Opinion ID: 1309503
Heading Depth: 2
Heading Rank: 1

Heading: Maternal Health

Text: Contending that it does not, the defendant points to the testimony of several medical experts. Dr. Harold Schulman testified that saline injections are often administered in ill-equipped treatment rooms at hospitals from which the patient is discharged to await labor. He suggested that hospitalization during the waiting period is not necessarily wise and could be dangerous to an expectant mother. He mentioned the possibility that some members of a hospital staff might be unsupportive or critical of unwed mothers and some might attempt to hasten expulsion by manipulation or instrumentation and thereby cause uterine or cervical perforation. A study he conducted showed that 65 percent of those injected as out-patients expelled the fetus at home, enroute to the hospital, or upon arrival and thereafter required no hospitalization. Yet, on cross-examination, Dr. Schulman conceded that the saline injection procedure entails certain risks which make it necessary to observe the patient to see if there are any unusual reactions to the instillation of the solution. Such reactions may occur for some unexplained reason or when a disproportionate amount of the salt solution somehow gets into her blood stream. This can cause thirst or headache, nausea, vomiting and on rare occasions the uterus will abruptly begin to swell. Dr. Schulman agreed that the saline solution can interfere with the clotting capacity of the blood and result in extensive hemorrhaging. He characterized this as a very serious problem, but one which occurs for the most part only during labor. He was familiar with some reported cases of maternal death due to total evacuation of blood. Although he felt that the defendant's clinic was better furnished than most facilities used for saline procedures, he recalled that it was not equipped to handle blood transfusions. In his own practice, Dr. Schulman instructs patients injected with saline to go to the hospital when labor begins. He follows this policy because of the danger that's inherent in this whole process. Dr. Samuel M. Belinsky testified that he had administered 93 second-trimester saline injections in a treatment room at Fairfax Hospital. As appears from his testimony, Dr. Belinsky considers an out-patient saline injection a reasonably safe medical procedure; he agrees that the defendant's clinic is adequately equipped for the procedure; he finds that the complication rates are about the same whether the procedure is performed on an in-patient or out-patient basis; he believes it is medically reasonable to release a saline patient following a period of observation, with instructions such as those given by the defendant; and he has some concern about the possibility of patient abuse by hospital staffs. On direct examination, Dr. Thomas Gressinger concurred generally in Dr. Belinsky's opinions. On cross-examination, however, he acknowledged that, if the saline solution enters the bloodstream too fast, it may cause hypernatremia. Although that condition may be corrected before the onset of labor by the body's natural defense mechanisms, he agreed that, when bleeding results, it is a major medical problem. He noted that Fairfax Hospital maintains a special facility apart from the operating room for delivery of patients injected with saline. Dr. Gressinger, who had administered numerous injections at that hospital, advises his patients to deliver there. He said that the saline process should be closely supervised and the facility is set up for close supervision. I feel, he added, it's the best facility around so I feel it's best for my patients. Testifying in his own defense, the defendant was of opinion that the saline procedure is the safest method of abortion, that it rarely causes significant complications, that his clinic is properly equipped to perform the procedure, and that the statutory hospital requirement is medically unnecessary for the protection of the patient. The testimony of Dr. Soyster, a witness for the defense, was to the same effect. It appears that the saline method is the procedure most commonly employed by physicians to induce an abortion in the second trimester. Indeed, saline amnio-infusion [is] the method of choice during that stage of pregnancy. See Colautti v. Franklin, 439 U.S. 379, 398, 99 S.Ct. 675, 687, 58 L.Ed.2d 596 (1979). And a statutory clause which forbids its use after the first trimester is not reasonably related to maternal health. Planned Parenthood of Missouri v. Danforth, 428 U.S. 52, 78-79, 96 S.Ct. 2831, 2845-46, 49 L.Ed.2d 788 (1976). But the method employed is not the issue here. Rather, the question is whether the state can require that the method chosen to initiate a second-trimester abortion be performed in a hospital. As Roe and Doe teach, once pregnancy has entered the second trimester, the state has a compelling interest in maternal health. In the exercise of the regulatory powers of the state, the legislature may adopt any measure reasonably designed to reduce health hazards inherent in the performance of medical practices. [6] Here, unlike the situation in Doe, the medical evidence shows that, from the moment a saline solution is injected to the time the fetus is expelled, the pregnant woman is exposed to certain risks [7]  some minor, others major, none precisely predictable. The state is empowered to license and regulate hospitals, clinics, home health agencies, and other medical care facilities, see generally, Title 32.1 of the Code, and to fix and enforce different standards of medical care for different facilities. The General Assembly has decided that medical procedures employed in second-trimester abortions must be performed in hospitals. Based upon the evidence in this record, we are of opinion that the hospital requirement is reasonably related to the State's compelling interest in preserving and protecting maternal health.