Clinic doc testifies in Fargo trial drug-induced abortions 'very safe'The trial over a state law that opponents argue would effectively ban drug-induced abortions in North Dakota began this morning with the medical director of the state’s only abortion clinic testifying the procedure is “very safe” and warning that the law could jeopardize patients’ health and force them to seek services out of state.
By: Mike Nowatski, Forum News Service
FARGO – The trial over a state law that opponents argue would effectively ban drug-induced abortions in North Dakota began this morning with the medical director of the state’s only abortion clinic testifying the procedure is “very safe” and warning that the law could jeopardize patients’ health and force them to seek services out of state.
Dr. Kathyrn Eggleston was called as the first witness for the Red River Women’s Clinic, which is challenging the law passed by state lawmakers and signed by Gov. Jack Dalrymple in 2011.
The New York-based Center for Reproductive Rights sued to block the law on behalf of the clinic and Eggleston on July 18, 2011.
Judge Wickham Corwin, who is presiding over this week’s trial in Cass County District Court, granted a temporary injunction three days later to stop the law from taking effect.
Attorneys did not give opening statements this morning.
“I do feel that the issues have been very clearly defined,” Corwin said. “I think we all know what the remaining issues are.”
Use of drug questioned
One of the key points of dispute is a section of the law that would prohibit giving an abortion-inducing drug unless it “satisfies the protocol tested and authorized” by the U.S. Food and Drug Administration and is labeled for that purpose.
Only one of the two drugs used in combination for medication abortions at the Fargo clinic, Mifeprex, is labeled for that use. The other drug, misoprostol, is labeled for treatment of gastric ulcers.
Under the protocol appearing on the FDA-approved label for Mifeprex, a patient takes 600 mg orally at a health facility and returns two days later to take 400 micrograms of misoprostol orally, then returns a third time about two weeks later for a follow-up visit.
But Eggleston said 200 mg of Mifeprex, which is the dosage given to pa-tients at the Fargo clinic, has been shown to be equally effective when combined with misoprostol, and at a third of the cost. Clinic patients take 800 micrograms of misoprostol buccally – by dissolving the tablets between the gum and cheek – 24 to 48 hours later at home or another location of their choice. The clinic schedules a follow-up visit about two weeks later.
Eggleston said if required to follow the Mifeprex regimen on the FDA-approved label, she doubts the clinic would provide medication abortions. Making patients return to the clinic to take misoprostol, as the law would require, “could put them in harm’s way,” she said, because bleeding can begin within 15 minutes of taking the drug.
“The point of a medication abortion is ... the women want this option because they want to have this option in the privacy of their home, and stopping at a truck stop on the way home is not private and not safe,” she said. “So we would not be able to provide a safe option for them.”
Following the Mifeprex label regimen also would restrict medication abortions to those at 49 days of pregnancy or less, denying those in the 50- to 63-day range, Eggleston said.
It also would require a third visit to the clinic, putting the cost and time requirements of the procedure out of reach for some potential patients and burdening the physicians who are currently present at the clinic only five days per month, she said.
About 20 percent of abortion patients choose medication abortion at the Fargo clinic, which began offering it in 2007, Eggleston said under questioning from the plaintiff’s lead attorney, Autumn Katz.
“This is the standard of care for the region and the U.S.,” Eggleston said.
Assistant Attorney General Douglas Anderson, who is defending the law for the state, questioned Eggleston about the safety of the misoprostol regimen, noting there have been 14 deaths associated with it, according to FDA reporting through April 2011.
Eggleston also testified under cross-examination that the higher dose of misoprostol could theoretically carry an increased risk of side effects but no increase in serious complications.
When Anderson asked if the risks of an 800-milligram dose of misoprostol were greater with vaginal use, Eggleston said the Fargo clinic has never used that method.
“But you can’t rule out the possibility that somebody might take it home and decide ‘I’m going to use it vaginally because if might be more effective,’ correct?” he asked.
“I don’t know why they would do that, but I have no control once they go home with the medication,” she said.
“Whereas you’d have control if they came into the clinic and took it oral-ly?” Anderson said, to which Eggleston responded yes.
Backup doctor required
Another provision of the law would require the clinic’s physicians to have a signed contract with an emergency backup physician to handle emergencies associated with the use of abortion-inducing drugs.
Eggleston said she tried to comply with that part of the law after it passed, but the four physicians she contacted who are supportive of the clinic weren’t willing to enter a contract because they were afraid of being harassed if their affiliation with the clinic were made public.
“They were pretty adamant that they thought this was a ridiculous rule. It is not how medicine is practiced,” she said.
The trial is scheduled to last up to four days. So far, it has drawn only a handful of courtroom spectators, including students from a local high school debate class.