Alice In Wonderland in a Louisville Federal Courtroom.

“Contrariwise,’ continued Tweedledee, ‘if it was so, it might be; and if it were so, it would be; but as it isn’t, it ain’t. That’s logic.”
Lewis Carroll

I began my day yesterday morning attending Medical Grand Rounds at University of Louisville Hospital.  These weekly sessions teach the principles of evidence-based, scientific medicine to the physicians of tomorrow.  They simultaneously emphasize the ethical and patient-centered ideals that underly and legitimize the practice of medicine.  For the physicians of today (and of yesterday like me) they provide a way to refresh and celebrate the ever-expanding knowledge of the science of medicine, and to reaffirm and share together our commitment to the highest standards of our profession.

Because I was already nearby and interested in the proceedings, I drove across town to observe the second day of trial in the courtroom of Judge Greg N. Stivers in the United States District Court for the Western District of Kentucky to hear the constitutional challenge to new Kentucky abortion restrictions which was brought by EMW  Women’s Surgical Center (joined by Planned Parenthood) against Gov. Matthew Bevin and Health Secretary Vicky Glisson.  Judge Stivers will pass judgement on whether the language, intent, or implementation of laws controlling transfers and transport of women with complications of abortion from an outpatient clinic to a hospital unduly burden the right to terminate a pregnancy.

I had the distinct feeling I had left the realm of contemporary, science-based medicine into an Alice-in-Wonderland world where words are assigned any meaning one wishes, and logic can be turned on its head to support any desired conclusion. Perhaps some of this is unavoidable as the language of science and medicine is transcribed into the language of contracts and law. The crisis– which would close the state’s only abortion provider and prevent Planned Parenthood from obtaining a license to do so– was triggered when Governor Bevin’s administration and the Republican-controlled legislature cranked up requirements on abortion providers, and when University of Louisville Hospital (which previously was willing to offer a formal transfer agreement) announced that it felt pressure to withdraw it.  All of this has been reported in local media over the last year or so, including allegations that Governor Bevin personally pressured KentuckyOne Health to withdraw its transfer agreement with Planned Parenthood under threat to cut state financial support.

I have not yet seen any smoking gun proving the Governor’s personal involvement, and his office has denied his applying any pressure, but given statements from University of Kentucky officials about comparable pressure originating from the Governor to fire a UK faculty member who was critical of the Governor’s healthcare policy, a reasonable person might consider the allegations in Louisville to be credible.  Evidence in the trial so far presented documents and new information that make it clear that at the very least, the Governor’s office was heavily involved in the current anti-abortion strategy.  Since Governor Bevin campaigned on the promise that he would eliminate abortion in Kentucky, why should we not believe him?

The Governor’s Office, Cabinet and the legislature claim that their restrictions are not intended to restrict abortion, but solely to protect the well-being of women.  In my opinion, based on the courtroom testimony I heard, and on my lifetime as a teacher of medicine; the claim of seeking to protect a pregnant women’s wellbeing is both medically unjustifiable, and patently and hypocritically false.  The only way everything I have seen and heard makes sense is to conclude that the writing, interpretation, and implementation of the transfer and transport restrictions are focused “with almost surgical precision” to eliminate the option of a women to voluntarily terminate her pregnancy in Kentucky!

The trial is scheduled to conclude on Friday.  When that happens, I will populate these comments with links to documents and the more detailed reporting by others.  I may comment on some specific aspects of the case about which I have something to add.  I will definitely comment on how the medically bogus strategy of carving out reproductive and women’s health services from the rest of University Hospital so as to allow Catholic Health Initiatives and Kentucky One Health to claim they were not involved in providing contraception or sterilization greatly complicated the matter described above giving the Governor’ office an opening to exploit.  This is an important case and the nation will be reading about it in the days to come.

It is easy for me to make a mistake about legal technicalities.  Help me correct any such. I feel however, quite confident about the medical aspects on which I base my opinion that the interests of women with the demonstrably rare complications of surgical abortion are adequately handled by existing community protocols between ambulances, hospitals, and outpatient settings.

Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
President, KPHI
Sept 7, 2017

“Curiouser and curiouser!”

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