Dr. Jenna Beckham

Dr. Erica Pettigrew

Health care providers face similar confusion also. We are now having to constantly wonder if the evidence-based, standard of care we know we should provide to our patients is, in that moment, legal and/or if it fits within the narrow yet often vague confines of poorly written legislation. We are having to call our hospital and clinic attorneys, consult with ethics committees, and at worst times, turn patients away or defer care.  Some are even unable to refer or transfer patients elsewhere for care due to concerns for repercussions of “aiding and abetting”. As physicians, we completed numerous years of education and training in order to take care of patients. We did not go to medical school and complete residency training to find ourselves spending hours in meetings with lawyers about patient care, but that is what hundreds of doctors have had to do over the last year since the Dobbs decision has allowed states to further interfere with reproductive healthcare.

The past year has felt somehow simultaneously long and grueling as well as one that has moved at lightning speed with constant blindsides of legislative restrictions, court cases, and worst of all, tragic stories of patient suffering. Abortion is now completely banned in 13 states, numerous other states have enacted new laws with extremely strict restrictions, and on a federal level there are ongoing attempts to revoke the FDA’s approval of mifepristone, one of two drugs in the most common medication abortion regimen in the United States.

In a post-Roe United States, the effects of each state’s abortion policy extends beyond its borders, with broad reaching impacts on abortion access regionally and even nationally. Here in North Carolina, we have seen firsthand the effects of increasing abortion bans and restrictions in many of our neighboring states, and much of the southeast region.  As reported by the New York Times, the “Fall of Roe Turned North Carolina Into an Abortion Destination”.  The Society of Family Planning’s #WeCount project, a national abortion reporting effort that aims to capture the shifts in abortion access, reports that the average difference in abortions post-Dobbs in North Carolina has been an increase of 881 abortions per month, ranking us 3rd of the states with the greatest increase. We now commonly see desperate patients from states like Tennessee, Georgia, and Florida as a direct result of their respective abortion bans.

Come July 1, North Carolina will no longer be a refuge for those in dire need for basic health care, and for doctors who wish to practice in a state that respects the medical profession. Our new abortion ban restricts abortions prior to 12 weeks with medically unnecessary barriers and bans most abortions after 12 weeks. It became law on May 16th, a short 14 days after the public and most members of the legislature were first able read the bill that was introduced late in the night on May 2.

Just two weeks. That’s a shockingly short window of time for any bill to become law, let alone a 46-page monster bill that so negatively affects the practice of medicine. The NC Medical Society, NC Society of OBGYNs, and the NC Academy of Family Physicians are all against the law. The bill did not go through the typical process of vetting and debate which is how confusion over vague wording, contradictions, and uncertain intersections with other laws ended up as statute. And now we are having to do our best to interpret what the law says so that we are not criminally charged or do not lose our licenses for providing the best evidence-based medicine to our patients. A lawsuit filed on June 16 by North Carolina health care professionals highlights a few of the most egregious aspects of the law, but even a successful outcome there will not stop most of the law’s harmful effects.

So what are the consequences of these hastily passed, poorly drafted, medically dangerous laws? Patients are unable to receive the best possible care, or at times any care at all.  Doctors have to choose between medical malpractice and criminal prosecution. Some patients who can come up with transportation and hotel costs, childcare, and time off work are forced to become health care refugees when they have to  leave their own state for less restrictive states. There will also be many who are unable to jump through the hoops and travel to access care, therefore being forced to carry a pregnancy against their will or resort to self-managed abortion (a safe option in some situations but not one that is universally preferred.).

Medical professionals are burned out by the moral injury of turning patients away, and soon new abortion ban states like North Carolina are no longer desirable places to practice medicine. OBGYN applications are down 10% in abortion ban states, and that is only the beginning of this phenomenon. Doctors and medical students look for other places to practice when state politicians interfere with the practice of medicine. This healthcare provider shortage goes far beyond abortion care. Family physicians and OBGYNs providing abortion care often do so as a part of their practice. We also provide prenatal care, deliver babies, and serve as primary care providers. When we move away, those services become harder to find. Maternity care deserts grow, the struggle to find a PCP for diabetes and hypertension care becomes even more difficult, and overall accessibility to high quality, full scope medical care suffers. These harmful laws need to be repealed. Leave the practice of medicine to health care professionals, not politicians.

 

Dr. Jenna Beckham

Dr. Jenna Beckham, MD, MSPH, FACOG, is a board-certified obstetrician and gynecologist and abortion provider in North Carolina. She also serves as the chair of the board of ProChoiceNC and board vice president of the ACLU of NC. A North Carolina native, Dr. Beckham completed her education and training at the University of North Carolina at Chapel Hill. Her views are her own.

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Dr. Erica Pettigrew

Dr. Erica Pettigrew is a North Carolina primary care physician, who is board-certified in both family medicine and preventive medicine. She is an associate professor, serves as the medical director of a county health department as well as medical director of Occupational Health Services. She earned her medical and law degrees at the University of North Carolina and a master of public health degree from Portland State. Her views are her own.

Via AZ Mirror

Published under Creative Commons license CC BY-NC-ND 4.0 .

By: Jerod MacDonald-Evoy

 

( AZ Mirror) – Phoenix is close to breaking a record streak for consecutive days with high temperatures at or above 110 degrees, and the heat will continue to become more enduring as urbanization grows and the impacts of climate change continue. 

“You can’t argue that we are definitely seeing that warming climate,” Phoenix National Weather Service Meteorologist Issac Smith told the Arizona Mirror. “This is becoming more frequent.” 

In the early 1900s, the Greater Phoenix area only experienced approximately five days per year that reached 110 degrees on average, as compared to the 27 it has typically seen from 2011 onward, according to State Climatologist Erinanne Saffell.

“It is five times what it was in the early 1900s,” Saffell said. 

A Flourish chart

The existing all-time record for consecutive days with a high at or above 110 degrees was set in 1974 — at 18 days. Current predictions have this year surpassing that record. The previous three years — 2020, 2021 and 2022 — are all in the top 10 for the most consecutive days with temperatures at or above 110. 

The current heat wave is caused by an area of high pressure that has stayed over the area for several weeks that will continue to build over the weekend, leading to even higher temperatures, according to Smith. That high pressure leads to less moisture in the atmosphere. 

Overall temperatures have been rising across the globe, contributing to what we are seeing in Arizona. The global temperature has risen by approximately 2 degrees Fahrenheit since 1880, but in Phoenix you can add another 5 degrees to that number, according to Saffell. 

That is due to the urban heat island effect. 

The urban heat island effect is when the temperatures in an urban area increase due to the heat the area retains, mostly due to heat-retaining structures and ground coverings, lack of vegetation and other impacts of urbanization.

A Flourish chart

This effect can have a swirl of consequences, such as a city temperatures not cooling at night, leading to residents “cranking their air conditioners” after sundown, which then drains energy usage and strains systems, according to Saffell. Asphalt can heat up to 180 degrees, which is then retained in the air. 

“While we may have once viewed heatwaves as random annoyances, it’s becoming impossible to deny that they are getting hotter, longer, more frequent, and more deadly at an alarming and unnatural pace,” said Mel Smith, spokesperson for 350 US, an organization that aims to address climate change and transition to renewable energy. “In extreme heat, air conditioning becomes even more essential, which overburdens our unstable power infrastructure, and increases the risk of power outages — which studies estimate could send half of Phoenix to the emergency room.”

Arizona isn’t the only place experiencing this type of heat. California and much of Europe are also experiencing record breaking heat, causing groups like 350 to take notice.  

“Unfortunately, heat waves are only one type of extreme weather caused by climate change, and it is rendering whole regions of our planet increasingly less livable,” Mel Smith said. “The good news is there’s still time to prevent things from getting even worse: we can end the era of fossil fuels and invest more resources in a swift and just transition to renewable energy.” 

Image by Kevin Ellis from Pixabay

Saffell says that efforts to install “cool pavement” that lowers the average temperature of the asphalt is one solution to helping minimize the impacts of the heat island effect, but other solutions like additional shade structures and planting desert-friendly trees could also have direct impacts. 

Meanwhile, the heat is already having deadly consequences for some of the most vulnerable. 

Twelve people have died from heat related causes in Maricopa county so far this year, with half of them being reported to be unhoused, according to reporting by the Arizona Republic. Those 12 are the first confirmed deaths, but there are 55 still under investigation that are suspected to have been caused by the heat.

“A lot of people in Arizona are like ‘it is July, it is hot, it is the desert,’” NWS Meteorologist Issac Smith said. “[Heat] is the number one weather-related killer in the United States.” 

There is some hope though, according to Smith and Saffell.  

The extreme heat can hopefully spawn some moisture, eventually. 

Arizona is currently in the middle of its monsoon, which runs from June 15 through Sept. 30, however, this season has been particularly dry. According to Issac Smith, next week Arizona may start to see some of that monsoonal moisture begin to rear its head. The extreme heat is sometimes necessary to spur the moisture into action, Saffell said. 

Last year, Arizona had one of its coldest winters on record. Another factor of climate change is many of the extreme temperatures on both ends of the spectrum appear to be increasing, research has shown. 

This means that much of last year’s snow melt didn’t melt as quickly and this essentially slowed down our monsoon season, Saffell said. 

“We are hoping that the heat will really be a benefit,” Saffell said. “Here’s hoping for a monsoon and at least a few thunderstorms.” 

Jerod MacDonald-Evoy

Reporter Jerod MacDonald-Evoy joined the Arizona Mirror from the Arizona Republic, where he spent 4 years covering everything from dark money in politics to Catholic priest sexual abuse scandals. He brings strong watchdog sensibilities and creative storytelling skills to the Arizona Mirror.

Via AZ Mirror

Published under Creative Commons license CC BY-NC-ND 4.0.