After the strict abortion ban in Idaho, gynecologists stage a rapid exodus

Sandpoint, Idaho • At a brewery in this north Idaho town, hundreds of people recently held a wake of sorts to mourn the closure of Sandpoint’s only maternity ward, collateral damage from the state’s Republican-led efforts to criminalize nearly all abortions.

Jen Quintano, the organizer of the event and a Sandpoint resident who runs a tree service, shouted shoulder to shoulder to the crowd as children ran underfoot: “Raise your hand if you were born in Bonner General! Raise your hand if you gave birth at Bonner General!” Almost everyone raised their hand.

Later this month, the hospital, which was founded in 1949 near the shore of Lake Pend Oreille, will stop providing services to expectant mothers, forcing patients across northern Idaho to travel at least an extra hour for care. Also in June, a second Idaho hospital, Valor Health, in the rural town of Emmett, will shut down labor and delivery services.

Those decisions came within months of Idaho’s abortion ban, one of the toughest in the country, which went into effect in August 2022. Doctors can now only perform the medical procedure to stop the death of a pregnant woman or in the case of rape or incest reported to the police.

In March, Bonn General Health officials said the law was a driving force in the closure, citing the legal and political climate in Idaho.

“Highly respected, talented doctors are leaving the hospital,” the hospital wrote in a statement. “Recruiting replacements will be extraordinarily difficult. In addition, the Idaho Legislature continues to introduce and pass legislation criminalizing physicians for medical care that is nationally recognized as the standard of care.”

OB-GYNs face dangerous dilemmas

Amelia Huntsberger, an obstetric gynecologist, has delivered babies and treated miscarriages at Bonner General for more than a decade. Shortly after abortion became illegal here, she saw a patient with a ruptured ectopic pregnancy — in which a fertilized egg grows outside the uterus — and faced a dangerous dilemma. State law did not allow doctors to terminate ectopic pregnancies that are never viable.

“I went to the emergency room and examined the patient,” Huntsberger said. “Her vital signs were stable at the time of my exam, but from her imaging I knew we had to move quickly to stabilize her.”

Huntsberger said her duty as a doctor is clear — to prioritize her patient’s safety — but added that she “also knew I was potentially putting myself at risk of a criminal offense that would carry at least two years in prison.” [and] Loss of my license to practice medicine for six months.”

She added, “I have tended to several cases of ruptured ectopic pregnancy in the first few weeks after this law went into effect.”

The Idaho Supreme Court has since ruled that the law does not apply to ectopic or molar pregnancies, a rare complication caused by abnormal cell growth. But doctors say limited changes don’t explain many common pregnancy complications, which can quickly escalate.

This has caused deep frustration and uproar in hospital emergency rooms.

“When can I act?” said Huntsberger. “Should I wait until she bleeds to death? Do I have to wait until we do CPR? When can I intervene? How close does she have to be to death before I take care of her?”

State Assemblyman Mark Sauter, a Republican from this lakeside community 60 miles northeast of Spokane, Washington, said he hadn’t given the state’s abortion ban much thought.

“It really wasn’t high on my radar, other than being a pro-life guy and running in that direction,” he said during an interview at his home overlooking the lake and forested mountains. “I haven’t seen it make a really big impact on the community.”

Then, in December, Sauter had dinner with Huntsberger, whose husband is an emergency doctor at Bonner General. “They started explaining all the details about what was going on and how uncomfortable it was for them,” Sauter said.

These conversations proved enlightening. “You get exposed to something, all of a sudden you’re like, ‘Wow, there’s another way of looking at it,'” he said. “‘What are we going to do about it?'”

When Sandpoint’s maternity ward closed, Sauter supported a bill that would have allowed doctors to terminate pregnancies to protect a woman’s health, not just prevent her death. But those efforts were squashed by fellow Republicans during a committee hearing in late March.

“The list was endless when we started looking at the terms that might fall under that language,” said Rep. Julianne Young, a Blackfoot Republican. “We want to make sure that the mother’s health doesn’t become so broad that everything becomes an exception to take the life of a potential child.”

The effects of the ban are being felt nationwide. In Boise, the state capital, Lauren Miller, a gynecologist, resigned earlier this month from her position at one of the state’s largest hospitals, St. Luke’s Health System, shrinking the already tiny corps of maternal fetal medicine specialists of the state further.

As a doctor handling complex, high-risk cases, Miller said she’s had to send patients abroad to terminate dangerous pregnancies, including a woman with severe kidney disease.

“I could have very well taken care of this patient with my partners,” she said, noting that the Boise-based medical center has kidney specialists and an intensive care unit. “Instead, she had to leave her family and fly a few more hours to be cared for in a timely manner. It’s just not what we signed up for.”

Miller said the abortion ban and the threat of criminal prosecution weren’t the only factors that prompted her to resign. She cited lawmakers’ failure to extend postpartum Medicaid coverage beyond two months and to renew the maternal mortality review panel. The state committee is investigating deaths of pregnant women and new mothers and whether they could have been prevented.

During a hearing before the House Health and Welfare Committee, Republican Mike Kingsley said the maternal mortality reports “all seem to identify the same thing: substance abuse, mental health. So, I think that has served its purpose.”

The beginning of an exodus

Directors of women’s health services at Idaho hospitals are preparing for what comes next: 75 of 117 Idaho gynecologists recently surveyed by the Idaho Coalition for Safe Reproductive Health Care said they are considering asking the state to leave. Of these, nearly 100% – 73 out of 75 – cited Idaho’s restrictive abortion laws.

An exodus could disrupt broader medical care for women who rely on OB-GYNs for routine and urgent gynecologic care unrelated to pregnancy, such as menstrual cramps, endometriosis, and pelvic pain.

Idaho is one of 15 states that have introduced strict abortion laws since the Supreme Court’s decision was overturned last year Roe v. calf. And while there’s not yet an official statewide census, anecdotal evidence shows that women’s health professionals from states that criminalize abortion are beginning to relocate to places like Washington state, which has strict abortion rights laws.

In Seattle, for example, about 270 miles west of Sandpoint, Sarah Villareal, an OB-GYN, now practices medicine without fear of prosecution after moving from Texas, where performing an abortion is a felony carrying up to life in prison will be punished. In Texas, private individuals can file civil suits against anyone who “assists or encourages” an abortion, earning at least $10,000 for successfully prosecuted cases.

The difference between Texas and Washington is great, Villareal said, noting an atmosphere of fear and distrust in many Texas hospitals. She recalled caring for a patient in a Gulf Coast emergency room who miscarried, although the fetus still had a heartbeat. The patient, who was already in a physical and emotional crisis, also had to deal with a legal issue.

“She was trying to figure out if I, as a provider, would report her if she decided to have a procedure done to save her life beyond the life of her fetus,” Villareal recalled. “And the worst part was being able to reassure her that I will try to do everything for her, but I couldn’t reassure her that someone else in the ER or someone else in the operating room wasn’t going to report her.”

Sarah Prager, a professor of obstetrics and gynecology at the University of Washington School of Medicine, who has recruited gynecologists from states with bans on abortion, including Texas and Tennessee, says doctors have a strong belief that they are failing their patients.

“There’s really a moral and ethical violation that happens when you’re not able to do the work that you want to do,” Prager said. “Not being able to take care of our patients makes doctors stressed. And when you add that we are now legally unable to protect patients from harm, it leads to incredible burnout rates.”

Even medical students are beginning to change their plans.

Kathryn Tiger and Allie Ward, first-year medical students in Moscow, Idaho, both plan to be surgeons, although both say they have no intention of practicing in Idaho.

“I wouldn’t feel safe here as a provider, and I wouldn’t feel safe here as a patient,” said Tiger, 25.

Ward said the new laws criminalizing abortion in the state limit doctors’ ability to provide comprehensive care.

“You need to be able to work not only with your care team, your nurses and everyone involved, but also with other doctors,” Ward said. “It’s frightening to think that the law doesn’t allow me to refer a patient who is seeking care or even education to a colleague of mine whom I trust.”

Back in Sandpoint, Huntsberger and her family say goodbye to Idaho, saddened by the idea that some of the patients left behind may be in medical danger.

“It breaks my heart to think about what this means for a woman going through a pregnancy crisis,” the doctor said.

But she added, “This is no longer a safe place to practice medicine.”

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