Iowa Board of Medicine considers tweaks to abortion rules

DES MOINES — Iowa’s Board of Medicine suggested changes Friday to the proposed rules to carry out an Iowa law that bans abortions early in pregnancy, which remains blocked as the Iowa Supreme Court weighs its constitutionality.

The law bans abortion once cardiac activity is detected in an embryo or fetus, which can be as early as six weeks. It includes exceptions for rape and incest and medical emergencies. Gov. Kim Reynolds, a Republican, signed the law last year after it was passed by legislative Republicans in a special session.

A Polk County District Court judge temporarily blocked the law shortly after its passage this summer, but allowed the rulemaking process to move forward.

Board members recommended a number of changes to the proposed rules after gathering feedback in a public hearing last week, where physicians raised concerns about the requirements placed on them and the impact on recruitment for OB-GYNs in the state.

During a board meeting Friday, members expressed some hesitation about requiring physicians to obtain information to determine whether a pregnancy is the result of a rape or incest.

According to the draft rules, physicians intending to perform an abortion after cardiac activity is detected must gather certain facts to determine whether the pregnancy was a result of a rape or incest. Those questions include the relationship between the patient and the perpetrator, whether the act constituted a rape under Iowa code, when the sex act occurred and whether the act was first reported to a separate agency or individual.

Board members worried that doctors would have a hard time verifying those facts, and said the questions generally are not within the scope of a general doctor’s visit.

“My personal sentiment for really all of the rules is to try to adopt a set of rules that, to the extent possible, minimizes any interference, delay or undue extras into the physician-patient relationship to the extent possible,” said board member Jason Myers.

The board recommended changing the rules to indicate that a physician needs to use the information in their determination, but does not need to ask the patient each question in person. Some board members suggested the information could be obtained by a nurse or submitted on a form before the visit.

Iowa Deputy Attorney General Leif Olson also said there is no burden on a physician to verify claims of rape or incest with a third party. According to the rules, doctors may “rely on a good-faith assessment” that the information provided by the pregnant woman is accurate.

“If it’s the sort of information that the physician would typically rely on that the patient were telling them the truth, and in good faith they think that the patient is doing so, they can proceed without having to call and get independent information or copies of other third-party documents to back up the woman’s story,” he told the board.

The board recommended including in the rules that a “parent or legal guardian” could attest to the facts about a rape or incest in cases of abortion, rather than just the pregnant person.

Board members said the change would make it more clear that a parent of a pregnant minor can provide the needed information to a physician in order to obtain an exception to the abortion ban.

Following the text of the law, the proposed rules refer to the pregnant person throughout as a “woman.” The board proposed extending the definition of “woman” in the rules to include a minor female child.

Olson said laws governing abortion have historically used the term “woman" to refer to the pregnant person, but they have been understood to mean both adults and minors. Doctors on the board, though, said the language does not match the medical terminology they generally use and wanted to clarify the rules.

Board members also proposed defining the term “unborn child” as “embryo or fetus.” The law uses the term “unborn child” to refer to an embryo or fetus from the time of conception to birth, but the board members said that is not the term used in medical practice.

The board also recommended changing the type of ultrasound required by doctors to determine whether cardiac activity is present in a pregnancy.

The law and draft rules use the term “abdominal ultrasound,” but board member Robert Donnelly, an OB-GYN, said an abdominal ultrasound is not what doctors use to determine a fetal heartbeat. Instead, he said the rules should require a “transabdominal pelvic ultrasound.”

"If you order an abdominal ultrasound, then you're not going to get the pelvic structures," he said. "So you're not going to get the uterus and ovaries and that sort of thing."

The Board of Medicine will vote on the amended rules at a later date. If approved, they will go before the state Legislature's Administrative Rules Review Committee. If the committee does not object to the rules, they will become law after 35 days.

Because of the injunction on the law, though, the rules would not be enforceable unless the court allows the law to go forward.