[Senate Hearing 118-778]
[From the U.S. Government Publishing Office]
S. Hrg. 118-778
HEALTH IMPACTS OF ABORTION BAN
ON GEORGIA WOMEN
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW
of the
COMMITTEE ON THE JUDICIARY
UNITED STATES SENATE
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
__________
JULY 23, 2024
__________
DECATUR, GEORGIA
__________
Serial No. J-118-73
__________
Printed for the use of the Committee on the Judiciary
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
www.judiciary.senate.gov
www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
63-049 WASHINGTON : 2026
COMMITTEE ON THE JUDICIARY
RICHARD J. DURBIN, Illinois, Chair
SHELDON WHITEHOUSE, Rhode Island LINDSEY O. GRAHAM, South Carolina,
AMY KLOBUCHAR, Minnesota Ranking Member
CHRISTOPHER A. COONS, Delaware CHARLES E. GRASSLEY, Iowa
RICHARD BLUMENTHAL, Connecticut JOHN CORNYN, Texas
MAZIE K. HIRONO, Hawaii MICHAEL S. LEE, Utah
CORY A. BOOKER, New Jersey TED CRUZ, Texas
ALEX PADILLA, California JOSH HAWLEY, Missouri
JON OSSOFF, Georgia TOM COTTON, Arkansas
PETER WELCH, Vermont JOHN KENNEDY, Louisiana
LAPHONZA BUTLER, California THOM TILLIS, North Carolina
MARSHA BLACKBURN, Tennessee
Joseph Zogby, Chief Counsel and Staff Director
Katherine Nikas, Republican Chief Counsel and Staff Director
Subcommittee on Human Rights and the Law
JON OSSOFF, Georgia, Chair
RICHARD BLUMENTHAL, Connecticut MARSHA BLACKBURN, Tennessee,
PETER WELCH, Vermont Ranking Member
LAPHONZA BUTLER, California JOHN KENNEDY, Louisiana
JOSH HAWLEY, Missouri
Sara Schaumburg, Democratic Chief Counsel
Kaitlyn Lane, Republican Chief Counsel
C O N T E N T S
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OPENING STATEMENT
Page
Ossoff, Hon. Jon................................................. 1
WITNESSES
Chandrasekaran, Suchitra, M.D., M.S.C.E.......................... 4
Prepared statement........................................... 24
Questions submitted with no response returned................ 28
Panakam, Aisvarya, M.D........................................... 6
Prepared statement........................................... 32
Responses to written questions............................... 35
Verma, Nisha, M.D., M.P.H., F.A.C.O.G............................ 2
Prepared statement........................................... 43
Responses to written questions............................... 45
HEALTH IMPACTS OF ABORTION BAN
ON GEORGIA WOMEN
----------
TUESDAY, JULY 23, 2024
United States Senate,
Subcommittee on Human Rights and the Law,
Committee on the Judiciary,
Decatur, Georgia.
The Subcommittee met, pursuant to notice, at 9:35 a.m., in
the Auditorium of Decatur City Hall, Decatur, Georgia, Hon. Jon
Ossoff, Chair of the Subcommittee, presiding.
Present: Senator Ossoff [presiding].
OPENING STATEMENT OF HON. JON OSSOFF,
A U.S. SENATOR FROM THE STATE OF GEORGIA
Chair Ossoff. The Subcommittee on Human Rights and the Law
will come to order. Good morning, everyone.
[Hearing attendees respond.]
Chair Ossoff. Good morning.
I first want to take a moment to thank the City of Decatur
and Mayor Garrett for opening your hall to us and for all you
do for the city and the State. Thank you, Mayor, for having us.
We are here today to hear from doctors about how Georgia's
abortion ban is impacting the health of women in our State.
After the Supreme Court overturned Roe v. Wade, a Georgia law
took effect banning abortion after just 6 weeks of pregnancy,
at which point many women do not even know that they're
pregnant.
The New York Times described Georgia's abortion ban as,
quote, ``one of the country's most restrictive laws.''
The Subcommittee on Human Rights has convened this hearing
roughly 2 years after the reversal of Roe v. Wade to hear
directly from Georgia doctors and health experts about the
impact on women's health of Georgia's 6-week abortion ban.
I want to thank our witnesses for taking the time to
provide testimonies today. You are all busy and hardworking
healthcare professionals. We appreciate your contributions.
I know this is a complex issue that evokes strong feelings
across the State, that's why it's critical that the public hear
directly from doctors about the consequences of Georgia's 6-
week abortion ban.
We often hear politicians and elected officials weighing in
on this issue. But today we're going to hear from the
healthcare professionals who treat women and support them
through pregnancy every day. On that note, without further ado,
I will now swear in our witnesses.
I'll begin with introductions.
Dr. Nisha Verma is an OB-GYN providing reproductive
healthcare in Atlanta, Georgia, and an assistant professor of
gynecology and obstetrics specializing in complex family
planning. She currently has a research grant to explore the
impact of Georgia's 6-week abortion ban on individuals with
high-risk pregnancies in the State of Georgia.
Dr. Suchitra Chandrasekaran is an associate professor in
gynecology and obstetrics and a maternal fetal medicine
specialist. She's also a member of the Society of Maternal
Fetal Medicine Health Policy and Advocacy Committee, and sits
on the Maternal Morbidity and Mortality Committee for the State
of Georgia.
And Dr. Aisvarya Panakam is an OB-GYN resident in
Pittsburgh, Pennsylvania, who originally hails from Cumming,
Georgia. Before beginning her residency, she obtained her
undergraduate education at Johns Hopkins University, completed
a Fulbright Fellowship, and graduated from Harvard Medical
School.
Before opening statements, we'll swear in the witnesses.
So, if you would all please rise and raise your right hand.
[Witnesses are sworn in.]
Let the record reflect that the witnesses have answered in
the affirmative, you may take your seats. We will now turn to
the witnesses for opening statements beginning with Dr. Verma
when you're ready.
STATEMENT OF NISHA VERMA, M.D., M.P.H., F.A.C.O.G.,
BOARD-CERTIFIED OB-GYN, AND FELLOW, AMERICAN
COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS,
ATLANTA, GEORGIA
Dr. Verma. Thank you, Senator Ossoff, and thank you all for
being here today. My name is Dr. Nisha Verma. I'm a board-
certified, fellowship trained obstetrician and gynecologist
providing full spectrum reproductive healthcare.
I'm a fellow with the American College of Obstetricians and
Gynecologists, a nonpartisan evidence-based professional
organization representing over 60,000 OB-GYNs.
I'm also a proud Southerner. I was born and raised in North
Carolina, and currently provide care in Georgia. And I've lived
in the Southeast for most of my life.
After the Supreme Court's Dobbs decision, with Georgia
enacting a law that bans most abortions in our State very early
in pregnancy, I struggle every day to provide necessary
lifesaving medical care.
I've seen young pregnant moms with worsening medical
conditions and couples whose deeply desired pregnancies are in
the process of miscarrying, be turned away or forced to leave
their communities to access needed healthcare.
As a doctor, I have the immense privilege of sitting with
patients and learning about their lives. For me, these patient
stories are a powerful reminder that abortion is not an
isolated political issue, and today I want to provide a glimpse
of how abortion restrictions impact real people.
Shortly after Georgia's ban went into effect, I saw a high
schooler that I'll call ``V,'' who realized after missing her
period that she might be pregnant. When she came to see me, she
unfortunately was just a couple days past Georgia's arbitrary
cutoff, which bans most abortions, after just 2 weeks from the
first missed period. I had to tell her that even though I have
the skills to help her, I can no longer perform her abortion in
our State.
Unfortunately, ``V'' was unable to find the resources and
support to leave Georgia for abortion care. Because of
workforce shortages in rural Georgia where she lives, she also
couldn't find a closeby doctor that could care for her for many
months. So even though ``V'' was forced to continue her
pregnancy against her will, she couldn't access the prenatal
care she needed to keep herself and her pregnancy healthy.
After delivering her baby, ``V'' struggled with postpartum
depression and had to move out of her home, drop out of school,
and work a minimum wage job to try to make ends meet. She told
me that she loves her son, but this is not the life that she
wanted or planned for herself. This story, while heartbreaking,
is not unique.
Over the past couple of years, I've conducted a research
study to learn about the experiences of patients with high-risk
pregnancies in Georgia who are attempting to access abortion
care.
Through this work I've heard women describe again and again
how Georgia's abortion restrictions exacerbate their suffering
in already devastating situations and leave them feeling
betrayed by a government and a healthcare system that is
supposed to protect them.
One participant, ``M,'' described breaking her water at 17
weeks when she had no chance of her baby ever developing lungs
that would allow it to live outside of her. She went to the
hospital but learned her doctors couldn't help her until she
started bleeding or developed an infection.
``M'' told me that, ``to be denied the basic medical care I
needed, to be told that I must first be at risk of dying, to be
forced to relive losing my baby every day for 5 days because of
Georgia's law, the trauma of that on top of my loss is
devastating.''
Another participant, ``A,'' discussed how Georgia's ban
rushed her into making a decision, instead of allowing her the
time to get genetic testing on her pregnancy. She shared that
her older son was diagnosed with a rare genetic condition that
destroyed his lungs when he was just a few years old.
Now, instead of starting middle school with his peers, he
is admitted to the hospital ICU and doctors have told ``A''
that he likely has less than a year to live. ``A'' describes
the pain of seeing her son suffer, and when she found herself
pregnant again, she knew that she could not have another child
affected by the same genetic condition.
However, because this condition does not qualify for
abortion care under Georgia's very narrow exceptions, and ``A''
could not risk leaving her son in the ICU to travel out of
State later in pregnancy, she made the decision to get an
abortion prior to Georgia's 6-week cutoff, before testing on
the pregnancy was possible.
It is clear that women who need medical care are suffering
because of Georgia's abortion restrictions.
We also know that these restrictions are not based in data
or science. In fact, in 2022, over 75 major professional
societies representing the overwhelming consensus of the
science-based medical community, came together to reaffirm that
abortion is safe, essential healthcare.
To make matters worse, doctors overwhelmed by laws that
threaten to make us criminals for providing evidence-based
life-saving care to our patients, are leaving their State.
In Georgia, where already over 50 percent of counties have
no OB-GYNs, where we have one of the highest maternal mortality
rates in the country, and where women, like my patient ``V,''
struggle to access prenatal care, these worsening workforce
shortages are devastating for all aspects of reproductive
healthcare.
I understand that abortion care can be a complicated issue
for many people, just like so many aspects of healthcare and
life can be. I also know that abortion is necessary,
compassionate, essential healthcare, and that patients are
capable of making complex, thoughtful decisions about their
health and lives. No law should prevent them from doing so.
Thank you for having me today, and I look forward to
questions.
[The prepared statement of Dr. Verma appears as a
submission for the record.]
Chair Ossoff. Thank you so much Dr. Verma. We'll now turn
to Dr. Chandrasekaran.
STATEMENT OF SUCHITRA CHANDRASEKARAN, M.D., M.S.C.E.,
SOCIETY FOR MATERNAL-FETAL MEDICINE, HEALTH POLICY
AND ADVOCACY COMMITTEE, ATLANTA, GEORGIA
Dr. Chandrasekaran. Thank you. Good morning, Senator
Ossoff, and Members of the Subcommittee. My name is Dr.
Suchitra Chandrasekaran. I'm a board certified and fellowship
trained maternal-fetal medicine or MFM specialist, and I'm here
today as a member of the Society of Maternal-Fetal Medicine to
describe the harmful effect restrictions on reproductive health
have on their patients, their families, and the clinicians that
care for them.
As an MFM, I actually provide care for pregnant persons who
experience complications that make their pregnancies high risk.
I proudly take care of pregnancies affected by maternal health
issues. They can range from hypertension, diabetes to cancer
and complex life-threatening heart disease. Throughout this
care, I perform ultrasound and provide genetic testing to
assess fetal well-being.
As an MFM practicing in Georgia, what I want to tell this
audience is that the Georgia abortion ban limits the ability of
myself and my colleagues to provide evidence-based care and
counseling, and significantly puts the well-being and lives of
our patients at unnecessary risk.
Having previously practiced in States where I could provide
full scope evidence-based care and counseling, I'm horrified
and deeply saddened by the situation and the lack of choices
our patients are given.
While I live and see these stories daily, I'm going to
bring up a few of them here. And I want to say, that while I am
using the word stories in this testimony for my patients, these
are not stories--these are real life nightmares and tragedies.
So previously I practiced in the State of Washington and
during one of those call shifts, I received a call about an
individual in her second trimester with a pre-existing heart
condition. This is actually pretty common in pregnancy, because
pregnancy is a time where your heart actually really changes
and that's often when pre-existing conditions might be
diagnosed.
This patient had inadequate healthcare coverage and so this
was the first time her condition was coming up. This was her
first pregnancy and this was her dream--her dream to be a
mother, to go through a pregnancy in a normal fashion.
But now she was facing her nightmare with a life-
threatening heart condition, scared for her health and her
baby's. Because of Washington State's protective abortion laws,
I was able to offer abortion as an option, as a choice for her.
After many days of a lot of thought, weighing her risks and
processes, she made the gut-wrenching and challenging decision
to terminate that pregnancy, to focus on taking care of her
heart so that she could potentially do this again.
Subsequently, this patient did have the opportunity to get
her heart condition fixed and had her next pregnancy. And I had
the personal joy and privilege of delivering that baby in her
next pregnancy. I had held this woman's dead fetus wrapped in a
knitted blanket in her first pregnancy. And I held her
beautiful baby boy in her second pregnancy and cried tears of
joy with her.
Fast forward 7 years, right, the dreaded morning of June
24th, 2022, when the United States Supreme Court released its
decision on Dobbs.
Right as we heard the news, my sonographer brought my next
ultrasound for me to review. This ultrasound was for a woman
who had not had access to insurance or care until the early
second trimester.
Access to healthcare is a major issue here in Georgia,
which is burdened by the presence of many obstetric deserts or
regions with limited medical access to prenatal-perinatal care.
This woman was excited and eager to see her baby. It's her
first ultrasound. I, however, saw a fetus with a significant
cardiac defect.
Although this baby would be born alive, meaning that the
case did not fit within Georgia's exception for medically
futile pregnancies, the prognosis and quality of life after
birth would be extremely limited. Even after multiple
surgeries, the long-term outlook for this kind of a heart
defect was questionable.
Ten minutes ago, before the scan, I would've counseled her
on all of the risks and the termination option of this
pregnancy. Ten minutes later, I walked into her room shell
shocked, at how the only practice and counseling methods I had
known for 15-plus years was now impacted. And I spoke to her
about my concerns for the fetus and what the cardiac defect
would mean for the infant when it was born.
As a doctor, my job is to support whatever decision the
person wants to make, whether it's to continue a challenging
pregnancy or whether to terminate. As a doctor, my job is to
inform of all the risks and outcomes.
But now, as a doctor, my ability to counsel and provide all
the opportunities was limited. My patient was in tears, knowing
the law had just gone into effect and I, too, only had tears to
share with her at that moment--and the nightmare had begun.
Even before the Dobbs decision, the high maternal morbidity
and mortality rates affecting the State of Georgia are well
known. One of the largest drivers of this rate is maternal
cardiac disease. Yet Georgia's ban forces women with very high-
risk maternal cardiac conditions to carry their pregnancies,
sometimes regardless of the dangers to a mother's health.
For example, I had a patient with a disease process called
lupus. In its severe form, it can significantly affect a
pregnancy and threaten maternal and fetal health, including
kidney, heart damage, or a very preterm delivery.
This patient had a severe aversion with significant heart
disease. She was in the late first trimester when she found out
about her pregnancy. She was scared, knowing her very serious
risk of becoming sick and facing health issues.
But now, even though she was only in the late first
trimester, I couldn't provide her all the options. I couldn't
provide her that full spectrum reproductive healthcare. I could
talk about it, but I couldn't realistically help provide it. My
hands were tied as a provider.
She didn't have the resources to obtain care anywhere else,
and in a State where maternal morbidity and mortality are
extremely high with cardiac risk factors, this abortion ban can
only worsen this issue.
In a State where maternal mental health is another key
contributor to morbidity and mortality, the trauma of being
stripped of autonomy to make critical personal health decisions
is real and long lasting. It's not just the now we have
affected, we have detrimentally impacted long-term maternal
morbidity and mortality in a State that already has high rates.
I'm committed to remaining in Georgia and providing the
best possible care for my patients in this challenging
environment. I have provided stories above. I have demonstrated
what success can look like when full scope care can be
provided. I have shown the aftermath of not being able to
provide that care.
High-risk pregnancies are unexpected, life-threatening,
emotionally traumatizing, and life-changing for all involved.
The current abortion ban in Georgia limits our ability to
provide the compassionate and full spectrum reproductive
counseling and choices to our patients and will only continue
to worsen the overall future health of pregnant persons in
Georgia. Thank you for having me today.
[The prepared statement of Dr. Chandrasekaran appears as a
submission for the record.]
Chair Ossoff. Thank you, Dr. Chandrasekaran. Dr. Panakam,
please.
STATEMENT OF AISVARYA PANAKAM, M.D., FIRST-YEAR
RESIDENT PHYSICIAN, PITTSBURGH, PENNSYLVANIA
Dr. Panakam. Good morning, Senator Ossoff and distinguished
Members of the Human Rights and the Law Judiciary Subcommittee.
My name is Dr. Aisvarya Panakam and I use she/her pronouns.
I'm a recent graduate of Harvard Medical School and a
current resident physician in obstetrics and gynecology at an
academic medical center in Pennsylvania. I'm testifying today
in my personal capacity and thank you for this opportunity.
I grew up in Georgia and I, too, am a proud Southerner.
After spending the past decade of my life studying in other
parts of the country, I was very eager to return home, to my
friends and family to complete my medical training. I'm here
today to explain why I chose not to pursue OB-GYN residency in
the South.
I was halfway through medical school when the Dobbs
position ended the constitutional right to abortion.
Immediately, trigger bans were initiated across the country,
including here in Georgia. Over the next 2 years, every single
Southern State instituted either a total ban or a prohibitively
early gestational age ban on abortion.
When it came time to apply for residency, many applicants
into OB-GYN, including myself, prioritized programs that offer
training in full spectrum reproductive care, which includes
abortion and miscarriage management.
It was a bitter day when I realized I wouldn't be able to
receive this training to the same extent in any Southern State,
including Georgia. Ultimately, I prioritized programs in other
regions of the country.
To contextualize why I made this choice, I would like to
share a few key facts. First, abortion is common. Prior to the
Dobbs decision, 1 in 4 women of reproductive age in the United
States was predicted to have an abortion by age 45.
Second, abortion is safe. It is one of the safest
procedures that a person can undergo. For abortion to remain
accessible and safe, reproductive health physicians, like
myself, must receive this essential training.
The need for comprehensive training is also recognized by
accrediting bodies. The Accreditation Council on Graduate
Medical Education, or ACGME, requires that all OB-GYN residency
programs provide their residents with comprehensive clinical
experience in abortion.
However, since the Dobbs decision, an OB-GYN in the South
now faces a myriad of uncertainties and often has more
questions than answers. Will I have sufficient case volume?
Will I learn to manage complex cases? Would I be able to
confidently perform this procedure on my own?
Residency is a difficult process in and of itself.
Additional roadblocks to obtaining necessary training will
continue to dissuade talented physicians from practicing in the
South and in other States with abortion restrictions.
It's important to recognize that abortion training gives
OB-GYN an additional skillset that they can apply to diverse
scenarios, including medical emergencies.
Even if an OB-GYN does not regularly perform abortions in
their clinical practice after training, if they are trained in
procedural abortion, they will be better equipped to manage a
variety of different conditions. This includes miscarriage,
hemorrhage, infection and many more. Training in abortion makes
for a capable OB-GYN.
Georgia must prioritize the development of OB-GYNs because
its maternal health outcomes are among the worst in this
country. Half of Georgia's counties lack a single OB-GYN,
leaving 1 in 3 women without access to essential healthcare.
The sad truth is that Georgia desperately needs more OB-GYNs,
but it is failing to attract them.
In 2022 to 2023, applications to OB-GYN residency in
restricted States decreased by 5.6 percent. A recent survey of
medical students applying into OB-GYNs shed light on a major
reason: 73 percent of survey respondents reported that the
Dobbs decision affected which programs they applied to, and
this is the case for myself, as well.
I am deeply concerned about the dangers that Georgia's 6-
week abortion ban creates for women. As a medical student in
Massachusetts, I helped care for a Georgia woman whose fetus
was diagnosed with severe genetic anomalies, even though it was
well understood that her fetus would die either in utero or
soon after delivery. She was unable to receive an abortion
because her fetus still had a heartbeat.
It took her several days to arrange childcare for her young
daughter and for her and her husband to come up to
Massachusetts, get a hotel room, and get an appointment at the
clinic that we were at. When she arrived to our clinic, her
fetus had already passed and had been dead for several days.
She was admitted to the ICU for a life-threatening clotting
disorder called disseminated intravascular coagulation, as well
as massive immune dysregulation in the form of sepsis.
Georgia's abortion ban jeopardized her life by delaying her
access to care. She survived. Others have not.
This case reaffirmed my commitment to train in a place
where abortions can be accessed by women who need them. I speak
on behalf of the tens of thousands of medical students and
physicians who are currently in the training pipeline, and who
will make up the future healthcare workforce of this country.
States that severely restrict abortion access will struggle
to attract and retain OB-GYN physicians. This will cause
shortages to their physician workforce.
I made the difficult decision to not return home for my
medical training. A lot of my peers have done the same. With
the support of our lawmakers, we can expand abortion access,
which in turn will help reverse this exodus of students,
doctors, and health professionals leaving restricted States.
Thank you for having me today, and I look forward to your
questions.
[The prepared statement of Dr. Panakam appears as a
submission for the record.]
Chair Ossoff. Thank you, Dr. Panakam. And thank you, all,
for your opening statements.
I'd like to begin with, with a yes-or-no question for all
of you. In your opinion, does Georgia's 6-week abortion ban
endanger the lives of pregnant women in Georgia? Dr. Verma?
Dr. Verma. Yes.
Chair Ossoff. Dr. Chandrasekaran?
Dr. Chandrasekaran. Yes.
Chair Ossoff. Dr. Panakam?
Dr. Panakam. Yes.
Chair Ossoff. Dr. Verma, Georgia's abortion ban contains an
exception for medical emergencies, which the law defines as,
quote, ``a condition where an abortion is necessary in order to
prevent the death of a pregnant woman, or a substantial and
irreversible physical impairment of a major bodily function of
the pregnant woman.'' Given that exception, why do you believe
Georgia's law nevertheless endangers the lives of pregnant
women in our State?
Dr. Verma. For that question, you know, as doctors, we
train for years and years and years to be able to sit in front
of the patient in front of us and help them and their families
make these complex individualized decisions.
Medicine is incredibly complicated. That's why we trained
for so long. There's not a line in the sand where someone goes
from being totally fine to acutely dying. A lot of times it is
a continuum, and doctors, because of this law in Georgia, are
forced to question, when can I intervene? How sick is sick
enough? How much bleeding is too much bleeding? That delays
care that forces patients to get sicker.
Georgia's exceptions in our abortion ban are incredibly
extreme, and we've seen in the data, as well, that even when
these types of exceptions exist, people with high-risk
pregnancies are still denied care and have a harder time
getting the care that they need.
Some are forced to continue very high-risk pregnancies.
Some are forced to leave their communities. And all of that
leads to people getting sicker and sicker.
Chair Ossoff. Thank you, Dr. Verma. Dr. Chandrasekaran, can
you weigh in here, where the so-called exception in the law, in
cases where a pregnant woman's health is severely at risk, but
perhaps not yet meeting this restrictive emergency standard?
Dr. Chandrasekaran. I think this goes to the concept that
biology is gray. Biology is not black and white. It's not a
mathematical equation. If our bodies were mathematical
equations, we could be running this very differently. And when
biology is gray, pregnancy, which is now putting two lives, a
mom, and a child, and making them interact with each other in a
relationship of sorts, is extremely gray.
So when we say words such as ``irreversible'' or
``futile,'' oftentimes by the time you've hit irreversible and
futile, mom's life is already at significant risk. You've taken
away her choice and capacity to make a decision to potentially
avoid hitting irreversible and futile. And I think that's the
challenge with the current abortion ban, and that's what
directly affects overall maternal health--mental and physical.
Chair Ossoff. Thank you, Dr. Chandrasekaran. And on that
point, with respect to, quote, ``medically futile pregnancy''--
and that's the term in Georgia's extreme 6-week abortion ban.
A quote from the statute is, ``in reasonable medical
judgment, an unborn child has a profound and irremediable
congenital or chromosomal abnormality that is incompatible with
sustaining life after birth.''
Does this exception meaningfully allow doctors in Georgia
to provide adequate care, when a fetus has been diagnosed with
a serious defect?
Dr. Chandrasekaran. Unfortunately, not. Because again,
fetal--fetal diagnostics is also a gray territory. When we see
a heart defect, we can say what we overall think the prognosis
might be.
But when we use words again such as futile, irreversible,
irrevocably, what does that mean? How are we protected under
that? How do you define that?
Biology changes. What might feel irrevocable to somebody
may not be to someone else, and that becomes a very personal
decision between a physician and the patient on what are they
looking at? What are the outcomes for this fetus looking like?
And so unfortunately, when we use those words, it doesn't
provide capacity to help the majority of our situations.
Now, the extreme situations are an exception. But the
majority of our situations fall into, ``We think this would be
the prognosis.'' ``This is the likely situation to happen.''
``This is likely the outcome.''
That doesn't get covered.
Chair Ossoff. Thank you. Dr. Verma, Georgia's law also
contains a so-called exception for, quote, ``removing a dead
unborn child caused by spontaneous abortion,'' end quote. Does
this exception meaningfully empower Georgia physicians to
provide medically necessary care for miscarrying patients?
Dr. Verma. It's a great question. I have absolutely seen
situations where patients in the process of miscarrying are
turned away or delayed from getting the care that they need in
Georgia. Again, all of this is really complicated, I think
that's why we keep going back to, medicine is incredibly
complicated.
So I've had situations where a patient presents to the
hospital, their cervix is opening, they're bleeding, they may
have broken their water, but that pregnancy still has cardiac
activity or a heartbeat. And there's a lot of uncertainty about
whether doctors can act in that situation, when in that
scenario they can act.
I've had patients, like some that I shared today in my
testimony, that are turned away even though they're in the
process of miscarrying, because that cardiac activity is still
present and they're told you have to start bleeding more, you
have to get sicker, you have to develop an infection.
And so often people are miscarrying, that's a process. And
we are having to wait until later in that process until they
get sicker, until they have more bleeding, until they have an
infection, until we can intervene, instead of working with that
patient to figure out what their needs and desires are, and
when in the process it works for them for that treatment to
happen.
Chair Ossoff. Thank you, Dr. Verma.
Dr. Chandrasekaran, miscarriage management in Georgia's 6-
week abortion ban. What's been your assessment and experience?
Dr. Chandrasekaran. I think I can only echo what Dr. Verma
has said. Here again, the term miscarriage encompasses a
spectrum of situations. And so it can start with bleeding, it
can start with continuing to have a heartbeat, it can start
with water breaking at a time in your, you know, mid-second
trimester, where now the fetus, even if it were born, what
would that look like in terms of lung development?
And then comes the question, a common discussion we have,
how much bleeding is too much bleeding? Are they stable?
The other key thing to remember with--I always say this
with pregnancy, is what seems normal 2 minutes before, can
change in pregnancy very fast.
And so when we have these restrictions and you're told you
have to wait until a tipping point, oftentimes once you've hit
that tipping point, you've hit a point of severe discomfort,
damage, and physical damage to mom. The procedure has become
more complicated to do at that time, and now you have extra
care issues and extra health issues going on.
So I think I can only repeat, it's complicated. It's not a
black and white issue. And when we've taken away that
discussion capacity between the physician and the patient to
have that choice on what is best for the patient in that
situation, by putting words that have to define that situation.
It is inhibiting and limiting capacity for care.
Chair Ossoff. Thank you. Dr. Verma, in your testimony you
stated that Georgia's law threatens to make criminals out of
doctors for providing necessary lifesaving care. Do doctors in
Georgia fear the threat of criminal prosecution for providing
necessary reproductive healthcare to pregnant women?
Dr. Verma. Absolutely. So we are practicing in incred--
again, we've said again and again, medicine is incredibly
complex. We are trying to navigate this complexity under a law
that says, if some--if a lawmaker or an attorney general
decides we have made the wrong decision, we acted too soon, the
consequences are criminal prosecution or having your license
removed, your livelihood threatened.
And that's creating a huge chilling effect for doctors
across the State. And so again, I've seen doctors that are
limiting their scope of practice or saying, I'm just not going
to take care of pregnant people anymore. I'm going to only do
GYN care because they're so afraid of those very extreme
consequences that makes the care deserts even larger in our
State.
I've talked to physicians that are leaving the State
completely because they're so afraid. And then I've seen
doctors that are not able to take care of patients, that have
to transfer them out of State, or transfer them to another
hospital, and those patients get sicker and sicker.
And so, when we're trying to figure out, again, where in
that ``how sick is sick enough we can intervene,'' we know what
the right thing to do is, medically. Right? That's what we
train for, for all of these years, to work with our patients
and make these medical decisions with our patients, with their
families.
That's not the question. It is, what is this law that
actually doesn't make any sense--that wasn't written by medical
people? When does the law say I can intervene? And none of us
know the answer to that.
And so navigating this environment is incredibly scary and
confusing.
Chair Ossoff. Thank you, Dr. Verma.
Dr. Chandrasekaran, you testified that you had a patient
with severe lupus, which could have had significant impacts on
maternal and fetal health. Can you explain in more detail what
kinds of complications this patient risked as a result of being
forced to continue her pregnancy with severe lupus?
Dr. Chandrasekaran. Yes. So again, biology is complex and
lupus is a process where for some reason your body thinks its
own cells are not its own and seems to want to attack it, those
are called autoimmune diseases.
And so, when you're undergoing a pregnancy which has its
own physiological changes to your body, sometimes the body can
turn against its own organs and really important organs--like
the heart and the kidneys and the lungs.
And when that happens to mom, obviously that's going to put
mom's life at significant risk. And then if mom's life is at
risk, oftentimes that means we need to do a delivery because
the pregnancy's adding to risk. And that can mean delivery of a
baby at a very scary gestational age where the baby's life is
at significant risk because baby isn't developed enough.
And so, these are very real situations that families can
face leading to kind of long-term consequences for all the
caretakers involved in that situation.
Chair Ossoff. And as you know, as we've discussed,
Georgia's law includes an exception for circumstances where
termination is necessary to prevent a patient's death or,
quote, ``substantial and irreversible physical impairment of a
major bodily function.''
Yet you were unable in that case, to offer termination as
an option to your patient with a condition that, as you just
described to us, created a risk of severe health complications.
Why was the exception insufficient in this case? And how
does the extremely narrow scope of this exception force doctors
to put women in a position where they may continue to bleed,
continue to be in pain, continue to take on greater and greater
risk of irreversible harm, but doctors are unable to help?
Dr. Chandrasekaran. The words, again, we use are,
substantial and irreversible. Right? So I've taken care of many
lupus patients now in my 15-plus years of practice. Some of
them have severe issues. Some of them may not. Severity ranges
on a scale.
So when we say substantial and irreversible, I'm going to
go back to the question, what does substantial mean? And this
is where that gray territory comes. We know kind of what
substantial means.
I can talk to a patient and say, look, your chance of
having cardiac failure might be this much. Your chance of
having renal damage might be this much.
But what defines substantial in terms of the law? And also,
what is substantial to each individual person in terms of the
damage I'm giving them?
I never have a crystal ball. If I had a crystal ball, I
could tell you exactly what's going to happen--we don't in
medicine. And especially in a field like OB where you're
dealing with two basically living organisms working kind of
symbiotically with each other. And so when we use those words,
it really limits that scope to feel safe in knowing what
defines substantial when that can vary in and of itself.
Chair Ossoff. You described a patient whose fetus had a
severe congenital heart abnormality and might either pass away
in utero or survive and need extensive medical intervention
with highly uncertain prospects for survival.
The patient did not have the choice to terminate the
pregnancy under Georgia's law. Why wouldn't that fall within
Georgia's exception for a medically futile pregnancy? And if
the fetus survived past birth, perhaps requiring intensive
neonatal care, perhaps in immense pain, what would that baby's
quality of life look like?
Dr. Chandrasekaran. So, again, the law puts the word
futile, and so it is hard to predict that futility. Sometimes,
yes, these babies can pass away in utero, sometimes they can
pass away right after birth, and sometimes they might do okay
with a surgery or so in terms of living.
But then that could mean, are they actually ever able to
come home? Do they need to stay in an ICU the whole time? How
are they recovering post-surgery?
Some of these babies can stay in a hospital for even a year
up to post-birth just undergoing surgeries and undergoing care.
So what does that put upon that life, that child, that family,
that again is not covered in that medically futile?
If you ask medically futile, some of us can be at
institutions where you can define certain diagnoses that yes,
this is a hundred percent medically futile. Again, 99 percent
of what we do, we can't predict that word medically futile, but
we know that the risks are extremely high.
Chair Ossoff. This conversation has been focused on legal
terminology, complex medical dynamics. Your patients are human
beings with immensely powerful emotions surrounding their
pregnancy and their health.
What's it like as a doctor who cares about them to look
into your patient's eyes, who are experiencing a health crisis,
who have learned that their fetus may have a severe health
complication, and not have a choice or be able to offer them a
choice in those extremely difficult situations? What are those
conversations, like that?
Dr. Chandrasekaran. It's horrific. It's horrific. It's--
it's awful.
It's almost degrading as a physician to not be able to do
what you feel you need to do. And you're watching for what's
protecting you in terms of a law. We will always do the best
for our patients. I can say that as a physician, we will always
do the best for our patients. We will always have open
discussions.
But, to practice in a situation with an umbrella above you,
that is limiting those discussions and having you also carry
some of that emotional trauma and burden with your patient as
you both are trying to navigate this with their families, is
unfortunately a very horrific situation in the State and one
that I agree with Dr. Verma, is potentially going to drive away
good physicians from our State.
Chair Ossoff. And we'll explore that dynamic more soon with
Dr. Panakam.
But Dr. Verma, you stated that you see young mothers who
have worsening medical conditions that make their pregnancies
high risk, or who are miscarrying being turned away by doctors.
I think it's--I think it's critically important that the
public understand that miscarrying women are being turned away
by their doctors in this State right now because of this
extreme abortion ban, or forced to leave their communities in
order to access care.
We heard a story recently about a pregnant woman who had to
travel to Massachusetts, and the fetus died in utero on the
way, putting her at extreme risk upon her arrival out of State.
Why are doctors in Georgia, Dr. Verma, turning away pregnant
women in these circumstances?
Dr. Verma. I think it goes back to how confusing these laws
are. There is no way to create a law that takes every
individual, every medical situation, every family into account.
And so you can put into a law, you know--I've heard lawmakers
who created these laws often say, well, there are exceptions.
And so people that need care will get care.
One, I take care of patients who need abortion care for
many different reasons. I would say the vast majority of them
are excluded from getting care under this law. And the
exceptions don't solve that problem. They're incredibly
confusing, they don't make sense to the practice of medicine.
We talked about how miscarriage is often a process. There
could be a time in that process when there's still a heartbeat
or cardiac activity and doctors don't know if they can
intervene. When we talk about medically futile pregnancy,
there's no consideration of quality of life. Right?
So the patient I discussed that wouldn't qualify under
Georgia's law because her baby once born could potentially live
for years. But she would have to watch that baby suffer and
die, if the baby was affected with the same genetic condition.
And so the quality is not taken into account at all.
When we talk about the medical emergency exception, it is
incredibly extreme and there are many people with high-risk
pregnancies that aren't yet in that category of being, you
know, immediately at risk of death.
One example I'll bring up, I had a patient with pulmonary
hypertension, which is the condition where your lungs don't
work correctly, your risk of death, if you continue the
pregnancy, is as high as 50 percent. When we see that patient
at, for example, 6 or 7 or 8 weeks, she often hasn't gotten a
chance to get very sick yet.
Can we provide an abortion then? Or do we have to turn her
away and say, come back when you get sicker, when your lungs
aren't working anymore, when you have that 50, you know, when
you are actually at risk of immediate death?
The right thing to do medically is to offer that patient
the options of termination or continuing a pregnancy when we
see her at 6 weeks. But under the law, it's often unclear if we
can do that.
The last thing I'll just mention, I do think it's really
important to recognize how this law takes these really
important risk assessments away from people. So all of us take
care of patients with very high-risk pregnancies, who choose to
continue those pregnancies. And our job is to support them and
optimize their health and the health of their pregnancies. But
that's a decision that a person should be able to make. Right?
And we also have patients who say, ``That risk of
continuing that pregnancy is too high.'' ``I cannot risk dying
and not be around for my existing children and my family.'' And
that's also something that that person, not the State, should
be able to choose to do. And so, it's not that people can't
continue risky pregnancies, but that is a decision that people
should be able to make.
Chair Ossoff. You mentioned that many patients who have
been denied care have expressed a sense of betrayal, too. Can
you elaborate on why patients might feel betrayed in those
circumstances?
Dr. Verma. Absolutely. I think when people go to the doctor
they expect to be able to get compassionate, evidence-based
medical care. And, to be told, you can't get the same care that
someone could get, for example, in Massachusetts where I
previously practiced, or in Delaware, you can't get that care
here.
Not because it isn't evidence-based, not because I don't
have the skills to do it, but because our lawmakers have
decided you don't deserve that care. You can't get that care
here. That is a huge sense of betrayal. Right? I, I feel
betrayed not being able to provide the care, patients feel
betrayed.
We've created an environment in this country where your
access to evidence-based care depends on your zip code, and
your resources, and whether you can get out of State.
Chair Ossoff. Thank you, Dr. Verma.
Dr. Panakam, you described a case, we just referred to it,
again, that you witnessed at a clinic in Massachusetts, where a
Georgia woman traveled to terminate a pregnancy after finding
out her fetus had been diagnosed with severe abnormalities.
She wasn't able to terminate the pregnancy in Georgia, had
to travel to Massachusetts instead, and by the time she arrived
in Massachusetts, her fetus had been dead for several days.
Why wasn't this patient able to terminate her pregnancy in
Georgia, under the exception for a medically futile pregnancy
in the Georgia law?
Dr. Panakam. So, although this patient had a fetus with
severe genetic anomalies, and it was well understood by all
providers that the fetus would die in utero, or soon
thereafter, she was not able to access an abortion because her
baby still had a heartbeat. And that is the reason why she had
to arrange alternate forms of clinical care and why she had to
travel out of State.
And ultimately that delayed her care by several days. And
in that time period, her pregnancy had deteriorated and she
didn't even realize it until she ended up becoming very sick.
Chair Ossoff. And what risks was she then faced with after
the demise of the fetus in utero?
Dr. Panakam. So a demise of fetus in utero increases the
risk of several alarming pregnancy complications. One is
hemorrhage, so the risk of excessive bleeding. The second is
infection, which is what happened to her. She had an
uncontrolled infection because we were not able to evacuate the
uterus and take out the source of her infection in a timely
fashion. And as a result of that, she developed a systemic
infection that almost cost her her life.
Chair Ossoff. As a physician and as a Georgian, how did it
make you feel to see a patient who was septic, whose life was
now at risk because she'd been unable to access evidence-based
care in her own State?
Dr. Panakam. It was really demoralizing. She was the first
patient that I saw as a medical student from Georgia, and she
suffered the worst consequence out of all the patients that I
had taken care of in that clinic.
That patient, and many others like her, are the reason why
I decided not to come back to Georgia for my medical training.
Because I want to practice and I want to learn in a State where
I can offer people the full spectrum of options and help them
achieve the highest standard of health possible for them.
I don't want my hands to be tied by a law, by legislators,
by people who have very little understanding of medicine. And
because of that, how my patients suffer as a result.
Chair Ossoff. And just to be clear, sepsis, after demise of
the fetus in utero, this woman could have died. Correct?
Dr. Panakam. Absolutely. Sepsis is a leading cause of death
in the United States. People often die from extremely,
extremely low blood pressures, which we call septic shock or
organ failure. And in her case, she was able to bounce back.
But not everyone is so fortunate.
Chair Ossoff. Did Georgia's 6-week abortion ban put your
patient's life at risk?
Dr. Panakam. Absolutely. She wanted an abortion. She was
not able to receive it in time, and as a result, her health
deteriorated and she could have died.
Chair Ossoff. You mentioned that you'd wanted to practice
in your home State. And, as we heard earlier--you may have
mentioned it, perhaps it was Dr. Verma--half of Georgia
counties have no OB-GYN.
We heard Dr. Verma's story about a patient in rural Georgia
who, being unable to access an abortion, was then marooned,
without access to prenatal care--that increases risks for
pregnant women.
You wanted to come practice where you were from, but you
chose not to because of our State's abortion ban. How did it
make you feel to be unable to choose to come and practice
medicine in your home State where we have a dire need for
professionals with your skills?
Dr. Panakam. I'm a good example of someone who wants to
stay in Georgia. This is my community. The people I love are
here. And I always envisioned a life here taking care of
people. But that vision is not superseded by my need to do the
right thing for my patients and my need to develop a skillset
where I can respond effectively to medical emergencies, where I
can appropriately advice and counsel my patients on the next
step in their pregnancy and in their care.
And unlike my colleagues, I'm still very early in my
training. And so, I speak from a place of potential. What is my
potential to respond in the scenario? What is my potential to
take care of people down the road? I make my decisions based
off of who I want to be in a few years, in a decade, in a
lifetime of service. And so, at this point, that is--that
person I want to become requires training outside of a
restricted State.
Chair Ossoff. And how did seeing this patient who had to
travel from Georgia to Massachusetts, is septic, whose life's
at risk because of Georgia's abortion ban, how did that
influence your decision not to come home and practice OB-GYN
medicine in Georgia?
Dr. Panakam. So the providers at the clinic I was working
at knew how to respond to the scenario. They were extremely
skilled in both the surgical management of her abortion, but
also, you know, taking care of her when she was admitted to the
ICU.
And I think we will see that more and more OB-GYNs are
finishing their training in restricted States without a comfort
level in offering or providing abortions. And that is due to a
lack of exposure and training within their residency programs.
I think that the patient I saw is one of many people who will
not access this care because it is no longer legal where they
come from.
But in turn for each of these patients, I think we will see
many doctors who are not able to offer that care, because they
were not trained in it or maybe they had some exposure, but
that's not something that they feel comfortable doing
independently without supervision.
Chair Ossoff. Thank you, Dr. Panakam.
Dr. Chandrasekaran, as you know, Georgia has
extraordinarily high rates of maternal morbidity and mortality,
meaning women in Georgia have high rates of health
complications and death related to pregnancy and childbirth.
Why are women in Georgia at such high risk of adverse
outcomes from pregnancy and how do you expect Georgia's 6-week
ban to affect maternal mortality and morbidity in Georgia?
Dr. Chandrasekaran. Georgia's maternal morbidity and
mortality rate is complicated, and it's layered. But many
things contribute to it. I would say from kind of starting at a
large eagle's eye view, access is a big issue. We've brought it
up over and over again.
So, 6 weeks, to give context, is a time where many women
don't even realize they're pregnant yet. Symptoms are barely
starting at that time.
So, by the time they've realized they're pregnant and now
potentially found a physician who can help them due to access,
we're delaying care to be able to intervene or make decisions.
So access is probably one of the big reasons for maternal
morbidity and mortality.
Along with access then comes ability to give that care. So
once access is gone, care isn't able to be given on time.
That's also contributing to our issues with maternal morbidity
and mortality. And then when care is not given on time, that's
affecting overall health at a very granular level. So increased
rates of diabetes, obesity, hypertension, all these
cardiometabolic processes that contribute to pregnancy.
So it's a tiered model of what's causing that risk. And the
abortion ban is only going to feed into all levels of that
model.
Chair Ossoff. Dr. Verma, how do you expect Georgia's 6-week
abortion ban to affect maternal morbidity and mortality for
pregnant women in Georgia?
Dr. Verma. It's expected to worsen maternal morbidity and
mortality in a State where we are already facing these terrible
rates, terrible outcomes for pregnant patients. We've seen in
the data that States that have abortion restrictions also tend
to be the States that have worse maternal mortality and
morbidity rates. And again, this is complex. It is very complex
and there are multiple things that play into that.
But having that limited access to care, whether it's
abortion care or prenatal care, definitely contributes to
worsening outcomes for our pregnant people.
Chair Ossoff. Dr. Verma, in your opening remarks, you
described a young patient who was compelled by Georgia's law to
continue an unwanted pregnancy, but was unable to access
prenatal care while she was pregnant because she lived in a
part of a State without sufficient doctors, without sufficient
clinics and expertise. What are the risks to pregnant women in
Georgia who are unable to access prenatal care?
Dr. Verma. There are many risks to not being able to access
prenatal care. Pregnancy is a time where, for many women, it is
the highest risk thing that they're going to do. There are
multiple complications that can come up. There are multiple
issues that can come up that make that pregnancy higher risk
for the patient that--or for the pregnancy itself.
And so prenatal care is incredibly important. This patient
had Medicaid, so she had insurance, she had Government
insurance, and there was no one in her part of the State,
closeby that she could get to easily as a teenager, who took
Medicaid. That is a huge shame. Right?
It--she had insurance from the Government and couldn't get
prenatal care when she was forced to continue her pregnancy. I
think that's also part--all of that combined has also
contributed to her developing postpartum depression.
We know that mental health conditions are one of the
leading causes of maternal morbidity and mortality in our State
and in the country.
Mental health conditions are specifically excluded from
Georgia's medical emergency exception. So Georgia, as a State,
has decided mental health is not--it's good enough to count for
an exception.
So if a patient is experiencing severe depression, is at
risk of suicide, that does not count as an example of when we
can provide care. And so this patient after this whole
experience, then experienced postpartum depression, that put
her life and her health and the health of her baby at risk as
well. And this isn't unique. Right? We're seeing this happen
again and again and again.
Chair Ossoff. Thank you Dr. Verma.
Dr. Panakam, did I hear you correctly earlier that OB-GYN
residents in States like Georgia, with extreme abortion bans,
often have to travel out of State to meet their own educational
requirements?
Dr. Panakam. That's correct, Senator. OB-GYN residents are
caught in a really awkward situation where they need to receive
this essential training, but they're not legally allowed to do
it in the location in which they are training. This often
necessitates them applying to away rotations in other States.
This is a very onerous process.
You have to do licensing again. It's expensive. You have to
find alternate housing. If you have children, you have to find
childcare and leave behind your family for several weeks to
months at a time.
And even if you can do all of that, there's a good chance
you'll be denied. Because there are not enough training spots
in other States. The system only has so many slots, and right
now cannot accommodate people coming up from out-of-State,
across the board.
So this is going to limit many people's ability to access
that training. Not everyone can travel out of State, and not
everyone will be granted the opportunity. They will not even be
granted a slot in order to do that. So it will restrict the
training of many physicians in this country.
Chair Ossoff. I would note, Dr. Panakam, applications for
OB-GYN residency slots in Georgia decreased by almost 10
percent in the 2023-2024 application cycle. Do you believe that
your peers are being deterred from applying for residency in
States like Georgia because they're unable to access the
training they need? They may be unable to provide the care
their patients need? They may face criminal prosecution?
Dr. Panakam. Absolutely. As I said earlier, abortion is
common. So training in abortion is a commonly sought out
experience by people going into reproductive healthcare. And
our training in a variety of different procedures will
determine what we can do as independently practitioning
physicians.
So we don't want to artificially restrict our skillset, our
medical knowledge, by legal restrictions. We want to understand
what the entire scope of evidence-based medicine is in OB-GYN.
And at this point, just entering the field, it seems like a
really tough pill to swallow, to go to a State where you won't
be able to train in the entire spectrum of OB-GYN care. And as
a result, many people are not coming to the South and to other
restricted States when they otherwise had planned to.
Chair Ossoff. Dr. Chandrasekaran, we just heard it
firsthand from an OB-GYN intern who decided not to train in her
home State. How do you expect the ban to impact recruitment and
retention of OB-GYNs in Georgia?
Dr. Chandrasekaran. Yes, thank you. That's a real important
point. It's going to continue to negatively impact us. I think
the hard part about this is you may not see that effect in 2
years, 3 years, 5 years.
You have those of us that are here a little longer, that
might still be doing this. But then comes that, you know, kind
of the pipeline. Right?
Who's coming behind us? Who can we bring? Who can we train?
How do we build up?
That impact may not be seen again tomorrow, or in a year.
But in 5, 10 years, I think this is going to be a huge impact
for a State that is already struggling.
Chair Ossoff. Dr. Verma, how about retention? We've been
focused on recruitment. Retention of an OB-GYN workforce in
Georgia now facing potential criminal prosecution for providing
healthcare.
Dr. Verma. Absolutely. You know, I think that some
physicians in practice are thinking about leaving--I think a
lot of physicians. Right? This is their home. This is their
community. They have houses here. They have families here.
Their kids are in school. And they aren't able to leave.
But people are also--I've talked to folks that are retiring
early or that are limiting their scope of practice. And that,
in addition to doctors leaving the State completely, limits
patient's abilities to get care. And so we're seeing all of
these things combined affecting our workforce.
As someone who mentors medical students and residents, you
know, I've had many people in the same situation where they
say, should I stay in Georgia for residency? This is my home.
This is my community.
And I, you know, I tell my mentees, I don't think you can
get the same level of training in abortion care anymore as you
used to. Like, I think--I think, you know, if I was making the
decision now, I would leave, get the training, and potentially
come back. But also, that's unclear. Right? Like it's a scary
environment to practice in.
Chair Ossoff. And I should note that was a 10 percent
reduction in residency applications across all specialties. Dr.
Panakam, why did you want to be a doctor?
Dr. Panakam. I wanted to be a doctor, in part, because of
my experiences growing up here in Georgia and seeing people not
being able to access healthcare, especially in rural
communities.
I studied public health in undergrad and I found medicine
as an extension of that. Doctors have an incredible platform to
educate, to take care of people, to directly change the course
of a community. And that's the reason I decided to go through
the long process of applying to medical school and complete
training.
I've already been in this for about 10 years and I have at
least four more to go and I would do it all over again. But I
think what is challenging at this point is that we are not
actually able to provide high-quality care, evidence-based
medicine to a lot of our patients.
And, you know, in regards to what you had said earlier
about how this might affect physician retention, we know that a
lot of doctors stay to practice in the same State where they
completed their training. This is well documented.
And so, if you are failing to attract physicians to come
and train in your State, you are also failing to potentially
fill many supervising physicians' slots in a handful of years.
This is something as Dr. Verma had mentioned, and Dr.
Chandrasekaran. It takes several years to see the effects, but
it will come in time. And we're already starting to see some of
these effects now.
Chair Ossoff. And you wanted to help people, you've entered
this field, you've worked so hard to get these qualifications,
you haven't been able to come and train in your home State.
How does it make you feel as a young doctor to know that
Georgia women are being forced to endure pain, risk of
hemorrhage, risk of sepsis, as you laid out, that doctors in
the exam room across from them have to look in their eyes and
tell them that they face serious and uncertain risk of
potentially fatal complications, but that the doctor's hands
are tied by politicians. How does it make you feel to know that
that is the situation facing physicians and patients in your
State?
Dr. Panakam. It is deeply demoralizing. Personally, I feel
very guilty for not coming back. This is my community. I've
always wanted to come back.
And I feel like I've failed a lot of people as a result. I
hope to come back one day. But I think that it's difficult
without changes to the existing laws here.
We want to do the right thing by our patients. You know,
physicians work really hard and train for a very long time so
that for every single person that walks through the door, we
can counsel them appropriately. We can take their medical
history into account, we can take their social circumstances
into account, and offer them the best choice for them.
And by restricting abortion access, and also by restricting
training in abortion as a result, you are stripping that away
from thousands of physicians practicing in restricted States.
And it causes a lot of distress. It is something that keeps a
lot of us up at night, you know, and it's a leading reason why
I think people decide to leave.
It's hard to go to work every day and realize you're not
offering your patients the level of care that you would expect
to, that you would hold yourself to, if you could. And the
emotional consequences of all of this, I think should not be
taken lightly, as well.
Chair Ossoff. Thank you, Dr. Panakam.
Final question for each of you, beginning with you please,
Dr. Verma. What do you think lawmakers should know about the
impact of abortion bans like Georgia's extreme 6-week abortion
ban?
Dr. Verma. Thank you for that question and for this hearing
to bring attention to this issue. I think we, as doctors, are
here trying to provide the care that we can to our patients. We
are trying to get people in quickly within that often
impossible 6-week timeline. We are trying to do whatever care
we can. We're trying to get patients out-of-State when we can't
provide them care here.
And my colleagues and I, you know, we're going to continue
to do what we can.
But the law has to change. It is limiting practice. It is
hurting people. You know, I get that abortion is complicated
for a lot of people, and it's okay to feel that complexity and
to also recognize that people are the experts in their own
lives and should be able to make these decisions about their
healthcare and their lives. And those things can exist
together.
There are so many reasons why people need abortions, and we
are just in a terrible environment where we are trying to do
what we can. We will keep trying to do what we can to support
our patients.
But as you've heard, it is an incredibly difficult
environment and people are struggling and the laws have to
change. We have to get to the polls. We have to do what we can
to change the laws.
Chair Ossoff. Thank you, Dr. Verma. Dr. Chandrasekaran.
Dr. Chandrasekaran. Thank you for that question. And again,
thank you for this hearing and bringing attention to this. Of
course, I echo what Dr. Verma said, but I want to add to that.
I think, again, biology, human systems, a pregnancy,
literally all the physiologic changes a maternal body and a new
being, a fetal being growing inside that body does to your
body, is not a machine.
It's not black and white. It varies. And putting laws on a
system that is extremely volatile and changeable and not
identifiable as yes-no, black-white, it is only going to lead
to tragedy.
And so, this is not a situation where law can cover all the
factors and the facets that we need to cover. That's why this
is medicine and it's not law.
Chair Ossoff. Dr. Panakam.
Dr. Panakam. I think I want to end simply by saying,
abortion is healthcare. And healthcare should be determined by
doctors, not by legislators.
There is a body of evidence that we follow, you know,
decades of research, of advocacy, that have gone into why we
think the way we do, why we offer certain procedures at certain
times, and not in other scenarios.
And I think it was incredibly concerning that people
without medical knowledge are now restricting our ability to
provide evidence-based care. They're not speaking from a place
of knowledge.
And as a result, real people are affected. Real people are
getting sick. Real people are having unwanted pregnancies. And
real people are dying.
And in order for all of this to change, we, as Georgians,
and as you know, all residents in this country, you have to
make it known that this is not--this is not something we will
stand for. This is not acceptable. And that we should leave
reproductive healthcare in the hands of physicians who have
worked very hard and very long to achieve the level of
knowledge needed to make those decisions.
Chair Ossoff. Thank you, Dr. Panakam.
I want to thank each of you for not just participating in
today's hearing, but also for dedicating your careers to the
health of your pregnant patients.
And I have a sense of just how hard you've worked and how
many extraordinarily long call shifts you've endured, and how
many 3 a.m. trips to the hospital to ensure that a laboring
patient has a safe delivery you've made, and just how much of
your lives you've invested in helping people.
And on behalf of all Georgians, I'm extremely grateful to
you--and grateful to you for lending your expertise today.
Because, as I said at the opening of the hearing, there's a lot
of political voices weighing in on this issue. The public needs
to hear from the doctors, who are providing care every day,
what this is really doing to pregnant women in Georgia.
And we've heard extremely concerning reports today from
leading OB-GYNs in Georgia, and a resident who was deterred
from coming to practice in her home State because of this
extreme abortion ban.
We've heard about women who struggle to get the healthcare
they need at critical moments when their health's at risk, when
they're experiencing a miscarriage and turned away from the
doctor, about extremely worrying and high-risk medical
scenarios that haven't yet reached some vague state of
sufficient emergency according to politicians who haven't
practiced a day of medicine in their life.
And we've heard about how Georgia's law is driving doctors
out of our State--when we already face a dire shortage of OB-
GYNs--that for years has been negatively impacting the health
and lives of women in Georgia, including worsening the access
to prenatal care in our State.
Well, I'm grateful to all of you for illustrating what this
really means for healthcare providers and for your patients.
I would note for you, and for members of the public, that
the hearing record will remain open for 1 week for statements
to be submitted into the record.
We welcome contributions from the public.
Questions for the record for our witnesses may be submitted
by other Senators by 5 p.m. on Tuesday, July 30th.
I want to restate my gratitude to Mayor Garrett and the
city of Decatur for hosting us today. It's great to be in
Decatur.
And thank you, again, and the hearing is adjourned.
[Whereupon, at 10:50 a.m., the hearing was adjourned.]
[Additional material submitted for the record follows.]
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