Florida clarified abortion rules after enacting ban. Doctors say it's "gaslighting" and unhelpful

One day after Florida’s six-week abortion went into effect, the state’s Agency for Health Care Administration (AHCA) issued clarifying “rules” ​​in the face of what the agency called a “deeply dishonest scare campaign and disinformation” by the media, the Biden Administration, and advocacy groups to misrepresent the new law. 

“The Agency is initiating rulemaking to safeguard against any immediate harm that could come to pregnant women due to disinformation,” the notice for emergency rule stated. “This rulemaking will ensure health care providers establish medical records procedures that will adequately protect the care and safety of both mothers and their unborn babies during medical emergencies.”

When Kara Cadwallader, who is a family medicine physician in Idaho, saw this news come from Florida, she thought this could be helpful. As a physician in a state with a similarly restrictive abortion landscape, Cadwallader told Salon she and her colleagues have been asking Idaho legislators for something similar — clarifications to address emergency situations. 

“And then I read through the actual rules. I think the problem is, they have to be written very precisely from the medical perspective,” Cadwallader said. “The ones that they wrote for Florida, none of those are helpful. They could be. It's like they took one step in that direction, but many of my colleagues immediately picked up on details that didn’t make sense.” 

According to Florida’s new law that went into effect May 1, 2024, known as the “Heartbeat Protection Act,” it is a felony to perform or actively participate in an abortion six weeks after gestation. The ban has exceptions up to 15 weeks for rape, incest and human trafficking and to save a woman’s life or prevent “substantial and irreversible” impairment. Physicians who violate the law are subject to committing a third-degree felony, fines or loss of medical licenses. 

As detailed in a recent report from Louisiana, which has a restriction abortion law with narrow exceptions, the implications of such bans range from doctors delaying care to doctors using extreme caution to avoid the appearance of terminating a pregnancy —like performing cesarean section surgeries to empty their uterus instead of performing an abortion procedure. In Idaho, pregnant women are now being airlifted out of the state in emergency situations due to physicians being unable to provide what once was considered to be a standard part of care.

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As Cadwallader pointed out, clarifying emergency situations could be helpful for physicians in Florida. But in Florida’s attempt to clarify the rules, doctors tell Salon it’s only made the law “more confusing” and that Florida’s attempt to cast physicians and public concerns about the six-week abortion ban as a “disinformation campaign” is a form of “gaslighting.”

“It’s trying to hide from the public that they've created a maternal health crisis,” Cadwallader said. “They don't want the public to know that, because of these laws, women are going to die. Women are going to have to go out of state and die, and it really hits the vulnerable communities hard. And they don't want that information out there.”

Cadwallader said she sees similar tactics in Idaho, such as when the state’s attorney general claimed that a hospital airlifting patients was to make a political statement.

Specifically, Cadwallader said Florida’s clarifying guidance around preterm premature rupture of membranes (PPROM) is confusing. PPROM is when a pregnant woman’s water breaks early. The likelihood of a fetus surviving under 22 weeks of gestation is low. At the same time, when a pregnant woman’s amniotic fluid sac breaks during the second trimester, it puts the woman at an increased risk for infections like chorioamnionitis and sepsis.

Florida’s clarifying rules said when a patient receives a diagnosis of premature rupture of membranes (PROM),” the patient shall be admitted “for observation.” From a clinical perspective, Cadwallader said this doesn’t make sense. PROM is when the water breaks at term and the fetus is viable. The standard approach to care is to observe and then induce if contractions don’t start. Cadwallader said Florida’s rules are conflating PPROM and PROM, and this could put pregnant patients in vulnerable situations.

“We don't need a rule about that — that's not dealing with abortion,” she said. “The thing we really want to focus on is preterm premature rupture (PPROM) because that is why all these patients are getting shipped out of Idaho. They have preterm premature rupture.”

The conflation also appeared in Florida’s “myth and fact” sheet that the AHCA shared on social media. Dr. Michael Belmonte, an OB-GYN in Washington D.C. and Darney-Landy Fellow with The American College of Obstetricians and Gynecologists (ACOG) told Salon the rules Florida released “raise more questions than they do provide answers.”

“I think it's really important to understand that rules like these can never apply to all situations, conditions and ultimately can never replace the clinical judgment of healthcare professionals,” Belmonte said. “Because we've spent significant time training and practicing medicine to be able to provide the best evidence-based care, and so trying to distill that into three short rules is never going to really replace that judgment.”

Florida’s clarifying rules also addressed the situation of an ectopic pregnancy and a trophoblastic tumor, which can form during abnormal pregnancies. Belmonte pointed out that the rules didn’t address preeclampsia or severe bleeding and hemorrhaging. 

“I think the focus of these rules are actually on scenarios where the pregnancy is not likely to end in a live birth to begin with — yet their language is primarily on the embryo or fetus rather than recognizing the pregnancy itself,” he said. “The life of the pregnant person has to be central because if you don't have a living pregnant person, you can never have a fetus that survives.”

Rachel Kingery, a media relations specialist at ACOG, told Salon many of Florida’s OBGYNs don’t feel comfortable speaking publicly about the new rules at the moment. She added that when she saw them she was shocked to see such “inflammatory language” come from a state agency claiming that concerns about Florida’s six-week abortion ban was “disinformation.” 

“Clearly when Florida is putting out quotes like that, where we are spreading disinformation, why would someone feel comfortable speaking to these issues?” Belmonte said. 

When Salon spoke to the Florida Health Department Jae Williams, press secretary of the Florida Department of Health said “we didn’t develop the rules” and deferred comment to AHCA. Instead, the Florida Health Department, he said, “oversee” the licensing of practitioners.

“The rules that you read, those were written by AHCA and AHCA is the agency that will be enforcing that,” Williams said. “The only way even remotely the Department Health is involved” is in “regulating the physicians.”

When asked what “disinformation” provoked the agency to establish clarifying rules, Alecia Collins, deputy chief of staff for Communications and External Affairs of AHCA sent Salon the myth and fact sheet and said the “lies” were listed on the left and “the facts are listed on the right.”

When asked if the AHCA had a medical professional write the rules, Collins said via email “the Agency consulted with doctors and medical professionals when drafting these rules.” When asked about the confusion about PPROM and PROM, Collins said the rule applies to both PPROM and PROM.