Episode Transcript
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(00:05):
The following is brought to youby the committee to protect
healthcare.
Chris (00:09):
In the emergency department, we see real time
consequences of people nothaving access to health care.
Expansion of Medicaid inWisconsin would mean less cases
to the emergency department.
It would prevent closures ofhospitals in our communities,
and most importantly, savelives.
The majority of states in thecountry have expanded Medicaid
with bipartisan support, yetlegislators in Wisconsin are
blocking expansion of Medicaid.
(00:31):
They're blocking the opportunityfor our patients to have a
healthier life.
Tell your legislator to savelives and pass Medicaid
expansion.
a Georgia woman has beenidentified as one of the first
deaths related to lack ofabortion care access.
Amber Thurman died waiting.
(00:52):
for a DNC.
a surgical procedure sometimesused in abortions.
The report finding her deathlikely could have been
prevented.
It was jarring, shocking, anddisheartening that my Georgia
doctors could not provide mewith the standard of care.
Georgia women and medicalproviders testified before
Senator Jon Ossoff's HumanRights Subcommittee in
opposition to Georgia's lawbanning abortions after a fetal
(01:15):
heartbeat is detected.
Medical experts say that'stypically around six weeks.
ProPublica released a report oninternal documents from the
Georgia committee reviewingpregnancy related deaths.
The report indicated thecommittee, run by the State
Department of Health, determinedthe death of 28 year old Amber
Thurman was likely preventableif she'd had access to abortion
(01:35):
care in Georgia.
In August, when Amanda was 18weeks, pregnant, her water
broke, losing the amniotic fluidher baby needed to survive.
Her doctor told her, You're 100percent for sure going to lose
your baby.
The nightmare got worse.
Her doctor said because of antiabortion laws in Texas, they
(01:56):
couldn't terminate thepregnancy, even though Amanda
was at high risk for a lifethreatening infection.
Texas law allows for abortion ifthe mother has a life
threatening physical conditionthat places her at risk of death
or substantial impairment.
But Texas lawmakers haven'tspelled out what that means.
I was shaking, my teethchattering, trying to tell Josh
(02:18):
I didn't feel good.
she went downhill very fast.
The bacterial infection couldhave been prevented if she'd
been provided an abortion.
when her temperature hit 103degrees, doctors terminated the
pregnancy, but Amanda was stillsick.
Her blood pressure crashed, andshe needed a blood transfusion.
(02:38):
they said, we're moving you tothe ICU Central issue physicians
must now navigate is theexception to save the life of
the mother.
The law, as written in the stateof Wisconsin, is still very grey
it's intrinsically vague, um,which then, Causes physicians to
potentially second guess, like,is this risky enough?
(02:59):
Because everyone who practicesmedicine knows that it can be
very gray for a while and thenbecome very black and white.
Um, and you, the longer you waitto intervene, the worst outcomes
are in general.
There was a time when I was inMinnesota where someone
presented in an, in an emergencyfor, on an ambulance, in an
(03:20):
ambulance, she was bleeding.
She had to go to the operatingroom right away and I had to
perform an abortion and Icouldn't help but to think to
myself, if this was happening tome in Wisconsin, I would be.
terrified about what the nextsteps would be, about what the
implications for my future, mycareer would be.
(03:40):
I will continue to fight forthese patients because they need
a voice.
Everybody needs a voice in this,in this fight.
And a lot of the voices that areat the table right now don't see
these patients and they don'thave any medical background, but
they're making these decisions.
Welcome to pulse check,Wisconsin.
(04:38):
Good morning.
Good evening.
Good afternoon.
This.
Dr.
Ford.
With Pulse Check I want to thankyou for.
More listening to now our secondpart of our series.
The politics of public health.
We have a.
A really good episode If youdidn't catch the first episode
of our series.
I recommend that you go.
Go back.
(04:59):
I Was able to speak withrepresentative.
Deb on Draka as well as Dr.
Megan Schultz.
Who's a pediatric ER, doctor.
And we discussed the importanceof gun legislation.
In the state of Wisconsin.
So if you didn't catch that forfree to go back and.
And listen to all the amazingthings that they had to offer.
And examples.
Samples that they had to give ofhow our current gun laws as
(05:21):
they.
They stand.
Affect Wisconsinites and waysthat we can improve the safety.
Of our communities and a safetyfor our children.
In this episode, What we will bedoing is we'll be talking to
Diane.
Diane Welsh, who is the leadlegal counsel for?
The current case that we have inthe Wisconsin Supreme court.
(05:44):
Regarding the statute, which.
Is on the books at this time,limiting.
Reproductive freedoms in thestate.
State of Wisconsin.\ Diane Walshis the partner with the firm.
Pines Bach.
And she has had over twodecades.
Of experience.
Advocating.
Four.
Citizens of the state ofWisconsin.
She served on the board ofdirectors.
(06:05):
For Wisconsin democracycampaign, domestic abuse.
Intervention.
And services as well asWisconsin women in government.
And she's.
Currently.
A member of the Dean's advisoryboard for the university of
Wisconsin.
And whitewater college ofletters and sciences.
So Diane.
Is the legal counsel for myselfand two, other of my colleagues.
(06:26):
In the roles that we have takenin this case as being
interveners.
And what we.
We provide as interveners isexpert opinion.
On.
On how restrictions andreproductive freedoms in the
state of Wisconsin.
It affects our patients.
And we give that context from.
The standing of our professionalroles So myself.
(06:49):
Uh, from the standpoint of anemergency medicine physician and
my other.
Two colleagues from thestandpoint of being
obstetricians and gynecologists.
Just in the state of Wisconsin.
So in this episode, Diane.
Updates us a little bit on.
Where we stand currently in thestate of Wisconsin with regards
to reproductive.
Inductive freedoms.
And where she perceives thiscase to go.
(07:11):
Go in the future.
So that being said, we'll goahead and get started with.
Chris (2) (07:37):
For our listeners, I gave a bit of an intro as to who
you are And the amazing thingsthat you're doing throughout the
state.
Uh, but if you can't, could youjust give us a little bit of
your background?
Diane (07:46):
Sure.
Um, I grew up in ruralsoutheastern Wisconsin and, uh,
worked in higher ed for about 10years before deciding to go to
law school.
One of my motivations for lawschool was I decided there
weren't enough women in thelegal profession, either making
the laws or interpreting andprosecuting or applying the laws
(08:07):
or judging the laws.
And so I really was focused inthe policy, uh, role that women
lawyers could make.
So I went to law school in D.
C.
and when I My first job afterlaw school was at the Wisconsin
Department of Justice where Iworked for about five years and
(08:28):
then I moved into the Departmentof Health and Family Services.
And worked there for about eightyears and that's where I really
became focused on reproductivehealth care and, uh, and access
for women among many, many otherissues.
But, you know, looking at someof the issues about like access
(08:49):
to reproductive health care,maternal and child health,
infant mortality rates, maternalmorbidity rates in Wisconsin,
um, and numerous other aspectsof health and family services in
Wisconsin.
Then I, uh, moved into privatepractice several years ago, and
where I have been since.
(09:09):
And since that time, I've hadthe great fortune of
representing a lot of the familyplanning clinics around the
state and some physicians andnurses and others who do this
important work.
Chris (2) (09:22):
Yeah.
And, and, and I commend you fordoing all that.
You know, it seems like you havea really good track record at
advocating for a lot of thewomen around the state of
Wisconsin.
I see that you're on the boardof, you know, the domestic abuse
intervention services, Wisconsinwomen in government, et cetera.
Um, and, and just to kind of tieall that in all that advocacy in
(09:42):
what drew you to, what motivatedyou to become involved in what
we'll discuss today, which isthe reproductive rights
litigation.
Diane (09:51):
So I think I've had like feminist beliefs going back to
girlhood, you know, like girlsshould have the same
opportunities as boys.
I don't know if it's havingstrong, you know, And send my
life that we're good role modelsor having five sisters or what?
But the idea that girls shouldbe more limited in their
opportunities than boys, likenever sat right with me, you
(10:14):
know, has I got older seeinglike the impact of like economic
disadvantages.
for women um, and also domesticabuse and that impact that
violence against women had.
Um, it really kind of framed mythinking and was one of the
motivators for going to lawschool.
As it relates to, access toreproductive health care.
(10:36):
I think women's opportunities inso many ways are really shaped
by their ability to decidewhether or when to have Children
and the timing and spacing oftheir pregnancies and and in
every way like this can, uh,their ability to maintain an
interesting, fulfilling career.
You know, and build upgenerational wealth, you know,
(10:57):
depends on, you know, how manykids are they taking care of
their ability to perhaps leavean abusive relationship, maybe
tied to, you know, theirpregnancy status or how many
kids they would need to supportwithout a partner, their ability
to fulfill a passion in thearts, you know, whether it's
acting or, you know, creativearts, you know, can depend on,
(11:22):
you know, You know, theirpregnancy status and how many
Chris (3) (11:24):
kids
Diane (11:24):
they're caring for.
So in so many ways, women'sability to live full and active
lives, you know, and makechoices they want to make are
also tied to their ability tomake choices about how many kids
to have and when to have thosekids or whether to have those
kids.
And I use the term women, and Iknow that across the gender
spectrum, there may be peoplewho don't identify as women who
(11:47):
may be pregnant or have childrenand just be a little less
complicated because I'm going touse the term women for people
with egregious.
Chris (2) (11:56):
Yeah, yeah.
And so, you know, just to kindof Bring that back to Wisconsin.
Like you were saying it, itlimits women through all
spectrums of life, allsocioeconomic, um, uh, walks of
life as well.
when you don't have that abilityto make, your own reproductive
decisions.
And in the beginning, we did acouple of news clips from
(12:17):
different instances, more sofrom the medical spectrum, you
know, what complications ofpregnancy may arise, et cetera,
et cetera.
But just to kind of go back in,in the state of Wisconsin.
So in June of 2022, as we allknow, overturn Roe v.
Wade, how, how did that affectfolks in Wisconsin?
What did that mean forWisconsin?
Just in kind of taking thisback,
Diane (12:37):
Fortunately, we had had some conversations prior to that
because as soon as the U.
S.
Supreme Court accepted the Dobbsdecision, those of us who were
working in this space were awarethat, um, a change could be
coming.
And so there were lots ofconversations with OBGYNs,
attorneys working with healthsystems, uh, and abortion
(13:00):
providers around the state totalk about, uh, What might this
mean and what would happen ifRoa was reversed?
But what happened was, um, inWisconsin was significant
because Wisconsin had this veryold law on the book that hasn't
been enforced for, you know,half a century.
And some, uh, Conservative legalscholars put out a paper, a
(13:24):
white paper, saying that, like,this old law would kind of come
back into force and beenforceable against physicians
who were providing abortioncare.
And We've never had a situationin Wisconsin or across the
country where a well recognizedright, you know, right, was
established by the U.
(13:44):
S.
Supreme Court.
The state legislature, you know,for the past 50 years has been
making laws about abortion.
And then all, but they nevertook the old law off the book,
you know, because it had been,you know, overruled.
It was first by a federal judge.
court, and then, you know, also,um, negated by Roe versus Wade.
(14:08):
And, um, so we were really feltlike a state of limbo and the
uncertainty was great as weapproached, you know, we were in
an election year.
We had candidates for attorneygeneral, we had district
attorneys saying, of course, theold ban could be enforced.
(14:30):
And we had others saying like,no, that old ban doesn't spring
back to life.
It's not like a zombie law thatcomes back to life and eats up
all the other abortion laws thatour modern day legislature has
passed in the last few decades.
Um, but there was uncertaintyand with the old ban, you know,
because it was a felony, therewas a six year statute of
(14:51):
limitations.
So anyone who's working in thehealth care space, abortion
space, you know, emergencydepartment space where a woman
might come in needing abortioncare, um, was faced with like,
okay, I know my current DA sayshe doesn't believe it's enforced
and won't enforce it, but whatwill a future DA do?
Or will an attorney general, uh,you know, that has a different
(15:14):
belief than the current attorneygeneral come in and try to
enforce this against me fiveyears from now?
So, uh, we, you know, so thatwe, we went from settled,
established law that physiciansworking in health care,
providing care to pregnant womenknew what the law was and when
(15:35):
they could provide care andtreatment and what they could do
to like, uh, uh, a lot ofuncertainty.
And,
Chris (3) (15:41):
um,
Diane (15:42):
it was very hard for, for healthcare practitioners and the
lawyers advising them.
Chris (2) (15:48):
And for all the listeners, you know, to be
clear, to put it into contextfrom a medical perspective, this
is before we knew that bacteriaand viruses cause sickness,
right?
Like this is before we knew theeffects of a medication like
Tylenol.
Right.
And so.
What we did was we reverted backto this law and it created, as
(16:09):
Diane was saying, thisuncertainty, not only for myself
practicing in the emergencydepartment, but for providers,
in the OB GYN realm, uh, forproviders who worked in rural
locations, you know, they wereon the phones with their
lawyers.
When they should have been onthe phone with their consultants
when they have patients that arepresenting with what we call
ruptured ectopic pregnancies,non survivable pregnancies to
(16:31):
term for the fetus, but could bedevastating, could be deadly
for, for the mothers.
And so, you know, these arethings that, that all of us in
the know, as Diane said, youknow, they were gearing up from
The legal standpoint, we weregearing up from the medical
standpoint when we saw the ballrolling to try to get providers
(16:52):
to know, hey, you're covered byEMTALA, um, uh, and you have
that coverage from a medical andfrom a legal standpoint, uh, to
do no harm in the cases of thesepatients.
Diane (17:03):
Right, and like if you're working in an emergency
department in a hospital, thenUMTALA applies, which is the
Emergency Medical Treatment Act,which applies for any hospital
that accepts Medicare funds thatmake sure that the hospital
provides like stabilizing careand treatment for any patient
regardless of their means topay.
(17:24):
It doesn't apply in physicianoffices, though, so somebody
working in a clinic, you know,serving high risk pregnant
patients or, you know, orotherwise wouldn't have the same
protection that was, you know,the Biden administration set up
by, you know, related to him.
We tried to very quickly haveconversations, you know, saying
(17:46):
like an ectopic pregnancy isnever going to be a viable
pregnancy and will always posesome risk to the pregnant
patient.
However, that didn't mean thereweren't health systems or
hospitals that were taking moreconservative approaches,
Chris (3) (18:00):
um,
Diane (18:00):
and conservative for multiple ways.
You know, we have a high numberof Catholic run health systems
in Wisconsin, but we also have,uh, uh, health systems that are
more risk adverse, you know,and, you know, just wanted to
like, not have any questionabout what the conduct might be.
So, um, you know, so it wastroubling to see how health
(18:28):
systems, physicians, otherhealth care providers too, had
to weigh the interest of theirown operations and their
physicians versus theirpatients.
And weighing out what was bestfor each, and it wasn't always
the same.
So we saw, you know, heardreports of patients being turned
away to go to Minnesota orIllinois or Michigan, uh, to get
(18:53):
the care they otherwise wouldhave been able to get in
Wisconsin.
Chris (2) (18:57):
And, and, and I gave a couple of examples to a
patient that I saw personallythat did just that day and read
that that went to Illinois andgot incomplete care because they
didn't have the financial meansto go back or even the physical
means to go back.
You know, in some cases, Some ofthese, these patients are
adolescents, right?
Um, and you know, had to goemergently to the OR.
(19:18):
Unfortunately, I was practicingin a, you know, uh, inner city
location that has a lot ofresources, has providers on
staff and we're able to getthem, uh, to those means to get
that definitive treatment.
But I've worked in rurallocations where, I was the OB
for 40 miles, right?
Like that, that was the, thatwas the situation just being the
emergency doctor in the, in thehospital.
And so, like you said, it couldcause that uncertainty and that
(19:41):
law is specifically gray, aswe've seen in other states as
well, that we don't know whatthat means.
We don't know what the life ofthe mother means or, you know,
what, what that means in thosecases.
Diane (19:51):
Chris, I'm glad you mentioned that, that the
grayness of the law, uh, isextra frustrating, you know, one
that, you know, an abortion canonly be provided to save the
life of the pregnant patient.
You know, it's like how imminentwould death need to be before
that would be triggered.
And then there's language thatsaid that determination could be
made by the treating physicianor to other physicians.
(20:15):
Well, some attorneys wereinterpreting that to mean like
three different positions had toall agree on it.
And and they were Requiringphysicians to like get a second
or a third physician to sign offon it.
And, you know, in rural areas,you know, there's not, you know,
multiple OBGYNs on duty all thetime, or you know, physicians.
(20:37):
Who are willing to like quicklysign off on a decision that
might have criminal implicationsdown the road if, if it's
misinterpreted or if somebody'ssecond guessing it.
Um, but.
Even that language is confusing,um, and you know, from our
perspective in our case, as youknow, we, that's one of the due
process concerns we make aboutthe old law that, like, that
(21:00):
doesn't get physicians noticeabout what's required.
Absolutely.
You know, like, knowing what itmeans to be required to save the
life, you know, of the patient.
Um, you know, the other, it's,all of them are required to be
performed at a maternityhospital.
Wisconsin doesn't even havematernity hospitals anymore.
You know, like there arehospitals who have maternity
(21:21):
maternity wards, but that wholecategory of licensure has went
away.
There's like separaterequirements or restrictions for
quickened children versus notyet quick, a quick child, which
is, you know, has no medicaldefinition in this day and age.
And in the Dobbs decision, eventhe majority opinion written by
(21:43):
it, just by Justice Alito saysthat, you know, that is, That
term is, you know, no one has acommon understanding of that
term, right?
Generally, like, when the fetusis felt to be moving, right?
Exactly.
Chris (2) (21:57):
Yeah, yeah.
And that, that was, you know, asyou said, that was one of the
points that we came to is justthe fact that there is no
standardization of that.
Right.
Like that, that, thatinterpretation of it was put
into law before there wereultrasound, in order to see or
to hear, uh, you know, a fetus'sheart rate.
And so it's just completelyarbitrary and dangerous to, to
(22:17):
be honest with you at this stateof the game.
Diane (22:20):
The other thing that made it extra confusing is that, you
know, decades ago our stateSupreme court had considered
what the statute meant and inlight of the more modern
abortion laws and said it was afetus side statute.
You know, the case black versusstate versus black arose in the
(22:41):
context of prosecuting a guy whobeat up his pregnant spouse with
the intention of killing theinfant a few days before her due
date.
Um, and Charges were brought bythe district attorney, you know,
back in the nineties of underthe old abortion ban, what was
(23:03):
that thought of has and but ithas like it was intentionally
killing.
You know, an unborn child, andso they brought it under that
law, and our state supreme courtlooked at that case and said,
yeah, so now kind of in light ofthe other law, this is a
feticide law.
Like it prohibits theintentional killing, you know,
in this manner, it doesn't applyto like medical abortions
(23:26):
because we have laws that dothat.
So that made it fair.
More confusing.
And that was, you know, thebasis for, and jumping ahead
here for the Dane County CircuitCourt saying, yeah, this is no
longer an abortion law.
The old, what used to be our oldban is now a feticide law.
Chris (2) (23:46):
Yeah, and it's totally fine to jump ahead.
So, so where are we at today interms of, because again, 2022,
we go back that's the law of theland.
We're all kind of working underthis cloud of uncertainty.
Where are we at now?
And, and kind of what role did,did you and your, your firm play
in that?
Diane (24:02):
Right.
So very shortly after the Dobbsdecision was decided, Attorney
General Call brought a lawsuitseeking a declaratory judgment
to, to what does this law mean?
Is it still in effect?
You know, um, how does it relatenow that we have all these other
laws?
Um, we intervened on behalf ofthree positions, including
(24:26):
yourself has persons who aremost directly impacted by the
confusion and and face potentialprosecution under the old ban.
You know, if there was adistrict attorney who
interpreted it differently than,you know, than we interpreted
it.
So we intervened and we had oralargument in the circuit court of
(24:52):
Dane County and the circuitcourt ruled in favor of the
Physicians who intervened andintervene means to like join the
lawsuit.
Like we're not the ones whobrought it the first time, but
we say we have a interest that'spotentially could be injured.
So we should be here too.
And we should be a party.
So by intervening, we were fullparties to the case.
(25:14):
Um, and we prevailed.
The judge said physicians are atrisk of being injured by a
misapplication of the old law.
And, uh, under state versusblack, the case I talked about a
few minutes ago, that is nolonger the standard for medical
abortions.
We have all these other lawsthat, that regulate medical
(25:37):
abortions.
And that's what applies to them.
So she issued a declaratoryjudgment saying it's no longer
in effect.
Um, so that was good news.
And I think most health systemsand providers, you know, saw
that has an opportunity to, tochange.
And the abortion clinics in thestate reopened and most health
(25:58):
systems took off some of therestraints that they may have
placed on, uh, their healthcareproviders while there was a
question.
District Attorney Aromanskyappealed the case, and he asked
that the Supreme Court grantbypass, which means instead of
having this argument before theCourt of Appeals, and then
(26:19):
seeing what the Court of Appealsdoes, and then the potential to
have it reviewed in the SupremeCourt, um, He asked the Supreme
Court just to shortcut the Courtof Appeals and hear it directly
because of the importantquestions that were raised.
Uh, the position intervenorsagreed.
We asked the Supreme Court totake it as well, as did the
Department of Justice.
(26:41):
And so, that case is set fororal argument on November 11th.
So the Monday after theelection, uh, we'll have
argument, uh, at the WisconsinSupreme Court to, we'll be
arguing to uphold the circuitcourt decision, which says the
sick old man is not an affected,as I like to say, it's not a
zombie law that comes back andtakes over, um, all the other
(27:05):
modern day abortion statutes.
Chris (2) (27:08):
So after these arguments, is there a potential
that we can revert back?
Like you said, or, or what doyou, what do you foresee, uh,
uh, to come out of this?
Diane (27:19):
There's the potential, but I'm very optimistic, you
know, but You know, electionsmatter.
Hmm.
And, uh, there was a judicialelection last April and the
court switched from aconservative majority to a
progressive majority.
And we don't know how any of thefour progressives will vote in
(27:40):
this case, but I remainoptimistic.
But even as it comes to theconservative justices, you know,
the notion that a law that waspassed and.
Replaced with many more modernlaws, to me, seems very
undemocratic.
Like, when you look back, whenthe law was originally passed,
(28:02):
women couldn't even vote.
There were no women legislators.
Even when it was, like, updatedand moved into a different
section in 1955, women had beenvoting for a short time, and
there was very littlerepresentation in the
legislature.
Um, to say that, Our forefathersview of what should happen
(28:22):
versus like all the modernlegislatures that like you and I
had the opportunity to vote forin the last 20 years.
Um, like that our modernlegislature has to take a
backseat to very old formerlegislatures makes no sense to
me from a democracy standpoint.
Right.
So I think to say that this oldlaw replaces all the modern
(28:47):
laws, seems like a bridge toofar.
Chris (3) (28:49):
And
Diane (28:52):
so I'm, I'm, I'm very optimistic.
You know, we also related tothis topic is there's another
case pending in our, in ourstate Supreme court, which deals
with, Whether that old statute,if it was a ban, would violate
our state constitution.
(29:13):
So, under that litigation, itkind of takes it another step
further.
Like, wouldn't applying that lawviolate People's right to life,
liberty, and the pursuit ofhappiness,
Chris (3) (29:25):
you know,
Diane (29:26):
like, and when I talk about this, you know, what we
talked about toward thebeginning, deciding like how
many kids do I want to have?
When do I want to have?
What else do I want to do?
Like, do I have health risksthat might be implicated by a
pregnancy, like all thosequestions, um, arise in the
context of our stateconstitution, which includes
language that doesn't exist inthe federal constitution.
(29:48):
And one thing that was madeclear in Dobbs is now abortion
is an issue to be left up to thestates.
So we don't just look at statestatutes, we have to look at our
state constitution as well, aslike a separate, uh, basis for
rights.
And that section of our stateconstitution is recognizing
inherent rights, like not rightsthat the government gave us, but
(30:10):
rights that we are born with,and the government needs to
recognize.
And in North Dakota, the statecourts found that their state
constitution provided rightssimilar to what we're seeking in
the second case.
So we anticipate that our stateSupreme Court will probably
decide Paul v.
Ermanski, the case you'reinvolved in, and also Planned
(30:34):
Parenthood v.
Ermanski, which raises theconstitutional question by the
end of this term, which is byearly July.
So we can.
have this firmly, whether it'sstatutory interpretation or
constitutional interpretation or
Chris (2) (30:50):
both.
Yeah.
And you bring up a good pointthere too, especially how the
doubt decision took it directlyto the states.
I was recently listening to anexcerpt, I believe it was
through Texas Public Radio,where they had a really good
piece on fetal personhood.
And how stricter, state,statutes will lead to issues not
(31:12):
only for emergent situationslike ectopic pregnancies, uh,
but also potentially for IVFpatients, patients that are
seeking to make their familiescomplete.
Uh, and in Wisconsin, we'restarting to hear some of this
language as well.
Folks interpretation, especiallynow.
This is an election year.
You have more conservativecandidates, even in my own
Senate district that arebringing this point up of fetal
personhood.
(31:33):
What is that?
And is that something that we'reconsidering as well?
And in some of these cases,
Diane (31:39):
it's not just a part of this case, but it is part of the
landscape because we have stateRepublican legislators.
who individually believe thatthere should be, you know,
personhood should be recognized.
Also that, um, you know, thatpersonhood life begins at
conception and who would bancertain forms of contraception.
(32:03):
So we certainly have somelegislators who would remove,
um, some contraceptions.
Um, And make them illegal, wouldremove funding, public funding
for certain forms ofcontraception or contraception
in general.
So, um, yes, there are certainlegislators who would prioritize
(32:27):
the life of, you know, a zygote,embryo, fetus, ahead of a
patient or woman.
Chris (2) (32:38):
Yeah.
Yeah.
And that's the part that'sconcerning, right?
Especially in the setting ofagain, national elections are
coming here and more and morerhetoric.
About bringing the things backto the states and quote unquote
letting the states make theirown decisions But as we
discussed on this on thispodcast before How much goes
into the states making thatdecision?
Is it really you making thatdecision or is it your
(32:59):
legislator?
Is it from a gerrymander likemap that your that your your
legislator is chosen, right?
There's so many things that gointo it and even looking at it
from a medical perspectiveAgain, in the cases of these non
viable pregnancies, but can beextremely dangerous for women,
especially if you get internalbleeding, et cetera, et cetera,
become septic.
You know, what does that mean tothose providers?
(33:20):
What does that mean to thosewomen who are coming in, Does
that mean that we wait for themto get to a certain level of you
know, a fever a certain level ofInstability, you know, do we
wait for them to lose a limb forinstance, which can happen in
the cases of of sepsis You know,that's not Considered in some
people's, ideology of, is thisactually the life of the mother?
Diane (33:41):
No.
And that brings up an importantpoint, getting back to your
earlier point.
Like, and then some of thosecases waiting too long can, can
impact the patient's futurefertility.
Chris (3) (33:52):
So
Diane (33:52):
having, right.
So, you know, something couldhappen.
You know, this could be a verywanted desired pregnancy, but
because of complications.
It goes wrong and medicalintervention is necessary to
save, you know, preserve herhealth, but also her fertility.
Should you want to have a childin the future?
And, and the laws that, uh, arepurportedly, you know,
(34:17):
protecting, you know, promotingbirth and my birth can get in
the way, The fetal type statutesor abortion laws could get in
the way of, of, of preservingher fertility for future healthy
births.
You know, it also, as you said,has implications for IVF where,
um, where again, couples whovery much want to have children,
(34:41):
IVF and then, but if everyembryo, you know, is a life that
can never be destroyed, raisessignificant, significant You
know, there are more eggs thatare fertilized than would ever
be planned to, you know, fullydevelop and, you know, be born,
(35:04):
right?
Yeah,
Chris (2) (35:04):
yeah.
Absolutely.
I've had many colleagues thathave gone the route of IVF and,
you know, it took years for themto, conceive, and have a infant
in their arms, right?
And so that, that is somethingthat we need to continue to keep
an eye on and especiallyconsidering The lack of science
(35:26):
in some of these cases now, Idon't, I don't want to talk, you
know, down on any, anyindividual representatives in
particular, but I've sat acrossfrom a number of legislators and
a number of representatives.
And have been shocked to behonest with you about their
understanding of science and youknow I could only imagine what
they get in science, you knowwhen they were coming up right
(35:46):
because it's just like whatwhat?
Let's just start from scratch.
All right, let's just start overagain.
But you know, it is that lack ofunderstanding and it's It's the,
the, the caliber of thatunderstanding that's sitting at
the table that not only aremaking these decisions, but
making the decisions for theirconstituents that may or may not
have voted for them.
That concerns us all, right?
Like in the instances of some ofthese, you know, uh, some of
(36:09):
these fertilized old women inthe setting of IVF.
Some of them.
have congenital abnormalities.
Some of them have, karyotypeabnormalities that will never be
viable.
Right.
And so in those cases, there,there is a lack of scientific
thinking.
There is a lack of criticalthinking to this, to this point,
and just kind of, this is whatit's going to be.
You know, that's what we're allconcerned about.
Diane (36:29):
Right.
And there's both a lack ofscientific thinking, and I don't
think it's necessarily relatedto poor education versus like
intentional disregard.
for science.
Um, but there's also just viewson the roles of women in
society.
And, um, and, you know, I haveheard a sitting legislator say
(36:54):
that, you know, our workforceshortage issues are because
women are having enough babies,you know, and, um, and I just
find that very offensive, youknow, like this view that, like,
we're the problem because we'renot all producing more Children,
you know, and if we did want toprovide incentives for, you
(37:15):
know, Couples, women to havebigger families.
There's way to ways to do that.
You know, like having, you know,universal healthcare, having
universal affordable childcare,having affordable education, K
through college, you know, allof these things that
considerations that people havewhen deciding how many children
(37:37):
to have, you know, cost is a bigdriver.
Having parental leave, you know,paid parental leave would be.
You know, one reason somepeople, might not have more
Children.
So there's ways of providingincentives for couples to have
more Children.
If we really think we need morefuture workers, but the idea
that this is just lands onwomen's shoulders.
(37:58):
And if we have anti abortionpolicies that will build up our
workforce, um, I think it's notthe right way to do it.
You know, I just think we're notbetter off adding unwanted
children into a society.
Chris (3) (38:15):
Exactly.
Diane (38:16):
Like if, if couples are affirmatively believe they
cannot, you know, raise,support, nourish a child.
Yeah.
I think that is an importantdecision to make, you know, you
know, hopefully in planningcontraception, but if in the, if
there's a failure in planning.
Um, our failure of contraceptionto make a decision versus taking
(38:40):
away the option forcontraception or abortion, and
then meaning like, that's how weget a bigger workforce.
Chris (2) (38:48):
And that's key to the point too, because as you said
before, a lot of times thecontraception is considered, you
know, to be included in therealm of abortion, right?
So, oral contraceptive, Plan B,all these things that are
definitively not that.
Are interpreted by people who,again, are either ignorant of
the science or, uh, purposefullyavoiding, you know, any, any,
(39:09):
any truth to the matter insaying that we're going to lump
all these things together.
All these things are abortionand you can't do any of them,
Diane (39:18):
right?
So if you're, you know, like.
View fertilization versusimplantation has, you know,
when, yeah.
one's conception, one's life,one's other things and applying
your own moral view versus thescientific view that makes it a
(39:38):
lot harder for, uh, for makinggood decisions about what
contraception should beavailable and what options
should be available.
Chris (2) (39:49):
One of the things that we're seeing now are the
beginnings of some of theconsequences to having this
reversion more strict laws inthe books on in some states such
as Texas and Georgia.
Unfortunately we saw, Um, atleast two women, that had fatal
results from this that we knowof, right, that, that we are,
(40:11):
that we are publishing in, in,in the mainstream media, so to
speak, what are some of the mostsignificant, legal and social
impact that you have observed,uh, just in your own practice
since this decision,
Diane (40:24):
right?
I think first is the confusion.
is, is, you know, was thegreatest.
And then the women who couldtravel out of state to get the
care they needed, you know, thathad to, instead of getting care
by their trusted providers closeto home, like then had to travel
(40:45):
out of state.
And when I heard from from womenis, you know, like their
physician saying, I wish I coulddo this,
Chris (3) (40:52):
but
Diane (40:53):
My lawyers are telling me I can't, or my hospital's
telling me I can't, or I'm toldI can't do this, so, you know,
like, you know, already indistress about, um, their
status, you know, that theyhave, you know, that their
pregnancy has failed, and nowthey have to go out of state to
get care, and then some beingdenied follow up care, because,
(41:13):
um, their healthcare providerwas just even concerned to do
the follow up, care that wasrequired.
You know, as you know, likesometimes even for medically
necessary abortion, there couldbe complications or follow up
care that's needed.
But like some physicians orhealth care systems not even
(41:34):
wanting to, um, to go there.
You know, and that part is veryfrustrating.
You know, in some states,there's been the concern about
where there would be amiscarriage and then women are,
are investigated as if they did,uh, self managed abortion when
it was, you know, a spontaneousabortion or miscarriage.
(41:58):
And, um, Which is extratroubling to me, like
criminalizing something, atraumatic
Chris (3) (42:07):
event.
Diane (42:09):
You know, many women were told, like, resorted to, like,
online pharmacy for,contraceptive pills.
Yeah.
Which, you know, so thatremoved, you know, like, since
I'd be able to come herelocally, meet with the
physician, get the follow upcare they needed.
Right.
You know, they were left to selfmanage it, even if they would
have preferred to do this withthe care of a health care
(42:32):
provider locally.
Chris (2) (42:34):
And to that point, to this day, even though we have
now swung out of this, at least,you know, hopefully permanently,
but at least temporarily.
I have recently seen women inthe emergency department who
have done just that, Diane, whohave gotten, you know, uh, quote
unquote abortion medicationonline because they're under the
(42:54):
assumption still that we arestill, under this restriction to
provide abortion care in thestate of Wisconsin.
So like we said, we have yet tosee the effects down the line of
just two years plus, right?
Because that, that, thatinformation has not gotten out
to everyone as of yet.
And people are still thinking,if I go to the emergency
department, which is what we sawat the very beginning of this,
(43:16):
if I go to the ER, they'll findout.
Right.
If I go to the ER, there'll bepolice waiting there for me
because again, as we're nearingnational elections, this is what
folks are hearing.
This is what people are seeingonline, social media, et cetera,
et cetera.
And it's building this veryunsafe environment for our
patients to live in and for ourcommunities to be under.
Diane (43:36):
And because this is left state by state by state, But the
dialogue and social media postsand everything are national.
There's just more confusionbecause if you read a story
about a woman in, you know, Ohiobeing prosecuted or something
happening in Texas, you know,People in Wisconsin don't know
(43:56):
what that means, you know, forthem, you know, and one thing
that we said repeatedly, likeunder Wisconsin statute, even,
you know, the worst version ofthe old law, women themselves
can't be prosecuted forobtaining an abortion or self
managing an abortion like that,that is specifically excluded
from that statute.
(44:17):
So the patients you see whomaybe have tried to self manage
an abortion, that's not illegalin Wisconsin, even under the
worst interpretation of the oldban.
Chris (3) (44:27):
But,
Diane (44:27):
again, how to get that message out when really what we
need to do is modernize ourabortion laws overall and make
them clear.
for all patients to know and notjust patients for people who are
planning their futures.
Um, so hopefully we'll get agood decision in this case.
Hopefully we'll get, you know,good legislature that could look
(44:48):
at, you know, improving ourcontraception and abortion laws
versus I'm taking them backcentury.
Chris (2) (44:57):
Yeah.
Yeah.
And you know, we, I know in yourfield, you likely get a lot of
opposition and a lot of counterarguments that are presented to
you.
I know I do, uh, just by beinginvolved in the case, how do you
address, you know, some ofthese, some of the opposition,
some of the counter argumentspresented by people who are very
supportive of restrictivereproductive laws in the state
(45:18):
of Wisconsin.
Diane (45:18):
You know, I respect that friends, family may have
different religious views ormoral views on, on abortion.
And, um, I just say that Ibelieve that it's a very
individual decision and, youknow, a very personal decision.
And I don't think I shouldimpose my religious moral views
(45:39):
on others and vice versa.
And that if a person Believesthey can't go through with the
pregnancy, whether it's becauseof health conditions, you know,
the risk to their own health orlife, or because they're just,
you know, not equipped to bringa child into the world.
That is just a decision I preferbe made at an individual by
(46:02):
individual level.
I think it's actually uncaring.
to demand that others bring anunwanted child into the world.
And, you know, I don't know thatthat's the best thing for that
potential child.
Chris (2) (46:19):
Absolutely.
What do you see as the futurenow?
Because I know that you saidthere, this case is split into
two places, two cases at thispoint in time.
Um, what do you see as thefuture of reproductive right
litigation in Wisconsin?
And also just kind of on thegrand stage, like in the United
States, where do you see thisgoing?
Diane (46:37):
So in Wisconsin, a lot will depend on how the court
addresses the two pending casesin the statutory case and the
constitutional case.
Yeah.
If Wisconsin follows otherstates in recognizing a state
constitutional right, then thathas implications about what kind
of restrictions could be, couldbe placed or could not be placed
(47:01):
on abortion or contraception orIVF or other forms of really any
issue that deals with bodilyautonomy going
Chris (3) (47:10):
forward,
Diane (47:11):
right?
Thank you.
You know, so if we, you know, ifour right to life, liberty and
pursuit of happiness reallymeans something for each of us,
I think that has broadimplications that we might see
other cases deal with
Chris (3) (47:24):
in the
Diane (47:24):
future.
I mean, if our court says, no,it doesn't, that doesn't mean
that, um, you know, then it mayhave negative consequences for
protecting some very rights thatwe think should be personal
decisions.
Chris (2) (47:38):
You know,
Diane (47:38):
like couples or individuals with names.
Chris (2) (47:42):
And along those lines, what do you think that,
we can do, both in your realmand in my realm to improve, that
public understanding and thatsupport for reproductive rights.
Because as we said before, thisis not only along the medical
track, this is not only, youknow, that life, liberty,
pursuit of happiness, the bodilyautonomy.
There's a lot of things that gointo this, including
socioeconomics, you know, there,there, there's a religious
(48:02):
aspect, there's cultural aspectsthat go into it too.
What can we do to improve thatpublic understanding of the need
to have, these reproductiverights in tech.
Diane (48:11):
I think we need to keep talking about it, not closet
this issue.
You know, when you think aboutlike maternal, life and like,
who's at greater risk of, uh,dying from, pregnancy or birth
and, and infant mortality ratesand other things where like, uh,
There are so many factors thatgo into that and to like just
(48:33):
pretend that everyone who getspregnant will be just fine, you
know, and that, you know, like
Chris (2) (48:38):
that doesn't work that way.
I
Diane (48:41):
think also like taking abortion out of just that it's
only this elective, you know,decision to make where, you
know, really abortions areprovided, you know, all around
the state, not just at abortionclinics, right?
Because it had, you know, in theemergency room when someone
presents with medical conditionfor which like abortion an
(49:03):
abortion is the right medicaldecision.
And then there's spontaneousabortion, things that just
happen on their own.
So to take it out of this ideathat like, it's only this, uh,
procedure that's only done atabortion clinics and should be
suspect at all times.
I think we need to just keeptalking about the realities of,
um, and not make it, a closetedissue that we don't talk about.
(49:28):
implications.
I think talking about theoverlap of again, this is some
of the same organizations thatare pushing the most restrictive
abortion policy also push limitsto contraception and who can
access contraception.
And, uh, I heard this early inmy career, I heard this story
(49:49):
about like how in Europe whenthey're talking to teens, like
they recognize that teens mightbe experimenting with sex, um,
So instead of just saying, like,they don't say, like, don't do
it, don't do it, like, just say,no, they say, don't get pregnant
and here's how you don't getpregnant.
And in many other countries,there's much lower teen
pregnancy rate than in theUnited States, because the
(50:12):
message isn't an unrealistic,just say no.
It's a more realistic, if you'regoing to do it, this is how you
prevent an unintended pregnancy.
And this is our expectation.
Chris (3) (50:25):
Yeah, yeah,
Diane (50:27):
so so I think again some of the same people who don't
want Um, we want to limit thelegality of abortion and limit
access to contraception.
Also want to limit discussionsof sex education or access to,
um, reproductive health carefor, for minors.
Chris (2) (50:48):
Which runs contrary to their, right, to the goal
ultimately, right?
Exactly.
Diane (50:52):
Yeah.
So, so I think we need a moreholistic and real, holistic and
realistic approach.
You know, overall to talkingabout, you know, family
planning, reproductive choices,sexuality and, um, you know,
should parents be involved inthose discussion?
Absolutely.
(51:12):
But if they're not, um, therestill is a role for others to be
involved.
Chris (2) (51:17):
Yeah.
Well, Diana, thank you so much.
Just to close everything outhere, is there anything else you
would like our listeners to knowabout the fight for reproductive
rights in Wisconsin and, how canlisteners follow you or, uh, get
in touch with you if they wantto get more information or
support any of your efforts?
Diane (51:35):
Great questions.
I think the most important thingthat listeners can do is vote.
Um,
you know, we have important elections coming up in
November, and then in Aprilthere's a state Supreme Court
election, and a lot of folksdon't vote in the state Supreme
Court elections in April.
But it's very important to knowthe candidates and know their
(51:55):
positions, uh, on, on issuesrelated to reproductive health
and everything else that mightbe important to you.
Uh, and, I don't, I, There's noway to follow me very well.
I'm not presence on socialmedia.
I'm just kind of quietly workingin the background and we
Chris (2) (52:16):
appreciate it.
Keep, keep working,
Diane (52:18):
but I'm happy to come and talk to you again, Chris,
whenever you want, and I thinkwhen we have a decision, which
might not be until summer, Ithink there will be news of that
decision or those decisions.
And, but again, uh, please vote.
Uh, in November and again inApril, and again, knowing who
(52:40):
supports, you know, the rightsthat you hold to be important in
the
Chris (2) (52:45):
work you do.
Absolutely.
And that's the intention ofthis, just to give folks that,
that, that idea of, you know,the background, right?
These are the facts.
The, this is coming straightfrom the source, as Diane said,
she's in, she's in the trenches.
So she may not be on socialmedia posting, but she's
fighting this fight for, forwomen throughout the state of
Wisconsin to make our livessafer, to make families safer,
(53:05):
our community safer as well.
Dan, I appreciate you so muchfor coming out and making the
time and thank you for all yourefforts.
And, uh, we, we are lookingforward to hearing more from
you.
We will definitely reach out totie a bow on this and figure out
where we're at in the summer.
Diane (53:18):
Thank you, Chris.
And thank you for being part ofthe litigation.
That's really important workthat you're doing in addition
to, you know, being at workevery day.
Your position code on.
Chris (2) (53:29):
Awesome.
Awesome.
Well, thank you so much.
In 2023, the American college ofemergency.
issued several statements onreproductive.
Of freedoms.
For our listeners, the Americancollege of emergency physicians
is the governing.
Burning body.
One of the main governing bodiesfor emergency medicine doctors
throughout.
The country.
(53:50):
And in their policy statements,they.
They supported equitable access.
Yes to reproductive healthcare,including abortion.
In emergency departmentsthroughout.
Throughout the country.
And they supported the idea thatabortion is a medical.
Procedure that should be ashared decision between a.
Patient in their physician.
As we also discussed in this.
(54:10):
This interview, we supportEMTALA as well, which is the
emergency.
Medical treatment at activelabor act.
And this.
Emphasize is the right ofemergency physicians to provide
care to pregnant patientswithout.
Without the fear of legalconsequences.
As we discuss.
The entire goal.
Of some of the advocacy thatwe've done over the years since
(54:31):
the overturn.
Of Roe V.
Wade.
Was to provide physicians.
With the information that.
They need to have on hand tomake the decisions that they
train their entire lives.
Lives to do when it comes topatients in active.
Labor patients who are inextremest due to complications.
Of pregnancy.
We want physicians to be on thephones with their consultants.
(54:53):
And not on the phones with theirlawyers when considering next
steps to.
Take because seconds and minutescount in these situations.
The way that the law is writtenas it is in the state of
Wisconsin.
Let's say if this case and theSupreme court is.
Overturn, we go back to a lawfrom the 18 hundreds.
I.
(55:14):
And in the 18 hundreds, we didnot know.
The extent of the things that weknow now in medicine, we did not
know what a survivor.
Pregnancy was.
There's language which isdiscussing.
Quickening as Diane referenced.
And that is ultimately.
The first time that a mother canfeel the baby in the womb and.
(55:34):
And so that was the measurement.
Of stating that a.
Pregnancy is viable in thosedays.
We have become moresophisticated.
Since that time in terms of.
Medical capability.
We know.
What a viable pregnancy is andwhat a viable pregnancy is not.
And so there's a lot more nuancethat we have now as compared.
(55:57):
Paired to the law when it waswritten in the 18 hundreds.
And.
Whereas all of us in.
The medical field.
And most of us who arereasonable on the subject.
No, we are currently.
In a better place in.
Terms of what we can do and thelives that we can.
(56:18):
Save where we are in 20, 24versus where we.
We're in the 18 hundreds.
However, there are some membersof the legislator that wish to
reverse.
Vert back to a law that isarchaic to a law.
That is dangerous.
And to a law that if.
It is made the rule of the land.
(56:38):
Yet again.
Will cause harm.
There will be deaths here in thestate of Wisconsin.
Wisconsin.
Just as there were in Georgia,just as there.
There are around the countrythat we may not even know about
as of yet.
'cause a lot of people do notpresent to the emergency
department again for.
For fear that they will facerepercussions based on doing.
(56:59):
Self-managed abortions orseeking abortion care.
In other states where it islegal.
So this is something that is.
Going to affect all of ourpopulations.
This is not something that'sgoing to affect one.
Group or the other, it willaffect everyone contrary to
some.
Opinions that you may hear ontalk radio that you may see on
social media.
Media It will affect those whoare traditionally most effected
(57:22):
by social.
Determinants of health.
I can tell you anecdotally.
As an ER.
Doctor.
I have seen women.
Who have been.
In very dangerous positionssince the overturn of Roe V.
Wade.
In my emergency departmentsbecause they were fearful.
Of what would happen if theysought care here in the state of
(57:42):
Wisconsin?
We all need to advocate for ourpatients.
And we all need to have thefacts at hand.
Uh, in order to help make thesedecisions.
That is why we went to medicalschool.
Right.
That is why we did all thisextensive.
Of training to have the scienceat our hands to be.
Fast aisle at appraising theinformation.
(58:04):
That we have in front of us todo no harm.
We want to make sure that we areable to practice at the best of
our abilities.
And what the full extent.
Of all the skills that we have.
Have acquired over the years.
In order to make.
Our hospital's safer for ourpatients and to make our
community safer.
(58:24):
As well.
A lot to think about.
And these episodes.
I want to thank you all fortaking the time.
Time to listen to part two,please join us for part three,
where we will be.
Discussing.
Badger care expansion, and wewill.
I'll be discussing that with afellow ER, provider.
Lieutenant governor.
Governor's Sarah Rodriguez.
as always take care ofyourselves, take care of each
(58:47):
other.
And if you need me.
Come and see me.
The following is brought to youby the committee to protect
healthcare.
Chris (00:09):
In the emergency department, we see real time
consequences of people nothaving access to health care.
Expansion of Medicaid inWisconsin would mean less cases
to the emergency department.
It would prevent closures ofhospitals in our communities,
and most importantly, savelives.
The majority of states in thecountry have expanded Medicaid
with bipartisan support, yetlegislators in Wisconsin are
blocking expansion of Medicaid.
(00:31):
They're blocking the opportunityfor our patients to have a
healthier life.
Tell your legislator to savelives and pass Medicaid
expansion.
a Georgia woman has beenidentified as one of the first
deaths related to lack ofabortion care access.
Amber Thurman died waiting.
(00:52):
for a DNC.
a surgical procedure sometimesused in abortions.
The report finding her deathlikely could have been
prevented.
It was jarring, shocking, anddisheartening that my Georgia
doctors could not provide mewith the standard of care.
Georgia women and medicalproviders testified before
Senator Jon Ossoff's HumanRights Subcommittee in
opposition to Georgia's lawbanning abortions after a fetal
(01:15):
heartbeat is detected.
Medical experts say that'stypically around six weeks.
ProPublica released a report oninternal documents from the
Georgia committee reviewingpregnancy related deaths.
The report indicated thecommittee, run by the State
Department of Health, determinedthe death of 28 year old Amber
Thurman was likely preventableif she'd had access to abortion
(01:35):
care in Georgia.
In August, when Amanda was 18weeks, pregnant, her water
broke, losing the amniotic fluidher baby needed to survive.
Her doctor told her, You're 100percent for sure going to lose
your baby.
The nightmare got worse.
Her doctor said because of antiabortion laws in Texas, they
(01:56):
couldn't terminate thepregnancy, even though Amanda
was at high risk for a lifethreatening infection.
Texas law allows for abortion ifthe mother has a life
threatening physical conditionthat places her at risk of death
or substantial impairment.
But Texas lawmakers haven'tspelled out what that means.
I was shaking, my teethchattering, trying to tell Josh
(02:18):
I didn't feel good.
she went downhill very fast.
The bacterial infection couldhave been prevented if she'd
been provided an abortion.
when her temperature hit 103degrees, doctors terminated the
pregnancy, but Amanda was stillsick.
Her blood pressure crashed, andshe needed a blood transfusion.
(02:38):
they said, we're moving you tothe ICU Central issue physicians
must now navigate is theexception to save the life of
the mother.
The law, as written in the stateof Wisconsin, is still very grey
it's intrinsically vague, um,which then, Causes physicians to
potentially second guess, like,is this risky enough?
(02:59):
Because everyone who practicesmedicine knows that it can be
very gray for a while and thenbecome very black and white.
Um, and you, the longer you waitto intervene, the worst outcomes
are in general.
There was a time when I was inMinnesota where someone
presented in an, in an emergencyfor, on an ambulance, in an
(03:20):
ambulance, she was bleeding.
She had to go to the operatingroom right away and I had to
perform an abortion and Icouldn't help but to think to
myself, if this was happening tome in Wisconsin, I would be.
terrified about what the nextsteps would be, about what the
implications for my future, mycareer would be.
(03:40):
I will continue to fight forthese patients because they need
a voice.
Everybody needs a voice in this,in this fight.
And a lot of the voices that areat the table right now don't see
these patients and they don'thave any medical background, but
they're making these decisions.
Welcome to pulse check,Wisconsin.
(04:38):
Good morning.
Good evening.
Good afternoon.
This.
Dr.
Ford.
With Pulse Check I want to thankyou for.
More listening to now our secondpart of our series.
The politics of public health.
We have a.
A really good episode If youdidn't catch the first episode
of our series.
I recommend that you go.
Go back.
(04:59):
I Was able to speak withrepresentative.
Deb on Draka as well as Dr.
Megan Schultz.
Who's a pediatric ER, doctor.
And we discussed the importanceof gun legislation.
In the state of Wisconsin.
So if you didn't catch that forfree to go back and.
And listen to all the amazingthings that they had to offer.
And examples.
Samples that they had to give ofhow our current gun laws as
(05:21):
they.
They stand.
Affect Wisconsinites and waysthat we can improve the safety.
Of our communities and a safetyfor our children.
In this episode, What we will bedoing is we'll be talking to
Diane.
Diane Welsh, who is the leadlegal counsel for?
The current case that we have inthe Wisconsin Supreme court.
(05:44):
Regarding the statute, which.
Is on the books at this time,limiting.
Reproductive freedoms in thestate.
State of Wisconsin.\ Diane Walshis the partner with the firm.
Pines Bach.
And she has had over twodecades.
Of experience.
Advocating.
Four.
Citizens of the state ofWisconsin.
She served on the board ofdirectors.
(06:05):
For Wisconsin democracycampaign, domestic abuse.
Intervention.
And services as well asWisconsin women in government.
And she's.
Currently.
A member of the Dean's advisoryboard for the university of
Wisconsin.
And whitewater college ofletters and sciences.
So Diane.
Is the legal counsel for myselfand two, other of my colleagues.
(06:26):
In the roles that we have takenin this case as being
interveners.
And what we.
We provide as interveners isexpert opinion.
On.
On how restrictions andreproductive freedoms in the
state of Wisconsin.
It affects our patients.
And we give that context from.
The standing of our professionalroles So myself.
(06:49):
Uh, from the standpoint of anemergency medicine physician and
my other.
Two colleagues from thestandpoint of being
obstetricians and gynecologists.
Just in the state of Wisconsin.
So in this episode, Diane.
Updates us a little bit on.
Where we stand currently in thestate of Wisconsin with regards
to reproductive.
Inductive freedoms.
And where she perceives thiscase to go.
(07:11):
Go in the future.
So that being said, we'll goahead and get started with.
Chris (2) (07:37):
For our listeners, I gave a bit of an intro as to who
you are And the amazing thingsthat you're doing throughout the
state.
Uh, but if you can't, could youjust give us a little bit of
your background?
Diane (07:46):
Sure.
Um, I grew up in ruralsoutheastern Wisconsin and, uh,
worked in higher ed for about 10years before deciding to go to
law school.
One of my motivations for lawschool was I decided there
weren't enough women in thelegal profession, either making
the laws or interpreting andprosecuting or applying the laws
(08:07):
or judging the laws.
And so I really was focused inthe policy, uh, role that women
lawyers could make.
So I went to law school in D.
C.
and when I My first job afterlaw school was at the Wisconsin
Department of Justice where Iworked for about five years and
(08:28):
then I moved into the Departmentof Health and Family Services.
And worked there for about eightyears and that's where I really
became focused on reproductivehealth care and, uh, and access
for women among many, many otherissues.
But, you know, looking at someof the issues about like access
(08:49):
to reproductive health care,maternal and child health,
infant mortality rates, maternalmorbidity rates in Wisconsin,
um, and numerous other aspectsof health and family services in
Wisconsin.
Then I, uh, moved into privatepractice several years ago, and
where I have been since.
(09:09):
And since that time, I've hadthe great fortune of
representing a lot of the familyplanning clinics around the
state and some physicians andnurses and others who do this
important work.
Chris (2) (09:22):
Yeah.
And, and, and I commend you fordoing all that.
You know, it seems like you havea really good track record at
advocating for a lot of thewomen around the state of
Wisconsin.
I see that you're on the boardof, you know, the domestic abuse
intervention services, Wisconsinwomen in government, et cetera.
Um, and, and just to kind of tieall that in all that advocacy in
(09:42):
what drew you to, what motivatedyou to become involved in what
we'll discuss today, which isthe reproductive rights
litigation.
Diane (09:51):
So I think I've had like feminist beliefs going back to
girlhood, you know, like girlsshould have the same
opportunities as boys.
I don't know if it's havingstrong, you know, And send my
life that we're good role modelsor having five sisters or what?
But the idea that girls shouldbe more limited in their
opportunities than boys, likenever sat right with me, you
(10:14):
know, has I got older seeinglike the impact of like economic
disadvantages.
for women um, and also domesticabuse and that impact that
violence against women had.
Um, it really kind of framed mythinking and was one of the
motivators for going to lawschool.
As it relates to, access toreproductive health care.
(10:36):
I think women's opportunities inso many ways are really shaped
by their ability to decidewhether or when to have Children
and the timing and spacing oftheir pregnancies and and in
every way like this can, uh,their ability to maintain an
interesting, fulfilling career.
You know, and build upgenerational wealth, you know,
(10:57):
depends on, you know, how manykids are they taking care of
their ability to perhaps leavean abusive relationship, maybe
tied to, you know, theirpregnancy status or how many
kids they would need to supportwithout a partner, their ability
to fulfill a passion in thearts, you know, whether it's
acting or, you know, creativearts, you know, can depend on,
(11:22):
you know, You know, theirpregnancy status and how many
Chris (3) (11:24):
kids
Diane (11:24):
they're caring for.
So in so many ways, women'sability to live full and active
lives, you know, and makechoices they want to make are
also tied to their ability tomake choices about how many kids
to have and when to have thosekids or whether to have those
kids.
And I use the term women, and Iknow that across the gender
spectrum, there may be peoplewho don't identify as women who
(11:47):
may be pregnant or have childrenand just be a little less
complicated because I'm going touse the term women for people
with egregious.
Chris (2) (11:56):
Yeah, yeah.
And so, you know, just to kindof Bring that back to Wisconsin.
Like you were saying it, itlimits women through all
spectrums of life, allsocioeconomic, um, uh, walks of
life as well.
when you don't have that abilityto make, your own reproductive
decisions.
And in the beginning, we did acouple of news clips from
(12:17):
different instances, more sofrom the medical spectrum, you
know, what complications ofpregnancy may arise, et cetera,
et cetera.
But just to kind of go back in,in the state of Wisconsin.
So in June of 2022, as we allknow, overturn Roe v.
Wade, how, how did that affectfolks in Wisconsin?
What did that mean forWisconsin?
Just in kind of taking thisback,
Diane (12:37):
Fortunately, we had had some conversations prior to that
because as soon as the U.
S.
Supreme Court accepted the Dobbsdecision, those of us who were
working in this space were awarethat, um, a change could be
coming.
And so there were lots ofconversations with OBGYNs,
attorneys working with healthsystems, uh, and abortion
(13:00):
providers around the state totalk about, uh, What might this
mean and what would happen ifRoa was reversed?
But what happened was, um, inWisconsin was significant
because Wisconsin had this veryold law on the book that hasn't
been enforced for, you know,half a century.
And some, uh, Conservative legalscholars put out a paper, a
(13:24):
white paper, saying that, like,this old law would kind of come
back into force and beenforceable against physicians
who were providing abortioncare.
And We've never had a situationin Wisconsin or across the
country where a well recognizedright, you know, right, was
established by the U.
(13:44):
S.
Supreme Court.
The state legislature, you know,for the past 50 years has been
making laws about abortion.
And then all, but they nevertook the old law off the book,
you know, because it had been,you know, overruled.
It was first by a federal judge.
court, and then, you know, also,um, negated by Roe versus Wade.
(14:08):
And, um, so we were really feltlike a state of limbo and the
uncertainty was great as weapproached, you know, we were in
an election year.
We had candidates for attorneygeneral, we had district
attorneys saying, of course, theold ban could be enforced.
(14:30):
And we had others saying like,no, that old ban doesn't spring
back to life.
It's not like a zombie law thatcomes back to life and eats up
all the other abortion laws thatour modern day legislature has
passed in the last few decades.
Um, but there was uncertaintyand with the old ban, you know,
because it was a felony, therewas a six year statute of
(14:51):
limitations.
So anyone who's working in thehealth care space, abortion
space, you know, emergencydepartment space where a woman
might come in needing abortioncare, um, was faced with like,
okay, I know my current DA sayshe doesn't believe it's enforced
and won't enforce it, but whatwill a future DA do?
Or will an attorney general, uh,you know, that has a different
(15:14):
belief than the current attorneygeneral come in and try to
enforce this against me fiveyears from now?
So, uh, we, you know, so thatwe, we went from settled,
established law that physiciansworking in health care,
providing care to pregnant womenknew what the law was and when
(15:35):
they could provide care andtreatment and what they could do
to like, uh, uh, a lot ofuncertainty.
And,
Chris (3) (15:41):
um,
Diane (15:42):
it was very hard for, for healthcare practitioners and the
lawyers advising them.
Chris (2) (15:48):
And for all the listeners, you know, to be
clear, to put it into contextfrom a medical perspective, this
is before we knew that bacteriaand viruses cause sickness,
right?
Like this is before we knew theeffects of a medication like
Tylenol.
Right.
And so.
What we did was we reverted backto this law and it created, as
(16:09):
Diane was saying, thisuncertainty, not only for myself
practicing in the emergencydepartment, but for providers,
in the OB GYN realm, uh, forproviders who worked in rural
locations, you know, they wereon the phones with their
lawyers.
When they should have been onthe phone with their consultants
when they have patients that arepresenting with what we call
ruptured ectopic pregnancies,non survivable pregnancies to
(16:31):
term for the fetus, but could bedevastating, could be deadly
for, for the mothers.
And so, you know, these arethings that, that all of us in
the know, as Diane said, youknow, they were gearing up from
The legal standpoint, we weregearing up from the medical
standpoint when we saw the ballrolling to try to get providers
(16:52):
to know, hey, you're covered byEMTALA, um, uh, and you have
that coverage from a medical andfrom a legal standpoint, uh, to
do no harm in the cases of thesepatients.
Diane (17:03):
Right, and like if you're working in an emergency
department in a hospital, thenUMTALA applies, which is the
Emergency Medical Treatment Act,which applies for any hospital
that accepts Medicare funds thatmake sure that the hospital
provides like stabilizing careand treatment for any patient
regardless of their means topay.
(17:24):
It doesn't apply in physicianoffices, though, so somebody
working in a clinic, you know,serving high risk pregnant
patients or, you know, orotherwise wouldn't have the same
protection that was, you know,the Biden administration set up
by, you know, related to him.
We tried to very quickly haveconversations, you know, saying
(17:46):
like an ectopic pregnancy isnever going to be a viable
pregnancy and will always posesome risk to the pregnant
patient.
However, that didn't mean thereweren't health systems or
hospitals that were taking moreconservative approaches,
Chris (3) (18:00):
um,
Diane (18:00):
and conservative for multiple ways.
You know, we have a high numberof Catholic run health systems
in Wisconsin, but we also have,uh, uh, health systems that are
more risk adverse, you know,and, you know, just wanted to
like, not have any questionabout what the conduct might be.
So, um, you know, so it wastroubling to see how health
(18:28):
systems, physicians, otherhealth care providers too, had
to weigh the interest of theirown operations and their
physicians versus theirpatients.
And weighing out what was bestfor each, and it wasn't always
the same.
So we saw, you know, heardreports of patients being turned
away to go to Minnesota orIllinois or Michigan, uh, to get
(18:53):
the care they otherwise wouldhave been able to get in
Wisconsin.
Chris (2) (18:57):
And, and, and I gave a couple of examples to a
patient that I saw personallythat did just that day and read
that that went to Illinois andgot incomplete care because they
didn't have the financial meansto go back or even the physical
means to go back.
You know, in some cases, Some ofthese, these patients are
adolescents, right?
Um, and you know, had to goemergently to the OR.
(19:18):
Unfortunately, I was practicingin a, you know, uh, inner city
location that has a lot ofresources, has providers on
staff and we're able to getthem, uh, to those means to get
that definitive treatment.
But I've worked in rurallocations where, I was the OB
for 40 miles, right?
Like that, that was the, thatwas the situation just being the
emergency doctor in the, in thehospital.
And so, like you said, it couldcause that uncertainty and that
(19:41):
law is specifically gray, aswe've seen in other states as
well, that we don't know whatthat means.
We don't know what the life ofthe mother means or, you know,
what, what that means in thosecases.
Diane (19:51):
Chris, I'm glad you mentioned that, that the
grayness of the law, uh, isextra frustrating, you know, one
that, you know, an abortion canonly be provided to save the
life of the pregnant patient.
You know, it's like how imminentwould death need to be before
that would be triggered.
And then there's language thatsaid that determination could be
made by the treating physicianor to other physicians.
(20:15):
Well, some attorneys wereinterpreting that to mean like
three different positions had toall agree on it.
And and they were Requiringphysicians to like get a second
or a third physician to sign offon it.
And, you know, in rural areas,you know, there's not, you know,
multiple OBGYNs on duty all thetime, or you know, physicians.
(20:37):
Who are willing to like quicklysign off on a decision that
might have criminal implicationsdown the road if, if it's
misinterpreted or if somebody'ssecond guessing it.
Um, but.
Even that language is confusing,um, and you know, from our
perspective in our case, as youknow, we, that's one of the due
process concerns we make aboutthe old law that, like, that
(21:00):
doesn't get physicians noticeabout what's required.
Absolutely.
You know, like, knowing what itmeans to be required to save the
life, you know, of the patient.
Um, you know, the other, it's,all of them are required to be
performed at a maternityhospital.
Wisconsin doesn't even havematernity hospitals anymore.
You know, like there arehospitals who have maternity
(21:21):
maternity wards, but that wholecategory of licensure has went
away.
There's like separaterequirements or restrictions for
quickened children versus notyet quick, a quick child, which
is, you know, has no medicaldefinition in this day and age.
And in the Dobbs decision, eventhe majority opinion written by
(21:43):
it, just by Justice Alito saysthat, you know, that is, That
term is, you know, no one has acommon understanding of that
term, right?
Generally, like, when the fetusis felt to be moving, right?
Exactly.
Chris (2) (21:57):
Yeah, yeah.
And that, that was, you know, asyou said, that was one of the
points that we came to is justthe fact that there is no
standardization of that.
Right.
Like that, that, thatinterpretation of it was put
into law before there wereultrasound, in order to see or
to hear, uh, you know, a fetus'sheart rate.
And so it's just completelyarbitrary and dangerous to, to
(22:17):
be honest with you at this stateof the game.
Diane (22:20):
The other thing that made it extra confusing is that, you
know, decades ago our stateSupreme court had considered
what the statute meant and inlight of the more modern
abortion laws and said it was afetus side statute.
You know, the case black versusstate versus black arose in the
(22:41):
context of prosecuting a guy whobeat up his pregnant spouse with
the intention of killing theinfant a few days before her due
date.
Um, and Charges were brought bythe district attorney, you know,
back in the nineties of underthe old abortion ban, what was
(23:03):
that thought of has and but ithas like it was intentionally
killing.
You know, an unborn child, andso they brought it under that
law, and our state supreme courtlooked at that case and said,
yeah, so now kind of in light ofthe other law, this is a
feticide law.
Like it prohibits theintentional killing, you know,
in this manner, it doesn't applyto like medical abortions
(23:26):
because we have laws that dothat.
So that made it fair.
More confusing.
And that was, you know, thebasis for, and jumping ahead
here for the Dane County CircuitCourt saying, yeah, this is no
longer an abortion law.
The old, what used to be our oldban is now a feticide law.
Chris (2) (23:46):
Yeah, and it's totally fine to jump ahead.
So, so where are we at today interms of, because again, 2022,
we go back that's the law of theland.
We're all kind of working underthis cloud of uncertainty.
Where are we at now?
And, and kind of what role did,did you and your, your firm play
in that?
Diane (24:02):
Right.
So very shortly after the Dobbsdecision was decided, Attorney
General Call brought a lawsuitseeking a declaratory judgment
to, to what does this law mean?
Is it still in effect?
You know, um, how does it relatenow that we have all these other
laws?
Um, we intervened on behalf ofthree positions, including
(24:26):
yourself has persons who aremost directly impacted by the
confusion and and face potentialprosecution under the old ban.
You know, if there was adistrict attorney who
interpreted it differently than,you know, than we interpreted
it.
So we intervened and we had oralargument in the circuit court of
(24:52):
Dane County and the circuitcourt ruled in favor of the
Physicians who intervened andintervene means to like join the
lawsuit.
Like we're not the ones whobrought it the first time, but
we say we have a interest that'spotentially could be injured.
So we should be here too.
And we should be a party.
So by intervening, we were fullparties to the case.
(25:14):
Um, and we prevailed.
The judge said physicians are atrisk of being injured by a
misapplication of the old law.
And, uh, under state versusblack, the case I talked about a
few minutes ago, that is nolonger the standard for medical
abortions.
We have all these other lawsthat, that regulate medical
(25:37):
abortions.
And that's what applies to them.
So she issued a declaratoryjudgment saying it's no longer
in effect.
Um, so that was good news.
And I think most health systemsand providers, you know, saw
that has an opportunity to, tochange.
And the abortion clinics in thestate reopened and most health
(25:58):
systems took off some of therestraints that they may have
placed on, uh, their healthcareproviders while there was a
question.
District Attorney Aromanskyappealed the case, and he asked
that the Supreme Court grantbypass, which means instead of
having this argument before theCourt of Appeals, and then
(26:19):
seeing what the Court of Appealsdoes, and then the potential to
have it reviewed in the SupremeCourt, um, He asked the Supreme
Court just to shortcut the Courtof Appeals and hear it directly
because of the importantquestions that were raised.
Uh, the position intervenorsagreed.
We asked the Supreme Court totake it as well, as did the
Department of Justice.
(26:41):
And so, that case is set fororal argument on November 11th.
So the Monday after theelection, uh, we'll have
argument, uh, at the WisconsinSupreme Court to, we'll be
arguing to uphold the circuitcourt decision, which says the
sick old man is not an affected,as I like to say, it's not a
zombie law that comes back andtakes over, um, all the other
(27:05):
modern day abortion statutes.
Chris (2) (27:08):
So after these arguments, is there a potential
that we can revert back?
Like you said, or, or what doyou, what do you foresee, uh,
uh, to come out of this?
Diane (27:19):
There's the potential, but I'm very optimistic, you
know, but You know, electionsmatter.
Hmm.
And, uh, there was a judicialelection last April and the
court switched from aconservative majority to a
progressive majority.
And we don't know how any of thefour progressives will vote in
(27:40):
this case, but I remainoptimistic.
But even as it comes to theconservative justices, you know,
the notion that a law that waspassed and.
Replaced with many more modernlaws, to me, seems very
undemocratic.
Like, when you look back, whenthe law was originally passed,
(28:02):
women couldn't even vote.
There were no women legislators.
Even when it was, like, updatedand moved into a different
section in 1955, women had beenvoting for a short time, and
there was very littlerepresentation in the
legislature.
Um, to say that, Our forefathersview of what should happen
(28:22):
versus like all the modernlegislatures that like you and I
had the opportunity to vote forin the last 20 years.
Um, like that our modernlegislature has to take a
backseat to very old formerlegislatures makes no sense to
me from a democracy standpoint.
Right.
So I think to say that this oldlaw replaces all the modern
(28:47):
laws, seems like a bridge toofar.
Chris (3) (28:49):
And
Diane (28:52):
so I'm, I'm, I'm very optimistic.
You know, we also related tothis topic is there's another
case pending in our, in ourstate Supreme court, which deals
with, Whether that old statute,if it was a ban, would violate
our state constitution.
(29:13):
So, under that litigation, itkind of takes it another step
further.
Like, wouldn't applying that lawviolate People's right to life,
liberty, and the pursuit ofhappiness,
Chris (3) (29:25):
you know,
Diane (29:26):
like, and when I talk about this, you know, what we
talked about toward thebeginning, deciding like how
many kids do I want to have?
When do I want to have?
What else do I want to do?
Like, do I have health risksthat might be implicated by a
pregnancy, like all thosequestions, um, arise in the
context of our stateconstitution, which includes
language that doesn't exist inthe federal constitution.
(29:48):
And one thing that was madeclear in Dobbs is now abortion
is an issue to be left up to thestates.
So we don't just look at statestatutes, we have to look at our
state constitution as well, aslike a separate, uh, basis for
rights.
And that section of our stateconstitution is recognizing
inherent rights, like not rightsthat the government gave us, but
(30:10):
rights that we are born with,and the government needs to
recognize.
And in North Dakota, the statecourts found that their state
constitution provided rightssimilar to what we're seeking in
the second case.
So we anticipate that our stateSupreme Court will probably
decide Paul v.
Ermanski, the case you'reinvolved in, and also Planned
(30:34):
Parenthood v.
Ermanski, which raises theconstitutional question by the
end of this term, which is byearly July.
So we can.
have this firmly, whether it'sstatutory interpretation or
constitutional interpretation or
Chris (2) (30:50):
both.
Yeah.
And you bring up a good pointthere too, especially how the
doubt decision took it directlyto the states.
I was recently listening to anexcerpt, I believe it was
through Texas Public Radio,where they had a really good
piece on fetal personhood.
And how stricter, state,statutes will lead to issues not
(31:12):
only for emergent situationslike ectopic pregnancies, uh,
but also potentially for IVFpatients, patients that are
seeking to make their familiescomplete.
Uh, and in Wisconsin, we'restarting to hear some of this
language as well.
Folks interpretation, especiallynow.
This is an election year.
You have more conservativecandidates, even in my own
Senate district that arebringing this point up of fetal
personhood.
(31:33):
What is that?
And is that something that we'reconsidering as well?
And in some of these cases,
Diane (31:39):
it's not just a part of this case, but it is part of the
landscape because we have stateRepublican legislators.
who individually believe thatthere should be, you know,
personhood should be recognized.
Also that, um, you know, thatpersonhood life begins at
conception and who would bancertain forms of contraception.
(32:03):
So we certainly have somelegislators who would remove,
um, some contraceptions.
Um, And make them illegal, wouldremove funding, public funding
for certain forms ofcontraception or contraception
in general.
So, um, yes, there are certainlegislators who would prioritize
(32:27):
the life of, you know, a zygote,embryo, fetus, ahead of a
patient or woman.
Chris (2) (32:38):
Yeah.
Yeah.
And that's the part that'sconcerning, right?
Especially in the setting ofagain, national elections are
coming here and more and morerhetoric.
About bringing the things backto the states and quote unquote
letting the states make theirown decisions But as we
discussed on this on thispodcast before How much goes
into the states making thatdecision?
Is it really you making thatdecision or is it your
(32:59):
legislator?
Is it from a gerrymander likemap that your that your your
legislator is chosen, right?
There's so many things that gointo it and even looking at it
from a medical perspectiveAgain, in the cases of these non
viable pregnancies, but can beextremely dangerous for women,
especially if you get internalbleeding, et cetera, et cetera,
become septic.
You know, what does that mean tothose providers?
(33:20):
What does that mean to thosewomen who are coming in, Does
that mean that we wait for themto get to a certain level of you
know, a fever a certain level ofInstability, you know, do we
wait for them to lose a limb forinstance, which can happen in
the cases of of sepsis You know,that's not Considered in some
people's, ideology of, is thisactually the life of the mother?
Diane (33:41):
No.
And that brings up an importantpoint, getting back to your
earlier point.
Like, and then some of thosecases waiting too long can, can
impact the patient's futurefertility.
Chris (3) (33:52):
So
Diane (33:52):
having, right.
So, you know, something couldhappen.
You know, this could be a verywanted desired pregnancy, but
because of complications.
It goes wrong and medicalintervention is necessary to
save, you know, preserve herhealth, but also her fertility.
Should you want to have a childin the future?
And, and the laws that, uh, arepurportedly, you know,
(34:17):
protecting, you know, promotingbirth and my birth can get in
the way, The fetal type statutesor abortion laws could get in
the way of, of, of preservingher fertility for future healthy
births.
You know, it also, as you said,has implications for IVF where,
um, where again, couples whovery much want to have children,
(34:41):
IVF and then, but if everyembryo, you know, is a life that
can never be destroyed, raisessignificant, significant You
know, there are more eggs thatare fertilized than would ever
be planned to, you know, fullydevelop and, you know, be born,
(35:04):
right?
Yeah,
Chris (2) (35:04):
yeah.
Absolutely.
I've had many colleagues thathave gone the route of IVF and,
you know, it took years for themto, conceive, and have a infant
in their arms, right?
And so that, that is somethingthat we need to continue to keep
an eye on and especiallyconsidering The lack of science
(35:26):
in some of these cases now, Idon't, I don't want to talk, you
know, down on any, anyindividual representatives in
particular, but I've sat acrossfrom a number of legislators and
a number of representatives.
And have been shocked to behonest with you about their
understanding of science and youknow I could only imagine what
they get in science, you knowwhen they were coming up right
(35:46):
because it's just like whatwhat?
Let's just start from scratch.
All right, let's just start overagain.
But you know, it is that lack ofunderstanding and it's It's the,
the, the caliber of thatunderstanding that's sitting at
the table that not only aremaking these decisions, but
making the decisions for theirconstituents that may or may not
have voted for them.
That concerns us all, right?
Like in the instances of some ofthese, you know, uh, some of
(36:09):
these fertilized old women inthe setting of IVF.
Some of them.
have congenital abnormalities.
Some of them have, karyotypeabnormalities that will never be
viable.
Right.
And so in those cases, there,there is a lack of scientific
thinking.
There is a lack of criticalthinking to this, to this point,
and just kind of, this is whatit's going to be.
You know, that's what we're allconcerned about.
Diane (36:29):
Right.
And there's both a lack ofscientific thinking, and I don't
think it's necessarily relatedto poor education versus like
intentional disregard.
for science.
Um, but there's also just viewson the roles of women in
society.
And, um, and, you know, I haveheard a sitting legislator say
(36:54):
that, you know, our workforceshortage issues are because
women are having enough babies,you know, and, um, and I just
find that very offensive, youknow, like this view that, like,
we're the problem because we'renot all producing more Children,
you know, and if we did want toprovide incentives for, you
(37:15):
know, Couples, women to havebigger families.
There's way to ways to do that.
You know, like having, you know,universal healthcare, having
universal affordable childcare,having affordable education, K
through college, you know, allof these things that
considerations that people havewhen deciding how many children
(37:37):
to have, you know, cost is a bigdriver.
Having parental leave, you know,paid parental leave would be.
You know, one reason somepeople, might not have more
Children.
So there's ways of providingincentives for couples to have
more Children.
If we really think we need morefuture workers, but the idea
that this is just lands onwomen's shoulders.
(37:58):
And if we have anti abortionpolicies that will build up our
workforce, um, I think it's notthe right way to do it.
You know, I just think we're notbetter off adding unwanted
children into a society.
Chris (3) (38:15):
Exactly.
Diane (38:16):
Like if, if couples are affirmatively believe they
cannot, you know, raise,support, nourish a child.
Yeah.
I think that is an importantdecision to make, you know, you
know, hopefully in planningcontraception, but if in the, if
there's a failure in planning.
Um, our failure of contraceptionto make a decision versus taking
(38:40):
away the option forcontraception or abortion, and
then meaning like, that's how weget a bigger workforce.
Chris (2) (38:48):
And that's key to the point too, because as you said
before, a lot of times thecontraception is considered, you
know, to be included in therealm of abortion, right?
So, oral contraceptive, Plan B,all these things that are
definitively not that.
Are interpreted by people who,again, are either ignorant of
the science or, uh, purposefullyavoiding, you know, any, any,
(39:09):
any truth to the matter insaying that we're going to lump
all these things together.
All these things are abortionand you can't do any of them,
Diane (39:18):
right?
So if you're, you know, like.
View fertilization versusimplantation has, you know,
when, yeah.
one's conception, one's life,one's other things and applying
your own moral view versus thescientific view that makes it a
(39:38):
lot harder for, uh, for makinggood decisions about what
contraception should beavailable and what options
should be available.
Chris (2) (39:49):
One of the things that we're seeing now are the
beginnings of some of theconsequences to having this
reversion more strict laws inthe books on in some states such
as Texas and Georgia.
Unfortunately we saw, Um, atleast two women, that had fatal
results from this that we knowof, right, that, that we are,
(40:11):
that we are publishing in, in,in the mainstream media, so to
speak, what are some of the mostsignificant, legal and social
impact that you have observed,uh, just in your own practice
since this decision,
Diane (40:24):
right?
I think first is the confusion.
is, is, you know, was thegreatest.
And then the women who couldtravel out of state to get the
care they needed, you know, thathad to, instead of getting care
by their trusted providers closeto home, like then had to travel
(40:45):
out of state.
And when I heard from from womenis, you know, like their
physician saying, I wish I coulddo this,
Chris (3) (40:52):
but
Diane (40:53):
My lawyers are telling me I can't, or my hospital's
telling me I can't, or I'm toldI can't do this, so, you know,
like, you know, already indistress about, um, their
status, you know, that theyhave, you know, that their
pregnancy has failed, and nowthey have to go out of state to
get care, and then some beingdenied follow up care, because,
(41:13):
um, their healthcare providerwas just even concerned to do
the follow up, care that wasrequired.
You know, as you know, likesometimes even for medically
necessary abortion, there couldbe complications or follow up
care that's needed.
But like some physicians orhealth care systems not even
(41:34):
wanting to, um, to go there.
You know, and that part is veryfrustrating.
You know, in some states,there's been the concern about
where there would be amiscarriage and then women are,
are investigated as if they did,uh, self managed abortion when
it was, you know, a spontaneousabortion or miscarriage.
(41:58):
And, um, Which is extratroubling to me, like
criminalizing something, atraumatic
Chris (3) (42:07):
event.
Diane (42:09):
You know, many women were told, like, resorted to, like,
online pharmacy for,contraceptive pills.
Yeah.
Which, you know, so thatremoved, you know, like, since
I'd be able to come herelocally, meet with the
physician, get the follow upcare they needed.
Right.
You know, they were left to selfmanage it, even if they would
have preferred to do this withthe care of a health care
(42:32):
provider locally.
Chris (2) (42:34):
And to that point, to this day, even though we have
now swung out of this, at least,you know, hopefully permanently,
but at least temporarily.
I have recently seen women inthe emergency department who
have done just that, Diane, whohave gotten, you know, uh, quote
unquote abortion medicationonline because they're under the
(42:54):
assumption still that we arestill, under this restriction to
provide abortion care in thestate of Wisconsin.
So like we said, we have yet tosee the effects down the line of
just two years plus, right?
Because that, that, thatinformation has not gotten out
to everyone as of yet.
And people are still thinking,if I go to the emergency
department, which is what we sawat the very beginning of this,
(43:16):
if I go to the ER, they'll findout.
Right.
If I go to the ER, there'll bepolice waiting there for me
because again, as we're nearingnational elections, this is what
folks are hearing.
This is what people are seeingonline, social media, et cetera,
et cetera.
And it's building this veryunsafe environment for our
patients to live in and for ourcommunities to be under.
Diane (43:36):
And because this is left state by state by state, But the
dialogue and social media postsand everything are national.
There's just more confusionbecause if you read a story
about a woman in, you know, Ohiobeing prosecuted or something
happening in Texas, you know,People in Wisconsin don't know
(43:56):
what that means, you know, forthem, you know, and one thing
that we said repeatedly, likeunder Wisconsin statute, even,
you know, the worst version ofthe old law, women themselves
can't be prosecuted forobtaining an abortion or self
managing an abortion like that,that is specifically excluded
from that statute.
(44:17):
So the patients you see whomaybe have tried to self manage
an abortion, that's not illegalin Wisconsin, even under the
worst interpretation of the oldban.
Chris (3) (44:27):
But,
Diane (44:27):
again, how to get that message out when really what we
need to do is modernize ourabortion laws overall and make
them clear.
for all patients to know and notjust patients for people who are
planning their futures.
Um, so hopefully we'll get agood decision in this case.
Hopefully we'll get, you know,good legislature that could look
(44:48):
at, you know, improving ourcontraception and abortion laws
versus I'm taking them backcentury.
Chris (2) (44:57):
Yeah.
Yeah.
And you know, we, I know in yourfield, you likely get a lot of
opposition and a lot of counterarguments that are presented to
you.
I know I do, uh, just by beinginvolved in the case, how do you
address, you know, some ofthese, some of the opposition,
some of the counter argumentspresented by people who are very
supportive of restrictivereproductive laws in the state
(45:18):
of Wisconsin.
Diane (45:18):
You know, I respect that friends, family may have
different religious views ormoral views on, on abortion.
And, um, I just say that Ibelieve that it's a very
individual decision and, youknow, a very personal decision.
And I don't think I shouldimpose my religious moral views
(45:39):
on others and vice versa.
And that if a person Believesthey can't go through with the
pregnancy, whether it's becauseof health conditions, you know,
the risk to their own health orlife, or because they're just,
you know, not equipped to bringa child into the world.
That is just a decision I preferbe made at an individual by
(46:02):
individual level.
I think it's actually uncaring.
to demand that others bring anunwanted child into the world.
And, you know, I don't know thatthat's the best thing for that
potential child.
Chris (2) (46:19):
Absolutely.
What do you see as the futurenow?
Because I know that you saidthere, this case is split into
two places, two cases at thispoint in time.
Um, what do you see as thefuture of reproductive right
litigation in Wisconsin?
And also just kind of on thegrand stage, like in the United
States, where do you see thisgoing?
Diane (46:37):
So in Wisconsin, a lot will depend on how the court
addresses the two pending casesin the statutory case and the
constitutional case.
Yeah.
If Wisconsin follows otherstates in recognizing a state
constitutional right, then thathas implications about what kind
of restrictions could be, couldbe placed or could not be placed
(47:01):
on abortion or contraception orIVF or other forms of really any
issue that deals with bodilyautonomy going
Chris (3) (47:10):
forward,
Diane (47:11):
right?
Thank you.
You know, so if we, you know, ifour right to life, liberty and
pursuit of happiness reallymeans something for each of us,
I think that has broadimplications that we might see
other cases deal with
Chris (3) (47:24):
in the
Diane (47:24):
future.
I mean, if our court says, no,it doesn't, that doesn't mean
that, um, you know, then it mayhave negative consequences for
protecting some very rights thatwe think should be personal
decisions.
Chris (2) (47:38):
You know,
Diane (47:38):
like couples or individuals with names.
Chris (2) (47:42):
And along those lines, what do you think that,
we can do, both in your realmand in my realm to improve, that
public understanding and thatsupport for reproductive rights.
Because as we said before, thisis not only along the medical
track, this is not only, youknow, that life, liberty,
pursuit of happiness, the bodilyautonomy.
There's a lot of things that gointo this, including
socioeconomics, you know, there,there, there's a religious
(48:02):
aspect, there's cultural aspectsthat go into it too.
What can we do to improve thatpublic understanding of the need
to have, these reproductiverights in tech.
Diane (48:11):
I think we need to keep talking about it, not closet
this issue.
You know, when you think aboutlike maternal, life and like,
who's at greater risk of, uh,dying from, pregnancy or birth
and, and infant mortality ratesand other things where like, uh,
There are so many factors thatgo into that and to like just
(48:33):
pretend that everyone who getspregnant will be just fine, you
know, and that, you know, like
Chris (2) (48:38):
that doesn't work that way.
I
Diane (48:41):
think also like taking abortion out of just that it's
only this elective, you know,decision to make where, you
know, really abortions areprovided, you know, all around
the state, not just at abortionclinics, right?
Because it had, you know, in theemergency room when someone
presents with medical conditionfor which like abortion an
(49:03):
abortion is the right medicaldecision.
And then there's spontaneousabortion, things that just
happen on their own.
So to take it out of this ideathat like, it's only this, uh,
procedure that's only done atabortion clinics and should be
suspect at all times.
I think we need to just keeptalking about the realities of,
um, and not make it, a closetedissue that we don't talk about.
(49:28):
implications.
I think talking about theoverlap of again, this is some
of the same organizations thatare pushing the most restrictive
abortion policy also push limitsto contraception and who can
access contraception.
And, uh, I heard this early inmy career, I heard this story
(49:49):
about like how in Europe whenthey're talking to teens, like
they recognize that teens mightbe experimenting with sex, um,
So instead of just saying, like,they don't say, like, don't do
it, don't do it, like, just say,no, they say, don't get pregnant
and here's how you don't getpregnant.
And in many other countries,there's much lower teen
pregnancy rate than in theUnited States, because the
(50:12):
message isn't an unrealistic,just say no.
It's a more realistic, if you'regoing to do it, this is how you
prevent an unintended pregnancy.
And this is our expectation.
Chris (3) (50:25):
Yeah, yeah,
Diane (50:27):
so so I think again some of the same people who don't
want Um, we want to limit thelegality of abortion and limit
access to contraception.
Also want to limit discussionsof sex education or access to,
um, reproductive health carefor, for minors.
Chris (2) (50:48):
Which runs contrary to their, right, to the goal
ultimately, right?
Exactly.
Diane (50:52):
Yeah.
So, so I think we need a moreholistic and real, holistic and
realistic approach.
You know, overall to talkingabout, you know, family
planning, reproductive choices,sexuality and, um, you know,
should parents be involved inthose discussion?
Absolutely.
(51:12):
But if they're not, um, therestill is a role for others to be
involved.
Chris (2) (51:17):
Yeah.
Well, Diana, thank you so much.
Just to close everything outhere, is there anything else you
would like our listeners to knowabout the fight for reproductive
rights in Wisconsin and, how canlisteners follow you or, uh, get
in touch with you if they wantto get more information or
support any of your efforts?
Diane (51:35):
Great questions.
I think the most important thingthat listeners can do is vote.
Um,
you know, we have important elections coming up in
November, and then in Aprilthere's a state Supreme Court
election, and a lot of folksdon't vote in the state Supreme
Court elections in April.
But it's very important to knowthe candidates and know their
(51:55):
positions, uh, on, on issuesrelated to reproductive health
and everything else that mightbe important to you.
Uh, and, I don't, I, There's noway to follow me very well.
I'm not presence on socialmedia.
I'm just kind of quietly workingin the background and we
Chris (2) (52:16):
appreciate it.
Keep, keep working,
Diane (52:18):
but I'm happy to come and talk to you again, Chris,
whenever you want, and I thinkwhen we have a decision, which
might not be until summer, Ithink there will be news of that
decision or those decisions.
And, but again, uh, please vote.
Uh, in November and again inApril, and again, knowing who
(52:40):
supports, you know, the rightsthat you hold to be important in
the
Chris (2) (52:45):
work you do.
Absolutely.
And that's the intention ofthis, just to give folks that,
that, that idea of, you know,the background, right?
These are the facts.
The, this is coming straightfrom the source, as Diane said,
she's in, she's in the trenches.
So she may not be on socialmedia posting, but she's
fighting this fight for, forwomen throughout the state of
Wisconsin to make our livessafer, to make families safer,
(53:05):
our community safer as well.
Dan, I appreciate you so muchfor coming out and making the
time and thank you for all yourefforts.
And, uh, we, we are lookingforward to hearing more from
you.
We will definitely reach out totie a bow on this and figure out
where we're at in the summer.
Diane (53:18):
Thank you, Chris.
And thank you for being part ofthe litigation.
That's really important workthat you're doing in addition
to, you know, being at workevery day.
Your position code on.
Chris (2) (53:29):
Awesome.
Awesome.
Well, thank you so much.
In 2023, the American college ofemergency.
issued several statements onreproductive.
Of freedoms.
For our listeners, the Americancollege of emergency physicians
is the governing.
Burning body.
One of the main governing bodiesfor emergency medicine doctors
throughout.
The country.
(53:50):
And in their policy statements,they.
They supported equitable access.
Yes to reproductive healthcare,including abortion.
In emergency departmentsthroughout.
Throughout the country.
And they supported the idea thatabortion is a medical.
Procedure that should be ashared decision between a.
Patient in their physician.
As we also discussed in this.
(54:10):
This interview, we supportEMTALA as well, which is the
emergency.
Medical treatment at activelabor act.
And this.
Emphasize is the right ofemergency physicians to provide
care to pregnant patientswithout.
Without the fear of legalconsequences.
As we discuss.
The entire goal.
Of some of the advocacy thatwe've done over the years since
(54:31):
the overturn.
Of Roe V.
Wade.
Was to provide physicians.
With the information that.
They need to have on hand tomake the decisions that they
train their entire lives.
Lives to do when it comes topatients in active.
Labor patients who are inextremest due to complications.
Of pregnancy.
We want physicians to be on thephones with their consultants.
(54:53):
And not on the phones with theirlawyers when considering next
steps to.
Take because seconds and minutescount in these situations.
The way that the law is writtenas it is in the state of
Wisconsin.
Let's say if this case and theSupreme court is.
Overturn, we go back to a lawfrom the 18 hundreds.
I.
(55:14):
And in the 18 hundreds, we didnot know.
The extent of the things that weknow now in medicine, we did not
know what a survivor.
Pregnancy was.
There's language which isdiscussing.
Quickening as Diane referenced.
And that is ultimately.
The first time that a mother canfeel the baby in the womb and.
(55:34):
And so that was the measurement.
Of stating that a.
Pregnancy is viable in thosedays.
We have become moresophisticated.
Since that time in terms of.
Medical capability.
We know.
What a viable pregnancy is andwhat a viable pregnancy is not.
And so there's a lot more nuancethat we have now as compared.
(55:57):
Paired to the law when it waswritten in the 18 hundreds.
And.
Whereas all of us in.
The medical field.
And most of us who arereasonable on the subject.
No, we are currently.
In a better place in.
Terms of what we can do and thelives that we can.
(56:18):
Save where we are in 20, 24versus where we.
We're in the 18 hundreds.
However, there are some membersof the legislator that wish to
reverse.
Vert back to a law that isarchaic to a law.
That is dangerous.
And to a law that if.
It is made the rule of the land.
(56:38):
Yet again.
Will cause harm.
There will be deaths here in thestate of Wisconsin.
Wisconsin.
Just as there were in Georgia,just as there.
There are around the countrythat we may not even know about
as of yet.
'cause a lot of people do notpresent to the emergency
department again for.
For fear that they will facerepercussions based on doing.
(56:59):
Self-managed abortions orseeking abortion care.
In other states where it islegal.
So this is something that is.
Going to affect all of ourpopulations.
This is not something that'sgoing to affect one.
Group or the other, it willaffect everyone contrary to
some.
Opinions that you may hear ontalk radio that you may see on
social media.
Media It will affect those whoare traditionally most effected
(57:22):
by social.
Determinants of health.
I can tell you anecdotally.
As an ER.
Doctor.
I have seen women.
Who have been.
In very dangerous positionssince the overturn of Roe V.
Wade.
In my emergency departmentsbecause they were fearful.
Of what would happen if theysought care here in the state of
(57:42):
Wisconsin?
We all need to advocate for ourpatients.
And we all need to have thefacts at hand.
Uh, in order to help make thesedecisions.
That is why we went to medicalschool.
Right.
That is why we did all thisextensive.
Of training to have the scienceat our hands to be.
Fast aisle at appraising theinformation.
(58:04):
That we have in front of us todo no harm.
We want to make sure that we areable to practice at the best of
our abilities.
And what the full extent.
Of all the skills that we have.
Have acquired over the years.
In order to make.
Our hospital's safer for ourpatients and to make our
community safer.
(58:24):
As well.
A lot to think about.
And these episodes.
I want to thank you all fortaking the time.
Time to listen to part two,please join us for part three,
where we will be.
Discussing.
Badger care expansion, and wewill.
I'll be discussing that with afellow ER, provider.
Lieutenant governor.
Governor's Sarah Rodriguez.
as always take care ofyourselves, take care of each
(58:47):
other.
And if you need me.
Come and see me.
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