No automatic punishment in proposed Colorado abortion pill reversal rule
Medical board urged to determine whether reversal is ‘standard of practice’
People gathered at the Colorado Capitol for the “Bans off our Bodies” rally in support of abortion rights on May 14, 2022. (Andrew Fraieli for Colorado Newsline)
Several physicians, organizers, state officials and residents urged a trio of state licensing boards during a virtual stakeholder meeting on Friday to determine whether medication abortion reversal pills are “standard practice.”
The Colorado Medical Board, Nursing Board and Pharmacy Board released their draft rules on medication abortion pill reversals, which state the boards would not automatically punish medical professionals for engaging in the practice. The rules also do not state the practice is a “generally accepted standard of practice.”
The draft rules state that the boards will investigate all complaints related to medication abortion reversal like “any other alleged deviations from accepted standards of medical practice,” which means they will evaluate the practice on a case-by-case basis.
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Senate Bill 23-190, passed in April, making Colorado the first state to ban abortion pill reversal practice as medical misconduct unless the three boards find it a “generally accepted standard of practice.”
The Colorado attorney general’s office, along with the boards, said it would not enforce the new law until the medical boards determine whether abortion reversal is a generally accepted standard practice.
The boards are now in the process of making their decision after releasing their draft rules. The process includes stakeholder meetings and other opportunities for the public to provide their input.
At Friday’s meeting, state Rep. Karen McCormick, a Longmont Democrat, said the General Assembly believes the practice to be harmful because it takes the place of “honest ethical patient care.”
McCormick took issue with a part of the draft rule that states the boards do not typically “adopt rules establishing a single standard of care applicable to all situations.”
McCormick said the General Assembly understood that rule and decided to deem the practice unprofessional.
“Your only task was to determine if at this time in the practice of medicine, if abortion pill reversal is a generally accepted standard of practice scientifically based,” McCormick said. “If you were able to say that then that is what goes into the rules, otherwise the law stands as is and abortion pill reversal is considered unprofessional conduct.”
The controversial practice called abortion pill reversal interferes with the process of a medication abortion where a patient takes two pills — mifepristone first and then within 48 hours misoprostol — to terminate a pregnancy within the first 11 weeks.
In the reversal practice, patients wishing to reverse the medication abortion process are instructed to take progesterone within 72 hours of taking the first medication, mifepristone, and before taking the second, misoprostol.
Several proponents of the practice who spoke during the meeting claimed the practice has enough evidence from studies to back it.
Tom Farrell, a physician who said he has previously reviewed cases for the medical board, claimed abortion reversal pills are evidenced-backed and to be considered “standard practice” does not need to be based on high-level evidence.
“I just want to emphasize that a generally accepted standard practice does not need to be popular, common or widely practiced. It does not need to be seen as the only approach to a patient with the same or similar circumstances, does not need to be based on high level evidence,” Farell said.
But the American College of Obstetricians and Gynecologists as well as the American Medical Association do not support the practice.
Sarah Peterson, a board-certified OB-GYN and vice chair of the Colorado section for ACOG, spoke during the meeting to share ACOG’s stance on the practice. She said much of the research was not ethically run and did not have institutional review board approval.
“The only known study that has been conducted with IRB approval in a randomized control study design, which is considered the gold standard, was ended early due to safety concerns among participants,” Peterson said.
Several participants in the meeting took issue with the Medical Board’s plan for case-by-case evaluation.
Peterson said doing so would put patients at risk of “junk science” that the practice is based on.
“There should be no reason to examine each instance on a case-by-case basis as there is no abortion reversal treatment that is based in science or that meets any generally accepted clinical standards,” Peterson said.
Mar Galvez Seminario, legislative and research coordinator for Colorado Organization for Latina Opportunity and Reproductive Rights, said the rule, which remains neutral on abortion pill reversal, legitimizes unproven treatment and allows for patients, especially patients of color, to be used in experiments with a questionable medicine.
“By evaluating this on a case-by-case basis, you’re placing the responsibility on our community members to ensure that medical practice is ethical, rather than on the actual experts. That is you,” Galvez Seminario said.
The boards will now meet to discuss and decide whether to adopt the draft rule. The Colorado Medical Board will hold a rulemaking hearing on Aug. 17 and the Board of Nursing will hold its hearing on Sept. 20 and the Board of Pharmacy on Sept. 21.
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