INDIANAPOLIS — With two weeks until Indiana’s new abortion law takes effect, leaders of the state’s largest health system said it is prepared.
“All been very committed and have put together what I consider to be a very sound and good plan, as the new law will be enacted on September 15,” Dr. David Ingram, IU Health’s Executive Vice President, said.
Once the new abortion legislation was signed into law last month, Indiana University Health got to work.
“We thought it was very important to quickly formulate a team in a response we call the implementation team,” Dr. Ingram said.
Over hours of meetings, some daily others several times a week, teams under an incident command structure sculpted how providers will proceed. They ran through some 80 issues involving the new law.
Dr. Caroline Rouse, Riley Maternity Tower’s Medical Director of Maternity services, was in charge of the implementation team.
“The other thing that was very important to us as a clinical team was ensuring that our providers were aware of the law and what it means and its implications on their current clinical practice,” Dr. Rouse said.
Although the data is being reviewed, IU Health did not provide how many abortions it is expecting to perform moving forward.
“After five weeks of intense work with 60 senior leaders and hundreds of patient hours, we're prepared,” Dr. Ingram said.
Dr. Ingram noted through preparations the health system is expecting a rise in pregnancies statewide. They further looked into what that means for capacity issues in the neonatal intensive care or similar units.
“We also know that about 10% of pregnancies lead to an admission to either a special nursery unit, or to a neonatal intensive care unit,” Dr. Ingram said. He continued, “The flip side of this is do we have the capacity in our systems with our neonatal intensive care units to accommodate that volume. And currently, we are running at about 90 to 95% capacity in those units. So that's something that we needed to think deeply about.”
Under the SEA1, abortion procedures must be done in a hospital-owned inpatient or outpatient setting only. In 2021, most abortions were done in a clinic setting, according to a report by the Indiana Department of Health. The report further details abortions were done at six hospitals across the state – four of those were owned by IU Health, and all four were in the Indianapolis area.
Leaders declined to put a number behind how much this all may cost. However, the hospital system’s executive vice president, Dr. David Ingram, noted abortion procedures done in the hospital setting “are definitely more expensive than an outpatient setting.” The neonatologist also spoke about the anticipated increase in neonatal intensive care patients and the rising cost associated with that.
IU Health notes it will review what comes out of real-time situations after the law goes into effect.
When it comes to the training of residents, IU Health notes at the IU School of Medicine’s OB-GYN program, some training will need to now be done out of state.
“We've needed to make arrangements for out-of-state training for those who need it,” Dr. Ingram said. He continued, “That’s a process that involved malpractice coverage, hoteling, how we figure out how to do the logistics of that.”
Dr. Rouse said the new law brings with it increased paperwork.
“I can tell you that the additional documentation and reporting requirements are a time burden for providers. And so that is certainly something that we have thought about as we're developing our processes and workflows with the implementation team,” Dr. Rouse said.
Creating New Resources
A cornerstone of IU Health’s plans to implement the new abortion law revolve around the creation of a rapid response team. A clinician, someone on the hospital’s ethical team, and a person from its legal team will be on standby, 24/7, to assist providers with any questions when it comes to abortion cases.
“In the event that a healthcare provider has an urgent legal question, related to the provision of abortion services, the rapid response team can be called for, for an opinion and advice,” Dr. Rouse said.
Leaders said they looked to outside states and what they did in relation to new abortion laws when creating the team.
“Many of those states where we consulted those systems were trigger states. They were dealing with this, this new change before us, and we have learned from them,” Dr. Ingram said.
Dr. Rouse spoke to possible gray areas when it comes to the law in terms of patients.
“From a clinical perspective, with new legislation like this, where it can be really difficult to implement that into individual patient situations. The law is broad patient situations are very specific and unique,” Dr. Rouse said.
The maternal-fetal medicine physician added when questions arise, the hope is for the rapid response team to help the situation.
What Will Staffing Look Like?
At this time, IU Health said no one has left the health system over the abortion law. However, leaders said there have been concerns over recruitment.
“We also have a few cases where we have been recruiting out-of-state providers who have withdrawn from the process because of passing of the bill,” Dr. Ingram said.
Dr. Ingram added a survey done of IU School of Medicine residents showed some “85% have told [them] that when seeking employment post-residency, the passage of this bill into law will be a consideration in making that decision.”
The health system’s executive vice president said there is a plan in place to retain and attract the best talent.