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Published April 17 2013

Fargo obstetrician says 2011 abortion law calls for ‘confusing’ arrangement

FARGO – A Fargo obstetrician testifying Wednesday in the trial over a state law that critics claim would outlaw medication abortions in North Dakota said it won’t make women safer and instead would obstruct them from getting good care in emergencies arising from the procedure.

Dr. Siri Fiebiger was called as the final witness by attorneys for the Red River Women’s Clinic, which is challenging the 2011 law in Cass County District Court.

A section of the law that would require any doctor who gives an abortion-inducing drug to enter a signed contract with another doctor who agrees to handle emergencies associated with the drug’s use is “a confusing arrangement” that would require a single doctor to take full responsibility around the clock for a particular patient, Fiebiger said.

“And in today’s world, that’s not in the patient’s best interest,” she said, noting medical providers often collaborate. “This would actually preclude getting timely, quality care.”

Asked if she would sign such a contract, Fiebiger said, “Absolutely not,” and explained why: “I’m not available 24/7.”

Attorneys for the Center for Reproductive Rights, which sued to block the law on behalf of the clinic, relied on testimony from Fiebiger and another medical expert to dispute the law, which opponents claim would unconstitutionally restrict a woman’s right to an abortion.

They specifically took aim at a section of the law that would ban giving an abortion-inducing drug unless it “satisfies the protocol tested and authorized” by the U.S. Food and Drug Administration and is labeled for that purpose.

The clinic uses two drugs in medication abortions: Mifeprex, which is FDA-labeled for used in medication abortions, and misoprostol, which is not.

Dr. Daniel Grossman, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, said off-label drug use is “very common.” He said the FDA doesn’t test protocols as stated in the law, but rather reviews data from pharmaceutical companies that have performed clinical trials.

Fiebiger, who practices at Essentia Health and also is a clinical assistant professor for the University of North Dakota’s medical school, said misoprostol has other common off-label uses, including to induce labor and to treat postpartum hemorrhage.

Restricting some off-label uses for one drug but not others “makes absolutely no sense” and has no medical justification, she said.

“We try to do things in an evidence-based way, and legislation does not necessarily lend itself to that in terms of keeping up with the evolving body of knowledge,” she said.

Grossman said a doctor couldn’t use both Mifeprex and misoprostol – a combination mentioned in the FDA-approved label for Mifeprex – and still comply with the law.

“Women would lose their choice to have a medical abortion, and certainly it’s my experience that many women have a very strong preference for that method,” he said of drug-induced abortions.

On cross-examination, Assistant Attorney General Jeanne Steiner grilled Grossman with a line of questions designed to paint medication abortion as less effective and less safe than surgical abortion.

Grossman testified that surgical abortion is effective 99 percent of the time and medication abortion 96 percent of the time. Surgical abortion typically takes 10 minutes or less, followed by about 30 minutes of observation and light bleeding afterward, whereas bleeding from medication abortion lasts an average of 10 days but can last up to 45 days and carries potential side effects such as pain, nausea, vomiting and diarrhea, he testified.

“And then some women end up with the surgery, despite all that?” Steiner asked.

“That’s right,” he said.

The trial is slated for up to four days but may wrap up today as the state calls its lone witness, Dr. Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists.

Judge Wickham Corwin is expected to issue his ruling at a later date. He previously granted a temporary injunction to keep the law from taking effect on Aug. 1, 2011.


Readers can reach Forum reporter Mike Nowatzki at (701) 241-5528