Politics of Public Health Part 2-Reproductive Rights with Diane M. Welch

Transcript

0:05

The following is brought to you by the committee to protect healthcare.

Chris: 0:09

In the emergency department, we see real time consequences of people not having access to health care. Expansion of Medicaid in Wisconsin would mean less cases to the emergency department. It would prevent closures of hospitals in our communities, and most importantly, save lives. The majority of states in the country have expanded Medicaid with bipartisan support, yet legislators in Wisconsin are blocking expansion of Medicaid. They're blocking the opportunity for our patients to have a healthier life. Tell your legislator to save lives and pass Medicaid expansion.

0:43

a Georgia woman has been identified as one of the first deaths related to lack of abortion care access. Amber Thurman died waiting. for a DNC. a surgical procedure sometimes used in abortions. The report finding her death likely could have been prevented. It was jarring, shocking, and disheartening that my Georgia doctors could not provide me with the standard of care. Georgia women and medical providers testified before Senator Jon Ossoff's Human Rights Subcommittee in opposition to Georgia's law banning abortions after a fetal heartbeat is detected. Medical experts say that's typically around six weeks. ProPublica released a report on internal documents from the Georgia committee reviewing pregnancy related deaths. The report indicated the committee, run by the State Department of Health, determined the death of 28 year old Amber Thurman was likely preventable if she'd had access to abortion care in Georgia. In August, when Amanda was 18 weeks, pregnant, her water broke, losing the amniotic fluid her baby needed to survive. Her doctor told her, You're 100 percent for sure going to lose your baby. The nightmare got worse. Her doctor said because of anti abortion laws in Texas, they couldn't terminate the pregnancy, even though Amanda was at high risk for a life threatening infection. Texas law allows for abortion if the mother has a life threatening physical condition that places her at risk of death or substantial impairment. But Texas lawmakers haven't spelled out what that means. I was shaking, my teeth chattering, trying to tell Josh I didn't feel good. she went downhill very fast. The bacterial infection could have been prevented if she'd been provided an abortion. when her temperature hit 103 degrees, doctors terminated the pregnancy, but Amanda was still sick. Her blood pressure crashed, and she needed a blood transfusion. they said, we're moving you to the ICU Central issue physicians must now navigate is the exception to save the life of the mother. The law, as written in the state of Wisconsin, is still very grey it's intrinsically vague, um, which then, Causes physicians to potentially second guess, like, is this risky enough? Because everyone who practices medicine knows that it can be very gray for a while and then become very black and white. Um, and you, the longer you wait to intervene, the worst outcomes are in general. There was a time when I was in Minnesota where someone presented in an, in an emergency for, on an ambulance, in an ambulance, she was bleeding. She had to go to the operating room right away and I had to perform an abortion and I couldn't help but to think to myself, if this was happening to me in Wisconsin, I would be. terrified about what the next steps would be, about what the implications for my future, my career would be. I will continue to fight for these patients because they need a voice. Everybody needs a voice in this, in this fight. And a lot of the voices that are at the table right now don't see these patients and they don't have any medical background, but they're making these decisions. Welcome to pulse check, Wisconsin. Good morning. Good evening. Good afternoon. This. Dr. Ford. With Pulse Check I want to thank you for. More listening to now our second part of our series. The politics of public health. We have a. A really good episode If you didn't catch the first episode of our series. I recommend that you go. Go back. I Was able to speak with representative. Deb on Draka as well as Dr. Megan Schultz. Who's a pediatric ER, doctor. And we discussed the importance of gun legislation. In the state of Wisconsin. So if you didn't catch that for free to go back and. And listen to all the amazing things that they had to offer. And examples. Samples that they had to give of how our current gun laws as they. They stand. Affect Wisconsinites and ways that we can improve the safety. Of our communities and a safety for our children. In this episode, What we will be doing is we'll be talking to Diane. Diane Welsh, who is the lead legal counsel for? The current case that we have in the Wisconsin Supreme court. Regarding the statute, which. Is on the books at this time, limiting. Reproductive freedoms in the state. State of Wisconsin.\ Diane Walsh is the partner with the firm. Pines Bach. And she has had over two decades. Of experience. Advocating. Four. Citizens of the state of Wisconsin. She served on the board of directors. For Wisconsin democracy campaign, domestic abuse. Intervention. And services as well as Wisconsin women in government. And she's. Currently. A member of the Dean's advisory board for the university of Wisconsin. And whitewater college of letters and sciences. So Diane. Is the legal counsel for myself and two, other of my colleagues. In the roles that we have taken in this case as being interveners. And what we. We provide as interveners is expert opinion. On. On how restrictions and reproductive freedoms in the state of Wisconsin. It affects our patients. And we give that context from. The standing of our professional roles So myself. Uh, from the standpoint of an emergency medicine physician and my other. Two colleagues from the standpoint of being obstetricians and gynecologists. Just in the state of Wisconsin. So in this episode, Diane. Updates us a little bit on. Where we stand currently in the state of Wisconsin with regards to reproductive. Inductive freedoms. And where she perceives this case to go. Go in the future. So that being said, we'll go ahead and get started with.

Chris (2): 7:37

For our listeners, I gave a bit of an intro as to who you are And the amazing things that you're doing throughout the state. Uh, but if you can't, could you just give us a little bit of your background?

Diane: 7:46

Sure. Um, I grew up in rural southeastern Wisconsin and, uh, worked in higher ed for about 10 years before deciding to go to law school. One of my motivations for law school was I decided there weren't enough women in the legal profession, either making the laws or interpreting and prosecuting or applying the laws or judging the laws. And so I really was focused in the policy, uh, role that women lawyers could make. So I went to law school in D. C. and when I My first job after law school was at the Wisconsin Department of Justice where I worked for about five years and then I moved into the Department of Health and Family Services. And worked there for about eight years and that's where I really became focused on reproductive health care and, uh, and access for women among many, many other issues. But, you know, looking at some of the issues about like access to reproductive health care, maternal and child health, infant mortality rates, maternal morbidity rates in Wisconsin, um, and numerous other aspects of health and family services in Wisconsin. Then I, uh, moved into private practice several years ago, and where I have been since. And since that time, I've had the great fortune of representing a lot of the family planning clinics around the state and some physicians and nurses and others who do this important work.

Chris (2): 9:22

Yeah. And, and, and I commend you for doing all that. You know, it seems like you have a really good track record at advocating for a lot of the women around the state of Wisconsin. I see that you're on the board of, you know, the domestic abuse intervention services, Wisconsin women in government, et cetera. Um, and, and just to kind of tie all that in all that advocacy in what drew you to, what motivated you to become involved in what we'll discuss today, which is the reproductive rights litigation.

Diane: 9:51

So I think I've had like feminist beliefs going back to girlhood, you know, like girls should have the same opportunities as boys. I don't know if it's having strong, you know, And send my life that we're good role models or having five sisters or what? But the idea that girls should be more limited in their opportunities than boys, like never sat right with me, you know, has I got older seeing like the impact of like economic disadvantages. for women um, and also domestic abuse and that impact that violence against women had. Um, it really kind of framed my thinking and was one of the motivators for going to law school. As it relates to, access to reproductive health care. I think women's opportunities in so many ways are really shaped by their ability to decide whether or when to have Children and the timing and spacing of their pregnancies and and in every way like this can, uh, their ability to maintain an interesting, fulfilling career. You know, and build up generational wealth, you know, depends on, you know, how many kids are they taking care of their ability to perhaps leave an abusive relationship, maybe tied to, you know, their pregnancy status or how many kids they would need to support without a partner, their ability to fulfill a passion in the arts, you know, whether it's acting or, you know, creative arts, you know, can depend on, you know, You know, their pregnancy status and how many

Chris (3): 11:24

kids

Diane: 11:24

they're caring for. So in so many ways, women's ability to live full and active lives, you know, and make choices they want to make are also tied to their ability to make choices about how many kids to have and when to have those kids or whether to have those kids. And I use the term women, and I know that across the gender spectrum, there may be people who don't identify as women who may be pregnant or have children and just be a little less complicated because I'm going to use the term women for people with egregious.

Chris (2): 11:56

Yeah, yeah. And so, you know, just to kind of Bring that back to Wisconsin. Like you were saying it, it limits women through all spectrums of life, all socioeconomic, um, uh, walks of life as well. when you don't have that ability to make, your own reproductive decisions. And in the beginning, we did a couple of news clips from different instances, more so from the medical spectrum, you know, what complications of pregnancy may arise, et cetera, et cetera. But just to kind of go back in, in the state of Wisconsin. So in June of 2022, as we all know, overturn Roe v. Wade, how, how did that affect folks in Wisconsin? What did that mean for Wisconsin? Just in kind of taking this back,

Diane: 12:37

Fortunately, we had had some conversations prior to that because as soon as the U. S. Supreme Court accepted the Dobbs decision, those of us who were working in this space were aware that, um, a change could be coming. And so there were lots of conversations with OBGYNs, attorneys working with health systems, uh, and abortion providers around the state to talk about, uh, What might this mean and what would happen if Roa was reversed? But what happened was, um, in Wisconsin was significant because Wisconsin had this very old law on the book that hasn't been enforced for, you know, half a century. And some, uh, Conservative legal scholars put out a paper, a white paper, saying that, like, this old law would kind of come back into force and be enforceable against physicians who were providing abortion care. And We've never had a situation in Wisconsin or across the country where a well recognized right, you know, right, was established by the U. S. Supreme Court. The state legislature, you know, for the past 50 years has been making laws about abortion. And then all, but they never took the old law off the book, you know, because it had been, you know, overruled. It was first by a federal judge. court, and then, you know, also, um, negated by Roe versus Wade. And, um, so we were really felt like a state of limbo and the uncertainty was great as we approached, you know, we were in an election year. We had candidates for attorney general, we had district attorneys saying, of course, the old ban could be enforced. And we had others saying like, no, that old ban doesn't spring back to life. It's not like a zombie law that comes back to life and eats up all the other abortion laws that our modern day legislature has passed in the last few decades. Um, but there was uncertainty and with the old ban, you know, because it was a felony, there was a six year statute of limitations. So anyone who's working in the health care space, abortion space, you know, emergency department space where a woman might come in needing abortion care, um, was faced with like, okay, I know my current DA says he doesn't believe it's enforced and won't enforce it, but what will a future DA do? Or will an attorney general, uh, you know, that has a different belief than the current attorney general come in and try to enforce this against me five years from now? So, uh, we, you know, so that we, we went from settled, established law that physicians working in health care, providing care to pregnant women knew what the law was and when they could provide care and treatment and what they could do to like, uh, uh, a lot of uncertainty. And,

Chris (3): 15:41

um,

Diane: 15:42

it was very hard for, for healthcare practitioners and the lawyers advising them.

Chris (2): 15:48

And for all the listeners, you know, to be clear, to put it into context from a medical perspective, this is before we knew that bacteria and viruses cause sickness, right? Like this is before we knew the effects of a medication like Tylenol. Right. And so. What we did was we reverted back to this law and it created, as Diane was saying, this uncertainty, not only for myself practicing in the emergency department, but for providers, in the OB GYN realm, uh, for providers who worked in rural locations, you know, they were on the phones with their lawyers. When they should have been on the phone with their consultants when they have patients that are presenting with what we call ruptured ectopic pregnancies, non survivable pregnancies to term for the fetus, but could be devastating, could be deadly for, for the mothers. And so, you know, these are things that, that all of us in the know, as Diane said, you know, they were gearing up from The legal standpoint, we were gearing up from the medical standpoint when we saw the ball rolling to try to get providers to know, hey, you're covered by EMTALA, um, uh, and you have that coverage from a medical and from a legal standpoint, uh, to do no harm in the cases of these patients.

Diane: 17:03

Right, and like if you're working in an emergency department in a hospital, then UMTALA applies, which is the Emergency Medical Treatment Act, which applies for any hospital that accepts Medicare funds that make sure that the hospital provides like stabilizing care and treatment for any patient regardless of their means to pay. It doesn't apply in physician offices, though, so somebody working in a clinic, you know, serving high risk pregnant patients or, you know, or otherwise wouldn't have the same protection that was, you know, the Biden administration set up by, you know, related to him. We tried to very quickly have conversations, you know, saying like an ectopic pregnancy is never going to be a viable pregnancy and will always pose some risk to the pregnant patient. However, that didn't mean there weren't health systems or hospitals that were taking more conservative approaches,

Chris (3): 18:00

um,

Diane: 18:00

and conservative for multiple ways. You know, we have a high number of Catholic run health systems in Wisconsin, but we also have, uh, uh, health systems that are more risk adverse, you know, and, you know, just wanted to like, not have any question about what the conduct might be. So, um, you know, so it was troubling to see how health systems, physicians, other health care providers too, had to weigh the interest of their own operations and their physicians versus their patients. And weighing out what was best for each, and it wasn't always the same. So we saw, you know, heard reports of patients being turned away to go to Minnesota or Illinois or Michigan, uh, to get the care they otherwise would have been able to get in Wisconsin.

Chris (2): 18:57

And, and, and I gave a couple of examples to a patient that I saw personally that did just that day and read that that went to Illinois and got incomplete care because they didn't have the financial means to go back or even the physical means to go back. You know, in some cases, Some of these, these patients are adolescents, right? Um, and you know, had to go emergently to the OR. Unfortunately, I was practicing in a, you know, uh, inner city location that has a lot of resources, has providers on staff and we're able to get them, uh, to those means to get that definitive treatment. But I've worked in rural locations where, I was the OB for 40 miles, right? Like that, that was the, that was the situation just being the emergency doctor in the, in the hospital. And so, like you said, it could cause that uncertainty and that law is specifically gray, as we've seen in other states as well, that we don't know what that means. We don't know what the life of the mother means or, you know, what, what that means in those cases.

Diane: 19:51

Chris, I'm glad you mentioned that, that the grayness of the law, uh, is extra frustrating, you know, one that, you know, an abortion can only be provided to save the life of the pregnant patient. You know, it's like how imminent would death need to be before that would be triggered. And then there's language that said that determination could be made by the treating physician or to other physicians. Well, some attorneys were interpreting that to mean like three different positions had to all agree on it. And and they were Requiring physicians to like get a second or a third physician to sign off on it. And, you know, in rural areas, you know, there's not, you know, multiple OBGYNs on duty all the time, or you know, physicians. Who are willing to like quickly sign off on a decision that might have criminal implications down the road if, if it's misinterpreted or if somebody's second guessing it. Um, but. Even that language is confusing, um, and you know, from our perspective in our case, as you know, we, that's one of the due process concerns we make about the old law that, like, that doesn't get physicians notice about what's required. Absolutely. You know, like, knowing what it means to be required to save the life, you know, of the patient. Um, you know, the other, it's, all of them are required to be performed at a maternity hospital. Wisconsin doesn't even have maternity hospitals anymore. You know, like there are hospitals who have maternity maternity wards, but that whole category of licensure has went away. There's like separate requirements or restrictions for quickened children versus not yet quick, a quick child, which is, you know, has no medical definition in this day and age. And in the Dobbs decision, even the majority opinion written by it, just by Justice Alito says that, you know, that is, That term is, you know, no one has a common understanding of that term, right? Generally, like, when the fetus is felt to be moving, right? Exactly.

Chris (2): 21:57

Yeah, yeah. And that, that was, you know, as you said, that was one of the points that we came to is just the fact that there is no standardization of that. Right. Like that, that, that interpretation of it was put into law before there were ultrasound, in order to see or to hear, uh, you know, a fetus's heart rate. And so it's just completely arbitrary and dangerous to, to be honest with you at this state of the game.

Diane: 22:20

The other thing that made it extra confusing is that, you know, decades ago our state Supreme court had considered what the statute meant and in light of the more modern abortion laws and said it was a fetus side statute. You know, the case black versus state versus black arose in the context of prosecuting a guy who beat up his pregnant spouse with the intention of killing the infant a few days before her due date. Um, and Charges were brought by the district attorney, you know, back in the nineties of under the old abortion ban, what was that thought of has and but it has like it was intentionally killing. You know, an unborn child, and so they brought it under that law, and our state supreme court looked at that case and said, yeah, so now kind of in light of the other law, this is a feticide law. Like it prohibits the intentional killing, you know, in this manner, it doesn't apply to like medical abortions because we have laws that do that. So that made it fair. More confusing. And that was, you know, the basis for, and jumping ahead here for the Dane County Circuit Court saying, yeah, this is no longer an abortion law. The old, what used to be our old ban is now a feticide law.

Chris (2): 23:46

Yeah, and it's totally fine to jump ahead. So, so where are we at today in terms of, because again, 2022, we go back that's the law of the land. We're all kind of working under this cloud of uncertainty. Where are we at now? And, and kind of what role did, did you and your, your firm play in that?

Diane: 24:02

Right. So very shortly after the Dobbs decision was decided, Attorney General Call brought a lawsuit seeking a declaratory judgment to, to what does this law mean? Is it still in effect? You know, um, how does it relate now that we have all these other laws? Um, we intervened on behalf of three positions, including yourself has persons who are most directly impacted by the confusion and and face potential prosecution under the old ban. You know, if there was a district attorney who interpreted it differently than, you know, than we interpreted it. So we intervened and we had oral argument in the circuit court of Dane County and the circuit court ruled in favor of the Physicians who intervened and intervene means to like join the lawsuit. Like we're not the ones who brought it the first time, but we say we have a interest that's potentially could be injured. So we should be here too. And we should be a party. So by intervening, we were full parties to the case. Um, and we prevailed. The judge said physicians are at risk of being injured by a misapplication of the old law. And, uh, under state versus black, the case I talked about a few minutes ago, that is no longer the standard for medical abortions. We have all these other laws that, that regulate medical abortions. And that's what applies to them. So she issued a declaratory judgment saying it's no longer in effect. Um, so that was good news. And I think most health systems and providers, you know, saw that has an opportunity to, to change. And the abortion clinics in the state reopened and most health systems took off some of the restraints that they may have placed on, uh, their healthcare providers while there was a question. District Attorney Aromansky appealed the case, and he asked that the Supreme Court grant bypass, which means instead of having this argument before the Court of Appeals, and then seeing what the Court of Appeals does, and then the potential to have it reviewed in the Supreme Court, um, He asked the Supreme Court just to shortcut the Court of Appeals and hear it directly because of the important questions that were raised. Uh, the position intervenors agreed. We asked the Supreme Court to take it as well, as did the Department of Justice. And so, that case is set for oral argument on November 11th. So the Monday after the election, uh, we'll have argument, uh, at the Wisconsin Supreme Court to, we'll be arguing to uphold the circuit court decision, which says the sick old man is not an affected, as I like to say, it's not a zombie law that comes back and takes over, um, all the other modern day abortion statutes.

Chris (2): 27:08

So after these arguments, is there a potential that we can revert back? Like you said, or, or what do you, what do you foresee, uh, uh, to come out of this?

Diane: 27:19

There's the potential, but I'm very optimistic, you know, but You know, elections matter. Hmm. And, uh, there was a judicial election last April and the court switched from a conservative majority to a progressive majority. And we don't know how any of the four progressives will vote in this case, but I remain optimistic. But even as it comes to the conservative justices, you know, the notion that a law that was passed and. Replaced with many more modern laws, to me, seems very undemocratic. Like, when you look back, when the law was originally passed, women couldn't even vote. There were no women legislators. Even when it was, like, updated and moved into a different section in 1955, women had been voting for a short time, and there was very little representation in the legislature. Um, to say that, Our forefathers view of what should happen versus like all the modern legislatures that like you and I had the opportunity to vote for in the last 20 years. Um, like that our modern legislature has to take a backseat to very old former legislatures makes no sense to me from a democracy standpoint. Right. So I think to say that this old law replaces all the modern laws, seems like a bridge too far.

Chris (3): 28:49

And

Diane: 28:52

so I'm, I'm, I'm very optimistic. You know, we also related to this topic is there's another case pending in our, in our state Supreme court, which deals with, Whether that old statute, if it was a ban, would violate our state constitution. So, under that litigation, it kind of takes it another step further. Like, wouldn't applying that law violate People's right to life, liberty, and the pursuit of happiness,

Chris (3): 29:25

you know,

Diane: 29:26

like, and when I talk about this, you know, what we talked about toward the beginning, deciding like how many kids do I want to have? When do I want to have? What else do I want to do? Like, do I have health risks that might be implicated by a pregnancy, like all those questions, um, arise in the context of our state constitution, which includes language that doesn't exist in the federal constitution. And one thing that was made clear in Dobbs is now abortion is an issue to be left up to the states. So we don't just look at state statutes, we have to look at our state constitution as well, as like a separate, uh, basis for rights. And that section of our state constitution is recognizing inherent rights, like not rights that the government gave us, but rights that we are born with, and the government needs to recognize. And in North Dakota, the state courts found that their state constitution provided rights similar to what we're seeking in the second case. So we anticipate that our state Supreme Court will probably decide Paul v. Ermanski, the case you're involved in, and also Planned Parenthood v. Ermanski, which raises the constitutional question by the end of this term, which is by early July. So we can. have this firmly, whether it's statutory interpretation or constitutional interpretation or

Chris (2): 30:50

both. Yeah. And you bring up a good point there too, especially how the doubt decision took it directly to the states. I was recently listening to an excerpt, I believe it was through Texas Public Radio, where they had a really good piece on fetal personhood. And how stricter, state, statutes will lead to issues not only for emergent situations like ectopic pregnancies, uh, but also potentially for IVF patients, patients that are seeking to make their families complete. Uh, and in Wisconsin, we're starting to hear some of this language as well. Folks interpretation, especially now. This is an election year. You have more conservative candidates, even in my own Senate district that are bringing this point up of fetal personhood. What is that? And is that something that we're considering as well? And in some of these cases,

Diane: 31:39

it's not just a part of this case, but it is part of the landscape because we have state Republican legislators. who individually believe that there should be, you know, personhood should be recognized. Also that, um, you know, that personhood life begins at conception and who would ban certain forms of contraception. So we certainly have some legislators who would remove, um, some contraceptions. Um, And make them illegal, would remove funding, public funding for certain forms of contraception or contraception in general. So, um, yes, there are certain legislators who would prioritize the life of, you know, a zygote, embryo, fetus, ahead of a patient or woman.

Chris (2): 32:38

Yeah. Yeah. And that's the part that's concerning, right? Especially in the setting of again, national elections are coming here and more and more rhetoric. About bringing the things back to the states and quote unquote letting the states make their own decisions But as we discussed on this on this podcast before How much goes into the states making that decision? Is it really you making that decision or is it your legislator? Is it from a gerrymander like map that your that your your legislator is chosen, right? There's so many things that go into it and even looking at it from a medical perspective Again, in the cases of these non viable pregnancies, but can be extremely dangerous for women, especially if you get internal bleeding, et cetera, et cetera, become septic. You know, what does that mean to those providers? What does that mean to those women who are coming in, Does that mean that we wait for them to get to a certain level of you know, a fever a certain level of Instability, you know, do we wait for them to lose a limb for instance, which can happen in the cases of of sepsis You know, that's not Considered in some people's, ideology of, is this actually the life of the mother?

Diane: 33:41

No. And that brings up an important point, getting back to your earlier point. Like, and then some of those cases waiting too long can, can impact the patient's future fertility.

Chris (3): 33:52

So

Diane: 33:52

having, right. So, you know, something could happen. You know, this could be a very wanted desired pregnancy, but because of complications. It goes wrong and medical intervention is necessary to save, you know, preserve her health, but also her fertility. Should you want to have a child in the future? And, and the laws that, uh, are purportedly, you know, protecting, you know, promoting birth and my birth can get in the way, The fetal type statutes or abortion laws could get in the way of, of, of preserving her fertility for future healthy births. You know, it also, as you said, has implications for IVF where, um, where again, couples who very much want to have children, IVF and then, but if every embryo, you know, is a life that can never be destroyed, raises significant, significant You know, there are more eggs that are fertilized than would ever be planned to, you know, fully develop and, you know, be born, right? Yeah,

Chris (2): 35:04

yeah. Absolutely. I've had many colleagues that have gone the route of IVF and, you know, it took years for them to, conceive, and have a infant in their arms, right? And so that, that is something that we need to continue to keep an eye on and especially considering The lack of science in some of these cases now, I don't, I don't want to talk, you know, down on any, any individual representatives in particular, but I've sat across from a number of legislators and a number of representatives. And have been shocked to be honest with you about their understanding of science and you know I could only imagine what they get in science, you know when they were coming up right because it's just like what what? Let's just start from scratch. All right, let's just start over again. But you know, it is that lack of understanding and it's It's the, the, the caliber of that understanding that's sitting at the table that not only are making these decisions, but making the decisions for their constituents that may or may not have voted for them. That concerns us all, right? Like in the instances of some of these, you know, uh, some of these fertilized old women in the setting of IVF. Some of them. have congenital abnormalities. Some of them have, karyotype abnormalities that will never be viable. Right. And so in those cases, there, there is a lack of scientific thinking. There is a lack of critical thinking to this, to this point, and just kind of, this is what it's going to be. You know, that's what we're all concerned about.

Diane: 36:29

Right. And there's both a lack of scientific thinking, and I don't think it's necessarily related to poor education versus like intentional disregard. for science. Um, but there's also just views on the roles of women in society. And, um, and, you know, I have heard a sitting legislator say that, you know, our workforce shortage issues are because women are having enough babies, you know, and, um, and I just find that very offensive, you know, like this view that, like, we're the problem because we're not all producing more Children, you know, and if we did want to provide incentives for, you know, Couples, women to have bigger families. There's way to ways to do that. You know, like having, you know, universal healthcare, having universal affordable childcare, having affordable education, K through college, you know, all of these things that considerations that people have when deciding how many children to have, you know, cost is a big driver. Having parental leave, you know, paid parental leave would be. You know, one reason some people, might not have more Children. So there's ways of providing incentives for couples to have more Children. If we really think we need more future workers, but the idea that this is just lands on women's shoulders. And if we have anti abortion policies that will build up our workforce, um, I think it's not the right way to do it. You know, I just think we're not better off adding unwanted children into a society.

Chris (3): 38:15

Exactly.

Diane: 38:16

Like if, if couples are affirmatively believe they cannot, you know, raise, support, nourish a child. Yeah. I think that is an important decision to make, you know, you know, hopefully in planning contraception, but if in the, if there's a failure in planning. Um, our failure of contraception to make a decision versus taking away the option for contraception or abortion, and then meaning like, that's how we get a bigger workforce.

Chris (2): 38:48

And that's key to the point too, because as you said before, a lot of times the contraception is considered, you know, to be included in the realm of abortion, right? So, oral contraceptive, Plan B, all these things that are definitively not that. Are interpreted by people who, again, are either ignorant of the science or, uh, purposefully avoiding, you know, any, any, any truth to the matter in saying that we're going to lump all these things together. All these things are abortion and you can't do any of them,

Diane: 39:18

right? So if you're, you know, like. View fertilization versus implantation has, you know, when, yeah. one's conception, one's life, one's other things and applying your own moral view versus the scientific view that makes it a lot harder for, uh, for making good decisions about what contraception should be available and what options should be available.

Chris (2): 39:49

One of the things that we're seeing now are the beginnings of some of the consequences to having this reversion more strict laws in the books on in some states such as Texas and Georgia. Unfortunately we saw, Um, at least two women, that had fatal results from this that we know of, right, that, that we are, that we are publishing in, in, in the mainstream media, so to speak, what are some of the most significant, legal and social impact that you have observed, uh, just in your own practice since this decision,

Diane: 40:24

right? I think first is the confusion. is, is, you know, was the greatest. And then the women who could travel out of state to get the care they needed, you know, that had to, instead of getting care by their trusted providers close to home, like then had to travel out of state. And when I heard from from women is, you know, like their physician saying, I wish I could do this,

Chris (3): 40:52

but

Diane: 40:53

My lawyers are telling me I can't, or my hospital's telling me I can't, or I'm told I can't do this, so, you know, like, you know, already in distress about, um, their status, you know, that they have, you know, that their pregnancy has failed, and now they have to go out of state to get care, and then some being denied follow up care, because, um, their healthcare provider was just even concerned to do the follow up, care that was required. You know, as you know, like sometimes even for medically necessary abortion, there could be complications or follow up care that's needed. But like some physicians or health care systems not even wanting to, um, to go there. You know, and that part is very frustrating. You know, in some states, there's been the concern about where there would be a miscarriage and then women are, are investigated as if they did, uh, self managed abortion when it was, you know, a spontaneous abortion or miscarriage. And, um, Which is extra troubling to me, like criminalizing something, a traumatic

Chris (3): 42:07

event.

Diane: 42:09

You know, many women were told, like, resorted to, like, online pharmacy for, contraceptive pills. Yeah. Which, you know, so that removed, you know, like, since I'd be able to come here locally, meet with the physician, get the follow up care they needed. Right. You know, they were left to self manage it, even if they would have preferred to do this with the care of a health care provider locally.

Chris (2): 42:34

And to that point, to this day, even though we have now swung out of this, at least, you know, hopefully permanently, but at least temporarily. I have recently seen women in the emergency department who have done just that, Diane, who have gotten, you know, uh, quote unquote abortion medication online because they're under the assumption still that we are still, under this restriction to provide abortion care in the state of Wisconsin. So like we said, we have yet to see the effects down the line of just two years plus, right? Because that, that, that information has not gotten out to everyone as of yet. And people are still thinking, if I go to the emergency department, which is what we saw at the very beginning of this, if I go to the ER, they'll find out. Right. If I go to the ER, there'll be police waiting there for me because again, as we're nearing national elections, this is what folks are hearing. This is what people are seeing online, social media, et cetera, et cetera. And it's building this very unsafe environment for our patients to live in and for our communities to be under.

Diane: 43:36

And because this is left state by state by state, But the dialogue and social media posts and everything are national. There's just more confusion because if you read a story about a woman in, you know, Ohio being prosecuted or something happening in Texas, you know, People in Wisconsin don't know what that means, you know, for them, you know, and one thing that we said repeatedly, like under Wisconsin statute, even, you know, the worst version of the old law, women themselves can't be prosecuted for obtaining an abortion or self managing an abortion like that, that is specifically excluded from that statute. So the patients you see who maybe have tried to self manage an abortion, that's not illegal in Wisconsin, even under the worst interpretation of the old ban.

Chris (3): 44:27

But,

Diane: 44:27

again, how to get that message out when really what we need to do is modernize our abortion laws overall and make them clear. for all patients to know and not just patients for people who are planning their futures. Um, so hopefully we'll get a good decision in this case. Hopefully we'll get, you know, good legislature that could look at, you know, improving our contraception and abortion laws versus I'm taking them back century.

Chris (2): 44:57

Yeah. Yeah. And you know, we, I know in your field, you likely get a lot of opposition and a lot of counter arguments that are presented to you. I know I do, uh, just by being involved in the case, how do you address, you know, some of these, some of the opposition, some of the counter arguments presented by people who are very supportive of restrictive reproductive laws in the state of Wisconsin.

Diane: 45:18

You know, I respect that friends, family may have different religious views or moral views on, on abortion. And, um, I just say that I believe that it's a very individual decision and, you know, a very personal decision. And I don't think I should impose my religious moral views on others and vice versa. And that if a person Believes they can't go through with the pregnancy, whether it's because of health conditions, you know, the risk to their own health or life, or because they're just, you know, not equipped to bring a child into the world. That is just a decision I prefer be made at an individual by individual level. I think it's actually uncaring. to demand that others bring an unwanted child into the world. And, you know, I don't know that that's the best thing for that potential child.

Chris (2): 46:19

Absolutely. What do you see as the future now? Because I know that you said there, this case is split into two places, two cases at this point in time. Um, what do you see as the future of reproductive right litigation in Wisconsin? And also just kind of on the grand stage, like in the United States, where do you see this going?

Diane: 46:37

So in Wisconsin, a lot will depend on how the court addresses the two pending cases in the statutory case and the constitutional case. Yeah. If Wisconsin follows other states in recognizing a state constitutional right, then that has implications about what kind of restrictions could be, could be placed or could not be placed on abortion or contraception or IVF or other forms of really any issue that deals with bodily autonomy going

Chris (3): 47:10

forward,

Diane: 47:11

right? Thank you. You know, so if we, you know, if our right to life, liberty and pursuit of happiness really means something for each of us, I think that has broad implications that we might see other cases deal with

Chris (3): 47:24

in the

Diane: 47:24

future. I mean, if our court says, no, it doesn't, that doesn't mean that, um, you know, then it may have negative consequences for protecting some very rights that we think should be personal decisions.

Chris (2): 47:38

You know,

Diane: 47:38

like couples or individuals with names.

Chris (2): 47:42

And along those lines, what do you think that, we can do, both in your realm and in my realm to improve, that public understanding and that support for reproductive rights. Because as we said before, this is not only along the medical track, this is not only, you know, that life, liberty, pursuit of happiness, the bodily autonomy. There's a lot of things that go into this, including socioeconomics, you know, there, there, there's a religious aspect, there's cultural aspects that go into it too. What can we do to improve that public understanding of the need to have, these reproductive rights in tech.

Diane: 48:11

I think we need to keep talking about it, not closet this issue. You know, when you think about like maternal, life and like, who's at greater risk of, uh, dying from, pregnancy or birth and, and infant mortality rates and other things where like, uh, There are so many factors that go into that and to like just pretend that everyone who gets pregnant will be just fine, you know, and that, you know, like

Chris (2): 48:38

that doesn't work that way. I

Diane: 48:41

think also like taking abortion out of just that it's only this elective, you know, decision to make where, you know, really abortions are provided, you know, all around the state, not just at abortion clinics, right? Because it had, you know, in the emergency room when someone presents with medical condition for which like abortion an abortion is the right medical decision. And then there's spontaneous abortion, things that just happen on their own. So to take it out of this idea that like, it's only this, uh, procedure that's only done at abortion clinics and should be suspect at all times. I think we need to just keep talking about the realities of, um, and not make it, a closeted issue that we don't talk about. implications. I think talking about the overlap of again, this is some of the same organizations that are pushing the most restrictive abortion policy also push limits to contraception and who can access contraception. And, uh, I heard this early in my career, I heard this story about like how in Europe when they're talking to teens, like they recognize that teens might be experimenting with sex, um, So instead of just saying, like, they don't say, like, don't do it, don't do it, like, just say, no, they say, don't get pregnant and here's how you don't get pregnant. And in many other countries, there's much lower teen pregnancy rate than in the United States, because the message isn't an unrealistic, just say no. It's a more realistic, if you're going to do it, this is how you prevent an unintended pregnancy. And this is our expectation.

Chris (3): 50:25

Yeah, yeah,

Diane: 50:27

so so I think again some of the same people who don't want Um, we want to limit the legality of abortion and limit access to contraception. Also want to limit discussions of sex education or access to, um, reproductive health care for, for minors.

Chris (2): 50:48

Which runs contrary to their, right, to the goal ultimately, right? Exactly.

Diane: 50:52

Yeah. So, so I think we need a more holistic and real, holistic and realistic approach. You know, overall to talking about, you know, family planning, reproductive choices, sexuality and, um, you know, should parents be involved in those discussion? Absolutely. But if they're not, um, there still is a role for others to be involved.

Chris (2): 51:17

Yeah. Well, Diana, thank you so much. Just to close everything out here, is there anything else you would like our listeners to know about the fight for reproductive rights in Wisconsin and, how can listeners follow you or, uh, get in touch with you if they want to get more information or support any of your efforts?

Diane: 51:35

Great questions. I think the most important thing that listeners can do is vote.

51:39

Um,

Diane: 51:40

you know, we have important elections coming up in November, and then in April there's a state Supreme Court election, and a lot of folks don't vote in the state Supreme Court elections in April. But it's very important to know the candidates and know their positions, uh, on, on issues related to reproductive health and everything else that might be important to you. Uh, and, I don't, I, There's no way to follow me very well. I'm not presence on social media. I'm just kind of quietly working in the background and we

Chris (2): 52:16

appreciate it. Keep, keep working,

Diane: 52:18

but I'm happy to come and talk to you again, Chris, whenever you want, and I think when we have a decision, which might not be until summer, I think there will be news of that decision or those decisions. And, but again, uh, please vote. Uh, in November and again in April, and again, knowing who supports, you know, the rights that you hold to be important in the

Chris (2): 52:45

work you do. Absolutely. And that's the intention of this, just to give folks that, that, that idea of, you know, the background, right? These are the facts. The, this is coming straight from the source, as Diane said, she's in, she's in the trenches. So she may not be on social media posting, but she's fighting this fight for, for women throughout the state of Wisconsin to make our lives safer, to make families safer, our community safer as well. Dan, I appreciate you so much for coming out and making the time and thank you for all your efforts. And, uh, we, we are looking forward to hearing more from you. We will definitely reach out to tie a bow on this and figure out where we're at in the summer.

Diane: 53:18

Thank you, Chris. And thank you for being part of the litigation. That's really important work that you're doing in addition to, you know, being at work every day. Your position code on.

Chris (2): 53:29

Awesome. Awesome. Well, thank you so much.

53:32

In 2023, the American college of emergency. issued several statements on reproductive. Of freedoms. For our listeners, the American college of emergency physicians is the governing. Burning body. One of the main governing bodies for emergency medicine doctors throughout. The country. And in their policy statements, they. They supported equitable access. Yes to reproductive healthcare, including abortion. In emergency departments throughout. Throughout the country. And they supported the idea that abortion is a medical. Procedure that should be a shared decision between a. Patient in their physician. As we also discussed in this. This interview, we support EMTALA as well, which is the emergency. Medical treatment at active labor act. And this. Emphasize is the right of emergency physicians to provide care to pregnant patients without. Without the fear of legal consequences. As we discuss. The entire goal. Of some of the advocacy that we've done over the years since the overturn. Of Roe V. Wade. Was to provide physicians. With the information that. They need to have on hand to make the decisions that they train their entire lives. Lives to do when it comes to patients in active. Labor patients who are in extremest due to complications. Of pregnancy. We want physicians to be on the phones with their consultants. And not on the phones with their lawyers when considering next steps to. Take because seconds and minutes count in these situations. The way that the law is written as it is in the state of Wisconsin. Let's say if this case and the Supreme court is. Overturn, we go back to a law from the 18 hundreds. I. And in the 18 hundreds, we did not know. The extent of the things that we know now in medicine, we did not know what a survivor. Pregnancy was. There's language which is discussing. Quickening as Diane referenced. And that is ultimately. The first time that a mother can feel the baby in the womb and. And so that was the measurement. Of stating that a. Pregnancy is viable in those days. We have become more sophisticated. Since that time in terms of. Medical capability. We know. What a viable pregnancy is and what a viable pregnancy is not. And so there's a lot more nuance that we have now as compared. Paired to the law when it was written in the 18 hundreds. And. Whereas all of us in. The medical field. And most of us who are reasonable on the subject. No, we are currently. In a better place in. Terms of what we can do and the lives that we can. Save where we are in 20, 24 versus where we. We're in the 18 hundreds. However, there are some members of the legislator that wish to reverse. Vert back to a law that is archaic to a law. That is dangerous. And to a law that if. It is made the rule of the land. Yet again. Will cause harm. There will be deaths here in the state of Wisconsin. Wisconsin. Just as there were in Georgia, just as there. There are around the country that we may not even know about as of yet.'cause a lot of people do not present to the emergency department again for. For fear that they will face repercussions based on doing. Self-managed abortions or seeking abortion care. In other states where it is legal. So this is something that is. Going to affect all of our populations. This is not something that's going to affect one. Group or the other, it will affect everyone contrary to some. Opinions that you may hear on talk radio that you may see on social media. Media It will affect those who are traditionally most effected by social. Determinants of health. I can tell you anecdotally. As an ER. Doctor. I have seen women. Who have been. In very dangerous positions since the overturn of Roe V. Wade. In my emergency departments because they were fearful. Of what would happen if they sought care here in the state of Wisconsin? We all need to advocate for our patients. And we all need to have the facts at hand. Uh, in order to help make these decisions. That is why we went to medical school. Right. That is why we did all this extensive. Of training to have the science at our hands to be. Fast aisle at appraising the information. That we have in front of us to do no harm. We want to make sure that we are able to practice at the best of our abilities. And what the full extent. Of all the skills that we have. Have acquired over the years. In order to make. Our hospital's safer for our patients and to make our community safer. As well. A lot to think about. And these episodes. I want to thank you all for taking the time. Time to listen to part two, please join us for part three, where we will be. Discussing. Badger care expansion, and we will. I'll be discussing that with a fellow ER, provider. Lieutenant governor. Governor's Sarah Rodriguez. as always take care of yourselves, take care of each other. And if you need me. Come and see me.