillips’ previous gastric bypass surgery, they excitedly told friends and family, found out they were having a daughter and chose a name, Miley Rose.

But a routine anatomy scan in mid-February led her doctor to refer her to a high-risk specialist, who delivered heartbreaking news after a follow-up scan. Miley Rose was measuring a month behind schedule. Her kidneys were undersized, her heart had developed only two chambers, and there were signs of a serious condition where the brain isn't correctly formed.

“When she started talking about her brain, I felt all the blood leave my face,” Phillips said in an interview with The Tennessean. “I felt my heart sink to the back of my chest. I was there physically, but I felt like I was having an out-of-body experience.”

It’s unlikely Phillips could carry to term and would be at risk for miscarriage and other complications for the remainder of her pregnancy. Were she to deliver at term, the baby was unlikely to survive or would live just a short time on hospice care.

These weren’t options Phillips and her husband wanted for their family. Instead, Phillips plans to seek out-of-state abortion care next week, something she can’t do in Tennessee. She’s lucky to have family support to care for her older daughter, Phillips said, but it’s still an immense financial cost on top of navigating the grief and depression of of losing the life they dreamed of for Miley.

On top of handling medical logistics, Phillips must also figure out how she might be able to transport Miley’s remains home.

“It’s extremely inhumane to force anybody out of their own home to have to seek healthcare. It’s wrong on so many different levels,” Phillips said.

Phillips has shared her news on social media, which led to an onslaught of support but also criticism that she should continue her pregnancy until a point of no return, a risk she doesn't want to take with a daughter to care for at home.

“I have a daughter here. I can get pregnant again — that’s not saying Miley’s life didn’t matter, that we don’t think she should live — but if there is a choice to be made in a moment like that, I have more to lose than the fetus does,” Phillips said. “In situations like mine, when there is no chance of viability, when there is zero chance of treatment, when it’s not going to happen, why would you still say a woman should have to go through pregnancy? Why would you force — and it is force — pregnancy, why wouldn’t you allow termination?"

There's an undercurrent of fear threaded through Tennessee's medical community at present as no one "wants to be the first one they go after" under the new law, DeRoche said. At least one maternal fetal medicine specialist, Dr. Leilah Zahedi-Spung, has already left the state over fears of practicing medicine under the law.

"It makes me angry. It disgusts me. But it truly saddens me that for 20 years, I’ve tried to get patients through their pregnancies," DeRoche said. "I've spent my life delivering devastating news and trying to help people, regardless of the outcome of the pregnancy, get through the pregnancy."

"I'm not pro-abortion, I’m pro-woman. I’m talking about appropriate medical care and a bad law. These are bad laws."

Though Right to Life points out that no doctor has been charged under the new law, DeRoche said this is cold comfort when doctors must knowingly choose to commit a felony to practice what they know to be good medicine.

"We’re trying to get two lives out of there. When we can’t, I’d rather get one. And the state is telling me if I choose one, they could throw me in jail," DeRoche said. "It can’t be that bad of a law because no one has been charged yet? That is dangerous."

Reach Melissa Brown at mabrown@tennessean.com.

This article originally appeared on Nashville Tennessean: Tennessee abortion ban: Doctors decry law as changes debated