Victims of Injustice

providers perform ultrasounds on abortion patients. Other state laws require patients be given the option to view an ultrasound image; force patients to receive counseling in person before their appointment; or ban abortion via telehealth outright. FDA guidelines require licensed clinicians to have additional certification by the distributor to write a prescription for mifepristone, which creates yet another potential and arbitrary hurdle.Inaddition,logistical,financial,andlegalchallengescan still stand between a patient and their necessary care. This is especially true for people of color, those living on low-incomes, and those living in rural areas, who are all more likely to live in states with restrictive policies.

All of these hurdles will only become much worse with the impending fall of Roe, especially in states that ban abortion, both procedural and medication abortion. However, this model of care might still help residents in these states to some degree — rather than trying to get an appointment with overburdened providers in states where abortion remains legal, people could travel across their border to a state that offers telehealth, and havetheabortionmedicationsmailedtothenearestpost-office after the telehealth consultation. This option may help relieve the surges we expect to see in protected access states.

Ultimately, this model could help expand access to abortion, lower costs, and shorten time to treatment. It can also empower a broader range of clinicians to provide abortion care at a time when the options are shrinking for so many. For patients and providers, that's a win-win.

Ushma Upadhyay, PhD, MPH, is an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the UCSF and core faculty at Advancing New Standards in Reproductive Health.

Marji Gold, MD, is a family physician in the Northeast. This piece originated on MedPage, May 2022.

David E. Smith, MD

In June 1964, right after I graduated from UCSF, I was on duty as an intern in the SFGH emergency department on the finalnightoftheRepublicanconventionhere.Iwaswatchingan attending physician stitch cuts on the face of a drunk Rockefeller delegatewho’dbeenhitbyadrunkGoldwatersupporterat the Republican convention. A call came through the hall for all surgeons: There was an incoming car accident victim with legs amputated to mid-thigh. “Finish up,” my supervisor told me, as hespedoutoftheroom.ThelaststitchingI’ddonewastoplace electrodes in the back of a hibernating hamster, but there was no time for my insecurities. I got to work on my patient. Just like my hamsters the patient did well; it was a great lesson in county hospital emergency medicine. But simple cases like those would never truly prepare me for the heartbreaking losses– especially those cases that piqued my awareness of social injustice.

So, another time, a woman came in feeling “very sick.” She spoke Spanish, and the teenage daughter who accompanied her translated for me as I did the intake, took her vitals, and insertedanIVforfluids.Shehadshakingchillsbutnofever, which suggested she was in septic shock. I asked the daughter what had happened. Suspecting that I was seeing the aftermath of a botched abortion, I explained that this could kill her mother. The daughter said her alcoholic father had left the mother raising three children alone. The mother became pregnant and, despite being a devout Catholic, had gone for an illegal abortion.

With that information, we rushed her to the operating room for an emergency hysterectomy. It was too late. She died on the table. She lost her life because the law forbade the prompt medical care she needed, and because her family felt they had to delay treatment as her condition worsened. I have been prochoice ever since. And now a teenage girl would be responsible to raise two children without a mother or a father. Ican’tfathomhowanyonewhohashadtocareforawoman brutalized in this way could ever be against the right to choose. In my childhood, I witnessed my mother giving dedicated nursing care when she herself was suffering. I saw my father get the care he needed, even though it did not save his life. Iwasn’tpreparedforthis:Iwatchedawomandiebecause judgmentalothersstoodbetweenherandmedicine’sability to save her life.

David E. Smith founded the Haight-Ashbury Free Clinics in 1967, was a co-founder of the specialty of Addiction Medicine and a President of the American Society of Addiction Medicine, has received UCSF’s highest awards for service to medicine and public health, and is a 53-year member of the SFMMS.