Hospitals can refuse Plan B

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Hospitals can refuse Plan B

But several area lawmakers are trying to change that

By Jennifer Nejman, York Daily Record, December 3, 2005

A rape exam performed in the hospital to collect forensic evidence can take two to four hours.

The woman is asked to disrobe. She isn't permitted to smoke. Health professionals collect oral and vaginal swabs. They take clothing samples. They scrape under nails. They remove pubic hair.

But some women do not have the option of being given two pills at the hospital to reduce their chances of becoming impregnated by their attackers.

In Pennsylvania, hospitals are not required to offer the medication. Some do. Others have policies that allow health-care providers to opt out of providing the medication because of personal religious or moral reasons.

Two Pennsylvania senators and one state representative have introduced bills that would mandate that hospitals provide information about the pills and give them to rape and sexual assault victims who want them. The legislation as it is written has no opt-out for individual doctors or religious-affiliated facilities.

It is estimated that more than 25,000 women become pregnant in the United States each year as a result of rape, according to statistics given by state lawmakers who have proposed the bill.

More than 300,000 adult women in the United States reported that they were raped during the previous 12 months, according to statistics from the Centers for Disease Control and Prevention.

Most medical experts agree that emergency contraception will not disrupt a pregnancy. It stops the release of an egg from the ovary and might prevent the union of a sperm and egg or a fertilized egg from attaching to the womb. If an egg already has implanted, the medication will not work, according to both the maker of the one progestin-only pill on the market, Plan B, and the Food and Drug Administration.

Yet, emergency contraception has become part of the county's ongoing abortion debate because it provokes thinking about when life begins and what type of interference in the process people are comfortable with.

Advocates of the state House and state Senate bill believe women of all ages who have been sexually assaulted or raped should be allowed to decide if they want to take emergency contraception when they seek emergency-room care. To be most effective, the medication must be taken with 72 hours of unprotected sex.

"Can you imagine anything more traumatic to a mother being faced with a child (who has been) raped and then the possibility that she could be pregnant?" asked Diane Moyer, legal director of the Pennsylvania Coalition Against Rape.

"I think everyone should be in agreement about this - whatever you think about conception. This is about innocent victims and a standard of care available in the emergency room."

Moyer expects opposition to the legislation, maybe because people don't understand how emergency contraception works, she said.

State Reps. Ron Miller, R-Jacobus, Bruce Smith, R-Dillsburg, and Stephen Stetler, D-York, have signed on as co-sponsors of the legislation. Several others say they would support it; two, including Bev Mackereth, R-Spring Grove, said they need to consider the bill and hear the debate.

Mackereth said she has no problem with dispensing emergency contraception to rape victims in the emergency room but needs to hear how the matter would be handled at Catholic and Christian hospitals. She had sponsored legislation on the same subject that was introduced in October that dealt with those issues differently.

The earlier bill specifically stated it would not require a religiously affiliated health-care facility or hospital to participate in something contrary to its beliefs. The hospital could provide a written notice to the victim of its policies.

The two new bills do not exclude religious-affiliated hospitals. It is possible those hospitals could seek to be excluded from following a new law by evoking a current state law that protects religious freedom.

State Sen. Connie Williams, D-Montgomery, said she wants people to view her legislation concerning emergency contraception in Pennsylvania as an issue separate from general access and use of emergency contraception.

"I don't see how anyone can oppose this," she said.

Planned Parenthood of Central Pennsylvania supports the legislation. Other groups, such as Human Life Services, and Catholic hospitals want to make sure the medication is not given to a woman they believe is pregnant.

At local hospitals

Representatives of four local hospitals in York County said they provide emergency contraception to rape and sexual assault victims if they desire it.

In the emergency rooms at York and Gettysburg hospitals, emergency contraception is given on a case-by-case basis, based on the medical judgment of the doctors, hospital spokesman Barry Sparks said.

"People are (providing the medication) as a physician, based in medicine, not on their personal beliefs," Sparks said. He said he didn't believe the hospital was running into any issues with doctors who objected to providing the emergency contraception.

Memorial Hospital offers emergency contraception to rape and sexual assault victims regardless of who is on-call that day, a hospital spokeswoman said.

Dr. Charles Marley, medical director of Hanover Hospital's emergency department, said a doctor on staff who objects does not have to provide emergency contraception to rape victims. In an e-mail, he said he knows of one doctor on staff who objects.

Marley said if a doctor objected to the treatment for moral or personal reasons, the patient would then have to go to a Planned Parenthood office or to her obstetrician/gynecologist.

"This creates a slight time delay, but the physicians who are ethically and/or morally limited in making this decision are at least directing the patient to where they can receive this type of treatment," Marley said.

Christina Mauhar, executive director of the Victim Assistance Center in York County, said her organization goes to hospitals to speak with rape victims if victims request their presence. Mauhar said she hasn't had a situation where a hospital has refused to provide a victim with emergency contraception, but she said her organization is not present with all victims because some do not want their services.

"I don't know if (hospitals) are out there acting as loud proponents of (emergency contraception) because it is a touchy subject," she said.

Even if the legislation passed, Catholic hospitals would be able to seek protection from following the mandate under a state religious freedom and protection act, said a spokeswoman from Sen. Williams' office.

The policy at Holy Spirit Hospital in Harrisburg, which is a Catholic hospital, is to provide emergency contraception on a limited basis.

An excerpt of guidelines from the Pennsylvania bishops states: "A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation or fertilization."

If they believe there is evidence of pregnancy, those medications may not be given, according to the policy.

Lori Moran, Holy Spirit's spokeswoman, said hospital staff would refer a patient elsewhere if she still wanted emergency contraception.

Opposition and support

Ron Sisto, executive director of Human Life Services, which has an office in York, said his organization opposes the legislation because it would require some hospitals to do something they find morally wrong.

Human Life Services offers free pregnancy tests and assistance to women in the form of diaper supplies and other needs.

The organization's position is that people should abstain from sex before marriage. Once married, the couple may use contraception, if they desire, with input from their doctor and minister, Sisto said.

His group would not support letting a woman use emergency contraception.

"Our position would be the same as if they were pregnant - we would not recommend they have an abortion," Sisto said. "It's a very hard decision. I know what the other side is. . . . It's so rare that a rape victim becomes pregnant."

Although his group disagrees with the legislation, Sisto said, it is glad for the discussion because people with opinions can voice their comments.

"At least the legislature is debating it out, and it's not in the court system," he said.

The Clara Bell Duvall Reproductive Freedom Project of the American Civil Liberties Union looked at access to emergency contraception in 2000, then updated its findings in 2002.

Of hospitals surveyed in 2002, 46 percent routinely offered and provided emergency contraception to sexual assault victims - an increase from the 28 percent that did so in the 2000 survey.

Hospitals determined by the survey to be appropriate followed well-established protocols that included offered emergency contraception.

York and Gettysburg hospitals, which fall under the WellSpan umbrella, were determined to be appropriate.

At that time, Hanover Hospital was noted as not providing emergency contraception, and Memorial Hospital's policy was unclear.

Carol Petraitis, director of the Duvall project at the ACLU, said the project plans to write letters to hospitals to tell them that legislation has been introduced.

In 2000, a representative from Memorial Hospital said, it sometimes gave both doses and sometimes gave a prescription, and it would depend on the time of day or circumstances.

Petraitis' notes on Hanover Hospital showed that, in 2000, someone at Hanover Hospital said it did give emergency contraception to rape victims, but during the follow-up survey, the person the surveyor spoke to was unsure and said it was up to the patient to get it.

A spokeswoman for Memorial Hospital said the hospital's policy has not changed. That policy has been to give emergency contraception to rape victims. A Hanover Hospital doctor said the hospital will give the medication, but if a staff member objected, the patient would be referred elsewhere.

"We would never have a problem with an individual physician opting out of providing a treatment, but there has to be a system in place, and it has to be seamless to the patient," Petraitis said. "If a woman leaves with a prescription (and no medication) - that's abandonment of the patient."

By the numbers

Number of sexual assault victims, including rape victims, treated in the local emergency rooms each year:

York Hospital: 130 seen last year
Memorial Hospital: estimated 25 per year
Hanover Hospital: estimated 15 to 20 victims per year
Gettysburg Hospital: no estimate available

Area legislators' opinions

Some area legislators' opinions on House Bill 2159, which proposes creating a mandate that would require hospitals to provide comprehensive care to victims of rape and sexual assault, including telling them about and offering emergency contraception, if the patient would like the medication:

State Rep. Ron Miller, R-Jacobus: Supports the bill; is a co-sponsor.
State Rep. Steven Nickol, R-Hanover: Would support bill if it came up for vote.
State Rep. Bev Mackereth, R-Spring Grove: Supports having emergency contraception available to rape victims in hospitals; said she wants to hear the debate from religious groups. Mackereth had supported another bill introduced in October on the same topic that dealt with the religious-affiliated health care providers differently.
State Rep. Stan Saylor, R-Windsor Township: Said he thinks there are some good parts of the bill; would like to see how religious hospitals are handled. "We don't want to mandate something that is against their religion," he said. He said that issue will be dealt with and the bill can be brought to a vote.
State Rep. Bruce Smith, R-Dillsburg: Supports the bill; is a co-sponsor.
State Rep. Stephen Stetler, D-York: Supports the bill; is a co-sponsor.
State Rep. Keith Gillespie, R-Hellam Township: Said he needs to look at the bill in its entirety and plans to take his past health care background into account. He said it would be appropriate to exclude religious-affiliated hospitals from the mandate. "I'm not real wild about mandates to begin with, and I have to see what's driving it."
State Sen. Mike Waugh, R-Shrewsbury Township: Supports the Senate bill, which is bill number 990.

What is Plan B?

Also called emergency contraception and the morning-after pill, Plan B is used as a backup method to prevent pregnancy after unprotected sex or failure of other contraceptive products, such as a condom. It differs from RU486, known as the "abortion pill," which is designed to be taken after a woman has become pregnant.

Plan B contains levonorgestrel, the same hormone that is in birth control pills, but in a higher dose. Plan B is designed to prevent pregnancy mainly by stopping the release of an egg from the ovary. It also might prevent the uniting of the sperm with an egg (fertilization), or keep the egg from attaching to the uterus, according to Barr Pharmaceuticals Inc.

The company states that taking Plan B will not affect an existing pregnancy. If the first tablet is taken within 72 hours after unprotected sex, it can reduce the likelihood of pregnancy by 89 percent.

Source: Barr Pharmaceuticals Inc.

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