Doctors seek more guidance from Louisiana officials as new maternal care drug law takes effect • Louisiana Illuminator

NEW ORLEANS — Louisiana’s new law reclassifying pregnancy care pills as controlled dangerous substances took effect Tuesday, creating an outcry from the state’s medical community as doctors, pharmacists and hospital lawyers try to determine how to navigate new protocols. The drugs are being targeted because they can be used to induce abortion.

The law, which Republican Gov. Jeff Landry signed in May, makes misoprostol and mifepristone Schedule IV drugs, adding the requirement that they be locked, securely stored and their use closely documented. Health care providers have shared worries that any delays in access to misoprostol, which has multiple other uses beyond medication abortions, could create life-threatening delays for patients bleeding post delivery. 

The New Orleans health department hosted a learning session for physicians and pharmacists Sept. 19 about the law, Act 246. After the session, city health director Dr. Jennifer Avegno sent a letter to Louisiana Surgeon General Dr. Ralph Abraham and Health Secretary Michael Harrington compiling some of the most pressing questions and seeking guidance. 

“We believe it is imperative that these questions are submitted to LDH for any necessary clarification, guidance, or additional rule-making, so that providers have legally accurate and medically appropriate tools,” Avegno wrote in the letter, a copy of which The Illuminator obtained. 

Avegno is also in charge of an investigation into the law’s impact and whether it leads to any delay of care issues. The city’s health department created a reporting form health care workers and patients can complete to submit confidential information about any challenges.

Questions from last month’s webinar included asking for photographs of and specific instructions for officially approved and legal “secured areas” where the drugs can be stored for immediate access. The Louisiana Department of Health issued a memo in early September suggesting hospitals store the drugs in a “locked or secured area of an obstetric hemorrhage cart.”

So far, hospitals have not found this to be a feasible option because of the logistics involved with tracking and storing controlled substances. Instead, they are storing misoprostol in passcode-protected storage lockers made by Pyxis Corp. and named after the company. They are located outside of patient rooms.

Another question dealt with the word “abortion.” Medically-speaking and outside of political context, abortion can mean a miscarriage and pregnancy loss. There are several common, legal and medically appropriate diagnosis words that include the word abortion, including missed abortion, incomplete abortion and spontaneous abortion. 

While elective abortions are almost entirely illegal in Louisiana, misoprostol is still safe and legal for use in miscarriage management. But providers are worried that pharmacists, particularly those in rural areas, might be fearful of filling any prescriptions with the word “abortion” in it. 

The webinar panel encouraged additional education and outreach to make sure pharmacists and patients understood the distinction, and they asked the state health department for additional clarification.

Act 246 has gained nationwide attention, with Louisiana becoming the first state to make these medications controlled substances.

Maternal fetal medicine specialist Dr. Jane Martin of New Orleans wrote a commentary for StatNews, a health and medicine periodical, criticizing the reclassification of the drugs.

“A pregnant uterus receives 700 milliliters of blood per minute leading up to delivery, and the same amount can be lost each minute if a postpartum hemorrhage is not adequately treated immediately after being recognized,” Martin wrote. She describes how the original version of the bill criminalized coerced abortion and had wide support, but it took “an unprecedented turn” when amendments were added to reclassify pregnancy care pills as controlled dangerous substances. 

“I didn’t choose this profession to navigate legal obstacles, but to provide compassionate care during some of the most pivotal and vulnerable moments in someone’s life,” Martin added, saying that restricting access to misoprostol puts her patients in “unnecessary danger.’ 

“The delivery room is a place of healing, not hesitation,” she wrote “The last thing I need to be asking myself during an emergency, while running through my mental checklist that I’ve used in every postpartum hemorrhage I’ve ever attended, is ‘Could I go to jail for this?”

Martin isn’t the only one speaking out forcefully. Dr. Veronica Gillispie-Bell, the state health department’s leading expert on maternal mortality, penned a column for  MSNBC voicing her opposition. She practices medicine in the New Orleans area.

“As an OB-GYN whose patients expect me to give the best care to them (and their babies), I’m convinced that this new law endangers them,” Gillispie-Bell wrote.  “Lawmakers must engage with physicians to craft evidence-based policies that protect our patients, not increase their risk of death.

Republican Attorney General Liz Murrill and anti-abortion group Louisiana Right to Life have accused the news media of fear-mongering and spreading ”disinformation” about the controversial law.

“The appropriate and professional way to obtain answers to questions about the law is to ask them, not to create and perpetuate confusion,” Murrill said Tuesday, when the law took effect, in a video address. 

Avegno sent the letter with doctors’ questions Sept. 26 but has yet to hear back, she said.

This report was published in partnership with the Pulitzer Center’s StoryReach U.S. fellowship. Read more of our coverage.