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'Heartbreaking' stories go untold, doctors say, as employers 'muzzle' them in wake of abortion ruling

Elizabeth Cohen - CNN- TODAY

After the US Supreme Court overturned Roe v. Wade in June, an obstetrician who works at a hospital in the Northeast thought she could make a difference by publicly describing what she was seeing, by telling the stories of the patients she saw suffering in the aftermath of the court’s historic court ruling.

MUZZLED AND SHACKLED, THAT'S WHAT DOCTORS TELL CNN THEY ARE
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So when a reporter from The New York Times reached out, she was grateful for the opportunity to discuss the plight of patients traveling to her hospital from states that had abortion restrictions.

The obstetrician passed along the reporter’s inquiry to her hospital’s public relations office, asking for permission to do the interview, noting that the reporter approached her because she holds a leadership position on a state government maternal mortality committee.

A hospital PR official replied that “without any notable exceptions, we are not participating in interviews at this time” and asked the doctor to send along the reporter’s questions and her proposed answers.

The doctor sent along the questions and answers and received a resounding “no” from the PR official: “We ask that you do not comment to the NY Times at this time.”

“They’re censoring me,” the doctor told CNN. “It’s shameful and embarrassing to work for an institution that is not supportive of women’s rights.

“I’m extremely angry,” she added. “It’s disgusting.”

A physician in another state echoed her: “I feel shackled. I feel muzzled. I feel completely restrained, and I’m outraged.”

These two doctors, and six others interviewed by CNN, say their employers – major public and private medical centers in five states – have asked them to not speak publicly about abortion, or have instructed them that if they do speak publicly about abortion, they can do so only as private citizens and cannot mention where they work.

Even when they are permitted to speak about abortion as private citizens, these doctors say, their employers have made it clear that they would prefer the doctors not talk at all, and so they have hesitated to speak up.

“If [they] don’t speak up, who is going to provide the evidence about the effect [abortion bans are] having on patients?” asked Dr. Erika Werner, who chairs the health policy and advocacy committee at the Society for Maternal-Fetal Medicine and is the chair of obstetrics and gynecology at Tufts Medical Center in Boston.

Dr. Eric Rubin, editor in chief of The New England Journal of Medicine, said doctors need to be able to speak up because “the world of medicine in general – and certainly abortion – is full of misinformation, and we have not found good ways to counter that.”

“We’re really spiting ourselves if we do not allow physicians to speak about the facts,” he said.

Dr. Rosha McCoy, acting chief health care officer at the Association of American Medical Colleges, said medical centers and universities are having to deal with a great deal of “fear” and “confusion” in the aftermath of new abortion limitations.

“They don’t want themselves or the physicians to be put in a position where something is said that could be interpreted that’s going to cause a problem for both the clinician and/or the institution,” said McCoy, whose group represents more than 400 teaching hospitals and health care systems.

“We would never support doctors being censored,” she added. “I’m hoping it’s not censorship as much as a protective desire.”

‘These stories are not getting told’

A Texas obstetrician watched as the pregnant woman she was caring for got sicker and sicker.

The woman was 19 weeks pregnant, the fetus too young to survive outside the womb. Her water had broken, an ultrasound showing no amniotic fluid around the baby. In states where abortion is allowed, doctors would offer to terminate the pregnancy, since pregnant women in this situation have a high likelihood of developing an infection and becoming septic, which is a life-threatening emergency.

But in Texas, where strict limitations on abortion took effect more than a year ago, doctors fear criminal and civil prosecution if they offer termination before the mother is on the brink of death.

“Literally, we’ve had to watch patients deteriorate in front of our eyes,” said the doctor, a specialist in high-risk pregnancies who works at a public university.

Since the passage of the Texas laws, some women have been denied abortions even when their lives were in danger and the fetus had fatal birth defects and would die within minutes of birth. Others have been denied abortions even after the fetus had died.

The hospital that employs the Texas doctor said she can speak about abortion and use her name, but she’s not allowed to say where she works, and she can’t communicate with journalists on her work email or using her work computer.

The doctor says it seems clear that her employer would prefer she stay quiet about abortion, so like other doctors in this story, she would only speak to CNN anonymously, for fear of reprisals from her employer.

“This has clearly been done to make us feel like criminals. That’s exactly how it makes us feel – like we’re doing something wrong,” she said. “I think we’re all pretty scared. I’m afraid of losing my job. I’m the primary breadwinner in my family, so losing my job would be a big, big deal.”

At a hospital in a different state, one that does allow abortion, a doctor said they “got called into the principal’s office” by hospital administrators after participating in a public event about abortion, even though at the event, the doctor never mentioned where they work.

The doctor told CNN that at this meeting, it was intimidating that “these very fancy, very high-level, high-powered administrators had watched a video [of the event] and obtained a transcript to make sure I in no way made a connection to my employer.”

The doctor, who works for a public university, said the administrators explained that if they want to speak publicly about abortion and identify the hospital where they work, they should run it by the hospital public relations office first.

“I got the strong sense they’ll say no,” they said. “They worry about state funding sources and what happens if it gets controversial, so unfortunately instead of supporting us, they want everyone to play nice and quiet and not stir up any trouble.”

The doctor does not want CNN to include their gender or what part of the country they work in for fear of reprisals from their employer.

Like this doctor, an obstetrician in the Midwest felt a “chilling effect” when their employer said they could speak publicly about abortion only if they didn’t mention where they worked.

“It’s so heartbreaking, the stories we’ve seen, and these stories are not getting told,” the obstetrician said.

An Instagram post that lasted 40 minutes

In another state, a few weeks after Roe was overturned, a group of residents in obstetrics and gynecology posted a photo that included the message: “Abortion is healthcare” on their group’s Instagram account. It was clear from the post where the residents worked.

The photo was taken down less than 40 minutes later at the insistence of a university lawyer, according to a doctor familiar with the situation.

That doctor says residents didn’t think twice about posting the picture, considering that multiple medical societies – the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the Society of Hospital Medicine, the National Association of Nurse Practitioners in Women’s Health, the National Hispanic Medical Association, the American Academy of Pediatrics and the International Federation of Gynecology and Obstetrics – have used the exact same phrase they did: Abortion is health care.

The association of medical schools, which represents where the residents work, has criticized the Supreme Court for “rescinding the protection of the right to safe and effective abortions.”

Despite these statements from respected national organizations, a university official told the residents to also remove the photo from their personal social media accounts, according to the doctor familiar with the situation. The doctor added that a little bit later, the official told the residents they could post the picture on their own accounts, as long as they didn’t identify where they work.

Emails and text messages obtained by CNN back up this doctor’s account.

A month later, at a mandatory lecture, university lawyers gave the residents a presentation about the limits of free speech, according to the doctor. CNN has seen a photo of a portion of the presentation.

The doctor said the lawyers instructed the residents that they could talk or write about abortion publicly as long as they didn’t say where they worked. If they did want to make a public statement about abortion and identify where they work, they had to first get approval from the legal department.

The doctor said residents are hesitant to make trouble because when they go to look for another job, “the world is very small, and you rely on senior colleagues to make calls for you, and you won’t be able to find a position if you are perceived as being difficult.”

‘I think real people are suffering’

In the past year, the University of Texas Southwestern Medical Center has issued more than 150 news releases detailing advances in the lab, studies conducted by its doctors, awards for its researchers and a new culinary medicine program, among dozens of other topics.

But when five of its doctors published a study – one of the first of its kind – about the effect of abortion bans in real life, the medical center didn’t issue a news release. The research, published in the American Journal of Gynecology, found that at two Texas hospitals, the abortion bans were “associated with significant maternal morbidity.”

When CNN reached out to one of the study’s authors last month, she said that she would be “happy to talk” but that all inquiries needed to go through the university’s media office.

CNN then received this response from the medical center’s director of public relations: “UT Southwestern continues to review the U.S. Supreme Court opinion in conjunction with Texas laws and will not be commenting at this time. The findings speak for themselves.”

When CNN pushed back, explaining that journalists often speak with study authors, the official said the researchers, if interested, could speak with CNN, but “they will be providing comments as private individuals, independent of their role with the state.”

One of the researchers contacted CNN but declined to be interviewed with their name, for fear of reprisals from UT Southwestern.

UT Southwestern isn’t the only medical center that has been hesitant to allow their doctors to speak with the media.

CNN reached out to two oncologists at MD Anderson Cancer Center in Houston, one of the largest cancer centers in the US, to ask them about their experiences treating pregnant patients, considering that Texas has had strict abortion limitations for more than a year.

Oncologists have expressed concern that abortion bans could hurt pregnant cancer patients. Pregnant women can’t receive certain cancer tests, and treatments that can harm a fetus, so if abortion is not an option, they sometimes have to delay lifesaving cancer care. As two breast cancer doctors wrote in August in The New England Journal of Medicine, abortion bans “will harm some of our patients” because sometimes, “we cannot offer complete or safe treatment to a pregnant person with a breast cancer diagnosis.”

When CNN reached out to the cancer doctors at MD Anderson on September 9 to discuss what they have seen since Texas passed strict abortion bans last year, an unsigned response from the MD Anderson public relations office stated that the doctors were “not available for an interview.”

MD Anderson said in a statement that its providers discuss the published data on the implications of delaying treatment due to pregnancy, and they refer patients to maternal fetal medicine specialists.​

On October 7, CNN pressed further to speak with the doctors, and an associate vice president said they were working on coordinating the interviews, but none was made available prior to the deadline for this story.

None of this surprises Kerri Wade.

Wade is the chief public affairs officer at the Society for Maternal-Fetal Medicine, a membership organization that includes physicians who are experts in high-risk pregnancies. A few months ago, a reporter from The New York Times Magazine approached Wade with the idea of embedding a photographer in a high-risk maternal-fetal medicine department.

“It seemed like an easy fit for us,” Wade said.

Wade shopped around the magazine’s request, which she said was clearly a great opportunity to showcase the work of high-risk pregnancy doctors.

About 10 hospitals and medical practices said no, Wade told CNN.

“We were told no by every single person we approached, with the exception of the Cleveland Clinic,” Wade said.

The magazine ran the story, “What a High-Risk Pregnancy Looks Like After Dobbs” on September 13.

Wade reflects on her struggle to place a story that documents the risks that families have had to take since the Supreme Court’s decision.

“When people don’t hear these stories, they don’t understand the reality of what these laws are doing to real people, and I think real people are suffering. That’s what people need to understand and hear,” she said.

She said the hospitals and practices that declined The New York Times’ invitation told her that “this would make our attorneys and public relations colleagues very nervous.’ “

“There is a part of me that understands that as these laws continue to change rapidly, [for hospitals] to interpret what can be done and can’t be done varies in some places day to day. So I can understand someone taking a very cautious approach – why they might see the world that way,” she said.

Doctor ‘a tiny bit more optimistic’

After The New York Times Magazine published its story, a high-risk pregnancy doctor at a large public academic medical center in the Northeast received a similar embed request from a different national media outlet. This doctor works in a “surge state” – one that allows abortion and has been seeing an influx of patients from neighboring states that have banned the procedure.

The doctor ran the request by her hospital’s media department, even though she knew they would say no. They said no.

She said it’s just one more disappointment in a series of disappointments.

It started soon after the Supreme Court’s decision, when she and other maternal-fetal medicine specialists got on a call with their hospital’s administrators.

“My assumption, as a state with relatively liberal abortion laws, is that we would step up in a number of ways, like structural ways to meet the surge we knew we would see. And I thought we would use our position as a respected women’s health institution to continue to educate about the impact these laws have on women’s health,” she told CNN.

But on the call, “it became pretty clear that [the medical center] was not going to take a particularly activist approach” and would not make it easy for doctors to describe the impact of the new laws to the public.

She said she and her fellow high-risk pregnancy doctors were crushed.

“People cried on that call – like 40-, 50-year-old women were in tears when they realized the extent to which the institution was going to make this difficult,” she said.

Then, last week, the doctor thought she might be seeing a glimmer of hope.

She said a physician in a leadership position at the hospital was disappointed that they’d had to say no to the journalist’s request to embed at their hospital. She said the doctor in the leadership position told her that ” ‘We have to stop muzzling physicians. I want to figure out a way to get our voices out there.’ “

“They’re just a doctor – they’re not corporate – but maybe it was a little bit of a thaw. I’m a tiny bit more optimistic,” she said.

CNN’s Lindsey Knight and Casey Hicks contributed to this report.

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