Louisiana
Some Louisiana patients struggle to fill reproductive care prescriptions under new drug law • Louisiana Illuminator
A Lafayette woman needed to get a uterine polyp removed so that she could get pregnant. A woman from northwest Louisiana and another from New Orleans wanted to take long-term birth control measures
What do these three women have in common? They all need misoprostol to soften their cervix before undergoing routine medical procedures, and they all faced challenges trying to fill their prescriptions.
A new law reclassifying misoprostol and mifepristone as controlled dangerous substances took effect Oct. 1 in Louisiana. The medications were reclassified because they can be used in medication abortions, but they have several other prescribed uses. Misoprostol is often used ahead of medical procedures to soften the cervix and when women bleed profusely after delivery.
The new designation requires medical facilities and pharmacies to securely store the drugs and closely record their dispensing and use.
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In May, Gov. Jeff Landry approved a bill from state Sen. Thomas Pressly, a Shreveport Republican, to reclassify the drugs. Since then, doctors have voiced concerns that the law could lead to delays of care for patients, both in hospital settings and for outpatient procedures.
Misoprostol has already been pulled off of postpartum hemorrhage carts in Louisiana and locked away in medical cabinets outside of patient rooms.
A New Orleans-area OB-GYN spoke Friday with the Illuminator about an experience she had with a patient earlier in the day that began the night prior. She asked that her name not be used because her employer did not grant her permission to speak with a reporter.
“I had set her up for an office hysteroscopy to remove [a uterine] polyp. But in preparation for that, she needed to take a medication called misoprostol in order to help open her cervix up so that I could do the procedure more safely and more comfortably,” the doctor said.
The patient was traveling from Lafayette for a minimally invasive medical procedure, and the doctor called in a misoprostol prescription a few days ahead of the procedure. But when the patient went to pick it up Thursday night at her local pharmacy, she was informed her prescription couldn’t be filled.
“She’s just trying to get this procedure done in order to get pregnant,” the doctor said, exasperated. “They told her they do not carry the medication at all anymore. She was very upset.”
An independent pharmacy shifts protocol
Reached for comment Friday, a pharmacist at the Lafayette drug store explained he hasn’t regularly stocked misoprostol for a decade because his small independent drugstore does not see a lot of demand for the drug. When they receive a prescription for misoprostol, they usually get the medication – often just one or two pills – from a larger pharmacy nearby.
But when the pharmacist went to do that in this case, he was told the drug was a controlled substance, and this was no longer an option because of how the medication needs to be counted.
The Louisiana Board of Pharmacy, the profession’s state regulatory body, mentioned the new law in their July newsletter, and the state health department sent guidelines on the new law to pharmacies in early September. The Lafayette pharmacist admitted he had not been aware of them until this week.
The Illuminator is not identifying pharmacists or small businesses in this story for security reasons.
“Sometimes pharmacies may borrow from one another. But it being a controlled substance, you can’t do that,” the Lafayette pharmacist said. “You’d have to replace it with the exact same medication.”
The pharmacist said this means he will no longer fill misoprostol prescriptions, as it does not make sense for him economically because he rarely gets requests for it.
The OB-GYN sent the prescription Friday morning to a New Orleans-area Walmart pharmacist, suspecting it would be easier to access at a chain pharmacy. But when the patient showed up, she was told the medication was not available.
“She was like, ‘This is ridiculous,’”the doctor said. “She had to drive to all these places — she’s chasing it.”
The doctor then called fellow OB-GYNs in the area to find out if there were specific pharmacies they have used recently to fill misoprostol prescriptions. She eventually reached a local CVS that had the medication in stock. The patient’s procedure was delayed until later in the day because the doctor said she was fortunate to have flexibility in her schedule to accommodate the change.
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However, the doctor said she was frustrated that she, her staff and the patient had to dedicate time to hunting down the medication, which is on the World Health Organization’s core list of essential medicines.
Louisiana is the only state to designate misoprostol and mifepristone controlled dangerous substances, a designation most often used for highly addictive painkillers.
“This has such a huge impact on our practice,” she said. She plans to talk to her employer about whether or not they need to adjust their protocols to store the medication onsite.
Major pharmacies insist they haven’t changed policy
A pharmacist at the New Orleans-area Walmart where the patient was unable to get her misoprostol prescription filled told the Illuminator late Friday afternoon the medication was not currently in stock but could be ordered and delivered from another pharmacy with the correct diagnosis code — a process that usually takes a day.
Corporate representatives for Walmart did not respond to requests for comment.
Amy Thibault, a CVS spokeswoman, said Louisiana’s new regulations haven’t affected how the pharmacy chain handles the targeted drugs.
“There’s been no impact to misoprostol supply or how we stock the medication due to the state law,” Thibault said.
A Walgreens spokesman said the company has had no issues with the supply of misoprostol to any of its Louisiana stores.
“There has been no change in policy” since the new law took effect, Fraser Engerman said. “Stock is based on sales at each of our stores. If there is low volume at a store, it can be ordered for next-day delivery to the store.”
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Dr. Nicole Freehill, New Orleans OB-GYN, said obtaining misoprostol was challenging immediately after the U.S. Supreme Court overturned Roe v. Wade in June 2022, effectively ending elective abortions in the state of Louisiana.
“We did encounter push back immediately after … but that improved over time and working with pharmacists directly to reassure them we were not prescribing it for ‘illegal’ uses,” Freehill said in a text message. “I am fearful this new law will destroy a lot of that work.”
On Sept. 30, Freehill said she encouraged a patient with an upcoming intrauterine device (IUD) insertion to fill her misoprostol prescription that day — before the new law took effect Oct. 1 — in case of any confusion. But when Freehill sent the prescription to a pharmacy, she said the patient’s insurance provider requested prior authorization.
“Prior authorization is another level an insurance company puts in place, often due to the cost of a medication or service, it’s usually for brand-name drugs or imaging like MRIs,” Freehill said. “I have never seen one for misoprostol, neither had the pharmacist that I talked to.”
The patient was able to obtain the prescription but had to pay out of pocket for it in order to avoid waiting for the prior authorization, said Freehill, who reported the issue to the New Orleans Health Department. City health director Dr. Jennifer Avegno is conducting an impact study on the new law to determine if it’s leading to care delays or difficulties.
Avegno described the new state law as a “poorly conceived, medically and scientifically baseless law” and said she’s heard from patients and providers across the state about outpatient access to misoprostol being “delayed and denied.” The reasons behind the barriers they face are varied and include pharmacies no longer carrying the medication as well as prolonged waits for prescriptions to be processed, she said.
“As hundreds of health care professionals have warned for months, this has disrupted women’s ability to have routine procedures, manage miscarriages, and even receive fertility treatments,” Avegno said.
‘It’s really frustrating’
An obstetrician in northwest Louisiana, who requested anonymity because her hospital did not give her permission to speak with a reporter, said she had a patient who faced challenges procuring misoprostol last week.
“I couldn’t get a single pharmacy in [my area] to dispense misoprostol for an IUD insertion,” the doctor said.
The OB explained that prior to May, she hadn’t had issues calling in misoprostol prescriptions the day before a procedure. She submitted the prescription in question Tuesday for a procedure the next day.
Doctors criticize misoprostol guidance from Louisiana Department of Health: ‘It’s not helpful’
“Usually the pharmacies would have the medicine the next day or make adjustments pending dosage availability,” she explained, saying that in her experience pharmacists can often get deliveries secured overnight.
The patient was able to fill her accompanying Valium prescription, according to her doctor, but four area pharmacies the patient called told her they did not have misoprostol in stock. One family-owned pharmacy told the patient they were no longer carrying it, her doctor said The patient ended up getting the procedure without misoprostol.
The doctor said she had her staff follow up with five pharmacies in the area and said none had it readily available. Only two offered to order the medication.
Now the doctor said she is considering steps to keep misoprostol in her office so that she can dispense it to patients herself, hours ahead of a procedure.
“I counsel these patients on the pain they might experience with IUD insertion and offer them ways to mitigate it. So it’s really frustrating when I can’t hold up my end of the bargain,” the physician said.
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If you’ve experienced challenges seeking reproductive health care in Louisiana, particularly if you are in a rural area, we’d love to hear from you. Please fill out this secure form or contact our reporter at lorenaoneil.64 on Signal, an encrypted messaging app.
HOUSTON, October 29, 2024–(BUSINESS WIRE)–Woodside Energy will invest $650,000 in Louisiana through the end of 2025, reinforcing the company’s commitment to the region and local communities.
The investment will fund five community grant programs and enable initiatives that support a broad range of needs across communities in the Greater Bayou area, including environmental preservation, coastal protection, education, workforce development and capacity building.
“Woodside has a long history in Louisiana through our Gulf of Mexico operations and an expanding footprint at Woodside Louisiana LNG in Lake Charles,” said Woodside Executive Vice President & Chief Operating Officer International Daniel Kalms.
“We’re excited to continue to invest in the communities where we operate and build on our existing strong relationships in the region. Through the selected programs, we are demonstrating our commitment to strengthening the sustainability of local communities.
“We believe in the value of working alongside our community stakeholders on the issues that matter to them and are pleased to partner with organisations that have a passion for making a meaningful difference in the lives of local residents.”
Woodside’s investment will cover one- and two-year programs through the end of 2025. The five programs and non-profit partners receiving an investment are:
About Woodside Energy
Woodside Energy is a global energy company, working across three continents to produce oil and natural gas and pursue new energy opportunities. Woodside has operated and non-operated oil and gas assets in the Gulf of Mexico and we are pursuing Woodside Louisiana LNG in Lake Charles, Louisiana.
View source version on businesswire.com: https://www.businesswire.com/news/home/20241029778954/en/
Contacts
Media Contacts:
Australia:
Christine Forster
M: +61 484 112 469
E: christine.forster@woodside.com
United States:
Rob Young
M: +1 281 790 2805
E: robert.young@woodside.com
Louisiana
Louisiana not keeping pace with new orphan oil and gas wells, audit finds • Louisiana Illuminator
An unprecedented amount of resources are flowing into Louisiana to help address abandoned oil and gas wells that present environmental and safety risks throughout the state. But according to a state audit, the money is nowhere near enough to get ahead of the problem, which continues to grow despite progress made in recent years.
State officials who oversee remediation of these orphan wells say a new entity under the Louisiana Department of Energy and Natural Resources (DENR) intends to better manage the problem — and find millions of dollars more to do so.
A Legislative Auditor’s report made public Monday indicates 976 orphaned wells were plugged in fiscal years 2020 through 2023, based on numbers from the Oilfield Site Restoration Program and the Louisiana Oilfield Restoration Association. Over that same period, nearly 1,700 new orphaned wells were reported to the DENR’s Office of Conservation.
Furthermore, the number of inactive wells — those with a high risk of becoming orphaned — increased 21.7% from August 2019 to April of this year, reaching 21,629.
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The audit connected the inability of the Office of Conservation to expand its orphaned well capping program to a state law that limits its ability to collect enough funding.
The audit report estimates it will take nearly $543 million to address the current number of orphan wells, but state law calls for oil and gas production fees to be suspended if the Oilfield site Restoration (OSR) Program fund exceeds $14 million. Additionally, the audit report notes the rate for gas production fees, which account for almost 80% of the program’s revenue, hasn’t been changed since 2004.
“The legislature may wish to consider removing the $14 million cap on the OSR Fund or increasing it based on the total estimated costs to plug orphaned wells, which would provide more adequate funding for addressing the growing orphaned well population,” the audit report said.
Another recommendation in the report suggests the Legislature consider increasing the production fee for gas wells or making the fee variable based on market prices, similar to the method the state uses to calculate oil production fees.
DENR Secretary Tyler Gray and Office of Conservation Commissioner Benjamin Bienvenu issued a joint response to the Legislative Auditor’s report. In response to multiple findings and suggestions, they referenced the Natural Resources Trust Authority, a subdivision of the department created through a legislative act earlier this year. It’s mission is to better manage the proper plugging and abandonment of oil and gas wells and to help other secure the funding needed for that work.
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An executive committee for the Trust Authority was appointed earlier this month, and the Department of Energy and Natural Resources is currently interviewing candidates for its executive director, according to DENR’s response to the audit report. State lawmakers will have to agree to fund the authority next year.
In summary, the Trust Authority is expected to better track and manage inactive wells while collaborating with other fiscal authorities — including the state Bond Commission and Mineral and Energy Board — to obtain a reliable funding stream to cap orphan wells, Gray and Bienvenu wrote.
Second audit questions industry-backed insurance
In a separate report, the Legislative Auditor evaluated how well the Office of Conservation monitors an industry-driven effort to address orphan wells. The Louisiana Oilfield Restoration Association (LORA) was created in September 2019 to help drillers meet state financial security requirements — or, put another way, the insurance — to plug wells if they are abandoned. LORA also collects fees from well operators to supplement the Oilfield Site Restoration Program.
Among the audit findings was that the Office of Conservation “does not conduct sufficient monitoring to ensure that LORA remains financially solvent …” LORA isn’t subject to federal or state regulations for financial institutions, so its operations and solvency aren’t tracked as closely as those of government-regulated banks.
The Office of Conservation allowed LORA to increase the percentage of fees its collects for administrative purposes from 20% to 36% once it meets a minimum $5 million reserve balance.
Because the state office doesn’t keep tabs on LORA’s administrative spending, officials don’t know if the for-profit association expenses are reasonable, auditors said.
“As a result, LORA retained $1.1 million from June 2022 through December 2023 that could have been used to plug orphaned wells,” according to the report.
Over the same period, auditors also noted LORA paid more than $4 million in management fees — or more than 30% of operator fees paid to the association — to Arkus, a Baton Rouge company that shares the same address and chief executive as LORA.
Exactly what those payments covered is unclear, auditors said. The Office of Conservation has never asked LORA for detailed information on what administrative duties it’s paying Arkrus to perform or the company’s profits and salaries, the report said. As a result, the state doesn’t know if the wage increases were merited for expanded individual job duties or working longer hours.
In its response, the Department of Natural Resources and Office of Conservation agreed with auditors’ recommendations to better monitor LORA’s administrative spending.
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New Orleans, often called the “Big Easy,” is famous for its vibrant live music scene, round-the-clock nightlife, street parties, parades, and fiery Southern cuisine along Bourbon Street. However, the real charm of Louisiana lies in its towns, each offering a unique and intriguing experience. From a shopping mecca in the heart of downtown West Monroe to Mardi Gras celebrations in New Roads to the rich Zydeco music scene in Opelousas, these towns have bustling main streets waiting to be discovered.
Natchitoches
The historic town of Natchitoches is tucked away along the picturesque Cane River. Along Front Street, in downtown Natchitoches, is Kaffie Frederick General Mercantile, Louisiana’s oldest general store, selling everything from home goods to gifts. For something to eat, Mayeaux’s Steak & Seafood offers a delightful experience with premium steaks and seafood in addition to the finest wines. Head to Mama’s Oyster House for a laid-back dining atmosphere and live music. Lasyone’s Meat Pie Restaurant, famous for its signature meat pies, is a short walk away. The Louisiana Sports Hall of Fame and Northwest Louisiana History Museum along Front Street are two incredible museums you will want to check out. For more nearby exploration, take a relaxing riverboat ride on the Cane River Queen. Residents and visitors retreat downtown for annual events like the Natchitoches Meat Pie Festival and the Natchitoches Christmas Festival, offering festive fun during the holiday season.
New Iberia
Main Street is one of the most bustling areas in New Iberia. It is home to the Bayou Teche Museum, a beautiful attraction with interactive displays highlighting local industries and culture. Another must-visit place to explore is Shadows-on-the-Teche, a historic plantation open year-round for tours. Books Along the Teche, an independent bookstore on Main Street, allows book lovers to discover rare books and more. The Sliman Theatre for the Performing Arts, housed in a beautifully restored Art Deco building, is the perfect place to see a show. Downtown New Iberia has many excellent places to eat and drink, too. Grab a coffee at Church Alley Cafe & Bistro, order delicious burgers at Bambino’s Burgers, have an elegant dinner at Amalfi, enjoy Japanese dishes at Bojangles Sushi, or sip on cocktails while listening to live music at Napoleon’s Bar. New Iberia hosts several community events at Bouligny Plaza, located along Main Street, hosts events, such as the World Championship Gumbo Cookoff, Teche Area Farmers Market, New Iberia Spanish Festival, and Louisiana Sugar Cane Festival.
West Monroe
West Monroe’s downtown, known as Antique Alley, has evolved to offer a unique and exciting shopping experience. The streets of Antique Alley are lined with trendy boutiques and unique stores selling everything from fashionable clothing and leather goods to gourmet spices and teas. After a day of shopping, enjoy a meal at nearby restaurants with beautiful views of the Ouachita River. With its signature Cajun specialties, Trapp’s is a popular dining destination. For a taste of New York-style pizza and craft beers, head to Flying Heart Brewing & Pub. West Monroe’s Main Street is the central hub for major events like the Twin Cities Mardi Gras Kickoff and the Downtown Gallery Crawl, adding to the city’s unique charm.
Covington
With multiple blocks of stores, galleries, boutiques selling apparel, and the well-known Covington Farmers Markets on Saturdays, there are many things to see and do in downtown Covington. While there, explore the renovated Southern Hotel after stopping by the St. Tammany Art Association to see exciting exhibits and art displays. Museums like the Covington Trailhead Museum and HJ Smith & Sons General Store & Museum are also must-visit attractions downtown. Buster’s Place Restaurant is a great dining option with its extensive menu of fresh seafood and Cajun dishes available for lunch or dinner. The Green Room, a vibrant bar on Boston Street, provides the perfect setting for a fun evening with pool tables, karaoke, live music, and a DJ. Boston Pub is another lively spot to drink and hear jukebox tunes. Enjoy live music at Columbia Street Landing, which hosts free concerts during the spring and fall. It is also the site of the annual Three Rivers Arts Festival.
St. Francisville
The lovely historic downtown St. Francviile has dozens of enjoyable eateries and shops to discover along its bustling main streets. On Commerce Street, dine on Neapolitan pizzas at Big River Pizza Company or French dip po-boys at Magnolia Café. Birdman Coffee & Books, also located on Commerce Street, offers an inviting atmosphere with coffee and baked goods on the menu alongside live music. There is also a restaurant and bar inside the charming St. Francisville Inn. Stroll down Ferdinand Street to get close views of historic churches, homes, and attractions, like the West Feliciana Historical Society Museum. Continue down the street to reach the Backwoods Gallery, District Mercantile, and The Oyster Bar, a beautiful waterfront dining destination. The roads in downtown St. Francisville get lively with annual events like the Tunica Hills Music Festival & Jam, Yellow Leaf Arts Festival, and Christmas in the Country.
New Roads
New Roads, known as “Little Carnival Capital,” is a huge mecca for parades and parties on Main Street during Mardi Gras season. Large crowds also retreat downtown for wine, shopping, and live music at the annual Wine Down on the False River event. New Roads offers ample shopping opportunities for those needing retail therapy in the heart of its downtown district. A stop at the New Roads Antique Mall is a must for rare finds and collectibles. The Pointe Mercantile & More is another ideal place to browse handcrafted artisan items and gifts. There are also fabulous places to eat in the area. Morel’s Restaurant offers seafood dishes, Southern hospitality, and beautiful views of the stunning False River. For other dining options, Ma Mama’s Kitchen and Hot Tails Restaurant serve up Louisiana-style fare in a casual atmosphere. Explore the art and cultural scene at the Julien Poydras Museum & Arts Center. Make plans to attend an art show, film screening, or a concert there.
Opelousas
Downtown Opelousas offers an authentic Louisiana experience deeply influenced by Cajun and Creole traditions. The Le Vieux Village Heritage Park & Museum is a noteworthy destination, as the historic area has early 19th-century houses, shops, and a fascinating museum. The Zydeco Music Exhibit in Le Vieux Village provides information about the origins of Zydeco music in Opelousas. The Creole Heritage Folklife Center, a short drive away, is a landmark that honors Creole heritage. Local eateries offer gumbo, shrimp Creole, jambalaya, and crawfish étouffée. Local eateries offer gumbo, shrimp Creole, jambalaya, and crawfish étouffée. You will also find some establishments known for specialties like boudin stuffed chicken wings or handmade yam country pies.
Breaux Bridge
Nestled among the picturesque banks of the Bayou Teche, Breaux Bridge is a charming town just two hours west of New Orleans. Stroll downtown to find dining establishments like Tante Marie on the corner of Main Street and Bridge Street. You can order everything from build-your-own-breakfast plates and beignets to bold burgers and Cajun dishes. Coffee lovers can also find Irish coffee, lattes, and cappuccinos on the menu. On the weekends, live music fills the room while you dine. Chez Jacqueline has seafood gumbo and crawfish étouffée, while Angelle’s, a few steps down, serves up old-fashioned hamburgers. Buck & Johnny’s, another option, offers eclectic Italian dishes with Cajun flair. Shop for antiques and collectible items every Friday and Saturday at Silver Screen Vintage Market on Main Street. You will also find stylish attire at Bayou Blush Boutique and Once Upon A Wing. The town’s lively side is on display at the annual Breaux Bridge Crawfish Festival, which takes place on the first weekend of May.
You may have had New Orleans on your travel bucket list for quite some time due to its scenic views, history, and fantastic music. However, after reading about West Monroe, New Roads, Opelousas, and the five other Louisiana towns on this list, you will soon want to visit them to experience each of their bustling main streets and everything they have to offer, including great food at local restaurants.
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