‘Unnecessary suffering and death’: doctors fear for patients’ lives in a post-Roe world

Dr Herman Miller didn't learn the news until he turned on MSNBC on Tuesday morning.

According to a draft opinion authored by Justice Samuel Alito, the supreme court was ready to overturn Roe v Wade, the 1973 ruling that guarantees the right to an abortion up until a fetus can live outside the womb - typically around 22 to 25 weeks. Someone had leaked the draft to Politico.

Miller was not surprised. He has provided abortions since he was a medical resident in 1978, and has watched for years as Republicans chipped away at abortion protections.

The 75-year-old doctor is semi-retired, but still works three days a week providing abortions as the medical director of A Woman's Choice, a clinic on the south side of Jacksonville, Florida.

He's the only doctor in the clinic who provides abortions up to 20 weeks of pregnancy. Many of his patients are teenagers; some are incest survivors.

So that morning he drove to the clinic. He saw maybe 16 patients for abortions. He counseled another 16 who were scheduled for Thursday appointments, and he told each of them the same thing: abortions were still legal right now. But their rights - enshrined for almost 50 years - were in grave danger.

Florida just recently passed a ban on abortions after 15 weeks, which will take effect if Roe is overturned. But Miller worries that's just the first step. He's waiting for when, not if, lawmakers move to ban abortion entirely.

"I tell my patients that that's why they need to get out to vote," he said.

When he started residency in 1978, he heard stories about what life was like before - about the patients who came into the hospital and died after attempting to terminate their pregnancies at home. He's afraid of that happening again.

But for now, nothing has changed. Abortion is still legal in Florida. So after seeing his patients, Miller came home and picked up his granddaughter from school. Next week, he'll go back to the clinic. He'll perform more abortions for as long as he can.

For Miller and other abortion providers, the leaked court opinion was in many ways not a surprise. They had expected a decision like this for months. But seeing the draft - reading the words - changed things, many told The 19th. It felt real in a way it hadn't before.

Many providers have already seen their jobs grow harder over the past several decades thanks to newly imposed restrictions on the procedure. Even now, questions remain about how overturning Roe will affect their medical practices and the people they see in their clinic. Many told The 19th that they fear the worst for their patients - particularly those who cannot afford to travel for care.

But until Roe is overturned, they said, they have a job to do. And for as long they can, they'll keep at it.

***The leaked supreme court opinion has no legal impact. In a statement on Tuesday, Chief Justice John Roberts emphasized that the leak, while authentic, is not a final draft. Elements of it could still change.

But since this past December, when the court heard oral arguments in Dobbs v Jackson Women's Health Organization, court observers, legal analysts and advocates on all sides of the abortion debate had expected this outcome: Roe would be overturned, or at least substantially weakened.

In anticipation, Republican-led states had already been passing new abortion bans and restrictions. Those new laws have already squeezed access to the procedure.

Andrea Gallegos was in between calls with abortion patients - canceling their appointments for the next day - when she heard the news.

Gallegos is the executive administrator for two abortion clinics: Tulsa Women's Clinic, in Oklahoma, and Alamo Women's Reproductive Clinic, in San Antonio, Texas. She had already seen firsthand the rollback in abortion protections.

Texas's abortion ban decimated access at the San Antonio clinic. Immediately after, Texas patients flooded Tulsa Women's Clinic. Then just last week, the Oklahoma legislature passed its version of Texas's six-week ban, which took effect immediately when the governor signed it on Tuesday evening.

Her staff anguished over the decision to cancel appointments for people past six weeks of pregnancy. But they feared they had no other choice.

"I heard a variety of emotions. Several were in fact literally on the road driving from Texas, were halfway there, saying, 'Can you please please let us be seen?' They were just desperate, with tears of anger," Gallegos said. "And then to read all of the headlines about the leaked opinion - it was just really defeating. The whole thing is really defeating."

Gallegos said she couldn't imagine what things will look like when the court issues its ruling. Both Texas and Oklahoma have trigger laws in place that would outlaw all abortions once Roe is overturned.

The clinic has not yet figured out what comes after that.

"It's hard to even envision," she said. "I mean we talk about it practically. But to really contemplate what will happen?" Gallegos trailed off.

She knows patients will have to travel to Kansas, which is almost 200 miles away from Tulsa, or New Mexico, which is closer to 600 miles. Some might try to order abortion pills - which can be safely taken at home. But such self-managed abortion isn't legal in Oklahoma, and patients run the risk of prosecution if they are caught.

"Speaking to physicians and providers that have been doing this pre-Roe, they'll tell you that they saw patients die," she said. "And I think that's exactly what we're going to see."

Marva Sadler, who directs clinical services for Whole Women's Health in Fort Worth, Texas, fears the same.

She's trying to hold on to some hope - that someone will change their mind, that the court will rule differently. But on weeks like this, it's hard.

"I don't want to say I've lost hope, because we're going to do what we're going to do. But I always make sure that, even though we prepare for the worst - we almost expect the worst, because we've been dealt it so many times - I want to make sure there's still a glimmer of hope," she said Tuesday, the day after the decision leaked. "There was a moment last night of feeling like that glimmer had been put out."

It's unclear how quickly many states will move to ban abortion. So far, 13 states have passed trigger bans, which would outlaw the procedure once Roe is overturned. But the mechanism for enforcement varies. Some must be certified by the attorney general, or the state governor. Some take effect right away. Some have waiting periods.

Five other states have abortion bans on the books that predate Roe. Legal scholars aren't sure what it will take for those to take effect - especially those that go back hundreds of years.

In West Virginia, one of those five states, the uncertainty is acute, said Katie Quinonez, who runs a clinic in Charleston. She found out about the news at dinner Monday night, just after she had attended a national conference for abortion providers. She flew back to Charleston the next day and headed straight to the clinic.

"I heard multiple staff say over and over again, 'I can't believe this is happening,'" she said.

West Virginia's abortion ban was passed in the mid-1800s. Legal experts are not sure whether the ban will have to be repassed or whether it could take effect right away. That means planning for the possibility that the next two months are the clinic's last for abortions. It means trying to connect patients to clinics in Pennsylvania, Maryland and Virginia, hundreds of miles from Charleston.

And it means telling patients about the possibility of taking medication abortion pills from home without a doctor's involvement. In West Virginia, like in the majority of states, this process isn't strictly illegal - and neither is talking about this kind of self-managed abortion, as long the person isn't seen as giving medical advice.

But patients who are caught still risk being prosecuted or arrested, potentially for other crimes. Just last month, a woman in Texas was briefly arrested on murder charges after allegedly inducing her own abortion.

"We're past a red alert moment. The house is burning right now," Quinonez said. "I feel exhausted and fucking angry."

****

Not every state will ban abortion if Roe is overturned. So far, about a dozen have put in place laws to protect access to the procedure. And a handful are expecting a crush of patients to come their way.

That was on Dr Jennifer Kerns' mind on Tuesday morning. The Oakland-based physician and professor at the University of California, San Francisco, provides abortions in the Bay Area. She has recently begun traveling once a month to help out an Oklahoma clinic. She is working to get certified as an abortion provider in Kansas.

Kerns was cooking dinner on Monday night when someone texted her the news. She sat down and read the decision. She knew it had been coming. And still, it felt almost unfathomable.

On Tuesday, Kerns had planned on seeing her patients in California, who are in no immediate danger of losing access to abortion. She doesn't know if she will ever again be able to provide care in Oklahoma. She can't stop thinking about the patients she saw there on her last visit to the state, just over a week ago. They could, she fears, be among the last to ever access an abortion in Oklahoma.

She's trying to figure out how she can help provide abortions to people in states where the procedure will be outlawed - whether that's establishing relationships with reproductive health clinics in those states, or helping train medical residents from other states.

"We're all just right now waiting and talking with each other about where our workforce deployment might be most impactful," she said. "On a personal front, that's a priority for me."

Still, she fears it will not be enough. She fears people will not be comfortable accessing medication abortions outside of the healthcare system. Others, she worries, won't be able to afford them. And still others, she fears, could be prosecuted for trying to end a pregnancy.

"I feel like we're staring down the barrel of decades to come where we have to witness unnecessary suffering and unnecessary death," she said. "This is not a complicated public health story. This is a really straightforward public health story. We've seen in this country and other countries - people won't stop accessing abortions. They'll access them less safely."

This story was originally published by The 19th.