Documents describe dozens of painful situations under Ohio abortion restrictions

BY: MARTY SCHLADEN – Ohio Capital Journal

At least two more minors made pregnant by sexual assault were forced to leave Ohio to avoid having their rapists’ babies, according to sworn affidavits filed by abortion providers.

The affidavits were filed in Cincinnati as part of a lawsuit aimed at stopping enforcement of Ohio’s strict new abortion law, which it temporarily did last week. Originally paused for two weeks, on Tuesday the enforcement delay was extended to at least Oct. 14.

If true, the affidavits show that a Columbus 10-year-old was not the only child or teen rape victim forced to leave the state. They also describe more than two dozen other instances in which the abortion law put women under extreme duress.

The descriptions include those of three women who threatened suicide. They also include two women with cancer who couldn’t terminate their pregnancies and also couldn’t get cancer treatment while they were pregnant. 

Another three examples were of women whose fetuses had severe abnormalities or other conditions that made a successful pregnancy impossible. Even so, they couldn’t get abortions in Ohio. 

And in three cases, debilitating vomiting was caused by pregnancy — so bad in one case that a woman couldn’t get off the clinic floor. But neither could these women get abortions in Ohio, the affidavits said.

The documents were filed in the case Preterm-Cleveland v (Ohio Attorney General) Dave Yost. Having already gotten a temporary order restraining enforcement of the abortion law — Senate Bill 23 — clinics across Ohio are now seeking a preliminary injunction.

In doing so, they’re arguing that SB 23 is so onerous that it violates women’s due-process rights under the Ohio Constitution. 

Disrupted clinics

Gov. Mike DeWine signed the law in 2019, but it couldn’t be enforced until the U.S. Supreme Court overturned Roe v Wade on June 24. Many of the affidavits describe how, as soon as the decision overturning Roe was announced that Friday, work at Ohio clinics was thrown into chaos.

Ohio law had allowed abortions until 20 weeks of pregnancy. Now, with only limited exceptions for the life and the health of the mother, no abortions were allowed after fetal cardiac activity could be detected by ultrasound.

In the affidavits, clinic workers said that usually happens after five to six weeks of pregnancy — a point at which as many as a third of women and girls don’t know they’re pregnant.

The new, much-earlier cutoff sent clinic workers scrambling.

“In the days after S.B. 23 took effect, we had to cancel over 600 appointments,” Sharon Liner, medical director of Planned Parenthood Southwest Ohio, said in her affidavit. “Many patients broke down in tears in our office. Many patients that we could not reach by phone who came to our health center expecting to have their appointment were extremely upset; some threatened to hurt themselves because they were so distraught.”

Liner added, “We have had at least three patients threaten to commit suicide. Another patient said she would attempt to terminate her pregnancy by drinking bleach. Another asked how much Vitamin C she would need to take to terminate her pregnancy.”

In July, 60% of patients at the clinic had to be turned away because fetal cardiac activity had been detected by the initial ultrasound, Liner said. 

The Ohio law requires a 24-hour waiting period and a second negative ultrasound before an abortion can be performed. Because things are changing so quickly at that stage of development, another 16% of women who’s fetuses had no cardiac activity during the first exam were turned away in July because it was detected in the second, Liner said.

The Ohio law requires a 24-hour waiting period and a second negative ultrasound before an abortion can be performed. Because things are changing so quickly at that stage of development, another 16% of women who’s fetuses had no cardiac activity during the first exam were turned away in July because it was detected in the second, Liner said.

“When we tell patients we cannot help them, they are extremely distressed, and all we can offer them is resources, information and emotional support,” Liner said in her affidavit, which was taken while S.B. 23 was still being enforced.

Ohio clinics have been referring patients who were ineligible for abortions here to clinics and hospitals in Michigan, Pennsylvania, Illinois and New York to get them. 

Planned Parenthood of Greater Ohio and other organizations have announced stepped-up assistance to help patients get to those states. But many — including at least one homeless woman — said problems with things like transportation, child care, poverty and getting time off work make the trips virtually impossible, according to the affidavits.

Allegra Pierce, a medical assistant at Preterm-Cleveland, doubted that most women turned away at Ohio clinics during the 11 weeks S.B. 23 was enforced ever made it out of state.

“The majority of patients I talk to say that they can’t travel out of state to access abortion care,” Pierce said in her affidavit. “Even though many patients can access sources of funding for seeking an abortion, there are so many barriers that make traveling out of state inaccessible for many of our patients, including the cost of travel, child-care responsibilities, and difficulty getting time off of work, just to name a few. Even those patients who are able to travel out of state often have a hard time getting an appointment due to increasingly long wait times at clinics in states where abortion is still legal.”

More victims

In July, when Ohio Attorney General Dave Yost was raising unfounded doubts about the existence of a 10-year-old rape victim, there were plenty of data indicating that the story was all too plausible.

In 2021, Ohio’s Children’s Advocacy Centers saw 6,717 cases of sexual abuse against Ohioans between infancy and adulthood. And in 2020, the most recent year for which statistics are available, 571 girls aged 17 or younger received abortions in Ohio, according to the state department of health. Fifty-two of them — or one a week — were 14 or younger.

Sadly, the affidavits filed in late August and early September by workers at abortion clinics provide further evidence that child and teen rape and subsequent pregnancy is a problem in Ohio. But so long as fetal cardiac activity is detected, S.B. 23 requires such victims to either have those babies or scramble out of state and try to find an abortion.

Adarsh E. Krishen, chief medical officer for Planned Parenthood of Greater Ohio, told of a minor who had been sexually assaulted and had to travel to Michigan for an abortion because of S.B. 23. Krishen’s organization operates clinics in Columbus and Cleveland.

“This patient experienced immense trauma from the assault itself and then endured further trauma from a forensic interview alongside a physical exam to collect evidence for the ongoing police investigation,” Krishen said in his affidavit. “This trauma was further exacerbated by needing to wait over three weeks for her appointment. In each step of this process she felt the complete denial of bodily autonomy and safety, something all people, especially children, should unequivocally have at all times.”

Another example shows how S.B. 23 makes police investigation of child and teen rapes more difficult.

Aeran Trick, operations manager of Women’s Med Center of Dayton, told of “a 16-year-old girl living in Southwestern Ohio who had become pregnant after being sexually assaulted by a family member.”

As with the 10-year-old from Columbus, Trick said this teenager was forced to go to Indianapolis for an abortion.

“The local Ohio law-enforcement agency — which was already involved at the time the clinic was contacted about the patient — had to drive to our Indianapolis clinic to retrieve the tissue for crime lab testing related to the sexual assault investigation,” Trick’s affidavit says. “I am concerned that Ohio’s ban and the need to travel increasingly far distances to obtain abortion care not only causes unimaginable harm to these young victims, but could also hamper law enforcement’s ability to investigate and prosecute these cases in the future.”

Cornered by cancer

The affidavits filed as part of the effort to stop S.B. 23 describe two cancer patients put in the most impossible of situations by the law. 

Both seem to illustrate doctors’ reluctance to terminate pregnancies despite the law’s exceptions for maternal health — exceptions that doctors say are woefully ill-defined. With potential penalties that include felony charges and the loss of professional licenses, some doctors have refused to terminate even though their patients’ health is at risk.

In the days after S.B. 23 took effect, a pregnant 25-year-old went to a clinic operated by Planned Parenthood of Southwest Ohio, said Liner, the medical director there. The patient had recurrent cancer and was undergoing chemotherapy when she learned that she was pregnant.

Chemotherapy is dangerous during the first 12 weeks of pregnancy and this patient had already skipped one treatment. But when the clinic determined that she was eight weeks pregnant, workers there said they couldn’t perform an abortion, Liner said.

“Due to the patient having cancer while pregnant, we sought documentation to support a medical exception to S.B. 23 for this patient,” Liner said in her affidavit. “Her provider of care did not feel comfortable providing this and the patient had to travel out of state for an abortion to resume her cancer treatment, which caused further delay.”

The effect of delaying chemotherapy on the patient’s health might be hard to determine, but it seems unlikely that it was good.

Just three days after S.B. 23 took effect, a 37-year-old suffering stage III melanoma went to Women’s Med Center in Dayton, Trick, the operations manager there, said. The woman was told by her doctors that she had to terminate her pregnancy before they could treat her, so she, too, would have to leave the state, Trick said. 

“Upon learning that she would need to travel out of state to have her abortion, the patient broke down and cried inconsolably despite the attempts of multiple staff members, including myself, to console her,” Trick said in her sworn affidavit.

Other illnesses

In addition to those cases, women with conditions that made successful pregnancies impossible had problems getting doctors outside the clinics to treat them, David Burkons, medical director of Northeast Ohio Women’s Center said. Two patients at the clinic said they had tubal, or “ectopic,” pregnancies “but the doctors (at emergency rooms) were afraid to treat them without being absolutely certain there was no intrauterine pregnancy,” Burkons wrote in his affidavit.

“In one case, the patient’s fallopian tube ruptured, and surgery (was needed) rather than medical management, which would have been possible if they had acted sooner,” he said. “In the other, my nurse intervened to convince a physician to treat the patient, but only several days later, which was emotionally wrenching for the patient.”

The affidavits also detail cases of fetal abnormalities and other problems so severe that pregnancies can’t result in a successful birth. One patient at a Planned Parenthood clinic in Southwest Ohio had a fetus with abnormalities including “a lack of lower extremities and the contents of the fetus’s abdomen, including possibly the heart, protruding through a defect in the abdominal wall,” Liner, a doctor, said in her sworn statement.

Because S.B. 23 doesn’t allow women in such cases to abort their pregnancies if they don’t pose an imminent threat to their health, they either have to leave the state for an abortion or carry the fetus to term — even though that “can be extremely distressing for patients,” Liner said.

In another case, this one in Dayton, a woman was 13 weeks pregnant but had no amniotic fluid, prompting her doctor to tell her the pregnancy was “nonviable.”

“However, because the fetus still had fetal heart tones, the physician discharged her with instructions to call the office if she developed a fever,” Trick said in her affidavit. “The patient was very distressed and expressed to (clinic) staff that she felt abandoned by her physician during an incredibly difficult experience. I’m concerned that confusion over the meaning of S.B. 23’s health exceptions has led physicians to avoid providing medically necessary care out of caution, and I worry about patients in similar positions who aren’t able to independently find an accessible abortion provider without their physician’s help.”

Clinic workers also reported cases of incessant vomiting caused by pregnancy, including in a high-school senior who found it impossible to attend class and finish her diploma. 

Another girl, 16, had vomited so much that she lost 20 pounds, Trick, of the Dayton clinic, reported. The girl’s mother didn’t have a reliable car, so she had to rent one to take her daughter to Indianapolis for an abortion, Trick said.

At the same clinic, another patient was “so sick she was lying on the floor vomiting into a bucket,” Trick wrote. 

The woman wasn’t only afraid that her condition would prevent her from making it to Indianapolis, Trick said. The woman had four kids to care for and she was the manager of a large retail store.

“She was concerned that she was going to lose her job because of all the time she had to take off to travel to and from the clinic for abortion care in addition to her repeated absences due to being hospitalized for her condition,” Trick wrote.

Undermining its own purpose

Proponents of S.B. 23 meant to dramatically curtail the number of abortions in Ohio. But the clinic workers said that for some patients, it’s having the perverse effect of rushing them to terminate pregnancies before they’ve had a chance to decide whether that’s what they really want.

Pierce of Preterm-Cleveland said that at five to six weeks, “these patients are very early on in their pregnancies and many of them have not had a chance to wrap their minds around the fact they are pregnant. A number of patients have told me that they wish they had more time to think about whether to continue the pregnancy.

“For example, I recently spoke with a patient with a young baby at home who had become pregnant again only months after giving birth,” Pierce’s affidavit continues. “She had experienced many postpartum health issues, and she was not sure if she was physically or mentally ready to go through a pregnancy again so soon. She wanted time to work through this decision but was terrified that if she waited she would no longer be able to have an abortion.”

In their lawsuit, the abortion clinics seem to be contending that in forcing such an early decision, S.B 23 denied that woman’s due-process rights under the Ohio Constitution. They seem to be asserting the same rights for the other women they describe in the affidavits as being injured by S.B. 23.

Whether Ohio’s court system agrees will be decided in the coming months.

Follow Marty Schladen on Twitter.