‘Women are not safe in Louisiana’: New Orleans leaders want pregnancy care drug law reversed

Effective Oct. 1, misoprostol, used to treat post-delivery hemorrhages, will become a Schedule IV controlled dangerous substance in Louisiana under a new law. The designation means the medicine will have to be securely stored, raising concerns among doctors who say they rely on immediate access to the medication in life-threatening situations. (Photo illustration by Anna Moneymaker/Getty Images)

NEW ORLEANS — Doctors and local elected officials alike vehemently decried a new Louisiana law that will reclassify the pregnancy care drugs misoprostol and mifepristone as controlled dangerous substances. The legislation takes effect on Oct. 1 and is the first of its kind in the nation.

“Women are not safe in Louisiana,” New Orleans City Councilwoman Lesli Harris said at a committee meeting Wednesday. “Child bearing women are not safe in Louisiana.”

Republican Gov. Jeff Landry signed a bill in May to reclassify the two drugs because of their association with medication abortion, but they have numerous other medical uses. Misoprostol, in particular, is used daily by OB-GYNs for miscarriage management, postpartum hemorrhaging and intrauterine device (IUD) insertion.

The law, authored by state Sen. Thomas Pressly, R-Shreveport, was originally meant to create the crime of coerced abortion. But, at the last minute and with Louisiana Right to Life’s support, Pressly introduced amendments to reclassify the drugs as Schedule IV medication, which will affect how they are stored and prescribed.

Councilman at-large JP Morrell criticized the legislation, which has been described as “confusing” and “unnecessary” by doctors across the state.

“The law is just so ill-written and unclear, and it really was a hatchet job done at the last moment,” said Morrell.

Council President Helena Moreno has requested the New Orleans Health Department investigate the impact of the legislation in the hopes that a data-driven approach will persuade legislators to “reverse these restrictions” in the future.

“I’ve heard a lot of different politicians talk about how there’s no problem with these restrictions, that everything’s just fine, no big deal, there’s not going to be any problem with access, but we’re hearing something very different from the medical community, from physicians, from doctors who are there every day, treating women,” Moreno said.

Upon learning of Moreno’s plans Attorney General Liz Murrill told the Illuminator that New Orleans is “manufacturing a problem that doesn’t exist.”

In her explanation Wednesday to members of the council’s Governmental Affairs Committee, Moreno likened Louisiana’s new law to a measure that would make airline pilots’ jobs harder and potentially lead to crashes.

“I guarantee you that we would see quite an uproar from everyone to try to reverse course,” she said. “This isn’t that different — we are hearing from the medical community [that] this is a problem. We should be listening to them.”

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Potential public health crisis

During public comments, Dr. Emily Holt, a New Orleans family physician said she uses misoprostol in her clinic to help patients with pain ahead of IUD insertion. However, come Oct. 1, she said she would no longer be able to offer it in her clinic even though it remains legal to prescribe.

“Keeping controlled substances in my clinic — the barrier is too high,” Holt said. She joined a handful of people who testified in person at the committee hearing, and 53 more filed comments online in support of Moreno’s proposal.

Dr. Jennifer Avegno, city health director, will lead the investigation into what she described as a public health crisis. She told council members about how when a medication is placed on a controlled dangerous substances schedule, it creates additional, tightly regulated requirements in terms of reporting, storing and monitoring the drugs.

It’s why doctors are worried about the effect the new law will have on delaying postpartum hemorrhage care — some hospitals have already pulled it off their obstetric carts .

“Physicians don’t follow politics. Physicians are trying to do their job,” Avegno said. “There are a lot of physicians that we’re hearing are just learning about this, and some that probably have no idea.”

The Illuminator previously spoke with a doctor in one of the state’s rural areas who had no idea the drugs were being reclassified until speaking with a reporter. She said others practicing in her area were also likely in the dark, having received no information from their employers or officials until just recently.

Some doctors don’t have access to attorneys

Avegno said her investigation is about health care, not politics.

“When we talk about these medications, every physician in Louisiana is very aware that abortion is highly restricted, and no one — no one — has a desire to do elective terminations outside of the law,” said Avegno, an emergency room physician.

The city health department will host a webinar on Thursday to help educate health care providers on how to troubleshoot the new misoprostol protocols.

Avegno said she’s fielded reports from local care providers about pharmacies refusing to fill misoprostol and mifepristone prescriptions for miscarriage management because they are afraid they’ll be criminalized even though the drugs remain legal.

“We are going against the standard of care for hospital providers all over the country. These are facts,” Avegno said.

Morrell, who was in the Louisiana Legislature before taking a City Council seat, raised concerns about how medicine is being politicized based on ideology.

“Even when legislators say things like, ‘Don’t worry if you’re doing the right thing, it’s going to work out.’ I mean, that’s not really true,” Morrell said. “You could have medical professionals who have people who wish them ill because they don’t agree with their political alignment or their beliefs, file frivolous complaints over stuff like this, highly subjective, life-altering decisions.”

And, as abortion rights advocate Michelle Erenberg with Lift Louisiana testified before the committee, not every doctor has immediate access to an attorney.

“Patients are coming to New Orleans when they have these health emergencies,” Erenberg said, “because doctors in other parts of the state maybe don’t have access to lawyers or they’re worried about going to jail.”

Even for well-resourced doctors who do have easy access to lawyers, Avegno pointed out they shouldn’t have to constantly request legal advice when they need to use misoprostol. She noted that the Louisiana Department of Health has advised doctors to consult their hospital’s lawyers in its recently issued guidelines on the new law.

“Most hospital attorneys are not well versed in this,” she said. “This drug is used every day all day. It’s not practical to call the attorney every single time.”

Morrell underscored Avegno’s point, saying a hospital lawyer is trained to do what’s best for the hospital from a liability perspective. A doctor making a decision at a patient’s bedside is prioritizing what’s best for the patient, he added.

‘it’s a horrible, horrible, horrible idea’

Louisiana’s pregnancy care debate is now part of the national conversation on the impact of abortion bans, now that more than two dozen states have restrictions or an outright prohibition against the procedure. Critics are pointing out the detrimental effects this has had on pregnancy care overall.

The deaths of two women in Georgia are being attributed to its abortion ban, ProPublica recently reported .

Amber Thurman experienced an extended delay in care because the hospital where she sought treatment was afraid to perform a surgical procedure. Candi Miller avoided going to the doctor for fear of legal repercussions. A team of state doctors deemed both of their deaths “preventable.”

Thurman and Miller were Black women, who face more than three times the risk of dying from postpartum hemorrhage compared with white women.

At Wednesday’s committee hearing, council members said they don’t want to wait for women to die in Louisiana in order for legislators to reverse course on the controversial law.

“I don’t want to see a woman sacrificed who is hemorrhaging,” Harris said. “Hopefully we can sway the people at the state level who think that this is a good idea because it’s a horrible, horrible, horrible idea that will cost people’s lives, cost women’s lives.

“If women who are miscarrying or who are hemorrhaging after childbirth don’t have easy access to this drug, they become the sacrificial lambs that have to change hearts and minds, and that’s what I don’t want to have to see. Nobody should have to put themselves in that position for some state legislator to change their mind on this issue.”