Kyle Pfannesnstiel

(Idaho Capital Sun) Idaho, already in a doctor shortage, is losing doctors who specialize in obstetrics and gynecology.

In a presentation at the Idaho State Capitol Building on Wednesday, Idaho medical leaders say the workforce shortage is exacerbated by doctors’ confusion about how to practice medicine under Idaho’s abortion ban that only allows abortion if it is needed for the mother’s life — not their health.

And they pleaded with lawmakers for a health exception, which would allow a doctor to terminate a pregnancy to prevent significant harm to a patient, not just prevent their death. For example, if a patient’s water broke early and infection was setting in before a fetus was viable, a physician could treat the infection, which may involve terminating the pregnancy, without fear of prosecution.

“Idaho is digging itself into a workforce hole that will take many years, if not decades, to fill. But before we can stabilize the environment and move forward, we have to stop digging. And we need more clarity in our laws to help with that,” said Susie Pouliot Keller, CEO of the Idaho Medical Association.

If a provider is prosecuted under Idaho’s abortion law, they face two to five years in prison and could have their medical license suspended or revoked. Idaho also has a civil enforcement law, allowing doctors to be sued for at least $20,000 by any family members of a person who obtained an abortion.

But legislation modifying Idaho’s abortion ban isn’t likely this year. The Idaho Legislature finished most of its business for the session on Wednesday and has recessed until April 10 to give itself time to address any potential vetoes Gov. Brad Little could issue.

Legislators held off on abortion legislation in 2024 while the U.S. Supreme Court considers a challenge to Idaho’s abortion ban, said Rep. Brent Crane, R-Nampa, who chairs the Idaho House State Affairs Committee, which typically handles abortion legislation.

Crane, after meeting with Treasure Valley doctors earlier this year on the issue, said he believes attorneys are being dishonest about how the abortion ban works. And he stressed that no doctor has been prosecuted or charged under Idaho’s abortion ban.

“I think that there’s still a push to try to undo Idaho’s abortion statutes. And they’re using doctors, OB docs, as a pawn in this political game, and I’m tired of it,” Crane told the Idaho Capital Sun in an interview. “Be honest with your doctors. Let them know the provisions that have been put in place by the Idaho Legislature. There are provisions that are clearly spelled out.”

Concerns about Idaho’s abortion ban being unclear aren’t new. In October, the Washington Post reported on how doctors had begged hospitals for guidance on abortion laws — including in Idaho.

“I really don’t think there’s any factual way to deny that it is, in fact, our abortion ban that is causing this very serious problem,” House Minority Leader Ilana Rubel, D-Boise, told the Idaho Capital Sun in an interview.

The Idaho Medical Association had worked on draft legislation for a maternal health exception, Pouliot Keller told the Sun in a statement. But “those conversations stopped” after the U.S. Supreme Court decided to hear Idaho’s case, she said.

“We learned that due to the impending court decision, there was no longer a legislative path forward. Regardless of the (Supreme Court) decision, IMA is still committed to a legislative change to preserve the health of patients faced with harmful pregnancy complications,” Pouliot Keller said.

‘A crisis of conscience’ for doctors 

Dr. Megan Kasper, an OB/GYN in Canyon County who spoke at the Capitol on Wednesday, said she’d recently cared for a patient in her second trimester — weeks away from viability — who had painful contractions and a dilated cervix.

Idaho’s abortion ban didn’t cause Kapser to change how she cared for that patient, she said, but the things she managed in the background did.

“What did I need to do to keep myself and the whole health care team out of trouble?”

“What was going to be my threshold for her health status?”

“If she started bleeding, how much bleeding was I going to tolerate?”

“At what point would her bleeding be enough that I would feel competent saying, ‘OK, this is life threatening?’”

Under normal circumstances, Kasper said, the baby “was not going to survive this process.”

“I would, as a physician, not have a whole lot of room for anything going the wrong direction. I would say ‘All right, this is starting to go not well. We need to step in and intervene and keep you miles away from anything life-threatening,’” she said.

Idaho Legislature 2023
Idaho House State Affairs committee chairman Brent J. Crane, R-Nampa, listens to Rep. Bruce Skaug present before the committee at the State Capitol building on Jan. 11, 2023. (Otto Kitsinger /Idaho Capital Sun)

But, Kasper said, “now, I have to think about that.” And she said she has to have parameters that she could potentially support in court.

“As we move forward, it has become very clear to me that the current situation here in Idaho is no longer about pro-life or pro-choice … It’s about basic maternity care that no one in 1972 even thought about questioning,” Kasper said.

Dr. Sara Thomson, a Boise OB-GYN who represented the Idaho section of the American College of Obstetricians and Gynecologists, said at the Capitol presentation some OB-GYNs she knows have left because of the “moral conflict” they experience while treating patients. And more are thinking about leaving if Idaho’s laws don’t change, she said.

“Many of us have had a crisis of conscience about what to do. Feeling both deeply committed to our patients, but also concerned about what this means for us personally and for our own families,” Thomson said. “The threat of incarceration for five years for patient care is a heavy burden. And being told that no physician in our state has been prosecuted — yet — or that a case of medical necessity is unlikely to be prosecuted, is not adequately reassuring.”

Idaho is seeing ‘obstetric deserts’ 

Three Idaho hospital labor and delivery departments recently closed: Bonner General Health in Sandpoint, Valor Health in Emmett, and most recently, West Valley Medical Center’s Caldwell facility.

Idaho is seeing the expansion of “obstetric deserts,” where “pregnant mothers may need to travel long distances either for prenatal care or for the delivery of their baby,” said Idaho Hospital Association CEO Brian Whitlock.

In Emmett, Valor Health CEO Brad Turpen said the hospital was unable to consistently staff the delivery program. If the hospital didn’t make significant changes, it was close to being “another story about a rural hospital closing its doors,” Turpen said.

Emmett is the seat of rural Gem County, in southwest Idaho.

The hospital still provides prenatal and postnatal care, Turpen said. But, its closed labor services “has made it more difficult for women in Gem County to deliver their babies,” he said.

Steele Memorial Medical Center, the most remote hospital in the lower 48 U.S. states in Salmon, Idaho, paused labor and delivery services because it didn’t have a doctor to do it, Whitlock said. For women who are pregnant and living in one of the counties served by that hospital, “they are now encouraging you to establish a relationship with a doctor 94 miles away or 168 miles away for your prenatal care and for the delivery of that baby,” he said.

The hospital is actively recruiting, Whitlock said.

“In the meantime, if you have an emergency, go to the hospital. They will stabilize you,” Whitlock said. “But you likely will be transported 168 miles away to Idaho Falls for the delivery of your baby.”

Idaho ‘digging workforce hole’ that could take decades to fill

Idaho lost 22% of practicing obstetricians since its abortion bans took effect, according to a report by the Idaho Physician Well-Being Action Collaborative.

“Hospital administrators are telling us that the lack of clarity in Idaho’s legal environment regarding maternal health care has created uncertainty and fear. And candidates are now looking elsewhere to practice,” Whitlock said.

Idaho already had a small share of OB-GYNs, at 2.2 per 10,000 women compared to 14 per 10,000 women nationally, Whitlock said. But Idaho hospitals have seen twice or sometimes three times the number of OB-GYN vacancies than they usually had, Whitlock said. Idaho hospitals, meanwhile, are seeing a third or half as many OB-GYNs applying to jobs, he said.

Since Idaho has no OB-GYN medical residencies or fellowships, Idaho can’t recruit new OB/GYNs or maternal-fetal specialists within Idaho, Thomson said. And out of state applications have dropped “dramatically,” she said.

Dr. Loren Colson, president of the Idaho Coalition for Safe Healthcare, said a pregnant patient came to him for help removing an intrauterine device (IUD), a long-acting birth control device inserted into the uterus. The patient, Colson said, had seen two other medical providers beforehand, “due to concerns of accidentally ending pregnancy with the removal of the IUD.”

And Colson said he’s heard similar stories from other other doctors, who’ve worried that “could be perceived as an abortion by somebody else.”

But not removing that IUD, Colson said, leaves the patient with a higher risk of miscarriage or infection.

Idaho has lost 55% of its high-risk obstetricians, according to the report by the Idaho Physician Well-Being Action Collaborative. That has left Idaho with less than five of those specialists full-time, which are called maternal-fetal medicine doctors, the report found.

Those doctors “are the safety net for the system of care, from the provider perspective,” said Dr. Jim Souza, chief physician executive for St. Luke’s Health System. “They are the reason that we can manage a high-risk pregnancy from literally 100 miles away, and carry it off safely.”

As those doctors have left, “family physicians and OBs across the state are asking if it’s still safe — personally and professionally — to be providing obstetrical care,” Souza said.

“The law is ambiguous on the circumstances in which a physician is allowed to act,” Souza said. “The law casts the issue of life and death as if it were a black and white, binary thing. Those of us who manage life and death know that those are the poles on a spectrum. And in between lies health.”

Why the Idaho Legislature didn’t act on Idaho’s abortion ban this year

In January, the U.S. Supreme Court agreed to hear a case challenging Idaho’s strict abortion ban. In 2022, the U.S. Department of Justice sued Idaho, arguing that Idaho’s abortion ban violates federal law that requires hospitals to provide medical care to stabilize all patients who come to the hospital with a medical emergency.

But even after the Supreme Court’s rules in the challenge to Idaho’s abortion ban, Idaho doctors still need clarity on how to provide care, said Ken McClure, lobbyist for the Idaho Medical Association.

“Driving women who have health care emergencies and making them wait until those emergencies become life-threatening is simply not good for any of us,” McClure said.

Legislators felt the best path forward in 2024 was to let the Supreme Court issue a decision, Crane said.

“Once they’ve made their decision, then we can look at things in 2025,” Crane said.

Crane said he expects the Idaho Legislature next year to pursue legislation similar to a bill recently passed in South Dakota, which required the state to create informational materials about the state’s abortion law.

Rubel said the full scope of the “disasters that have ensued” from Idaho’s abortion ban are likely not known.

“The fallout, of course, is going to be catastrophic for women, but it will also be catastrophic for babies and frankly, for anybody in the state who needs medical help,” Rubel said.