Florida doctors find themselves in the middle -- and on both sides -- of the abortion access battle

Not just Florida women will be affected by the monumental battle over Amendment 4, which allows access to abortion: The state’s doctors also will feel its impact — and many of them are loudly voicing their opinion.

Physicians for and against Amendment 4 have formed coalitions and are speaking out to define what’s at stake.

On Tuesday, Gov. Ron DeSantis held a news briefing in a Jacksonville church surrounded by his pro-life physician allies who want to crush Amendment 4, Doctors Against Amendment 4. It was the governor’s second of three media events so far this week in which he brought Florida physicians with him to a church to speak out against Amendment 4, lending his political weight to defeat the abortion access amendment. The doctors joined him in raising concerns about vague language in the amendment, illustrating how divisive the issue has become, even in the medical community.

The wording of Amendment 4 says, “No law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider.”

“By failing to define terms such as patients’ health and health-care provider, Amendment 4 will codify the right to abortion for all nine months for basically any reason on the recommendation of an undefined health-care provider, not a doctor” asserted Dr. Kathi Aultman, a retired Florida obstetrician and associate scholar with the Charlotte Lozier Institute, a research institute that advises and leads the pro-life movement. “The unintended consequences would be catastrophic,” she said at the DeSantis news conference in Jacksonville on Tuesday.

But later in the afternoon, Florida Physicians to Endorse Amendment 4 held a media call to highlight the 800 Florida doctors in favor of the constitutional amendment that allows abortion access. They emphasized the majority of Florida physicians support the amendment.

“Physicians like us are proud to endorse Amendment 4, but this really shouldn’t come as a surprise because as medical experts, we know that abortion bans like Florida’s are dangerous for patients,” said Dr. Kathleen Dumitru, a Jacksonville emergency medicine physician also trained in obstetrics and gynecology.

Regardless of the outcome of the election, doctors in emergency rooms, birthing centers and private offices are and will continue to be on the front lines of how abortion access plays out in the state.

What’s happening now

Under the state’s current six-week abortion ban, Florida medical providers must navigate the complexities of maternal pregnancy and exceptions to the state’s abortion law.

Included in the six-week ban are exceptions up to 15 weeks of pregnancy in cases of rape, incest, and human trafficking with documentation. Florida law also allows physicians to terminate a pregnancy if necessary to save the life of the mother or prevent “a serious risk of substantial and irreversible physical impairment.” Physicians must decide what constitutes the narrow exceptions to Florida’s law — knowing that the penalties for doctors who violate the ban are severe, including imprisonment, fines, and loss of medical license. That responsibility will continue if Amendment 4 is defeated.

Florida women already have come forward to say that after Florida put abortion restrictions into effect, they were denied emergency care while pregnant and experiencing complications by hospital doctors who feared taking action would land them in legal trouble. One of those women, Anya Cook of Margate, has been an outspoken advocate of Amendment 4. Florida’s health agency sent guidance to medical providers in September to further clarify which pregnancy complications qualify for treatment.

During a media call Tuesday, doctors said Florida clinicians are afraid to care for pregnant patients with complications under Florida’s current abortion law. In some cases, they are waiting for hospital lawyers to weigh in.

A report by KFF, a health policy research firm, found in states with abortion bans, physicians respond differently to pregnancy complications.

“Abortion bans and restrictions have led physicians to delay providing miscarriage management care,” the report found. “Many states allow for the removal of a dead fetus or embryo, but pregnant people who are actively miscarrying may be denied care if there is still detectable fetal cardiac activity or until the miscarriage puts the life of the pregnant person in jeopardy.”

Dumitru, the Jacksonville emergency medicine doctor, said those scenarios happen in Florida and put patients at risk, particularly for infection.

“I have heard stories from colleagues across the state of Florida on how this extreme ban is interfering with care,” she said. “Part of the problem is just the fact that there are these legal questions at all. That is the problem for doctors who want to provide care. We want to take care of people. We want to take the best care of people that we possibly can. But if there are these questions of losing your license or going to jail, that just means that there’s a hesitation. There should be no hesitation to providing necessary care.”

If Amendment 4 passes, what changes?

If Amendment 4 passes, a different issue emerges for doctors.

The wording says a health-care provider would determine if an abortion is needed to protect a patient’s health. What is the definition of that term?

Some Florida doctors are echoing DeSantis’ refrain that the amendment would displace the role of physicians, allowing unlicensed professionals to perform procedures. And because of the elimination of parental consent (only notification would be needed), doctors could find themselves in tricky situations.

Dr. Ana Verdeja-Perez, an obstetrician-gynecologist in Plant City, spoke against Amendment 4 at the DeSantis news conference in Winter Garden on Tuesday. “It’s important that communities know how doctors feel and why they are against Amendment 4,” she said. “The vague language without definitions will allow abortion at any time of pregnancy and for any reason. It will allow abortion without us doctors and without parental consent.”

Verdeja-Perez said the advertisements for Amendment 4 have caused confusion among medical professionals. “Don’t fall for the scare tactics,” she warned doctors. “As a physician who took an oath to do no harm, there is no way I can say yes to this amendment.”

Dr. Cheryl Daniels, a Miami abortion provider, said these are scare tactics. She believes the medical community has more to lose if the amendment fails.

“We are faced every day with the heart-wrenching stories of women and sometimes girls who are harmed by our state abortion bans,” she said. “As medical professionals, providers know first-hand that Florida’s near total abortion ban criminalizes essential health care, endangering both patients and physicians.”

Daniels said she is not concerned about who could and would provide abortions if the constitutional amendment is approved by 60% of voters.

“‘Healthcare provider’ as it is in the amendment is clearly defined in other parts of the Florida statute. So there is not actually a legal concern that non-licensed abortion providers would be providing abortions … the presumption that something as serious as patient care would not be provided by doctors is inaccurate,” she said.

If approved, legal experts say the courts or lawmakers likely will further define the wording of the constitutional amendment to determine precisely who is a “healthcare provider” and potentially how late in pregnancy an abortion could be performed.

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