The reversal of Roe v. Wade one year later... Its impact on local doctors as out-of-state patients travel here for abortions, that's this week on Nevada Week.

♪♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt.

Welcome to Nevada Week.

I'm Amber Renee Dixon.

It's been one year since the Supreme Court overturned Roe v. Wade.

The ruling known as Dobbs versus Jackson Women's Health Organization gave states the power to make their own abortion laws.

Because abortion within 24 weeks of pregnancy was already part of Nevada state law, some pro-choice advocates warn the state would see an influx of patients from states that had implemented bans or restrictions.

Among those advocates was Planned Parenthood of the Rocky Mountains which oversees Las Vegas, Colorado, New Mexico, and Wyoming.

Its CEO, Adrienne Mansanares, joins us now.

Adrienne, tell us what has this last year been like for Planned Parenthoods in Las Vegas that provide abortions?

(Adrienne Mansanares) Well, last year, the Dobbs Decision stripped tens of millions of people of their right to access abortion care in their home state.

So here, Planned Parenthood of Southern Nevada with the support of our communities, our partners on the ground, we've been able to continue providing care for patients not only locally from Las Vegas, but those traveling very long distances from their home states.

-Now, according to statistics provided by your organization, out-of-state abortion appointments at Las Vegas Planned Parenthoods have more than doubled in the year after the Dobbs Decision.

What kind of strain, if any, has this put on local Planned Parenthoods?

-Oh, it's a tremendous strain.

We've had to extend our health center hours.

We've expanded our patient navigation efforts, helping patients figure out if they're going to ride the bus, if they're going to get on an airplane, what they're going to do with their kiddos at home if they need childcare support while they're accessing this care, and we've also expanded our telehealth footprint to make sure folks can get the care they need quickly and not have to worry about wait times.

-How does the telehealth aspect work?

-Patients come into our health centers and they're greeted of course, checked in, and then they log onto a computer and they can see a physician.

-Okay.

-And then, depending on their care, they can access the medication right there in the health center.

-So they still have to physically come in person?

-Yes, uh-huh.

-Okay.

All right, so that has helped alleviate some of the burden, I guess, in staffing perhaps?

Is that accurate?

-Yes.

So the physician can access the patient via telehealth and not have to be at one health center.

So they can see multiple patients at both the health centers.

-Now, in a phone conversation that you and I had prior to this show, you said this is not sustainable.

How so?

-Well, it's a tremendous burden across the country when the state of Texas bans abortion care.

There's millions of people that live in Texas.

It's a heavily populated state.

And if you think about Nevada, for example, we're a pretty rural state.

We've got the hubs of Reno and Las Vegas, of course, but there's only so many health centers that could be expected to see that number of people.

-Then what do you do?

Are you planning on opening more Planned Parenthood centers?

-Yes.

My colleague who operates Planned Parenthoods in Northern Nevada has opened a new health center in Reno, and we would be delighted to be able to think about the financial needs to be able to open another health center in Las Vegas.

-So that would require, I'm guessing, donations, private funding?

-Yes.

It's because of philanthropic support that we're able to see so many patients in Las Vegas.

-Now, according to the data that you provided as well, the majority of the out-of-state patients are from Texas, then Arizona, and then Utah.

I understand Arizona and Utah, because they border Nevada, so coming here would be easier.

But for the Texas patients, why aren't they going to Colorado or New Mexico which are closer?

-When patients are seeking care from Texas, we work with them to find the closest place that they can go to, but the wait times in our health centers in New Mexico and in Colorado may be prohibitive.

So we want to get them into a health center as soon as possible.

Oftentimes, that may be Las Vegas.

-What do you mean by "prohibitive"?

-Meaning that the wait times may be longer than their pregnancy.

As you imagine, the abortion care is very timely.

We want to get folks in as soon as we can.

-And will you explain that aspect in relation to the medicine versus the surgical abortion?

How many of the abortions you're providing are via medicine?

-Mm-hmm.

Yeah, you bet.

So in Las Vegas, 100% of the abortions that we provide at Planned Parenthood are through medication.

It's very convenient.

Patients prefer it.

But they have to get in at 11 weeks, so within that short time period.

-And if they do not, then what happens?

-Then we work with a pool of abortion care providers in Southern Nevada, and we'll refer those patients to them.

-Okay.

So the patients that are coming from out of state to Planned Parenthoods in Las Vegas, they're flying here simply for medicine?

-That's exactly right.

When you look at the numbers, it's a tremendous increase of patients traveling for care to get to Las Vegas, Nevada.

And right now we are able to meet the need, which is great, because of the various ways we've expanded access and care.

But I do worry that the continued pressure of patients traveling from out of state may become too burdensome for our local health centers.

And of course, we're also looking at other states across the country that may continue to ban abortion care.

I'm nervous about Florida, for example.

Again, a very heavily populated state.

And right now my colleagues that are running Planned Parenthoods in Florida are able to take on more patients from across that area.

If Florida goes dark, all those patients will be looking for care out here West.

-At the moment, how are patients seeking care outside of abortion?

Are they being impacted when they visit a local Planned Parenthood because of this influx?

-At this moment, no.

We're able to see all forms of family planning services, mostly due to telehealth care, but also our ability to see walk-ins if people need birth control, cancer screening, sexually transmitted testing or treatment.

But I do worry about if there continue to be a pressure on those wait times.

-Adrienne Mansanares, CEO of Planned Parenthood of the Rocky Mountains, thank you for your time.

-You bet, Amber.

Thank you so much.

-When the Supreme Court overturned Roe v. Wade last summer, Nevada Week had a local obstetrician-gynecologist on to discuss the immediate impacts on her practice.

Dr. Anna Cantomitros of Woman to Woman Gynecology joins us again now for an update.

And doctor, I want to first start with a clip from that interview from last year.

You chose to wear a mask during it, one, because of COVID and, two, well, let's take a listen.

(Anna Contomitros) I wear my mask because I'm scared because violence, unfortunately, is directed at doctors who provide abortion care.

So I would like to hide my features to decrease the chance of being recognized.

-I know you were unable to hear that in here, but that was you saying you wear the mask to hide your features out of fear of violence, that abortion providers are targeted.

Have you experienced that in the year since the reversal of Roe v Wade?

-Um, the risk has increased, but we have not had any direct violence in our office.

And not wearing my mask does not diminish the risk that I'm facing.

But we are in the environment where all of us have to take risks on behalf of the women that we serve.

If women patients can risk their lives trying to find medical care, I can risk being recognized for my support of them.

-The women that you're talking about risking their lives, they're risking their lives to come here in your opinion?

-Um, when you are pregnant and you cannot find care, whether it is for a pregnancy termination or for a pregnancy complication, that places your life at risk.

The emotional life of a woman who is in distress because she is unable to control her body, to control the capacity to have a child, is a very valid medical concern.

So women can harm themselves if they find themselves in despair.

So that is dangerous for them.

So providing a place where they can safely access a consultation and medical termination or medical care, it's critical.

-Of the patients you are seeing from out of state, how many are reporting that they are at risk, that their health is at risk and they cannot receive abortion care in their home state?

-Nearly all of them who come to see us from, let's say, Utah or Arizona, Tennessee, Louisiana, Texas, Florida, all of them tell us they cannot find care there.

And what is happening, even if abortion is limited but still provided, the amount of appointments available is such that they, by the time they can be seen, they would have already missed the window of opportunity to terminate the pregnancy.

So there is a sense of urgency that they need to-- they feel and an anxiety that comes as a result of that.

And they call asking to be seen immediately, which of course we do our very best to do, to see them.

-Would you describe it as an influx?

-Yes.

There is-- we have had more patients from out of state than ever before.

Before, we used to have some patients from Utah because it was restrictive in Utah.

But in the last 10 years, up until just recently, we have not had patients from, let's say, Mississippi or Tennessee or Louisiana or Ohio or Florida.

And the reason why we have these patients is because they cannot find care in their own states because of the laws that are currently present in their states.

-Some of those states have laws that allow abortion but only up to a certain amount of time.

-Correct.

-And then they're having trouble just getting appointments within that time frame.

-Correct.

The time passes and they cannot be seen.

And now rather than having a very early pregnancy termination that can be there with pills or with surgery, now we go from the first trimester where the risks are very few to a second trimester abortion which the risk can be pretty significant: heavy bleeding, infections, complications in general.

And so the earlier the care can be provided, the better it is for women, the safer it is for women.

-Of the women that are coming to your practice, are they in that second trimester?

-Some of them are.

-Okay.

But would you say the majority are there for the medicine, the medication abortion?

-They are actually coming for both.

They're coming for both medication and surgical abortion depending on their gestational age.

For patients who are in restrictive states, even if they're early, I do advise them of the option to have an earlier surgical abortion because that prevents them from needing to have a follow-up appointment, which is in their best interest.

They don't have to discuss if they had the procedure.

They-- we have confidence that the procedure was terminated because we do perform in our office postoperative and intraoperative ultrasounds to make sure that things that can potentially cause complications such as bleeding, collection of blood clots inside the uterus, a perforation, or an incomplete abortion do not happen because we have realtime evidence of success by performing intraoperative and postoperative ultrasounds.

-Why do they not need follow-up care if it's a surgical abortion?

-Because we have evidence of completion.

The reason why people needed to have follow-up care after a pregnancy termination by pill is to make sure that it has completed, because quite often people-- and I see that in my practice almost on a weekly basis.

People who have had pregnancy terminations by pill don't necessarily complete.

Some pregnancies do continue, and they need to be terminated because a pregnancy that continues after have been exposed to Mifeprisone and Mifeprex can have potentially birth defects.

So such pregnancy should not continue, should be terminated surgically.

-So you are seeing patients coming in who've already had-- -Correct.

- --the pills-- -And it has failed, yes.

I am one of the referrals locally from places such as Planned Parenthood.

But not only Planned Parenthood, other facilities out of state where patients have been seen and they do have persistent pregnancy symptoms.

They cannot be seen locally because there is no appointments available.

They have tried to see their OBGYN who will not take on the risk of taking care of a woman who had the pregnancy termination.

And they eventually find me.

They come to the office where they get evaluated and, lo and behold, we find a continuation of the pregnancy.

So we have to terminate the pregnancy surgically at that point.

-For that reason, is that why you may advise against the telehealth aspect?

-There are benefits to telehealth in the current political environment where abortion care is very difficult to find.

But telehealth without proper evaluations before telehealth services and without followup thereafter, especially in cases where patients have complications, places women at risk.

That is the area where I feel telehealth could normalize something that needs more attention.

And I-- imagine having a surgery, let's say a breast surgery, and you don't have ever followup after that.

What if you say you develop an infection?

What if you have cosmetic results that are not normal?

What if there is an unevenness to your treatment?

You need to have close followup with your provider, with your surgeon, so you can have completion of your medical care.

And because abortion does have risks, I truly believe that not providing follow-up care-- that's a personal opinion --not providing follow-up care can be harmful, because during that time, not only do you confirm that the pregnancy has successfully terminated, that there is no infections, but you have the opportunity to advise women about their contraception, about their wellness, so things like that don't happen again.

-But that follow-up care is not a possibility for some of the patients that you see, because they're flying in-- -Correct.

- --getting medicine, and leaving how shortly after?

-They're leaving sometimes that same day or maybe 24 hours later.

So I do advise them to have both options.

But the option of not having followup places them at potential risk because sometimes the pills don't work.

-Right.

Which you explained.

How are you handling this influx?

-Well, we do have enough capacity currently to be able to take care of the patients that currently call us.

But this is the first year after the Dobbs Decision.

We do not know exactly how things are going to settle down.

Will there be more trouble?

Will there be more medical emergencies?

It's something that we have to wait and see.

It is a social event in evolution.

We have to be patient to see how it pans out.

But right now, my office and I have the capacity to take care of patients that come from out of state.

-And what about the patients seeking routine care?

Are you having to reschedule, cancel appointments?

-We have still enough capacity to be able to see them.

In-- I have a unique practice in the sense that I don't take all comers.

We are-- we do not provide medical care for all patients who have insurances.

I have a unique payer mix.

So as a result, I don't have as many patients seeking services at my office because we are not contracted with many of the insurances.

But patients still need to see them, especially because in Nevada, we have a shortage of physicians.

And now because of the pandemic, we also have a shortage in ancillary personnel.

So people have to wait months on end to be seen and to be evaluated.

-Dr. Anna Contomitros, thank you for your time.

-Thank you.

-In 1990 is when nearly two-thirds of Nevada voters approved a ballot measure to ratify into state law the right to a legal abortion within 24 weeks of pregnancy.

And this legislative session, state lawmakers took further steps to protect abortion access.

Joining Nevada Week to talk about that and efforts at the national level is Gabby Birenbaum, Washington, D.C., correspondent for The Nevada Independent.

Gabby, welcome to Nevada Week.

(Gabby Birenbaum) Thank you for having me.

-All right.

So as you reported, Democrats in the U.S. Senate use the anniversary of Roe v. Wade's reversal to introduce some legislation protecting reproductive rights.

The bills failed.

But as you wrote, quote, The message was clear.

Democrats will continue to make abortion a marquee election issue heading into 2024.

Is this true for Nevada's congressional Democrats, though, since this is already part of state law protecting abortion rights?

-Yeah, so it's absolutely true in Nevada, even though as you mentioned, through that 1990 referendum, the right to an abortion in Nevada has been codified and can only be undone via a state referendum.

Nevada's Democrats banked on successfully in 2022 and are banking on again in '24 that this is an issue that Nevadans care about regardless of whether it affects them in their day-to-day.

I think Nevada Democrats have made and are gonna continue to make the argument that if Republicans were to take over both chambers of Congress, as well as the White House, they could pass a national abortion ban.

And that's something that would supersede Nevada state law.

So that's an issue that I think they saw was successful for them in '22, and they definitely want to make it a big deal in 2024.

-How much do Nevada voters care about this issue?

-Yeah, so we have data from 2022.

In our polling before the midterms, we found at The Nevada Independent that abortion was the second biggest issue for Nevadans going into that election right after the economy.

So I believe it was 40% of the economy, 17% listed abortion as their top issue.

So I guess the question is-- this happened right after the Dobbs Decision after Roe v. Wade was overturned in the summer of 2022.

The question for both parties, I think, is will abortion continue to be salient moving into the next election?

And Nevada voters, I think, in our recent polling have continued to say that this is something they care about.

It's a pretty big consensus.

Nearly two-thirds supported that 1990 referendum and, again, today, nearly two-thirds would describe themselves as pro-choice.

We found in our polling, and so it's a question of do those attitudes translate into something that will motivate people to vote for one party or another based on that pro-choice majority.

-And is it just Nevada Democrats who care about this, or does this issue cross party lines according to that polling you're talking about?

-Yeah, I think it depends.

I mean, we saw Governor Lombardo was able to win in 2022.

He described himself as taking a pro-life lens, I believe the term he used, towards legislation.

And we've seen a a mixed record on him.

Out of the legislature he approved a bill, signed off on a bill, that permitted travel between states for people seeking abortion, but he rejected one codifying the right to contraception.

So I think for Republicans moving forward, it's something that Democrats are going to continue to hammer them on.

And it'll be up to them to decide how much they want to talk about it, if they want to talk about it at all, particularly since the Republican position for so long has been that this is an issue that should be returned to the states.

The court did that.

In the state of Nevada, it's been clear that abortion is something that Nevadans want to protect.

So it puts Republicans in a bit of an interesting bind.

-It sure does.

What about Representative Mark Amodei, the lone Republican congressional member in Nevada?

Where does he stand on abortion?

What has he said?

-I've talked to him about it a few times.

I mean, when the Roe v. Wade decision-- or when the Dobbs decision came out, he released a statement basically saying, you know, he's pro-life, always has.

He thinks it's the right choice, and he'll continue in his federal capacity to vote against, you know, funding abortions at any federal level.

For example, with provisions like the Hyde Amendment, he'll vote with Republicans for that.

But he's also been clear in my conversations with him that Nevada has made its choice, and it's made a choice to support having abortions in the state.

And so a few months ago when a federal judge in Texas released the decision to ban the FDA from approving Mifeprisone, which is one of those abortion pills that's commonly used, that was eventually overturned and the ability to use Mifeprisone continues.

But that's something he said made him uncomfortable, that a federal judge could decide abortion policy for the whole country, given that that was not in Nevadan's interest as they've expressed it.

-And lastly, as we mentioned, abortion protections are already part of Nevada state law.

But this legislative session, state lawmakers sought to make them part of the state constitution.

Why did they argue that's necessary, and what comes next for that to become part of the constitution?

-I mean, I think that's a bit of a safeguard against, I think, what Democrats are worried about, which is the idea that Republicans federally could do a national ban.

If it's safeguarded in the state constitution, I imagine then it would go over to the courts.

So I think the idea is to sort of codify it to an even further level, affirm, once again, that Nevada is a state that believes in the right to an abortion and make it so that then a state constitution would directly contradict with a federal policy of Congress and the President go that route and set up a legal fight.

But I think it also, yeah, I think people are-- in the aftermath of Dobbs, people are more concerned than ever, even in a state like Nevada that has the right to an abortion codified via referendum.

And so this extra layer of protection, I think, is something that Democrats were interested in, in giving people an opportunity to vote on.

-And that would have to come before the voters again, correct?

-Yeah, so I don't-- as I understand it.

I mostly cover the federal side.

As I understand it, yeah, it would have to come before the voters again in another referendum asking do you want this added to the state constitution.

-All right.

Gabby Birenbaum of The Nevada Independent, thank you for your time.

And thank you for watching.

For any of the resources discussed on this show, go to our website, vegaspbs.org/nevadaweek.

And I'll see you next week on Nevada Week.

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