Colorado doctors who prescribe the so-called abortion reversal pill will be operating outside the “generally accepted standard of practice” and subject to investigation by the state medical board, the board decided Thursday.
The decision — which came after hours of debate, an executive session to consult the board’s attorney and what one board member called “linguistic acrobatics” — comes after Gov. Jared Polis signed the first law in the nation to attempt to ban the abortion reversal pill.
The board that regulates medical practice did not go as far as Democrats in the legislature had wanted, which was to consider it automatic “unprofessional conduct” if a physician prescribes the reversal pill, but it comes close to an outright ban. It took deliberate care to add language into its rules to make clear that the board considers the practice unethical.
The board, composed mainly of doctors, also made clear that it will review reported uses of the reversal pill, which is progesterone, on a case-by-case basis.
“Although the board will not treat medication abortion reversal as a per se act of unprofessional misconduct, the board does not consider administering, dispensing or delivering progesterone with the intent to interfere with, reverse, or halt a medication abortion through the use of mifepristone to meet generally accepted standards of medical practice,” its new rule states.
“Licensees are expected to practice evidence-based medicine, and any licensee who provides unscientific treatments that fall below the generally accepted standard of care may be subjected to discipline.”
Abortion rights groups were celebrating the ruling. “We’re so excited. It was the outcome we wanted,” said Natasha Berwick, a policy director at New Era Colorado, which works to get young people involved in the political process.
The language for the new rule was so tricky because the medical board does not typically adopt rules about a standard of care for a single treatment. Instead, it investigates complaints of malpractice on a case-by-case basis.
The debate, which included testimony from multiple doctors on both sides of the abortion issue, centered on whether prescribing the so-called abortion reversal pill is an unethical practice that the state should ban, or whether the medical board should consider disciplinary action only when there is a specific complaint against a doctor. In the end, the board seemed to land on both.
The board’s counsel, first assistant attorney general Ashley Moller, warned the board against sending a mixed message by saying the practice was outside the bounds of accepted standards and also that the board would decide every case on its own merits.
The board would need to investigate specific complaints because that’s how its disciplinary action works.
“Are you making a determination right now, right here that when someone gives progesterone following the administration of mifepristone, it is not generally accepted standards of medical practice?” she asked. “If that’s what you’re deciding, then you don’t need your case-by-case language.”
A draft rule released by the medical board last month made it appear the board was poised to rebuff the legislature, which passed Senate Bill 190 this year. The bill declared abortion pill reversal treatment to be unprofessional conduct, meaning doctors and others who provide it could face sanctions against their licenses. But the bill left room for the state’s medical, nursing and pharmacy boards to overrule that decision by declaring reversal to be a “generally accepted standard of practice.”
Board was concerned about unintended consequences of the state law
Nearly three-quarters of the 14,000 abortions provided in Colorado last year were medication abortions, or via the “abortion pill.” Patients first take a pill called mifepristone, which blocks the body’s progesterone, a hormone needed for pregnancy. Within the next 48 hours, patients take a second medication, called misoprostol.
The abortion “reversal” pill is taken after women have taken the drug mifepristone but before they have taken misoprostol. The reversal is a high dose of the hormone progesterone in an attempt to counteract the effects of the mifepristone and preserve the pregnancy.
There have been no clinical trials showing the reversal pill is safe or effective, and the American College of Obstetricians and Gynecologists says abortion reversal “is not supported by science.”
Before the vote, board members went into executive session to consult with an attorney about what language they could add to the new rule.
Dr. Roland Flores, president of the medical board, said he had concerns that the language in the state law is too broad and could unintentionally prevent doctors from providing certain care. In one hypothetical scenario, he asked what would happen if a woman tried to end a pregnancy by taking beta blockers, typically used as heart medication, and then a doctor feared that treating the overdose was interrupting a medical abortion. And, he asked, what if pharmacists feel like they can no longer dispense progesterone because it could be used in an attempt to reverse an abortion?
“The intent of this bill was to stop this predatory bait-and-switch, deceiving women and especially at-risk women,” he said. “My assumption is that none of us have any question about whether a bait-and-switch and deception is an unethical practice of medicine.
But “as the law is written now, it’s written so broadly that it captures situations that we may not intend.”
The rule adopted by the board included language to make it obvious it pertains only to cases in which progesterone is prescribed specifically to stop a medication abortion. The Board of Nursing and the Board of Pharmacy are scheduled to decide on the proposed rules Sept. 20 and 21.
Doctors who testified were split on abortion issue and whether reversal works
Dr. Catrina Bubier, a Denver area obstetrician-gynecologist, urged the medical board to consider any use of the abortion reversal pill unprofessional conduct. It does not work and telling patients it will work is unethical, she said.
“It’s not possible,” she said. “There’s no way to reverse once you’ve taken the medication. No amount of progesterone will make a difference.”
Allowing it, she said, would open the door to allowing other nonevidence-based medicine in Colorado. “The current abortion reversal topic does not have any peer reviewed literature and is not substantiated by any validated research or data, therefore, is quite frankly, someone’s opinion,” she said. “We cannot change our way of treating patients when someone says ‘just because I said so.’”
But Dr. Scott Sundheim, medical director of Life Choices pregnancy center, said he could lose his job and face investigation by the medical board unless the board decided the reversal pill was within the standard of care. The pregnancy center offers progesterone therapy to attempt to reverse abortions, he said.
One clinical trial that was halted before its conclusion found that some women experienced heavy bleeding when they took the first abortion pill but did not take the second pill. If a woman in that scenario came to Life Choices, Sundheim argued the best medical care would be to give that woman progesterone therapy, or the abortion reversal pill.
“It is a fact that if these women seek our progesterone therapy, and we don’t give it because we’re not allowed, then we actually increase their risk of heavy bleeding, which is not the best medical care which I have vowed to give my patients,” he said.
The abortion pill was approved by the Food and Drug Administration in 2000. Whether it will remain legal in the United States is the subject of a case likely headed for the U.S. Supreme Court. A federal appeals court ruling this week said that the pill is legal but allowed restrictions, including that patients could not receive the pill through the mail or via telemedicine.
Several states have banned or restricted the abortion pill. In Texas, the pill cannot be prescribed via telehealth and cannot be mailed. Prescriptions are not allowed at all after seven weeks of pregnancy.
Once people cross into Colorado, they can attend a telehealth appointment with Planned Parenthood or another Colorado abortion care provider. They can pick up the medication at a local pharmacy, or have it mailed to a Colorado address, including a post office. An organization called Just the Pill also has mobile clinics and dispenses the abortion pill in Colorado towns near the state border.