Pandemic brings telehealth boom to rural Wisconsin, but barriers linger

Pandemic brings telehealth boom to rural Wisconsin, but barriers linger

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Story highlights
  • Telehealth is increasingly connecting Wisconsinites living in remote areas to health resources.
  • Helping fuel that growth was the federal government’s COVID-19 Public Health Emergency declaration, which eased regulatory barriers that previously blocked telehealth access.
  • The federal government ended its emergency declaration in May, leaving questions about how long some telehealth flexibilities will last.
  • Gaps in broadband access continue to limit services in many rural communities.

This story is part of our series Unhealthy Wisconsin, which examines areas where Wisconsin falls short in well-being.

Marshfield Medical Center family nurse practitioner Brianna Czaikowski says telehealth appointments are a game-changer for some patients. But in serving a mostly rural community, Czaikowski often fights spotty connections and miscommunication when providing virtual care.

“They feel a lot that I’m talking over them, which sometimes I probably am because (of) the delay,” said Czaikowski, a doctor of nursing practice and pediatric urology specialist who sees patients as far away as Michigan’s Upper Peninsula. “You’re not getting that full connection.”

Fresh off a COVID-19 pandemic boom, telehealth is increasingly connecting Wisconsinites living in remote areas to a web of health resources. Telehealth claims in 2020 swelled to a 6.3% share of total claims in Wisconsin — an increase of more than 2,400% from the previous year, according to a report from the Wisconsin Health Information Organization. Some northern counties reported high gains compared with the rest of the state.

Helping fuel that growth is the federal government’s COVID-19 Public Health Emergency declaration, which eased regulatory barriers that previously blocked telehealth access. That included relaxing rules for certain prescriptions and changing regulations pertaining to appointments and reimbursement for those on Medicare or Medicaid.

But lingering gaps in broadband access continue to limit services in many rural communities, where telehealth use lags behind better-connected urban communities.

A screenshot from a Wisconsin broadband mapping tool
A screenshot from the Public Service Commission of Wisconsin’s online broadband mapping tool. Lingering gaps in broadband access continue to limit services in many rural communities, where telehealth use lags behind better-connected urban communities.

Meanwhile, the federal government ended its emergency declaration in May, leaving questions about how long some telehealth flexibilities will last. Legislation made some changes permanent, but others are set to expire by the end of 2024 or before.

Without action, some of the state’s most vulnerable patients could lose telehealth options they gained during the pandemic.

Pandemic actions expanded telehealth services 

After the COVID-19 pandemic struck in March 2020, the Biden administration announced initial telehealth flexibilities that Congress further expanded temporarily — igniting a 63-fold increase in Medicare patients seeking telehealth services that year, according to a federal Department of Health and Human Services report.

Pandemic-era changes, for instance, allowed all eligible Medicare providers to deliver telehealth services that patients could access in their home and outside of previously designated rural areas. The changes waived geographic restrictions on telehealth services and increased options to receive them.

The changes cleared a “huge hurdle” that previously blocked telehealth growth, said Mary DeVany, associate director for the Great Plains Telehealth Resource and Assistance Center.

The pandemic ushered in significant growth for telehealth services for behavioral and mental health. And it has also increased options for certain types of primary care, DeVany said. Remote patient monitoring software, for instance, allows doctors to keep tabs on weight, blood pressure and other vital signs for patients with chronic health conditions, meaning patients with chronic conditions need less frequent hospital or clinic visits.

Telehealth has its limitations. “We can’t see certain things that we could see in the office,” Czaikowski said. That could include immediately spotting signs of child abuse or diagnosing ailments that might not be on a patient’s radar.

But expanded telehealth options have proved “really beneficial” for Czaikowski’s patients in many ways. Although most of her patients still use in-person visits, she said, telehealth visits allow families to check in more often or get simple diagnoses without having to pull their kids out of school and drive long distances for a short in-person visit.

“I see people from Michigan,” Czaikowski said. “They have to drive six hours just to see me. And then to have a 10-minute visit and tell them that their kid is just constipated? Or that they wet the bed — okay, here’s your medicine. That’s a lot for the families to have to give up.”

Health care by phone and Zoom 

But not all telehealth options are equal — or accessible to all.

Czaikowski conducts telehealth appointments over video or phone. She prefers video appointments when possible, allowing her to see patients and keep their attention. But she said the majority of telehealth patients she treats rely only on phone calls. That’s in line with national trends among rural patients.

“People will call you from work or when they’re driving and not really give you their full attention,” Czaikowski said. “You have to be really talented in what questions you ask as a provider.”

A family nurse practitioner at her computer
Brianna Czaikowski, a Marshfield Medical Center family nurse practitioner, is photographed at her computer on July 26, 2023, in Marshfield, Wis. (Drake White-Bergey / Wisconsin Watch)

While phone visits work well for those with less tech literacy or working parents with multiple kids at home, they reduce opportunities for children to communicate health information that parents might not think or want to mention, Czaikowski said.

“The kids tell the truth. When we’re on the (phone) visit, you don’t really hear the kids, it’s more the parent.”

Rural broadband access lags

Poor internet service ranks among the top reasons Czaikowski’s patients choose phone appointments over video, which generally should work at download speeds of 25 megabits per second and upload speeds of 3 Mbps — the federal standard for broadband access.

Nearly 22% of rural Wisconsinites lack adequate broadband services — a rate far above the rest of the state, according to a 2021 Federal Communications Commission report. And data from the U.S. Census Bureau’s American Community Survey show 38% of low-income households in Wisconsin lack an internet subscription.

State leaders are working on solutions.

In 2020 Democratic Gov. Tony Evers established the Governor’s Task Force on Broadband Access, which assists rural communities, many with older populations that want high-quality internet but don’t know where to start.

“They didn’t mind not having broadband, maybe they didn’t see the importance of it,” task force chair Chris Meyer said. “But as their communities age, telehealth suddenly becomes a reason.”

People watch a video showing Wisconsin Gov. Tony Evers speaking
A video showing Democratic Gov. Tony Evers speaking about broadband access plays during a Public Service Commission of Wisconsin Internet for All listening tour on May 23, 2023, at the Madison College Truax Campus in Madison, Wis. Evers created the Governor’s Task Force on Broadband Access in 2020 to help address the state’s internet needs. (Drake White-Bergey / Wisconsin Watch)

Telecommunications companies find it more lucrative to provide broadband to densely populated urban areas. For-profit businesses happily make the initial, and often heavy, infrastructure investment because they expect to have a large customer base.

But sparsely populated areas are less enticing for private companies. The cost of burying miles of fiber optic cables — one of the fastest and most reliable ways to deliver the internet — can be prohibitive. While a mile of internet service could serve hundreds of homes in a metropolitan area, it would cover only a few homes in northern Wisconsin, Meyer said.

Wisconsin has directed at least $340 million to broadband expansion and connected about 390,000 people to the internet since Evers launched the task force, Meyer said. The state had previously spent about $20 million.

Despite the task force’s increase in spending, Meyer said many people, especially those in northern Wisconsin, have yet to gain high-speed service.

Without broadband access, telehealth is “not a cure-all,” said Kirk Moore, Covering Wisconsin’s navigator who connects northern Wisconsinites to health insurance.

“Just to be able to take on the task of telehealth is a barrier.”

Meanwhile, low-income rural Wisconsinites may not make full use of the internet even after fiber optic cables arrive in their communities.

Rural households tend to earn less than urban households in Wisconsin, federal data show. And while a growing share of rural Wisconsinites own a computer, Moore said, “they have a computer but they don’t have the broadband access to be able to hook up to a physician or a behavioral health person through a video.”

Some telehealth flexibilities are temporary 

The federal government made some telehealth flexibilities permanent before the emergency declaration ended, particularly for those related to behavioral and mental health. Federally Qualified Health Centers and Rural Health Clinics, for instance, may continue providing such services to Medicare patients without previous geographic restrictions — including over audio-only platforms.

The government has extended similar flexibilities for issues unrelated to behavioral and mental health through only Dec. 31, 2024.

The Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration additionally extended flexibilities for remote prescriptions of controlled medications, such as treatments for opioid use disorder, through Nov. 11, 2023. The deadline will extend an additional year for new practitioner-patient telemedicine relationships.

Financial incentives affected

The pandemic also affected how hospitals were reimbursed — and financially incentivized — to offer telehealth services.

Under the federal emergency declaration, Medicare and Medicaid in Wisconsin and most other states began reimbursing hospitals for telehealth visits at the same rate as in-person visits.

“That means if you are seen … for something that you would have had covered in person, you are seen for that through telehealth,” DeVany said.

The Wisconsin Department of Health Services in March announced it would permanently reimburse hospitals for most video and audio telehealth services offered to the more than 1 million Wisconsinites on Medicaid — as long as the quality of virtual appointments matched in-person services.

The long-term future of reimbursements for telehealth services through Medicare remains less certain. Without further action, the equal treatment of telehealth and in-person services for billing will expire at the end of 2024.

At that point, Medicare could pay a lower rate for telehealth appointments — excluding the costs of items associated with in-person visits. That would require health care providers to absorb additional costs — or even eliminate services they can’t afford, DeVany said, adding that a similar result could happen with the private insurance market, which often follows Medicare’s lead.

Marshfield Medical Center
The Marshfield Medical Center is photographed on July 26, 2023, in Marshfield, Wis. The Wisconsin Department of Health Services says it will permanently reimburse hospitals for most video and audio telehealth services offered to Medicaid patients — as long as the quality of virtual appointments matched in-person services. (Drake White-Bergey / Wisconsin Watch)

“Once again, the patient would have to come and figure out how to come in,” DeVany said. “It’s a dual-edged sword, in that the patient gets the short end of that deal.”

A bipartisan group of dozens of lawmakers in Congress are pushing to make a range of pandemic-era telehealth flexibilities permanent.

“While telehealth use has skyrocketed these last few years, our laws have not kept up,” U.S. Sen. Brian Schatz, D-Hawaii, said in a June statement. “Telehealth is helping people in every part of the country get the care they need, and it’s here to stay.”

Czaikowski hopes Medicare continues covering telehealth appointments for specialists, which she said are in short supply across Wisconsin. She is among just six nurse practitioners statewide certified in urology, she said.

“They can’t just go to the doctor an hour away. They are traveling six hours,” Czaikowski said about some of her rural patients in Upper Michigan. “I really hope Medicare doesn’t ever take that away because it’s really going to hurt us.”

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Walgreens fined for violating closure requirements at two Washington County pharmacies

Walgreens has been fined $10,500 by the state because two of its Washington County pharmacies closed without notification, as regulators continue cracking down on unreported closures and the chain begins to shutter other locations in Maine and around the nation.

Walgreens agreed to pay the penalty for 11 days of unreported closures between February and December 2022 at its site on Dublin Street in Machias, and for six days of closures between May and September 2022 at its North Street store in Calais, state records show.

The Maine Board of Pharmacy regulators said they began investigating after receiving complaints last December about “frequent closures” at the stores. The regulators said the company violated a requirement that it reports to the board if a store deviates from remaining open a minimum of 40 hours a week.

The Maine Monitor reported in November that Walgreens paid $68,000 in fines last year for violating state staffing and operating hours laws at 10 Maine locations. At the time, CVS was the chain with the second-highest number of penalties in the state, with four cases and $13,500 in fines.


Several previous violations also stemmed from failing to remain open a minimum of 40 hours a week, the Monitor reported. Others targeted a rule that the stores have a pharmacist in charge. 

The Monitor previously reported some pharmacists complained they are overworked and understaffed. There are also continuing complaints of a shortage of pharmacists. 

Meanwhile, Walgreens, which operates approximately 9,000 stores nationally, announced earlier this year it plans to close 150 U.S. locations by next August.

The Bangor Daily News reported earlier this month a Walgreens store in the Piscataquis County town of Guilford laid off 12 employees when it permanently closed Sept. 18.

Walgreens operated the only pharmacy for the town of 1,267 residents on the Piscataquis River, with the next-closest pharmacy six miles east in Dover-Foxcroft.

Even before Walgreens announced the closure of its Guilford location, Wendy Denney, a local bed and breakfast owner, noticed lapses in staffing and inventory that made it difficult for her to receive vital diabetes medications.

Denney said Walgreens didn’t keep the medications she needed adequately stocked, and even when she tried to ensure the pharmacy had her prescriptions on hand well in advance, the medications wouldn’t be there when she went to pick them up.

“I would often run there to pick up my meds because I would get a message on my phone (from Walgreens) saying the med was ready,” Denney said. “Then I would go to pick it up and they’d be like, ‘Oh, well, we’re out of this med. Come back later.’”

The pharmacy became so unreliable that a couple of months ago, Denney switched to an online program to get her prescriptions delivered by mail.

“I realized I couldn’t rely on Walgreens to have the prescriptions when they were supposed to have them, even though they were repetitious prescriptions,” Denney said.

In a sign of worker unrest in the industry, pharmacists in at least a dozen Kansas City-area CVS pharmacies did not show up for work for two days in September, the Associated Press reported. They planned to be out again last week until the company sent its chief pharmacy officer with promises to fill open positions and increase staffing levels, the AP said.

The story Walgreens fined for violating closure requirements at two Washington County pharmacies appeared first on The Maine Monitor.

Oklahoma health agency gets grant to support new mothers during Medicaid unwinding

The Oklahoma State Department of Health received about $170,000 to support new mothers and their families during the Medicaid redetermination process.

Spurred by government funding, controversial waste-to-energy plants eye West Virginia

JACKSON COUNTY — When she first bought her house in Millwood nearly 20 years ago, Michelle Roach saw it as an investment for her family.

“I plan to give my property to my son,” she said. “That’s supposed to be his, and I’ve been telling him that since he was little.”

But now, for the first time, she’s reconsidering that plan in light of a plant to turn medical waste into energy proposed off state Route 2 — roughly a mile from her home.

“I don’t want to leave. I love it up there,” she said. “But that’s what everybody is talking about.”

Spurred by federal incentives meant for clean energy, these kinds of waste-to-energy facility proposals are becoming more common, especially in West Virginia. A plan for a plant in Follansbee was scuttled earlier this year, and there are two other projects in the works, including the proposed plant in Millwood.

There are some environmental benefits to these types of facilities. Waste incinerators are viewed as an alternative to landfills, and have been lauded as an eco-friendly substitute method for disposing of waste.

Millwood resident Michelle Roach pulls up on a map on her phone to show the proposed location of Thunder Mountain’s medical waste incinerator. Photo by Sarah Elbeshbishi.

But residents like Roach are concerned about what they see as a lack of transparency in the process, and they’re worried about the potential environmental and health effects of a new waste incinerator. Because these sites are proposing to use relatively uncommon chemical processes, Heather Sprouse, an organizer with the West Virginia Rivers Coalition, said the consequences of the facility’s potential emissions are unknown.

“One of the challenges here is that many people don’t have understanding or no access to even understand what the long-term impacts can be because there’s very little information available about cumulative impacts,” Sprouse said.

A plan to convert needles and syringes into energy

The proposal by Thunder Mountain Environmental Services would build the medical waste facility in a warehouse space off Point Pleasant Road, right outside of Ravenswood.

The facility would dispose of solid medical waste by converting it into energy through gasification — a process that converts waste into synthetic gas, which can then be used to produce energy. The company plans to power the facility with that energy. It expects to employ between 15 and 20 people full time, according to Thunder Mountain President Bryan Fennell.

The waste the facility is incinerating will include used medical gloves, paper towels, bandages, needles, syringes, chemotherapy administration supplies, expired or tainted medicines and human or animal tissue or fluids generated during medical procedures. And while it will keep about 1,650 pounds of this waste from going into a landfill every hour, the incinerator will emit 12.29 tons of pollutants into the air annually, according to the permit engineering evaluation.

One of those pollutants is tetrachlorodibenzo-p-dioxin, otherwise known as TCDD, one of the most toxic kinds of dioxins.

While the engineering evaluation estimates that the Millwood site will emit less than two tenths of a milligram of TCDD per year, the chemical is a carcinogen — a substance or agent capable of causing cancer — and dioxins can be incredibly harmful even at low emission rates.

“They induce birth defects, they alter the immune responses, and so even exceedingly low concentrations are quite troubling for people,” said West Virginia Sierra Club chair Jim Kotcon, also an associate professor of plant pathology at West Virginia University.

The facility will operate “in strict compliance” with its permits, said Fennell. The site is permitted to emit nine nanograms of TCDD per cubic meter; 90 times greater than the emissions level permitted in the European Union.

Medical waste-to-energy facilities: An emerging trend

The proposal by Thunder Mountain Environmental Services marks the second recent attempt by an out-of-state company to establish a medical waste-to-energy facility in West Virginia.

“It does seem like we’re seeing this as a trend, and it looks like Central Appalachia might be kind of the bullseye for how these facilities are developing throughout the nation,” Sprouse said.

Concerns over medical waste-to-energy facilities in the state began following the proposal of a facility in Follansbee last year by Empire Green Generation. The out-of-state company proposed using pyrolysis — a process that thermally decomposes material into combustible gas — to convert medical waste into gaseous fuel. The company dropped the project following opposition from residents and city officials.

A June announcement by Gov. Jim Justice of another waste-to-energy facility, this time in Eastern Kanawha County, has only further heightened concerns.

Sprouse credits the sudden boom to state and federal governments incentivizing such facilities.

Last year’s Inflation Reduction Act included a variety of incentives to promote clean energy and reduce carbon emissions. Some of those benefits were aimed at encouraging the commercialization of carbon capture and storage and hydrogen hubs.

The bipartisan Infrastructure Investment and Jobs Act passed in 2021 also allocated funds to invest in projects utilizing hydrogen technology in an effort to help the country transition to a zero-carbon economy.

“These tax credits are available for a variety of circumstances, but we’re seeing that it does create an environment where for business owners it can be ever more profitable for them to engage in this waste incineration technology,” Sprouse said.

While it’s unclear whether the Millwood or Follansbee facilities would qualify for the incentives, the interest in the capture of carbon from waste-to-energy plants has grown over the past decade, according to the Oxford Institute for Energy Studies.

A community effort to educate

Millwood resident Henry Ligier, sat in his den, flipping through a stack of papers in his lap. A few stray papers were scattered around him, while his wife Adelle perched on a seat nearby, her own documents in hand.

“I’ve been doing a lot of research in reference to how this whole process works,” Ligier said. While he’s not an engineer, he previously worked at a recycling plant as a safety director before retiring. Over the past few weeks, he’s read the DEP’s engineering evaluation for the facility, researched the proposed processes and watched videos on the technology.

“I understand the recycling business and I understand safety,” he said. “I’m trying to learn this, and what I’m learning I’m passing on to all the community.”

Henry and Adelle Ligier go through research they’ve collected on waste-to-energy plants in their home in Millwood. Photo by Sarah Elbeshbishi

Most, if not all, of the information the community has on the proposed medical waste facility has come from research by either the Ligiers or Roach, and it’s what they plan to use as they now set their sights on mobilizing opposition in the neighboring town of Ravenswood.

But even as their effort grows, their underlying frustration has too. Despite their research, they still have a lot of unanswered questions and concerns over the overall impacts of a medical waste facility.

“Had we known that this was happening, we would definitely not have moved here,” said Ligier, looking at his wife. The couple moved to West Virginia just two years ago from New Jersey. “We would not have moved here at all.”

For now, whether Thunder Mountain’s plant will open down the road from the Ligier’s house is still unknown. The facility needs three state permits to operate: an alternative treatment technology permit and a commercial infectious medical waste facility permit from the Department of Health and Human Services and an air permit from the Department of Environmental Protection’s Division of Air Quality.

In early August, DHHR’s Office of Environmental Health Services denied two of the permits, saying the facility is classified as a large Hospital Medical Infectious Waste Incinerator, which are prohibited under the state’s Medical Waste Act. The site’s failure to qualify for the exemption to the rule also contributed to the permit denial.

While Fennell says the company hasn’t yet made any decisions, they’re still hoping to continue with the Jackson County project.

Spurred by government funding, controversial waste-to-energy plants eye West Virginia appeared first on Mountain State Spotlight, West Virginia’s civic newsroom.

Danville becomes one of only two Southside localities to join health data tracking program

Long Story Short: 60% of Oklahoma Jails Failed 2022 Inspections – Oklahoma Watch

The state health department conducts surprise inspections of county, municipal and police station jails each year. Sixty percent of Oklahoma’s failed in 2022, up from about 40% two years earlier. The violations include moldy cells and broken fire alarms, but only one formal complaint was filed by the health department.

After the fall of Roe, physicians confronted their toughest year working in reproductive health care

A group of abortion providers in white coats stand in a line at a rally held around Gov. Roy Cooper's veto of SB20.

By Rachel Crumpler

After graduating from a medical school in the Northeast, Caledonia Buckheit came south to Duke University Hospital to complete her obstetrics and gynecology residency. She finished up last June and found work in North Carolina — ready to provide comprehensive reproductive health care to patients, including abortion.

Just weeks after finishing, the Supreme Court overturned Roe v. Wade. The June 24 decision in Dobbs v. Jackson Women’s Health Organization eliminated the constitutional right to abortion that had existed for nearly half a century.

“Controlling women’s bodies has always been a topic but I didn’t really think it would get to this,” Buckheit said.

Suddenly, working in reproductive health care got a lot more complicated. 

The Dobbs decision handed the authority to regulate abortion back to states and their elected officials, ushering in a seismic change in access to the procedure nationwide. Lawmakers in dozens of states — including North Carolina — pursued greater restrictions.

On top of the challenges that come with entering a new profession, Buckheit — like everyone else working in reproductive health care — has spent the past year navigating a shifting legal landscape and all the questions and unknowns that come with continuing to provide care.

It’s a dynamic that will continue to be part of the job for the foreseeable future as North Carolina’s new restrictions limiting most abortions after 12 weeks take effect July 1 and access to the abortion pill mifepristone is being contested in court.

“It’s just been really disheartening, feeling like my patients have less autonomy,” said Buckheit, a general OB-GYN working at a private practice in the Triangle.

  • a white woman stands behind a podium. She's flanked by a group of other white women.
  • shows a woman in a white coat standing at a podium speaking about abortion
  • Hundreds of people with signs in Raleigh at a rally for abortion rights
  • A woman speaks to protestors in Raleigh during a rally for abortion rights
  • Shows a Black man in a suit standing with a microphone among a group of desks as he debates a recently introduced abortion ban.
  • A large group of abortion rights advocates at a rally held in support of the governor's veto of SB20
  • A white man at a podium holding a stamp with doctors lined behind him
  • shows people holding up signs that say, "Abortion is health care," "Vote Pro-Life" and other slogans
  • shows abortion supporters sitting in rows, hands in the air as you can see the chamber of the House of Representatives below
  • Shows a woman in a pink dress standing framed in a doorway that has flags on either side of it and a formal portrait within.
  • Shows a formal chamber with a group of people standing up, holding up signs reading, "Politicians make crappy doctors"
  • two teenage girls stand holding pro-choice signs in opposition to new abortion restrictions passed by the General Assembly

Adjusting practice

Even for those who have been practicing for years, like OB-GYN Amy Bryant, it’s unquestionable that the past year has been the most challenging and exhausting time to be in the reproductive health care field.

Since the fall of Roe, the legal landscape has been continuously shifting. Abortion providers across the nation and in North Carolina have had to adjust their practices to stay within the bounds of the law.

“When I think back to the early days after the Dobbs decision after Roe v. Wade was overturned, I just really think about the chaos and the uncertainty and the difficulties that we confronted, like, almost instantaneously with this new law of the land,” Bryant said. “It was truly just kind of scary.” 

Beverly Gray, another long-time OB-GYN who works with many high-risk and complicated pregnancies, said she was startled by how quickly some neighboring states took action to cut access to abortion. For months, North Carolina — and its 14 abortion clinics located in nine counties — became a critical abortion access point in the Southeast, providing care to an increased number of out-of-state patients.

A timeline showing significant dates of increased abortion restrictions in North Carolina
Over the past year, the legal landscape for abortion access has changed in North Carolina. Credit: Rachel Crumpler/NC Health News

In August, North Carolina physicians had to adjust their practices for the first time following the Dobbs decision when a federal judge reinstated North Carolina’s 20-week abortion ban, citing the disappearance of constitutional protections on the procedure. The ruling cut the window of time pregnant people had for seeking abortions in the state from fetal viability, which typically falls between 24 and 26 weeks of pregnancy. 

The loss of those weeks was palpable for abortion providers like Gray who had to turn patients beyond 20 weeks away — patients she could previously care for. In her practice, she said those patients mainly consisted of people who received a diagnosis of severe birth defects. 

Then it was a waiting game. Republican state lawmakers expressed their intentions to pursue greater restrictions on abortion shortly after Roe was overturned, but no one knew the speed at which they would move or what if any restrictions would entail. 

The uncertainty spanned many months.

“We didn’t know when the law might change and how we were going to respond if somebody was already scheduled and ready to go and they’d come from eight hours away,” Bryant said. “We didn’t know if we would still be able to care for them or not. That was just not a good way to practice medicine.” 

Ultimately, North Carolina lawmakers brushed aside medical providers’ pleas against adding more restrictions this past May. They passed a ban on the procedure after 12 weeks with exceptions for rape, incest, fetal problems and risk to the mother in May, and overrode a subsequent veto from Gov. Roy Cooper.

Next month, once again, a change in law will necessitate people who work in reproductive health care to alter their practices to conform to new constraints on their work.

Even a month after Senate Bill 20 was passed and the veto overridden, there are still more changes, as just this past week, the state Senate added an amendment to a separate bill that clarifies some of the timing of restrictions.

Gray said it’s not normal for physicians to have to significantly rethink how they practice, especially so many times over the span of one year. She emphasized that practice changes are being dictated by an arbitrary change in law, not as a result of improved medical guidelines.

“It’s completely disruptive to our practice, to our lives, to our day-to-day,” Gray said.

‘Exhausting on so many levels’

In addition to Gray maintaining a busy schedule providing patient care, the year has been full of trips to the legislature to voice opposition to increased abortion restrictions, conversations with lawyers to understand new rules, internal meetings to adjust practices to be legally compliant and media interviews explaining what changes mean to the public.

She’s even filed a federal lawsuit along with Planned Parenthood South Atlantic challenging several provisions of the new state law banning most abortions after 12 weeks, arguing they are unclear or unconstitutional.

It’s a heavy load to carry — added stresses and tasks that Gray said most other physicians don’t have to experience.

“It’s really just exhausting on so many levels because I’m doing all that and at the same time still providing care, still doing all the other work that’s required as a physician and now it’s just all these extra layers,” Gray said. 

When Gray decided to go to medical school, she never thought her role as an OB-GYN would involve so much advocacy and parsing new laws, but that’s what it’s turned into in the post-Dobbs period.  

Bryant agrees that the role has changed significantly over the past year.

“I have spent so much time poring over the legal issues related to my work,” she said. “It is not what I would like to be doing. 

“I think that pregnancy is just far too complicated to be legislated. And when nonmedical professionals start to try to legislate it, it becomes even more complicated to really understand the nuance — to be able to address the nuances in the individual situations that arise when a person becomes pregnant. This is not in any way what I expected my life to become.” 

Buckheit, the new OB-GYN, didn’t expect lawmakers would be dictating how she can do her job, either. And she believes they may have written the law differently if they interacted with pregnant patients on a daily basis.

“I truly feel that if lawmakers spent a week at Planned Parenthood or spent a week in a high-risk OB-GYN office, they would have a really different take,” Buckheit said. “There’s so much complexity and nuance to what we see and what patients and families are going through.”

For example, she’s had to read the state-mandated counseling script 72 hours before an abortion to patients whose babies have serious fetal anomalies.

“It’s like, adoption is an option, parenting is an option,” Buckheit said. “I’m saying this to someone whose baby doesn’t have a brain. It’s just so cruel.” 

The work, particularly in an environment of tightening restrictions, also takes an emotional toll.

“Living in this world now where basic health protections are no longer in place is very difficult,” Bryant said. “Obviously, for patients and also for providers who experience a whole lot of moral distress, knowing that you can care for someone yet not be able to because lawyers, legislators, the courts are telling you that you can’t. It’s a really uncomfortable and distressing place to be.”

Gray and Bryant can’t help but think about the patients they’ve cared for recently and consider whether the same options will be available after July 1.

It’s a devastating reality, Gray said, to know she still has the same skills to help patients in an array of situations but her hands will soon be tied by new rules where she will have to turn some people away she could previously care for.

“I think every single patient that we’re able to care for is meaningful and important, and we’re able to help change the trajectory of people’s lives,” Gray said. “I worry about all of those people that didn’t make the exceptions [to the new rules], but still have really important things that are happening in their lives and the lack of compassion for the people that didn’t make these arbitrary exceptions. It’s heartbreaking.”

Despite the more burdensome and taxing legal landscape, those providing reproductive health care remain committed to providing as much access as possible. The patients are the motivation.

“I feel this immense responsibility to get it right and to still be able to provide care for people,” Gray said. “There’s a huge stress and responsibility.”

Tell us your story about abortion access

NC Health News will be continuing to cover the effects of increased abortion restrictions in the months ahead and the best way for us to do that is with your help — hearing concrete examples of how you are navigating the new law. Have you been affected by new abortion restrictions as a medical professional or a patient? NC Health News is interested in hearing your experience.

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