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Why My Patients Need Easier Ways to Get the Abortion Pill

Dr. C
Dr. C
Graham T. Chelius, M.D.,
Chief Medical Officer,
Hawaii Health Systems Corportation
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October 4, 2017

For the past eight years, I have been a family medicine doctor in Kauai, Hawaii, providing a range of health services and delivering over 800 babies on the island. It is stunningly beautiful here, but what the honeymooners don’t see are the challenges faced by many who live on this remote island. Kauai has a high rate of poverty, domestic violence, food insecurity, and a shortage of doctors.

And there is not a single abortion provider on the island.

I am qualified and willing to change that. If I were allowed to write a prescription for Mifeprex — commonly known as the abortion pill — a safe and effective method for ending an early pregnancy up to 10 weeks, then I would be able to help patients who come to me facing unwanted pregnancies.

Because I can’t stock this medication, my patients are forced to fly to a different island, 150 miles away, just to get a pill or any other kind of abortion care.

But the U.S. Food and Drug Administration subjects Mifeprex to unique restrictions that prohibit the drug from being dispensed at retail pharmacies. Instead, FDA regulations require that patients be handed the medication at a clinic, medical office, or hospital by clinicians who have pre-registered with the drug manufacturer and arranged to stock this medication in their health care facility.

Unfortunately, many health care providers across the country, including myself, are unable to comply with these medically unnecessary requirements, in particular stocking the abortion pill on site. Often it’s because of the bureaucratic hurdles of adding a drug to a hospital formulary or — as in my case — because of opposition to abortion by coworkers.

Because I can’t stock this medication, my patients are forced to fly to a different island, 150 miles away, just to get a pill or any other kind of abortion care. Making this trip is a real challenge for my patients, many of whom don’t have a lot of money, and it generally takes weeks to arrange. They have to work with the insurance company to get prior authorization and organize the travel, on top of having to arrange for time off work, childcare, and other logistics. If a patient’s abortion is delayed to the point where the procedure requires two visits, she must also arrange to stay on the other island overnight.

Abortion care, of course, is time-sensitive. Since many women don’t know they’re pregnant until they miss a period or two, there is often only a small time window of a few weeks when a woman can use this medication, which is only available during the first 10 weeks of pregnancy. That means that the delays caused by the FDA restrictions often push medication abortion out of reach for my patients, even blocking some patients from getting an abortion altogether.

None of this would be necessary if the FDA would lift the needless restrictions on the abortion pill and allow pharmacies to fill patients’ prescriptions for Mifeprex — just as they fill prescriptions for equally or less safe drugs, such as Viagra or blood thinners, thousands of times every day.

I swore an oath, and I believe it is my moral and professional obligation to provide my patients with the best care available — including abortion care. Because the FDA’s restrictions prevent me from doing that, I, along with several professional health care associations, filed a federal lawsuit today with the help of the ACLU. We maintain that the FDA’s restrictions on Mifeprex unconstitutionally burden and harm patients with no medical benefit. Overwhelming medical evidence and 17 years of clinical practice have shown this drug to be a safe and effective way to end a pregnancy: Whether a patient fills her prescription at a pharmacy or is handed the pill at a clinic or medical office makes no difference.

If we are successful, when a patient who has decided to end her pregnancy comes to my office, I’ll be able to write her a prescription the very same day, enabling her to get the medication and end her pregnancy without unnecessary, harmful delays. What’s more, she’ll be able to do so using her preferred method, in the privacy of her home, surrounded by her loved ones.

I wish the FDA had done the right thing when medical and public health experts asked them last year to remove these unnecessary restrictions. But they did not, and my patients are suffering as a result. So I’m taking them to court.

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