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Ochsner Health sends out guidance on pregnancy medication ahead of new law

Ochsner Baptist Medical Center. March 25, 2020.
Patrick Madden
/
WWNO
Ochsner Baptist Medical Center. March 25, 2020.

This story was updated to include a new statement from Ochsner Health leadership. An earlier version of the article reported that Ochsner Health supported efforts to study the impacts of the new law. That language was included in guidance sent to staff on Thursday, which was obtained by WWNO/WRKF. You can read the full statement from Ochsner Health leadership below.

Louisiana’s largest health system has sent guidance to some staff on the state’s new anti-abortion law that reclassifies two common pregnancy medications as controlled dangerous substances.

WWNO/WRKF obtained a copy of the guidance, which was sent out on Thursday. It expressed support for efforts by the New Orleans Health Department to study the impacts of the law on women’s health.

But a statement from Ochsner Health’s chief physician executive on Friday contradicts that stance.

“We do not believe a study is necessary as it relates to protocols at Ochsner,” said Dr. Robert Hart.

The guidance sent Thursday to staff details how the hospital will comply with the law, which makes mifepristone and misoprostol Scheduled IV controlled substances.

The drugs are used for routine pregnancy care, including inducing labor and treating miscarriages or massive bleeding after birth, but they can also be used to induce abortions.

Louisiana Right to Life and Republican State Senator Thomas Pressly, who authored the law, said the drugs should be reclassified as Schedule IV medications to crack down on illegal use, including getting them mailed into Louisiana from out of state. As a result, misoprostol and mifepristone will be required by law to be locked in cabinets in hospitals and pharmacies beginning on Oct. 1.


Hospitals lock up misoprostol 

The restrictions on misoprostol have become the main source of concern from Louisiana doctors who worry the law could put women’s health and potentially their lives at risk by delaying access to the medication when women start bleeding out after giving birth.

Any delay in accessing the medications as a result of requiring them to be locked away could harm women, said Dr. Veronica Gillispie-Bell, a New Orleans OB-GYN and the lead expert on maternal health in Louisiana.

“If these are medications that we want to give when we start seeing hemorrhage taking place, minutes count,” she said.

Misoprostol is one of three front-line drugs used to treat postpartum hemorrhage. It’s the only drug that doesn’t have contraindications — the second can’t be given if a woman has hypertension, while the third can’t be administered to patients with asthma, said Dr. Nicole Freehill, a New Orleans OB-GYN.

If doctors can’t stem the bleeding fast enough, women could need blood transfusions or surgery, Freehill added. Postpartum hemorrhage is a leading cause of maternal mortality, Gillispie-Bell said.

In its guidance to staff, Ochsner says misoprostol will only be stored in the hospital’s Pyxis medication dispensing machines, and not on any obstetric hemorrhage carts. One doctor who works for Ochsner said misoprostol had already been pulled from obstetric hemorrhage carts at the facility where they work earlier in September.

Ochner nurses who access the drugs will need to count and verify the number of pills before being able to retrieve them. There will be a process to access the medications in an emergency without a written prescription, Ochsner’s guidance says. The guidance doesn’t detail where Pyxis machines are located in its hospitals, and whether all those machines will carry misoprostol.

In Hart’s statement, he said that misoprostol will be “readily and immediately available” in labor and delivery units “across the system, including in emergency situations.”

“Ochsner Health continues to provide care for patients in accordance with the law, using misoprostol when it is clinically indicated, following the protocols in place for all controlled substances,” he said.

He went on to state that misoprostol can be prescribed with “clear documentation of the clinical condition with accompanying diagnosis codes” by any provider with a Drug Enforcement Agency license.

“It is standard practice to securely store certain medical supplies in patient care areas. All controlled substances and the majority of non-controlled substances are stored in locked drawers,” he added.


Experts say state guidance is unclear

Dr. Jennifer Avegno, director of the New Orleans Health Department, said most hospitals she’s aware of have started locking misoprostol in Pyxis machines, instead of storing them on hemorrhage carts.

“I think that hospitals are trying to follow the absolute letter of the law because they are reasonably concerned about increased scrutiny, and they don't want to get it wrong,” she said.

Guidance released by the Louisiana Department of Health said medications can be stored in a “locked” or “secured” area of an obstetric hemorrhage cart.

But Dr. William Kirchain, who teaches pharmacy law and is the director of the Xavier University College of Pharmacy Health and Wellness Center, said there’s a “disconnect” between that guidance and Louisiana Board of Pharmacy regulations under the new law.

The regulations state that controlled substances must be stored in “a securely locked, substantially constructed cabinet.”

“When you try and resolve those two, it is very tricky,” he said in a webinar for physicians and pharmacists on the new state law.


Ochsner Health addresses city council study 

The guidance sent to Ochsner staff on Thursday said “we are aware of the city council’s proposal” to study the law, called Act 246.

Last week, New Orleans City Council voted to task the city’s health department to “investigate and study any delay of care issues” because of the law.

Ochsner’s guidance states that “patients are always our first priority at Ochsner and we applaud this proposal” and that the hospital system “will participate in research studies that advance women’s health.”

Ochsner will “continue to provide care for patients in accordance with the law, using these medications when it is clinically indicated,” the guidance to staff said.

In a different statement sent to WWNO/WRKF on Friday, Hart said that Ochsner Health “has not previously made a statement” related to its position on New Orleans city council’s study of the impact of the law.

“To avoid any ambiguity, we do not believe a study is necessary as it relates to protocols at Ochsner,” Hart said. “We are confident in the new procedures being implemented, and as always, we remain committed to serving our patients and providing high-quality and compassionate healthcare.”

Read the full statement here:

Ochsner Health continues to provide care for patients in accordance with the law, using misoprostol when it is clinically indicated, following the protocols in place for all controlled substances. We respect the guidance in Louisiana Act 246 and have updated our processes to be compliant with the law and also ensuring that misoprostol will be readily and immediately available in Labor & Delivery units across the system, including in emergency situations.

As with all controlled substances, misoprostol can be prescribed with clear documentation of clinical condition with accompanying diagnosis codes both in the patient’s medical record and the prescription/order by any provider with a DEA license. It is standard practice to securely store certain medical supplies in patient care areas. All controlled substances and the majority of non-controlled substances are stored in locked drawers.  

We appreciate the close collaboration with the Louisiana Department of Health, the Attorney General and other government partners in developing these protocols. With respect to New Orleans City Council Motion M-24-499, Ochsner has not previously made a statement related to our position on the proposed study, but to avoid any ambiguity, we do not believe a study is necessary as it relates to protocols at Ochsner. We are confident in the new procedures being implemented, and as always, we remain committed to serving our patients and providing high-quality and compassionate healthcare.

- Dr. Robert Hart, Chief Physician Executive, Ochsner Health and President, Ochsner Clinic

Rosemary Westwood is the public and reproductive health reporter for WWNO/WRKF. She was previously a freelance writer specializing in gender and reproductive rights, a radio producer, columnist, magazine writer and podcast host.