-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.