Michigan medical community grapples with providing abortion care after Roe v. Wade ruling

Michigan's largest health system said Friday it would follow the guidance of the state's 1931 abortion law and only allow pregnancy termination when necessary to preserve the life of the pregnant person after the U.S. Supreme Court's landmark decision to overturn Roe v. Wade.

But hours later, BHSH System President and CEO Tina Freese Decker sent a second message to employees to provide "additional clarity," saying "we will continue to provide high quality reproductive care to all women in Michigan. Both Beaumont Health and Spectrum Health have historically performed abortions when the mother's life was at risk and BHSH System will continue to do so."

Despite Roe being overturned, abortion remains legal in Michigan — for now — because of a temporary injunction barring the enforcement of the state law that bans it in all cases except to save the life of the pregnant person. It's not clear where courts will take the issue in Michigan, leaving health systems, including BHSH System, grappling with an uncertain legal landscape.

Freese Decker said the health system established a systemwide, multidisciplinary committee to provide guidance to physicians and clinical teams.

"As has been our practice at both Beaumont Health and Spectrum Health and will continue to be our practice, all non-emergent circumstances where an abortion is considered medically necessary will be proactively reviewed," she said in the second message provided by health system spokesman Mark Geary late Friday night.

More: Roe v. Wade in Michigan: Women on both sides of debate take to the streets

More: Beaumont, Spectrum set to launch Michigan's biggest health system Tuesday

Minutes before midnight, he said that message was just sent to all BHSH System team members. He did not respond to questions about why the message appears to have shifted and whether the health system is only going to allow abortions when necessary to preserve the life of the pregnant person.

In an earlier message to employees obtained by the Free Press, Freese Decker said: "Previously, BHSH System's policies and procedures generally allowed pregnancy termination for medical indications, such as when necessary to prevent serious risks to the woman's health or in situations where the fetus is not likely to survive.

"With the Supreme Court ruling, BHSH System's new policy and practices will follow the guidance of the Michigan 1931 law and only allow pregnancy termination when necessary to preserve the life of the woman."

On Twitter and in an emailed release received after 10 p.m. Friday, U.S. Rep. Andy Levin, D-Bloomfield Township, called on BHSH System "to reverse this policy immediately, to continue to allow their providers to give patients the health care they are entitled to under current law, and not to circumvent the courts.”

“We must be very clear: abortion is still legal in Michigan. Judge Elizabeth Gleicher granted a preliminary injunction to stop the enforcement of the 1931 law if Roe v. Wade was overturned," said Levin, a member of the House Pro-Choice Caucus. "Yet the very day that the Supreme Court released their decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe, BHSH System sent a message to all staff saying the entire system would now follow the 1931 law."

In her second message, Freese Decker said there was "legal ambiguity" regarding the law and its enforcement, and that the hospital system was "seeking clarity."

More: Roe v. Wade overturned, rallies planned across Michigan: Live updates

More: Nessel calls Supreme Court ruling overturning Roe 'a dangerous precedent'

Earlier this year, Grand Rapids-based Spectrum Health merged with Beaumont Health in southeast Michigan, temporarily renaming itself BHSH System.

In his release, Levin said while the prosecutor in Kent County, where Grand Rapids is situated, is appealing Gleicher's opinion: "Kent County politics should not be dictating health care for my constituents in southeast Michigan."

Other health care systems also are making decisions or in discussions based on the new legal landscape.

Michigan Medicine said on its Facebook page Friday that it will continue to offer reproductive services, including abortion care. It said it primarily provides abortions for patients who need hospital-level care.

"Many of the patients we see are diagnosed with fetal anomalies or experience other complications that make ongoing pregnancy and giving birth dangerous, or they have serious underlying illnesses or other needs that make abortion care in an outpatient facility not possible," it stated. "Our commitment is to be there for those who need the specialized care we can offer."

Henry Ford Health said in a statement that as health care providers "we have an unwavering commitment to the health and wellbeing of those we serve, and a responsibility to approach this issue through the lens of what’s in the best interest medically of our expectant patients and their families.

"Sometimes those patients are faced with heartbreakingly complex — even life-threatening — scenarios, and they turn to us as their trusted health advisors to guide them — or, sometimes, save them — through our capabilities in medicine. While we will comply with whatever laws come from the overturning of Roe v. Wade, our steadfast dedication to supporting people along their entire health journeys remains.”

Michigan's top doctor and some in the state's medical community expressed concern in the wake of Roe being overturned, while others in health care said they are working to understand the implications of the ruling's impact on hospitals, patients and providers.

Abortions are still legal in Michigan, but that could change if the temporary injunction against the state's abortion law is lifted or removed. The 1931 law only allows abortions "necessary to preserve the life of such woman,” a vague standard left untested by doctors and the courts for decades, and does not allow exceptions for cases of rape or incest.

“Decisions about whether to end or continue a pregnancy should be made by a woman with the counsel of her family, her faith and her doctor — not politics," Dr. Natasha Bagdasarian, the state's chief medical executive, said in a statement Friday.

"As a physician, I know that the decision of the Supreme Court of the United States to overturn nearly half a century of precedent protecting safe, legal abortion violates the trusted relationship between a patient and their doctor. This ruling completely supersedes and overrides a woman's ability to dictate her health care in consultation with her physician. And it clears a path for draconian laws like Michigan’s 1931 criminal abortion ban to take full effect."

Bagdasarian said she is concerned about how the decision will "negatively impact health outcomes for women and children, particularly women and children of color as they have greater disparities in health outcomes in general."

More: The decision to overturn Roe v. Wade changes everything

More: Abortion access in Michigan after Roe v. Wade overturned: What we know

Bagdasarian said the court's opinion and state law "will not only punish women seeking abortion care, but it will also punish and criminalize health care providers who have dedicated their lives to providing the best care for their patients. It casts a dark shadow over the medical community — and doctors will now be forced to choose whether to honor our oath to our patients, to our communities and to our profession, or uphold a law that is unjust and discriminatory and does not reflect the wishes of the majority of Michigan residents.”

There were 30,074 induced abortions reported in Michigan last year, a 1.4% increase from 2020, according to an annual abortion report released this month by the state health department.

Induced abortion ends a pregnancy with medication or a medical procedure, according to The American College of Obstetricians and Gynecologists.

The figure was a 38.7% decrease from 1987, when the largest number of induced abortions in the state was reported at 49,098.

Michigan residents received nearly 95% of the induced abortions in the state last year, according to the report.

Among all the induced abortions last year, including residents and nonresidents, it stated, nearly 89% involved pregnancies of 12 weeks or less. Fewer than half of pregnant people receiving abortions in Michigan in 2021 had no prior induced abortions.

Eighty-five percent of Michigan women who obtained an induced abortion were not married, according to the report, and nearly 35% of residents receiving one were under age 25, with 7.6% younger than 20 years old.

Michigan's largest union and professional association of registered nurses and health care professionals affirmed its support for reproductive health freedoms Friday.

“Reproductive care is health care, plain and simple, and access to health care is a fundamental human right. The danger to people’s lives — especially people of color and those with low incomes — is very real without full safe and legal access to care," association President Jamie Brown said.

"MNA agrees with the majority of Michigan residents who believe that people should be able to decide the best course of action for their own health and well-being; health decisions should be made by patients in conjunction with their health care provider, not restricted by the government."

Brown said the association supports Gov. Gretchen Whitmer’s lawsuit before the Michigan Supreme Court to declare the 1931 state law unconstitutional as well as Michigan’s Reproductive Freedom for All ballot initiative.

More: Whitmer reacts to Supreme Court overturning Roe v. Wade: 'A sad day for America'

More: Michigan ballot initiative seeks to guarantee abortion rights after Roe v. Wade decision

Brian Peters, CEO of the Michigan Health & Hospital Association, said the decision also "will have practical consequences that will impact hospitals, patients and providers. Hospitals have been evaluating for some time what changes may need to occur to operations if today’s decision did come to fruition and we expect hospitals to begin to put those changes in motion.

"The MHA is in the process of understanding the implications of these changes and providing education to our membership. Above all, we will seek legal guidance to protect health care providers and patients from incurring any unintentional criminal liability, harassment or negative health consequences due to a lack of clarity about Michigan’s law regarding reproductive healthcare services."

Kevin McFatridge, chief operating officer of the Michigan State Medical Society, said individual physicians have "strong, deeply-held beliefs on the issue of abortion" and as an organization representing Michigan doctors "we respect those beliefs."

More: Reactions around Michigan after Roe V. Wade ruling that legalized abortions is overturned

More: Roe v. Wade overturned: Michigan leaders react to Supreme Court abortion decision

He said the decision "takes what has been a mostly theoretical debate and sets up very real and practical public policy decisions around how, if at all, abortion should be regulated in Michigan."

Philip Van Hulle, spokesman for Wayne State University's School of Medicine, said officials are reviewing what the decision may mean for medical education.

"At this time, we don't believe it will have any effect on medical education as the SCOTUS decision does not outlaw/ban abortion, nor does it have anything to say about medical education," he said.

Contact Christina Hall: chall@freepress.com. Follow her on Twitter: @challreporter.

Support local journalism. Subscribe to the Free Press.

This article originally appeared on Detroit Free Press: Michigan's largest health system sends mixed messages on abortion