LINCOLN — A pregnant woman seeking a medication abortion in Nebraska would be required under a new bill to attend an in-person appointment with her physician before receiving the drugs and a follow-up appointment after to document any “adverse events.”

Legislative Bill 512, by State Sen. Rick Holdcroft of Bellevue, has proposed the Chemical Abortion Safety Protocol Act. It would apply to any “abortion-inducing drug” that has the specific intent of terminating a pregnancy.

Other drugs, medications or substances that can be known to cause an abortion but are provided for other medical reasons, such as chemotherapy meds, would be excluded.

“The purpose of the bill [is] just to try and ensure we’re providing good health care for our women who are receiving abortions,” Holdcroft told reporters after introducing LB 512.

Some reproductive health doctors for Nebraska women said the proposed restrictions appear aimed at making it harder to get a medication abortion in the state.

New requirements and documentation

State law already prohibits telemedicine for receiving abortion medications, but Holdcroft said his goal is to prevent physicians from flying into Nebraska just to prescribe the drug, then leave.

LB 512 would add additional steps before a physician could give a woman an abortion-inducing drug in the state:

• Independently verify the woman is pregnant.
• Determine whether the woman has an ectopic pregnancy.
• Document the gestational age and location of the pregnancy.
• Determine the woman’s blood type and, if the woman is Rh negative, offer to administer Rh immunoglobulin to prevent Rh incompatibility, complications or miscarriage in future pregnancies.

The physician also would need to schedule an in-person follow-up visit with the woman who received the drug between three and 14 days after it is given. The physician would need to confirm the woman’s pregnancy is completely terminated and document any adverse events

An “adverse event” could include shock, heavy or prolonged bleeding, hemorrhage, aspiration or allergic response, infection, sepsis, pelvic inflammatory disease or missed ectopic pregnancy.

That report would need to be sent to the Nebraska Department of Health and Human Services, similar to current reports for non-medication abortions in the state.

A woman who receives an attempted or successful medication abortion could not be held liable under the new law.

‘Effectively a total ban’

Dr. Elizabeth Constance, a reproductive endocrinologist in Omaha, said the bill doesn’t ban major drugs like mifepristone or misoprostol, the most common two-drug regimen for a medication abortion. 

“But I do think it puts so many onerous and non-standard of care restrictions on their use that it will effectively be a total ban on medication abortions,” Constance said in a text. “Effective ban if not an outright one.”

Constance said the bill doesn’t explicitly include an exception for the targeted drugs to be used in miscarriage management, which they often are.

She said that could complicate access to care, including in emergencies, as the drugs are more highly regulated. That includes misoprostol, routinely used to treat postpartum hemorrhage.

Mifepristone is also used to treat endometriosis, fibroids or hyperglycemia associated with Cushing’s syndrome. Misoprostol can also be used to treat ulcers. Both medications can be used to induce labor.

Dr. Emily Patel, a maternal-fetal medicine specialist in Omaha, said other medications can be obtained without someone ever seeing a physician but are more dangerous, such as certain over-the-counter pain relievers or erectile-dysfunction meds that could be bought online.

Patel said the characterization that physicians are flown in to provide abortions is “overblown,” though some physicians do travel to provide general care, like she does to Hastings or Fremont.

‘Pretty slipshod operation’

Holdcroft said he didn’t know whether mifepristone could be used for other medical purposes but that his intent isn’t to ban medication abortions, just to tighten up the medical care.

He said if his bill needs amendments, he’s willing to look into any needed changes, but he thinks LB 512 has support for an issue that isn’t “that far a stretch.”

“I just want to make sure we’re providing safe procedures, and that’s not what we’re seeing,” Holdcroft said. “We’re seeing a pretty slipshod operation, in my opinion.”

Patel said the assumption patients aren’t receiving standard-of-practice care is “blatantly false.” 

“It is not standard practice to have mandated follow ups,” Patel said in a text, “nor is it standard to have to report how we practice medicine to the state.”

LB 512 was among 96 legislative bills or constitutional amendments introduced Tuesday, including:

• LB 443, by State Sen. Brad von Gillern of Omaha, would outlaw “unlawful squatting,” defined as the intent to claim ownership of someone’s land or property by refusing to leave.
• LB 457, by State Sen. Eliot Bostar of Lincoln, would require school districts and licensed child care facilities to design policies to prevent and respond to serious allergic reactions — anaphylaxis or anaphylactic shock. It would also limit the cost that an insured individual must pay for a two-pack of medically necessary epinephrine injectors to up to $60, regardless of the type of brand.
• LB 463, by State Sen. Beau Ballard of Lincoln, would require school districts to develop a cardiac emergency response plan and place automated external defibrillators on school grounds. The bill would create up to $1.5 million in grants to fund the plans.
• LB 475, by State Sen. Merv Riepe of Ralston, would classify tianeptine — known as “gas station heroin” — as a controlled substance in Nebraska. The drug had previously been used to treat depression in dozens of countries, and even though it is illegal to market or sell the drug, it is not on the list of federally controlled substances.
• LB 500, by State Sen. Wendy DeBoer of Omaha, would create a 21-member School Financing Review Commission for an in-depth review of how K-12 schools are funded in the state.
• LB 513, by State Sen. Carolyn Bosn of Lincoln, would increase the salaries of justices on the Nebraska Supreme Court by 4% each on July 1, 2025, and July 1, 2026. They would rise from $225,055.35 currently to $243,419.87 next year.
• LB 523, by State Sen. Margo Juarez of Omaha, would create a stipend program for student teachers, who could apply for stipends at $4,000 per student-teaching semester. Most student teachers are not currently paid by their districts.
• Legislative Resolution 22CA, by State Sen. George Dungan of Lincoln, would enshrine a right to a clean and healthy natural environment and that political subdivisions serve as trustees of Nebraska’s natural resources in the Nebraska Constitution.
• LR 25CA, by State Sen. Ben Hansen of Blair, would amend the Nebraska Constitution so lawmakers are paid the state’s minimum wage, which will rise from $13.50 to $15 next year, before annual cost-of-living increases. Lawmakers would also receive health insurance. Senators currently receive a $12,000 salary, as set in the Constitution. The proposal does not set a floor or ceiling for how much lawmakers would be paid.