On Tuesday, Sen. Jon Ossoff (D-GA) held a hearing on the impact the abortion ban has has on women in Georgia.
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NewsTranscript
00:00:00After the Supreme Court overturned Roe v. Wade, a Georgia law took effect banning abortion
00:00:06after just six weeks of pregnancy, at which point many women do not even know that they're
00:00:12pregnant.
00:00:13The New York Times described Georgia's abortion ban as, quote, one of the country's most restrictive
00:00:18laws.
00:00:19The Subcommittee on Human Rights has convened this hearing roughly two years after the reversal
00:00:25of Roe v. Wade to hear directly from Georgia doctors and health experts about the impact
00:00:31on women's health of Georgia's six-week abortion ban.
00:00:35I want to thank our witnesses for taking the time to provide testimony today.
00:00:40You are all busy and hardworking health care professionals.
00:00:44We appreciate your contributions.
00:00:47I know this is a complex issue that evokes strong feelings across the state.
00:00:53That's why it's critical that the public hear directly from doctors about the consequences
00:01:00of Georgia's six-week abortion ban.
00:01:03We often hear politicians and elected officials weighing in on this issue, but today we're
00:01:08going to hear from the health care professionals who treat women and support them through pregnancy
00:01:14every day.
00:01:16On that note, without further ado, I will now swear in our witnesses.
00:01:25I'll begin with introductions.
00:01:28Dr. Nisha Verma is an OBGYN providing reproductive health care in Atlanta, Georgia, and an assistant
00:01:36professor of gynecology and obstetrics specializing in complex family planning.
00:01:42She currently has a research grant to explore the impact of Georgia's six-week abortion
00:01:47ban on individuals with high-risk pregnancies in the state of Georgia.
00:01:53Dr. Suchitra Chandrasekaran is an associate professor in gynecology and obstetrics and
00:02:00maternal fetal medicine specialist.
00:02:02She is also a member of the society of maternal fetal medicine, health policy and advocacy
00:02:07committee and sits on the maternal morbidity and mortality committee for the state of Georgia.
00:02:14And Dr. Aiswara Panikam is an OBGYN resident in Pittsburgh, Pennsylvania, who originally
00:02:21hails from Cumming, Georgia.
00:02:24Before beginning her residency, she obtained her undergraduate education at Johns Hopkins
00:02:27University, completed a Fulbright fellowship, and graduated from Harvard Medical School.
00:02:35Before opening statements, we'll swear in the witnesses.
00:02:37So if you would all please rise and raise your right hand.
00:02:41Do you solemnly swear that the testimony you are about to give before the subcommittee
00:02:46is the truth, the whole truth, and nothing but the truth, so help you God?
00:02:51Yes.
00:02:52Let the record reflect that the witnesses have answered in the affirmative.
00:02:55You may take your seats.
00:02:57And we will now turn to the witnesses for opening statements, beginning with Dr. Verma,
00:03:03when you're ready.
00:03:04Thank you, Senator Ossoff, and thank you all for being here today.
00:03:07My name is Dr. Nisha Verma.
00:03:09I'm a board-certified, fellowship-trained obstetrician and gynecologist providing full-spectrum
00:03:14reproductive health care.
00:03:16I'm a fellow with the American College of Obstetricians and Gynecologists, a nonpartisan
00:03:22evidence-based professional organization representing over 60,000 OBGYNs.
00:03:27I'm also a proud Southerner.
00:03:29I was born and raised in North Carolina and currently provide care in Georgia, and I've
00:03:34lived in the Southeast for most of my life.
00:03:38After the Supreme Court's Dobbs decision, with Georgia enacting a law that bans most
00:03:42abortions in our state very early in pregnancy, I struggle every day to provide necessary,
00:03:49life-saving medical care.
00:03:50I've seen young pregnant moms with worsening medical conditions and couples whose deeply
00:03:55desired pregnancies are in the process of miscarrying be turned away.
00:03:59Or forced to leave their communities to access needed health care.
00:04:04As a doctor, I have the immense privilege of sitting with patients and learning about
00:04:09their lives.
00:04:10For me, these patient stories are a powerful reminder that abortion is not an isolated
00:04:15political issue.
00:04:17And today, I want to provide a glimpse of how abortion restrictions impact real people.
00:04:22Shortly after Georgia's ban went into effect, I saw a high schooler that I'll call V, who
00:04:27realized after missing her period that she might be pregnant.
00:04:31When she came to see me, she unfortunately was just a couple days past Georgia's arbitrary
00:04:35cutoff, which bans most abortions, after just two weeks from the first missed period.
00:04:41I had to tell her that, even though I have the skills to help her, I can no longer perform
00:04:46her abortion in our state.
00:04:48Unfortunately, V was unable to find the resources and support to leave Georgia for abortion
00:04:53care.
00:04:54Because of workforce shortages in rural Georgia, where she lives, she also couldn't find a
00:04:59close by doctor that could care for her for many months.
00:05:03So even though V was forced to continue her pregnancy against her will, she couldn't access
00:05:08the prenatal care she needed to keep herself and her pregnancy healthy.
00:05:13After delivering her baby, V struggled with postpartum depression and had to move out
00:05:18of her home, drop out of school, and work a minimum wage job to try to make ends meet.
00:05:23She told me that she loves her son, but this is not the life that she wanted or planned
00:05:28for herself.
00:05:29V's story, while heartbreaking, is not unique.
00:05:33Over the past couple years, I've conducted a research study to learn about the experiences
00:05:37of patients with high-risk pregnancies in Georgia who are attempting to access abortion
00:05:42care.
00:05:43Through this work, I've heard women describe again and again how Georgia's abortion restrictions
00:05:49exacerbate their suffering in already devastating situations and leave them feeling betrayed
00:05:55by a government and a health care system that is supposed to protect them.
00:06:00One participant, M, described breaking her water at 17 weeks, when she had no chance
00:06:05of her baby ever developing lungs that would allow it to live outside of her.
00:06:10She went to the hospital, but learned her doctors couldn't help her until she started
00:06:15bleeding or developed an infection.
00:06:18M told me that, to be denied the basic medical care I needed, to be told that I must first
00:06:24be at risk of dying, to be forced to relive losing my baby every day for five days because
00:06:30of Georgia's law, the trauma of that on top of my loss is devastating.
00:06:36Another participant, A, discussed how Georgia's ban rushed her into making a decision instead
00:06:41of allowing her the time to get genetic testing on her pregnancy.
00:06:46She shared that her older son was diagnosed with a rare genetic condition that destroyed
00:06:50his lungs when he was just a few years old.
00:06:53Now, instead of starting middle school with his peers, he is admitted to the hospital
00:06:58ICU, and doctors have told A that he likely has less than a year to live.
00:07:03A described the pain of seeing her son suffer, and when she found herself pregnant again,
00:07:08she knew that she could not have another child affected by the same genetic condition.
00:07:13However, because this condition does not qualify for abortion care under Georgia's very narrow
00:07:19exceptions, and A could not risk leaving her son in the ICU to travel out of state later
00:07:25in pregnancy, she made the decision to get an abortion prior to Georgia's six-week cutoff
00:07:30before testing on the pregnancy was possible.
00:07:34It is clear that women who need medical care are suffering because of Georgia's abortion
00:07:39restrictions.
00:07:40We also know that these restrictions are not based in data or science.
00:07:45In fact, in 2022, over 75 major professional societies representing the overwhelming consensus
00:07:52of the science-based medical community came together to reaffirm that abortion is safe,
00:07:57essential health care.
00:07:59To make matters worse, doctors overwhelmed by laws that threaten to make us criminals
00:08:04for providing evidence-based, life-saving care to our patients are leaving their state.
00:08:10In Georgia, where already over 50% of counties have no OBGYNs, where we have one of the highest
00:08:16maternal mortality rates in the country, and where women like my patient B struggle to
00:08:21access prenatal care, these worsening workforce shortages are devastating for all aspects
00:08:27of reproductive health care.
00:08:30I understand that abortion care can be a complicated issue for many people, just like so many aspects
00:08:37of health care and life can be.
00:08:39I also know that abortion is necessary, compassionate, essential health care, and that patients are
00:08:45capable of making complex, thoughtful decisions about their health and lives.
00:08:50No law should prevent them from doing so.
00:08:53Thank you for having me today, and I look forward to questions.
00:08:58Thank you so much, Dr. Verma.
00:09:01We'll now turn to Dr. Chandra Sekharan.
00:09:07Good morning, Senator Ossoff and members of the subcommittee.
00:09:11My name is Dr. Suchitra Chandra Sekharan.
00:09:13I am a board-certified and fellowship-trained maternal fetal medicine, or MFM, specialist,
00:09:19and I am here today as a member of the Society of Maternal Fetal Medicine to describe the
00:09:24harmful effect restrictions on reproductive health have on their patients, their families,
00:09:30and the clinicians that care for them.
00:09:33As an MFM, I actually provide care for pregnant persons who experience complications that
00:09:38make their pregnancies high-risk.
00:09:40I proudly take care of pregnancies affected by maternal health issues.
00:09:44They can range from hypertension, diabetes, to cancer and complex life-threatening heart
00:09:49disease.
00:09:51Throughout this care, I perform ultrasound and provide genetic testing to assess fetal
00:09:56well-being.
00:09:58As an MFM practicing in Georgia, what I want to tell this audience is that the Georgia
00:10:03abortion ban limits the ability of myself and my colleagues to provide evidence-based
00:10:09care and counseling and significantly puts the well-being and lives of our patients at
00:10:14unnecessary risk.
00:10:16Having previously practiced in states where I could provide full-scope evidence-based
00:10:20care and counseling, I'm horrified and deeply saddened by the situation and the lack of
00:10:25choices our patients are given.
00:10:29While I live and see these stories daily, I'm going to bring up a few of them here.
00:10:34And I want to say that while I am using the word stories in this testimony for my patients,
00:10:39these are not stories.
00:10:40These are real-life nightmares and tragedies.
00:10:46So previously, I practiced in the state of Washington.
00:10:48And during one of those call shifts, I received a call about an individual in her second trimester
00:10:53with a pre-existing heart condition.
00:10:55This is actually pretty common in pregnancy because pregnancy is a time where your heart
00:11:00actually really changes.
00:11:01And that's often when pre-existing conditions might be diagnosed.
00:11:05This patient had inadequate health care coverage.
00:11:08And so this was the first time her condition was coming up.
00:11:12This was her first pregnancy, and this was her dream, her dream to be a mother, to go
00:11:16through a pregnancy in a normal fashion.
00:11:19But now she was facing her nightmare with a life-threatening heart condition, scared
00:11:24for her health and her babies.
00:11:27Because of Washington State's protective abortion laws, I was able to offer abortion as an option,
00:11:32as a choice for her.
00:11:35After many days of a lot of thought, weighing her risks and processes, she made the gut-wrenching
00:11:43and challenging decision to terminate that pregnancy, to focus on taking care of her
00:11:47heart so that she could potentially do this again.
00:11:52Subsequently, this patient did have the opportunity to get her heart condition fixed and had her
00:11:57next pregnancy.
00:11:59And I had the personal joy and privilege of delivering that baby in her next pregnancy.
00:12:05I had held this woman's dead fetus, wrapped in a knitted blanket, in her first pregnancy.
00:12:11And I held her beautiful baby boy in her second pregnancy and cried tears of joy with her.
00:12:17Fast forward seven years, right?
00:12:19The dreaded morning of June 24th, 2022, when the United States Supreme Court released its
00:12:25decision on DOS.
00:12:27Right as we heard the news, my sonographer brought my next ultrasound for me to review.
00:12:33This ultrasound was for a woman who had not had access to insurance or care until the
00:12:37early second trimester.
00:12:39Access to healthcare is a major issue here in Georgia, which is burdened by the presence
00:12:44of many obstetric deserts or regions with limited medical access to prenatal, perinatal
00:12:49care.
00:12:51This woman was excited and eager to see her baby.
00:12:53It's her first ultrasound.
00:12:55I, however, saw a fetus with a significant cardiac defect.
00:13:00Although this baby would be born alive, meaning that the case did not fit within Georgia's
00:13:05exception for medically futile pregnancies, the prognosis and quality of life after birth
00:13:12would be extremely limited.
00:13:14Even after multiple surgeries, the long-term outlook for this kind of a heart defect was
00:13:19questionable.
00:13:21Ten minutes ago, before the scan, I would have counseled her on all of the risks and
00:13:26the termination option of this pregnancy.
00:13:30Ten minutes later, I walked into her room shell-shocked at how the only practice and
00:13:35counseling methods I had known for 15 plus years was now impacted.
00:13:41And I spoke to her about my concerns for this fetus and what the cardiac defect would
00:13:45mean for the infant when it was born.
00:13:48As a doctor, my job is to support whatever decision the person wants to make, whether
00:13:53it's to continue a challenging pregnancy or whether to terminate it.
00:13:57As a doctor, my job is to inform of all the risks and outcomes.
00:14:02But now, as a doctor, my ability to counsel and provide all the opportunities was limited.
00:14:09My patient was in tears, knowing the law had just gone into effect, and I, too, only had
00:14:15tears to share with her at that moment, and the nightmare had begun.
00:14:20Even before the Dobbs decision, the high maternal morbidity and mortality rates affecting the
00:14:25state of Georgia are well known.
00:14:27One of the largest drivers of this rate is maternal cardiac disease.
00:14:31Yet, Georgia's ban forces women with very high-risk maternal cardiac conditions to carry
00:14:37their pregnancies, sometimes regardless of the dangers to a mother's health.
00:14:42For example, I had a patient with a disease process called lupus.
00:14:45In its severe form, it can significantly affect a pregnancy and threaten maternal and fetal
00:14:50health, including kidney, heart damage, or a very preterm delivery.
00:14:56This patient had a severe version with significant heart disease.
00:14:59She was in the late first trimester when she found out about her pregnancy.
00:15:03She was scared, knowing her very serious risk of becoming sick and facing health issues.
00:15:09But now, even though she was only in the late first trimester, I couldn't provide her all
00:15:15the options.
00:15:16I couldn't provide her that full-spectrum reproductive health care.
00:15:19I could talk about it, but I couldn't realistically help provide it.
00:15:23My hands were tied as a provider.
00:15:25She didn't have the resources to obtain care anywhere else, and in a state where maternal
00:15:29morbidity and mortality are extremely high with cardiac risk factors, this abortion ban
00:15:34can only worsen this issue.
00:15:36In a state where maternal mental health is another key contributor to morbidity and mortality,
00:15:43the trauma of being stripped of autonomy to make critical personal health decisions is
00:15:49real and long-lasting.
00:15:52It's not just the now we have affected.
00:15:54We have detrimentally impacted long-term maternal morbidity and mortality in a state that already
00:16:01has high rates.
00:16:02I am committed to remaining in Georgia and providing the best possible care for my patients
00:16:07in this challenging environment.
00:16:09I have provided stories above.
00:16:12I have demonstrated what success can look like when full-scope care can be provided.
00:16:16I have shown the aftermath of not being able to provide that care.
00:16:21High-risk pregnancies are unexpected, life-threatening, emotionally traumatizing, and life-changing
00:16:26for all involved.
00:16:28The current abortion ban in Georgia limits our ability to provide the compassionate and
00:16:32full-spectrum reproductive counseling and choices to our patients, and will only continue
00:16:37to worsen the overall future health of pregnant persons in Georgia.
00:16:42Thank you for having me today.
00:16:43Thank you, Dr. Chandrasekharan.
00:16:46Dr. Panikham, please.
00:16:50Good morning, Senator Ossoff and distinguished members of the Human Rights and the Law Judiciary
00:16:54Subcommittee.
00:16:55My name is Dr. Aishwarya Panikham, and I use she, her pronouns.
00:16:59I am a recent graduate of Harvard Medical School and a current resident physician in
00:17:03obstetrics and gynecology at an academic medical center in Pennsylvania.
00:17:08I'm testifying today in my personal capacity, and thank you for this opportunity.
00:17:12I grew up in Georgia, and I, too, am a proud Southerner.
00:17:16After spending the past decade of my life studying in other parts of the country, I
00:17:20was very eager to return home to my friends and family to complete my medical training.
00:17:25Yet, I'm here today to explain why I chose not to pursue OB-GYN residency in the South.
00:17:33I was halfway through medical school when the Dobbs decision ended the constitutional
00:17:36right to abortion.
00:17:38Immediately, trigger bans were initiated across the country, including here in Georgia.
00:17:44Over the next two years, every single Southern state instituted either a total ban or a prohibitively
00:17:50early gestational age ban on abortion.
00:17:52When it came time to apply for residency, many applicants into OB-GYN, including myself,
00:17:59prioritized programs that offered training in full-spectrum reproductive care, which
00:18:04includes abortion and miscarriage management.
00:18:06It was a bitter day when I realized I wouldn't be able to receive this training to the same
00:18:12extent in any Southern state, including Georgia.
00:18:14Ultimately, I prioritized programs in other regions of the country.
00:18:20To contextualize why I made this choice, I would like to share a few key facts.
00:18:24First, abortion is common.
00:18:27Prior to the Dobbs decision, one in four women of reproductive age in the United States was
00:18:32predicted to have an abortion by age 45.
00:18:35Second, abortion is safe.
00:18:38It is one of the safest procedures that a person can undergo.
00:18:43For abortion to remain accessible and safe, reproductive health physicians like myself
00:18:48must receive this essential training.
00:18:51The need for comprehensive training is also recognized by accrediting bodies.
00:18:56The Accreditation Council on Graduate Medical Education, or ACGME, requires that all OB-GYN
00:19:02residency programs provide their residents with comprehensive clinical experience in
00:19:06abortion.
00:19:07However, since the Dobbs decision, an OB-GYN in the South now faces a myriad of uncertainties
00:19:14and often has more questions than answers.
00:19:17Will I have sufficient case volume?
00:19:19Will I learn to manage complex cases?
00:19:21Would I be able to confidently perform this procedure on my own?
00:19:27Residency is a difficult process in and of itself.
00:19:30Additional roadblocks to obtaining necessary training will continue to dissuade talented
00:19:35physicians from practicing in the South and in other states with abortion restrictions.
00:19:41It is important to recognize that abortion training gives OB-GYN an additional skill
00:19:46set that they can apply to diverse scenarios, including medical emergencies.
00:19:52Even if an OB-GYN does not regularly perform abortions in their clinical practice after
00:19:58training, if they are trained in procedural abortion, they will be better equipped to
00:20:02manage a variety of different conditions.
00:20:05This includes miscarriage, hemorrhage, infection, and many more.
00:20:11Training in abortion makes for a capable OB-GYN.
00:20:15Georgia must prioritize the development of OB-GYNs because its maternal health outcomes
00:20:22are among the worst in this country.
00:20:24Half of Georgia's counties lack a single OB-GYN, leaving one in three women without
00:20:30access to essential health care.
00:20:33The sad truth is that Georgia desperately needs more OB-GYNs, but it is failing to attract
00:20:38them.
00:20:39In 2022 to 2023, applications to OB-GYN residency in restricted states decreased by 5.6%.
00:20:49A recent survey of medical students applying into OB-GYN shed light on a major reason.
00:20:5573% of survey respondents reported that the DoB's decision affected which programs they
00:21:00applied to.
00:21:02And this is the case for myself as well.
00:21:04I am deeply concerned about the dangers that Georgia's six-week abortion ban creates for
00:21:09women.
00:21:10As a medical student in Massachusetts, I helped care for a Georgia woman whose fetus was diagnosed
00:21:16with severe genetic anomalies.
00:21:19Even though it was well understood that her fetus would die either in utero or soon after
00:21:24delivery, she was unable to receive an abortion because her fetus still had a heartbeat.
00:21:32It took her several days to arrange childcare for her young daughter and for her and her
00:21:36husband to come up to Massachusetts, get a hotel room, and get an appointment at the
00:21:41clinic that we were at.
00:21:43When she arrived to our clinic, her fetus had already passed and had been dead for several
00:21:47days.
00:21:48She was admitted to the ICU for a life-threatening clotting disorder called disseminated intravascular
00:21:54coagulation, as well as massive immune dysregulation in the form of sepsis.
00:22:00Georgia's abortion ban jeopardized her life by delaying her access to care.
00:22:05She survived.
00:22:06Others have not.
00:22:09This case reaffirmed my commitment to train in a place where abortions can be accessed
00:22:13by women who need them.
00:22:16I speak on behalf of the tens of thousands of medical students and physicians who are
00:22:21currently in the training pipeline and who will make up the future healthcare workforce
00:22:26of this country.
00:22:28States that severely restrict abortion access will struggle to attract and retain OBGYN
00:22:34physicians.
00:22:35This will cause shortages to their physician workforce.
00:22:39I made the difficult decision to not return home for my medical training.
00:22:43A lot of my peers have done the same.
00:22:46With the support of our lawmakers, we can expand abortion access, which in turn will
00:22:51help reverse this exodus of students, doctors, and health professionals leaving restricted
00:22:56states.
00:22:57Thank you for having me today.
00:22:58I look forward to your questions.
00:23:00Thank you, Dr. Panikam.
00:23:02Thank you all for your opening statements.
00:23:04I'd like to begin with a yes or no question for all of you.
00:23:11In your opinion, does Georgia's six week abortion ban endanger the lives of pregnant women in
00:23:18Georgia?
00:23:19Dr. Verma?
00:23:20Yes.
00:23:21Dr. Chandrasekaran?
00:23:22Yes.
00:23:23Dr. Panikam?
00:23:24Yes.
00:23:25Dr. Verma, Georgia's abortion ban contains an exception for medical emergencies, which
00:23:32the law defines as, quote, a condition where an abortion is necessary in order to prevent
00:23:39the death of a pregnant woman or a substantial and irreversible physical impairment of a
00:23:45major bodily function of the pregnant woman.
00:23:49Given that exception, why do you believe Georgia's law nevertheless endangers the lives of
00:23:54pregnant women in our state?
00:23:56Thank you for that question.
00:23:59As doctors, we train for years and years and years to be able to sit in front of the patient
00:24:06in front of us and help them and their families make these complex, individualized decisions.
00:24:13Medicine is incredibly complicated.
00:24:15That's why we train for so long.
00:24:17There's not a line in the sand where someone goes from being totally fine to acutely dying.
00:24:22A lot of times, it is a continuum.
00:24:25Doctors, because of this law in Georgia, are forced to question, when can I intervene?
00:24:31How sick is sick enough?
00:24:32How much bleeding is too much bleeding?
00:24:35That delays care, that forces patients to get sicker.
00:24:40Georgia's exceptions in our abortion ban are incredibly extreme.
00:24:44We've seen in the data as well that even when these types of exceptions exist, people with
00:24:50high-risk pregnancies are still denied care and have a harder time getting the care that
00:24:55they need.
00:24:56Some are forced to continue very high-risk pregnancies, and some are forced to leave
00:25:01their communities, and all of that leads to people getting sicker and sicker.
00:25:06Thank you, Dr. Verma.
00:25:07Dr. Chandrasekaran, can you weigh in here where the so-called exception in the law in
00:25:17cases where a pregnant woman's health is severely at risk, but perhaps not yet meeting
00:25:23this restrictive emergency standard?
00:25:28I think this goes to the concept that biology is gray.
00:25:32Biology is not black and white.
00:25:34It's not a mathematical equation.
00:25:36If our bodies were mathematical equations, we could be running this very differently.
00:25:41And when biology is gray, pregnancy, which is now putting two lives, a mom and a child,
00:25:48and making them interact with each other in a relationship of sorts, is extremely gray.
00:25:55So when we say words such as irreversible or futile, oftentimes by the time you've hit
00:26:02irreversible and futile, mom's life is already at significant risk.
00:26:07You've taken away her choice and capacity to make a decision to potentially avoid hitting
00:26:12irreversible and futile.
00:26:15And I think that's the challenge with the current abortion ban, and that's what directly
00:26:19affects overall maternal health, mental and physical.
00:26:24Thank you, Dr. Chandrasekaran.
00:26:27On that point, with respect to, quote, medically futile pregnancy, and that's the term in Georgia's
00:26:34extreme six-week abortion ban, a quote from the statute is, in reasonable medical judgment,
00:26:46an unborn child has a profound and irremediable congenital or chromosomal abnormality that
00:26:54is incompatible with sustaining life after birth.
00:26:59Does this exception meaningfully allow doctors in Georgia to provide adequate care when a
00:27:05fetus has been diagnosed with a serious defect?
00:27:08Unfortunately not, because again, fetal diagnostics is also a gray territory.
00:27:15When we see a heart defect, we can say what we overall think the prognosis might be.
00:27:21But when we use words, again, such as futile, irreversible, irrevocably, what does that
00:27:27mean?
00:27:29How are we protected under that?
00:27:31How do you define that?
00:27:33Biology changes.
00:27:34What might feel irrevocable to somebody may not be to someone else.
00:27:37And that becomes a very personal decision between a physician and the patient on what
00:27:43are they looking at?
00:27:44What are the outcomes for this fetus looking like?
00:27:46And so unfortunately, when we use those words, it doesn't provide capacity to help the majority
00:27:54of our situations.
00:27:55Now the extreme situations are an exception, but the majority of our situations fall into
00:28:01we think this would be the prognosis.
00:28:03This is the likely situation to happen.
00:28:06This is likely the outcome that doesn't get covered.
00:28:10Thank you, Dr. Verma.
00:28:13Georgia's law also contains a so-called exception for quote, removing a dead unborn child caused
00:28:20by spontaneous abortion, end quote.
00:28:23Does this exception meaningfully empower Georgia physicians to provide medically necessary
00:28:29care for miscarrying patients?
00:28:31Great question.
00:28:33I have absolutely seen situations where patients in the process of miscarrying are turned away
00:28:40or delayed from getting the care that they need in Georgia.
00:28:44Again, all of this is really complicated.
00:28:46I think that's what we keep going back to medicine is incredibly complicated.
00:28:49So I've had situations where a patient presents to the hospital, their cervix is opening,
00:28:56they're bleeding, they may have broken their water, but that pregnancy still has cardiac
00:29:01activity or a heartbeat.
00:29:03And there's a lot of uncertainty about whether doctors can act in that situation, when in
00:29:08that scenario they can act.
00:29:10I've had patients like some that I shared today in my testimony that are turned away
00:29:16and even though they're in the process of miscarrying, because that cardiac activity
00:29:21is still present and they're told you have to start bleeding more, you have to get sicker,
00:29:25you have to develop an infection.
00:29:29And so often people are miscarrying, that's a process and we are having to wait until
00:29:35later in that process until they get sicker, until they have more bleeding, until they
00:29:39have an infection, until we can intervene.
00:29:42Instead of working with that patient to figure out what their needs and desires are and when
00:29:48in the process it works for them for that treatment to happen.
00:29:53Thank you, Dr. Burma.
00:29:54Dr. Chandrasekaran, miscarriage management and Georgia's six-week abortion ban, what's
00:29:59been your assessment and experience?
00:30:01I think I can only echo what Dr. Burma has said here.
00:30:05Again, the term miscarriage encompasses a spectrum of situations.
00:30:10And so it can start with bleeding, it can start with continuing to have a heartbeat,
00:30:14it can start with water breaking at a time in your, you know, mid-second trimester where
00:30:20now the fetus, even if it were born, what would that look like in terms of lung development?
00:30:26And then comes the question, a common discussion we have, how much bleeding is too much bleeding?
00:30:31Are they stable?
00:30:33The other key thing to remember with, I always say this with pregnancy is what seems normal
00:30:38two minutes before can change in pregnancy very fast.
00:30:41And so when we have these restrictions and you're told you have to wait until a tipping
00:30:46point, oftentimes once you've hit that tipping point, you've hit a point of severe discomfort,
00:30:53damage and physical damage to mom, the procedures become more complicated to do at that time.
00:31:00And now you have extra care issues and extra health issues going on.
00:31:05So I think I can only repeat.
00:31:08It's complicated.
00:31:09It's not a black and white issue.
00:31:11And when we've taken away that discussion capacity between the physician and the patient
00:31:19to have that choice on what is best for the patient in that situation, by putting words
00:31:26that have to define that situation, it is inhibiting and limiting capacity for care.
00:31:34Thank you, Dr. Verma.
00:31:35In your testimony, you stated that Georgia's law threatens to make criminals out of doctors
00:31:38for providing necessary life-saving care.
00:31:42Do doctors in Georgia fear the threat of criminal prosecution for providing necessary reproductive
00:31:49health care to pregnant women?
00:31:50Absolutely.
00:31:51So we are practicing and again, we've said again and again, medicine is incredibly complex.
00:31:57We are trying to navigate this complexity under a law that says if a lawmaker or an
00:32:05attorney general decides we have made the wrong decision, we acted too soon, the consequences
00:32:12are criminal prosecution or having your license removed, your livelihood threatened.
00:32:18And that's creating a huge chilling effect for doctors across the state.
00:32:23And so again, I've seen doctors that are limiting their scope of practice or saying, I'm just
00:32:29not going to take care of pregnant people anymore, I'm going to only do GYN care because
00:32:34they're so afraid of those very extreme consequences that makes the care desert even larger in
00:32:42our state.
00:32:43I've talked to physicians that are leaving the state completely because they're so afraid.
00:32:49And then I've seen doctors that are not able to take care of patients that have to transfer
00:32:53them out of state or transfer them to another hospital and those patients get sicker and
00:32:58sicker.
00:33:00And so when we're trying to figure out again, where in that house, sick is sick enough,
00:33:03we can intervene.
00:33:05We know what the right thing to do is medically, right?
00:33:08That's what we train for, for all of these years to work with our patients and make these
00:33:12medical decisions with our patients, with their families.
00:33:16That's not the question.
00:33:17It is what, what is this law that actually doesn't make any sense that wasn't written
00:33:23by medical people?
00:33:25When does the law say I can intervene?
00:33:27And none of us know the answer to that.
00:33:29And so navigating this environment is incredibly scary and confusing.
00:33:35Thank you, Dr. Verma, Dr. Chandrasekaran, you testified that you had a patient with
00:33:40severe lupus, which could have had significant impacts on maternal and fetal health.
00:33:46Can you explain in more detail what kinds of complications this patient risked as a
00:33:51result of being forced to continue her pregnancy with severe lupus?
00:33:57Yeah.
00:33:58So again, biology is complex and lupus is a process where for some reason your body
00:34:04thinks its own cells are not its own and seems to want to attack it.
00:34:08Those are called autoimmune diseases.
00:34:10And so when you're undergoing a pregnancy, which has its own physiological changes to
00:34:15your body, sometimes the body can turn against its own organs and really important organs
00:34:21like the heart and the kidneys and the lungs.
00:34:24And when that happens to mom, obviously that's going to put mom's life at significant risk.
00:34:31And then if mom's life is at risk, oftentimes that means we need to do a delivery because
00:34:35the pregnancy is adding to risk.
00:34:37And that can mean delivery of a baby at a very scary gestational age where the baby's
00:34:43life is at significant risk because baby isn't developed enough.
00:34:47And so these are very real situations that families can face leading to kind of long-term
00:34:52consequences for all the caretakers involved in that situation.
00:34:57And as you know, as we've discussed, Georgia's law includes an exception for circumstances
00:35:03where termination is necessary to prevent a patient's death or quote substantial and
00:35:10irreversible physical impairment of a major bodily function.
00:35:15Yet you were unable in that case to offer termination as an option to your patient with
00:35:20a condition that as you just described to us, created a risk of severe health complications.
00:35:29Why was the exception insufficient in this case?
00:35:32And how does the extremely narrow scope of this exception force doctors to put women
00:35:41in a position where they may continue to bleed, continue to be in pain, continue to take on
00:35:46greater and greater risk of irreversible harm, but doctors are unable to help.
00:35:53The words again, we used are substantial and irreversible, right?
00:35:57So I've taken care of many lupus patients now in my 15 plus years of practice.
00:36:04Some of them have severe issues.
00:36:07Some of them may not severity ranges on a scale.
00:36:12So when we say substantial and irreversible, I'm going to go back to the question, what
00:36:16does substantial mean?
00:36:18And this is where that gray territory comes.
00:36:21We know kind of what substantial means.
00:36:23I can talk to a patient and say, look, your chance of having cardiac failure might be
00:36:28this much.
00:36:29Your chance of having renal damage might be this much, but what defines substantial in
00:36:35terms of the law and also what is substantial to each individual person in terms of the
00:36:40damage I'm giving them.
00:36:42I never have a crystal ball.
00:36:43If I had a crystal ball, I could tell you exactly what's going to happen.
00:36:47We don't in medicine and especially in a field like OB where you're dealing with two
00:36:53basically living organisms working kind of symbiotically with each other.
00:36:59And so when we use those words, it really limits that scope to feel safe in knowing
00:37:04what defines substantial when that can vary in and of itself.
00:37:13You described a patient whose fetus had a severe congenital heart abnormality and might
00:37:21either pass away in utero or survive and need extensive medical intervention with highly
00:37:28uncertain prospects for survival.
00:37:31The patient did not have the choice to terminate the pregnancy under Georgia's law.
00:37:37Why wouldn't that fall within Georgia's exception for a medically futile pregnancy?
00:37:42And if the fetus survived past birth, perhaps requiring intensive neonatal care, perhaps
00:37:49in immense pain, what would that baby's quality of life look like?
00:37:55So again, the law puts the word futile.
00:37:59And so it is hard to predict that futility.
00:38:03Sometimes yes, these babies can pass away in utero.
00:38:06Sometimes they can pass away right after birth and sometimes they might do okay with a surgery
00:38:10or so in terms of living, but then that could mean, are they actually ever able to come
00:38:16home?
00:38:17Do they need to stay in a ICU the whole time?
00:38:20How are they recovering post-surgery?
00:38:22Some of these babies can stay in a hospital for even a year up to post birth, just undergoing
00:38:28surgeries and undergoing care.
00:38:30So what does that put upon that life, that child, that family that again is not covered
00:38:37in that medically futile.
00:38:39If you ask medically futile, some of us can be at institutions where you can define certain
00:38:45diagnoses that yes, this is a hundred percent medically futile, again, 99% of what we do.
00:38:52We can't predict that word medically futile, but we know that the risks are extremely high.
00:38:59This conversation has been focused on legal terminology, complex medical dynamics.
00:39:09Your patients are human beings with immensely powerful emotions surrounding their pregnancy
00:39:23and their health.
00:39:24What is it like as a doctor who cares about them to look into your patient's eyes who
00:39:30are experiencing a health crisis, who have learned that their fetus may have a severe
00:39:34health complication and not have a choice or be able to offer them a choice in those
00:39:41extremely difficult situations?
00:39:43What are those conversations like that?
00:39:46It's horrific.
00:39:48It's horrific.
00:39:49It's awful.
00:39:51It's almost degrading as a physician to not be able to do what you feel you need to do
00:40:01and you're watching for what's protecting you in terms of a law.
00:40:05We will always do the best for our patients.
00:40:08I can say that as a physician, we will always do the best for our patients.
00:40:12We will always have open discussions, but to practice in a situation with an umbrella
00:40:19above you that is limiting those discussions and having you also carry some of that emotional
00:40:26trauma and burden with your patient as you both are trying to navigate this with their
00:40:32families is unfortunately a very horrific situation in the state and one that I agree
00:40:39with Dr. Verma is potentially going to drive away good physicians from our state.
00:40:46And we'll explore that dynamic more soon with Dr. Panikin, but Dr. Verma, you stated
00:40:51that you see young mothers who have worsening medical conditions that make their pregnancies
00:40:57high risk or who are miscarrying being turned away by doctors.
00:41:04I think it's critically important that the public understand that miscarrying women are
00:41:09being turned away by their doctors in this state right now because of this extreme abortion
00:41:15ban or forced to leave their communities in order to access care.
00:41:19We heard a story recently about a pregnant woman who had to travel to Massachusetts and
00:41:28the fetus died in utero on the way, putting her at extreme risk upon her arrival out of
00:41:34state.
00:41:36Why are doctors in Georgia, Dr. Verma turning away pregnant women in these circumstances?
00:41:43I think it goes back to how confusing these laws are.
00:41:49There is no way to create a law that takes every individual, every medical situation,
00:41:56every family into account.
00:41:58And so you can put into a law, you know, I've heard lawmakers who created these laws often
00:42:03say, well, there are exceptions.
00:42:05And so people that need care will get care.
00:42:07One, I take care of patients who need abortion care for many different reasons.
00:42:12I would say the vast majority of them are excluded from getting care under this law.
00:42:19And the exceptions don't solve that problem.
00:42:23They're incredibly confusing.
00:42:24They don't make sense to the practice of medicine.
00:42:28We talked about how miscarriage is often a process.
00:42:31There could be a time in that process when there's still a heartbeat or cardiac activity
00:42:36and doctors don't know if they can intervene.
00:42:39When we talk about medically futile pregnancy, there's no consideration of quality of life,
00:42:44right?
00:42:45So the patient I discussed, that wouldn't qualify under Georgia's law because her baby
00:42:50once born could potentially live for years, but she would have to watch that baby suffer
00:42:56and die if the baby was affected with the same genetic condition.
00:43:02And so the quality is not taken into account at all.
00:43:06When we talk about the medical emergency exception, it is incredibly extreme and there are many
00:43:12people with high risk pregnancies that aren't yet in that category of being immediately
00:43:21at risk of death.
00:43:22One example I'll bring up, I had a patient with pulmonary hypertension, which is a condition
00:43:27where your lungs don't work correctly.
00:43:31Your risk of death if you continue the pregnancy is as high as 50%.
00:43:36When we see that patient at, for example, six or seven or eight weeks, she often hasn't
00:43:40gotten a chance to get very sick yet.
00:43:43Can we provide an abortion then?
00:43:45Or do we have to turn her away and say, come back when you get sicker, when your lungs
00:43:49aren't working anymore, when you have that 50, you know, when you are actually at risk
00:43:54of immediate death.
00:43:57The right thing to do medically, right, is to offer that patient the options of termination
00:44:02or continuing the pregnancy when we see her at six weeks.
00:44:05But under the law, it's often unclear if we can do that.
00:44:09The last thing I'll just mention, I do think it's really important to recognize how this
00:44:12law takes these really important risk assessments away from people.
00:44:17So all of us take care of patients with very high risk pregnancies who choose to continue
00:44:22those pregnancies.
00:44:23And our job is to support them and optimize their health and the health of their pregnancies.
00:44:29But that's a decision that a person should be able to make.
00:44:32Right.
00:44:33And we also have patients who say that risk of continuing that pregnancy is too high.
00:44:38I cannot risk dying and not be around for my existing children and my family.
00:44:43And that's also something that that person, not the state, should be able to choose to
00:44:47do.
00:44:48And so it's not that people can't continue risky pregnancies, but that is a decision
00:44:52that people should be able to make.
00:44:56You mentioned that many patients who have been denied care have expressed a sense of
00:45:01betrayal to you.
00:45:03Can you elaborate on why patients might feel betrayed in those circumstances?
00:45:08Absolutely.
00:45:09I think when people go to the doctor, they expect to be able to get compassionate, evidence-based
00:45:16medical care and to be told you can't get the same care that someone could get, for
00:45:22example, in Massachusetts, where I previously practiced, or in Delaware.
00:45:27You can't get that care here, not because it isn't evidence-based, not because I don't
00:45:31have the skills to do it, but because our lawmakers have decided you don't deserve that
00:45:37care.
00:45:38You can't get that care here.
00:45:39That is a huge sense of betrayal, right?
00:45:42I feel betrayed not being able to provide the care.
00:45:45Patients feel betrayed.
00:45:46We've created an environment in this country where your access to evidence-based care depends
00:45:52on your zip code and your resources and whether you can get out of state.
00:45:57Thank you, Dr. Verma.
00:46:00Dr. Panikam, you described a case, we just referred to it again, that you witnessed at
00:46:05a clinic in Massachusetts where a Georgia woman traveled to terminate a pregnancy.
00:46:12After finding out her fetus had been diagnosed with severe abnormalities, she wasn't able
00:46:18to terminate the pregnancy in Georgia, had to travel to Massachusetts instead, and by
00:46:21the time she arrived in Massachusetts, her fetus had been dead for several days.
00:46:26Why wasn't this patient able to terminate her pregnancy in Georgia under the exception
00:46:32for a medically futile pregnancy in the Georgia law?
00:46:36So although this patient had a fetus with severe genetic anomalies and it was well understood
00:46:41by all providers that the fetus would die in utero or soon thereafter, she was not able
00:46:48to access an abortion because her baby still had a heartbeat.
00:46:52And that is the reason why she had to arrange alternate forms of clinical care and why she
00:46:58had to travel out of state.
00:47:00And ultimately that delayed her care by several days.
00:47:04And in that time period, her pregnancy had deteriorated and she didn't even realize it
00:47:09until she ended up becoming very sick.
00:47:12And what risks was she then faced with after the demise of the fetus in utero?
00:47:19So a demised fetus in utero increases the risk of several alarming pregnancy complications.
00:47:26One is hemorrhage, so the risk of excessive bleeding.
00:47:30The second is infection, which is what happened to her.
00:47:34She had an uncontrolled infection because we were not able to evacuate the uterus and
00:47:41take out the source of her infection in a timely fashion.
00:47:45And as a result of that, she developed a systemic infection that almost cost her her life.
00:47:51As a physician and as a Georgian, how did it make you feel to see a patient who was
00:47:58septic, whose life was now at risk because she'd been unable to access evidence-based
00:48:06care in her own state?
00:48:09It was really demoralizing.
00:48:10She was the first patient that I saw as a medical student from Georgia, and she suffered
00:48:16the worst consequence out of all the patients that I had taken care of in that clinic.
00:48:23That patient and many others like her are the reason why I decided not to come back
00:48:28to Georgia for my medical training, because I want to practice and I want to learn in
00:48:32a state where I can offer people the full spectrum of options and help them achieve
00:48:38the highest standard of health possible for them.
00:48:41I don't want my hands to be tied by a law, by legislators, by people who have very little
00:48:46understanding of medicine.
00:48:49And because of that, how my patients suffer as a result.
00:48:53And just to be clear, sepsis after demise of the fetus in utero, this woman could have
00:49:00died, correct?
00:49:01Absolutely.
00:49:02Sepsis is a leading cause of death in the United States.
00:49:05People often die from extremely, extremely low blood pressures, which we call septic
00:49:10shock or organ failure.
00:49:14And in her case, she was able to bounce back, but not everyone is so fortunate.
00:49:21Did Georgia's six week abortion ban put your patient's life at risk?
00:49:26Absolutely.
00:49:27She wanted an abortion.
00:49:28She was not able to receive it in time.
00:49:30And as a result, her health deteriorated and she could have died.
00:49:35You mentioned that you'd wanted to practice in your home state.
00:49:43And as we heard earlier, you may have mentioned it, perhaps it was Dr. Verma, half of Georgia
00:49:52counties have no OBGYN.
00:49:55We heard Dr. Verma's story about a patient in rural Georgia who being unable to access
00:50:03an abortion was then marooned without access to prenatal care that increases risks for
00:50:12pregnant women.
00:50:13You wanted to come practice where you were from, but you chose not to because of our
00:50:21state's abortion ban.
00:50:23How did it make you feel to be unable to choose to come and practice medicine in your home
00:50:29state where we have a dire need for professionals with your skills?
00:50:33I'm a good example of someone who wants to stay in Georgia.
00:50:36This is my community.
00:50:37The people I love are here.
00:50:39And I always envisioned a life here taking care of people.
00:50:44But that vision is not superseded by my need to do the right thing for my patients and
00:50:49my need to develop a skill set where I can respond effectively to medical emergencies,
00:50:54where I can appropriately advise and counsel my patients on the next step in their pregnancy
00:51:01and in their care.
00:51:02And unlike my colleagues, I'm still very early in my training.
00:51:06And so I speak from a place of potential.
00:51:09What is my potential to respond in the scenario?
00:51:13What is my potential to take care of people down the road?
00:51:16I make my decisions based off of who I want to be in a few years, in a decade, in a lifetime
00:51:23of service.
00:51:25And so at this point, that is that person I want to become requires training outside
00:51:35of a restricted state.
00:51:37And how did seeing this patient who had to travel from Georgia to Massachusetts, a septic
00:51:45whose life's at risk because of Georgia's abortion ban, how did that influence your
00:51:49decision not to come home and practice OBGYN medicine in Georgia?
00:51:55So the providers at the clinic I was working at knew how to respond to the scenario.
00:52:02They were extremely skilled in both the surgical management of her abortion, but also taking
00:52:11care of her when she was admitted to the ICU.
00:52:14And I think we will see that more and more OBGYNs are finishing their training in restricted
00:52:20states without a comfort level in offering or providing abortions.
00:52:27And that is due to a lack of exposure and training within their residency programs.
00:52:34I think that the patient I saw is one of many people who will not access this care because
00:52:44it is no longer legal where they come from.
00:52:47But in turn, for each of these patients, I think we will see many doctors who are not
00:52:51able to offer that care because they were not trained in it.
00:52:55Or maybe they had some exposure, but that's not something that they feel comfortable doing
00:52:59independently without supervision.
00:53:02Thank you, Dr. Panikam.
00:53:03Dr. Chandrasekaran, as you know, Georgia has extraordinarily high rates of maternal morbidity
00:53:09and mortality, meaning women in Georgia have high rates of health complications and death
00:53:16related to pregnancy and childbirth.
00:53:18Why are women in Georgia at such high risk of adverse outcomes from pregnancy?
00:53:24And how do you expect Georgia's six-week ban to affect maternal mortality and morbidity
00:53:29in Georgia?
00:53:32Georgia's maternal morbidity and mortality rate is complicated and it's layered.
00:53:40But many things contribute to it.
00:53:41I would say from kind of starting at a large eagle's eye view, access is a big issue.
00:53:47We've brought it up over and over again.
00:53:50So six weeks, to give context, is a time where many women don't even realize they're pregnant
00:53:56yet.
00:53:57Symptoms are barely starting at that time.
00:54:00So by the time they've realized they're pregnant and now potentially found a physician who
00:54:05can help them due to access, we're delaying care to be able to intervene or make decisions.
00:54:12So access is probably one of the big reasons for maternal morbidity and mortality.
00:54:17Along with access then comes ability to give that care.
00:54:20So once access is gone, care isn't able to be given on time.
00:54:24That's also contributing to our issues with maternal morbidity and mortality.
00:54:29And then when care is not given on time, that's affecting overall health at a very granular
00:54:33level.
00:54:35So we're seeing high rates of diabetes, obesity, hypertension, all these cardiometabolic processes
00:54:40that contribute to pregnancy.
00:54:42So it's a tiered model of what's causing that risk.
00:54:45And the abortion ban is only going to feed into all levels of that model.
00:54:50Dr. Verma, how do you expect Georgia's six-week abortion ban to affect maternal morbidity
00:54:55and mortality for pregnant women in Georgia?
00:54:58It's expected to worsen maternal morbidity and mortality in a state where we are already
00:55:03facing these terrible rates, terrible outcomes for pregnant patients.
00:55:09We've seen in the data that states that have abortion restrictions also tend to be the
00:55:16states that have worse maternal mortality and morbidity rates.
00:55:21And again, this is complex.
00:55:22It is very complex and there are multiple things that play into that.
00:55:26But having that limited access to care, whether it's abortion care or prenatal care, definitely
00:55:33contributes to worsening outcomes for our pregnant people.
00:55:45Dr. Verma, in your opening remarks, you described a young patient who was compelled by Georgia's
00:55:52law to continue an unwanted pregnancy, but was unable to access prenatal care while she
00:56:00was pregnant because she lived in a part of a state without sufficient doctors, without
00:56:06sufficient clinics and expertise.
00:56:08What are the risks to pregnant women in Georgia who are unable to access prenatal care?
00:56:12There are many risks to not being able to access prenatal care.
00:56:16Pregnancy is a time where, for many women, it is the highest risk thing that they are
00:56:21going to do.
00:56:22There are multiple complications that can come up.
00:56:24There are multiple issues that can come up that make that pregnancy higher risk for the
00:56:29patient, for the pregnancy itself.
00:56:33And so prenatal care is incredibly important.
00:56:36This patient had Medicaid, so she had insurance.
00:56:39She had government insurance and there was no one in her part of the state close by that
00:56:45she could get to easily as a teenager who took Medicaid.
00:56:50That is a huge shame, right?
00:56:52She had insurance from the government and couldn't get prenatal care when she was forced
00:56:57to continue her pregnancy.
00:56:59I think that's also part of where all of that combined is also contributed to her developing
00:57:05postpartum depression.
00:57:08We know that mental health conditions are one of the leading causes of maternal morbidity
00:57:13and mortality in our state and in the country.
00:57:17Mental health conditions are specifically excluded from Georgia's medical emergency
00:57:22exception.
00:57:23Georgia as a state has decided mental health is not good enough to count for an exception.
00:57:31If a patient is experiencing severe depression, is at risk of suicide, that does not count
00:57:39as an example of when we can provide care.
00:57:43This patient, after this whole experience, then experienced postpartum depression that
00:57:48put her life and her health and the health of her baby at risk as well.
00:57:52And this isn't unique, right?
00:57:54We're seeing this happen again and again and again.
00:57:58Thank you, Dr. Verma.
00:57:59Dr. Panicam, did I hear you correctly earlier that OBGYN residents in states like Georgia
00:58:10with extreme abortion bans often have to travel out of state to meet their own educational
00:58:16requirements?
00:58:17That's correct, Senator.
00:58:19OBGYN residents are caught in a really awkward situation where they need to receive this
00:58:25essential training, but they're not legally allowed to do it in the location in which
00:58:30they are training.
00:58:31This often necessitates them applying to away rotations in other states.
00:58:38This is a very onerous process.
00:58:39You have to do licensing again.
00:58:41It's expensive.
00:58:42You have to find alternate housing.
00:58:44If you have children, you have to find child care and leave behind your family for several
00:58:48weeks to months at a time.
00:58:50And even if you can do all of that, there's a good chance you will be denied because there
00:58:54are not enough training spots in other states.
00:58:57The system only has so many slots and right now cannot accommodate people coming from
00:59:03out of state across the board.
00:59:06So this is going to limit many people's ability to access that training.
00:59:10Not everyone can travel out of state and not everyone will be granted the opportunity.
00:59:15They will not even be granted a slot in order to do that.
00:59:18So it will restrict the training of many physicians in this country.
00:59:24I would note, Dr. Panikam, applications for OBGYN residency slots in Georgia decreased
00:59:31by almost 10% in the 2023 to 2024 application cycle.
00:59:37Do you believe that your peers are being deterred from applying for residency in states like
00:59:44Georgia because they're unable to access the training they need?
00:59:49They may be unable to provide the care their patients need.
00:59:51They may face criminal prosecution.
00:59:54Absolutely.
00:59:56As I said earlier, abortion is common.
00:59:58So training in abortion is a commonly sought out experience by people going into reproductive
01:00:06health care and our training in a variety of different procedures will determine what
01:00:14we can do as independently practitioning physicians.
01:00:18So we don't want to artificially restrict our skill set, our medical knowledge by legal
01:00:23restrictions.
01:00:24We want to understand what the entire scope of evidence-based medicine is in OBGYN.
01:00:30And at this point, just entering the field, it seems like a really tough pill to swallow
01:00:40to go to a state where you won't be able to train in the entire spectrum of OBGYN care.
01:00:46And as a result, many people are not coming to the South and to other restricted states
01:00:51when they otherwise had planned to.
01:00:53Dr. Tranchasekran, we just heard it firsthand from an OBGYN intern who decided not to train
01:00:59in her home state.
01:01:02How do you expect the ban to impact recruitment and retention of OBGYNs in Georgia?
01:01:09Yes, thank you.
01:01:10That's a real important point.
01:01:11It's going to continue to negatively impact this.
01:01:14I think the hard part about this is you may not see that effect in two years, three years,
01:01:18five years.
01:01:19Five years, you have those of us that are here a little longer that might stand be doing
01:01:24this, but then comes that, you know, kind of the pipeline, right?
01:01:28Who's coming behind us?
01:01:29Who can we bring?
01:01:30Who can we train?
01:01:30How do we build up?
01:01:32That impact may not be seen again tomorrow or in a year, but in five, 10 years, I think
01:01:38this is going to be a huge impact for a state that is already struggling.
01:01:42Dr. Verma, how about retention?
01:01:44We've been focused on recruitment, retention of an OBGYN workforce in Georgia now facing
01:01:54potential criminal prosecution for providing health care.
01:01:58Absolutely.
01:01:59You know, I think that some physicians in practice are thinking about leaving.
01:02:05I think a lot of physicians, right?
01:02:06This is their home.
01:02:07This is their community.
01:02:08They have houses here.
01:02:09They have families here.
01:02:10Their kids are in school and they aren't able to leave.
01:02:14But people are also, I've talked to folks that are retiring early or that are limiting
01:02:18their scope of practice.
01:02:20And that, in addition to doctors leaving the state completely, limits patients' abilities
01:02:26to get care.
01:02:28And so we're seeing all of these things combined affecting our workforce.
01:02:32As someone who mentors medical students and residents, you know, I've had many people
01:02:37in the same situation where they say, should I stay in Georgia for residency?
01:02:42This is my home.
01:02:42This is my community.
01:02:44And I, you know, I tell my mentees, I don't think you can get the same level of training
01:02:50in abortion care anymore as you used to.
01:02:53Like, I think, you know, if I was making the decision now, I would leave, get the training
01:02:58and potentially come back.
01:03:01But also that's unclear, right?
01:03:02Like, it's a scary environment to practice in.
01:03:06And I should note that was a 10% reduction in residency applications across all specialties.
01:03:13Dr. Panikam, why did you want to be a doctor?
01:03:20I wanted to be a doctor in part because of my experiences growing up here in Georgia
01:03:25and seeing people not being able to access health care, especially in rural communities.
01:03:31I studied public health in undergrad, and I found medicine as an extension of that.
01:03:36Doctors have an incredible platform to educate, to take care of people, to directly change
01:03:41the course of a community.
01:03:43And that's the reason I decided to go through the long process of applying to medical school
01:03:49and complete training.
01:03:50I've already been in this for about 10 years, and I have at least four more to go.
01:03:55And I would do it all over again.
01:03:57But I think what is challenging at this point is that we are not actually able to provide
01:04:03high quality care, evidence-based medicine to a lot of our patients.
01:04:07And in regards to what you had said earlier about how this might affect physician retention,
01:04:13we know that a lot of doctors stay to practice in the same state where they completed their
01:04:18training.
01:04:19This is well documented.
01:04:21And so if you are failing to attract physicians to come and train in your state, you are
01:04:27also failing to potentially fill many supervising physician slots in a handful of years.
01:04:35This is something, as Dr. Verma had mentioned and Dr. Chandrasekaran, it takes several years
01:04:42to see the effects, but it will come in time.
01:04:45And we're already starting to see some of these effects now.
01:04:48And you wanted to help people.
01:04:50You've entered this field.
01:04:51You've worked so hard to get these qualifications.
01:04:53You haven't been able to come and train in your home state.
01:04:57How does it make you feel as a young doctor to know that Georgia women are being forced
01:05:04to endure pain, risk of hemorrhage, risk of sepsis, as you laid out, that doctors in the
01:05:13exam room across from them have to look in their eyes and tell them that they face serious
01:05:19and uncertain risk of potentially fatal complications, or that the doctor's hands are tied by politicians?
01:05:25How does it make you feel to know that that is the situation facing physicians and patients
01:05:30in your state?
01:05:32It is deeply demoralizing.
01:05:34Personally, I feel very guilty for not coming back.
01:05:38This is my community.
01:05:39I've always wanted to come back.
01:05:41And I feel like I failed a lot of people as a result.
01:05:44And I hope to come back one day.
01:05:49But I think that it's difficult without changes to the existing laws here.
01:05:58We want to do the right thing by our patients.
01:06:00You know, physicians work really hard and train for a very long time so that for every
01:06:05single person that walks through the door, we can counsel them appropriately.
01:06:10We can take their medical history into account.
01:06:11We can take their social circumstances into account and offer them the best choice for
01:06:18them.
01:06:19And by restricting abortion access and also by restricting training in abortion, as a
01:06:25result, you are stripping that away from thousands of physicians practicing in restricted states.
01:06:31And it causes a lot of distress.
01:06:33It is something that keeps a lot of us up at night, you know, and it's a leading reason
01:06:40why I think people decide to leave.
01:06:42It's hard to go to work every day and realize you're not offering your patients the level
01:06:48of care that you would expect to, that you would hold yourself to, if you could.
01:06:56And the emotional consequences of all of this, I think, should not be taken lightly as well.
01:07:03Thank you, Dr. Panikam.
01:07:04Final question for each of you, beginning with you, please, Dr. Verma.
01:07:10What do you think lawmakers should know about the impact of abortion bans like Georgia's
01:07:17extreme six-week abortion ban?
01:07:19I think for that question and for those hearing to bring attention to this issue, I think
01:07:25we as doctors are here trying to provide the care that we can to our patients.
01:07:31We are trying to get people in quickly within that often impossible six-week timeline.
01:07:38We are trying to do whatever care we can.
01:07:40We're trying to get patients out of state when we can't provide them care here.
01:07:44And my colleagues and I, you know, we're going to continue to do what we can, but the law
01:07:49has to change.
01:07:50It is limiting practice.
01:07:51It is hurting people.
01:07:53You know, I get that abortion is complicated for a lot of people, and it's okay to feel
01:07:58that complexity and to also recognize that people are the experts in their own lives
01:08:04and should be able to make these decisions about their health care and their lives.
01:08:08And those things can exist together.
01:08:10There's so many reasons why people need abortions.
01:08:13And we are just in a terrible environment where we are trying to do what we can.
01:08:18We will keep trying to do what we can to support our patients.
01:08:22But as you've heard, it is an incredibly difficult environment, and people are struggling.
01:08:28And the laws have to change.
01:08:30We have to get to the polls.
01:08:31We have to do what we can to change the laws.
01:08:35Thank you, Dr. Verma.
01:08:36Dr. Chanchasekwaran.
01:08:37Thank you for that question, and again, thank you for this hearing and bringing attention
01:08:41to this.
01:08:42Of course, I echo what Dr. Verma said, but I want to add to that.
01:08:46I think, again, biology, human systems, a pregnancy, literally all the physiologic
01:08:54changes, a maternal body and a new being, a fetal being growing inside that body, dust
01:08:59your body, is not a machine.
01:09:01It's not black and white.
01:09:03It varies.
01:09:04And putting laws on a system that is extremely volatile and changeable and not identifiable
01:09:12as yes, no, black, white, this is it, is only going to lead to tragedy.
01:09:16And so this is not a situation where a law can cover all the factors and the facets that
01:09:23we need to cover.
01:09:24That's why this is medicine, and it's not law.
01:09:28Dr. Panikin.
01:09:29I think I want to end simply by saying abortion is health care, and health care should be
01:09:34determined by doctors, not by legislators.
01:09:37There is a body of evidence that we follow, you know, decades of research, of advocacy
01:09:43that have gone into why we think the way we do, why we offer certain procedures at certain
01:09:50times and not in other scenarios.
01:09:53And I think it is incredibly concerning that people without medical knowledge are now restricting
01:10:03our ability to provide evidence-based care.
01:10:08They are not speaking from a place of knowledge.
01:10:10And as a result, real people are affected.
01:10:14Real people are getting sick.
01:10:16Real people are having unwanted pregnancies, and real people are dying.
01:10:20And in order for all of this to change, we as Georgians and as, you know, all residents
01:10:28in this country have to make it known that this is not something we will stand for.
01:10:33This is not acceptable, and that we should leave reproductive health care in the hands
01:10:39of physicians who have worked very hard and very long to achieve the level of knowledge
01:10:44needed to make those decisions.
01:10:47Thank you, Dr. Panakamal.
01:10:48I want to thank each of you for not just participating in today's hearing, but also for dedicating
01:10:54your careers to the health of your pregnant patients.
01:10:59And I have a sense of just how hard you've worked and how many extraordinarily long call
01:11:10shifts you've endured.
01:11:12And how many 3 a.m. trips to the hospital to ensure that a laboring patient has a safe
01:11:19delivery you've made, and just how much of your lives you've invested in helping people.
01:11:27And on behalf of all Georgians, I'm extremely grateful to you, and grateful to you for lending
01:11:32your expertise today.
01:11:34Because as I said at the opening of the hearing, we have a lot of work to do, and a lot of
01:11:41at the opening of the hearing, there's a lot of political voices weighing in on this issue.
01:11:48The public needs to hear from the doctors who are providing care every day, what this
01:11:53is really doing to pregnant women in Georgia.
01:11:57We've heard extremely concerning reports today from leading OBGYNs in Georgia, and a resident
01:12:09who was deterred from coming to practice in her home state because of this extreme abortion
01:12:16ban.
01:12:16We've heard about women who struggle to get the health care they need at critical moments
01:12:21when their health's at risk, when they're experiencing a miscarriage, and turned away
01:12:28from the doctor.
01:12:29About extremely worrying and high-risk medical scenarios that haven't yet reached some vague
01:12:38state of sufficient emergency, according to politicians who haven't practiced a day of
01:12:44medicine in their life.
01:12:50And we've heard about how Georgia's law is driving doctors out of our state when we already
01:12:55face a death penalty.
01:12:57When we already face a dire shortage of OBGYNs, that for years has been negatively impacting
01:13:05the health and lives of women in Georgia, including worsening the access to prenatal
01:13:11care in our state.
01:13:13So I'm grateful to all of you for illustrating what this really means for health care providers
01:13:22and for your patients.
01:13:23I would note for you and for members of the public that the hearing record will remain
01:13:28open for one week for statements to be submitted into the record.
01:13:31We welcome contributions from the public.
01:13:34Questions for the record for our witnesses may be submitted by other senators by 5 p.m.
01:13:41on Tuesday, July 30th.
01:13:43I want to restate my gratitude to Mayor Garrett and the City of Decatur for hosting us today.
01:13:50It's great to be in Decatur.
01:13:52And thank you again.
01:13:55And the hearing is adjourned.