Louisiana doctors say they still have many questions about how they will be able to access the life-saving drug if it goes under restricted access starting next month, even after state health officials provided new guidance on the law.
On Friday afternoon, the Louisiana Department of Health The memo was published Here are instructions for your doctor on how to use misoprostol in the hospital: Misoprostol has long been one of the go-to options for women who experience excessive bleeding after giving birth.
The new law is intended to restrict the use of misoprostol and mifepristone for medical abortions, but they are also used to treat other conditions, such as ulcers and pituitary disorders. Misoprostol, in particular, is frequently used by obstetricians-gynecologists to soften the cervix for endometrial biopsies, to induce labor, or to insert intrauterine devices.
The Health Department’s approach to doctors is as follows: Louisiana Illuminator Report The report details “confusion and anxiety” among health professionals over new legislation that will reclassify misoprostol and mifepristone as controlled substances. The new legislation comes into effect on October 1, and doctors have expressed concern that the change will mean the important medicines are removed from the medicine cabinet for postpartum bleeding.
So far, the LDH memo has done little to reassure the medical community.
That doesn’t help “at all,” said a New Orleans obstetrician-gynecologist, who spoke on condition of anonymity because she wasn’t authorized by the hospital to speak to reporters.
“The person who wrote this has never spent time in a labor unit,” she said. “This is There’s no real guidance for people who are trying to revise their protocols because it doesn’t really tell them how to track the drugs in their carts, how often to count them, what to do if they need to, etc.”
The memo tells doctors that mifepristone and misoprostol “may be used” to treat postpartum hemorrhage, but mifepristone is not used to treat postpartum hemorrhage. The two drugs can be used together for medical abortion but are not interchangeable for other indications.
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That error aside, doctors’ biggest concern about the new law is that it will delay access to misoprostol because it must be stored as a controlled substance. A delay in administering the drug when a patient is bleeding heavily can significantly worsen outcomes.
“It’s actually kind of rude to say it’s OK to have those on hand, and we know that,” says the New Orleans-based obstetrician-gynecologist, who adds that LDH’s use of the term “crash cart” is also confusing, because it can be confused with maternal Code Blue carts, which are completely different from postpartum hemorrhage medications.
“I would have liked more guidance on having miso available at the bedside, since other controlled substances cannot be ‘floating’ around the hospital like this,” the obstetrician-gynecologist said. “I would have liked guidance on the diagnosis codes needed to fill prescriptions.” [for misoprostol] Based on Letter from the Louisiana Board of Pharmacists It was released this summer.”
“It doesn’t seem like a viable solution.”
The state’s Board of Pharmacy addressed the law in a July newsletter, explaining that the reclassification was part of a law that created the crime of “forced abortion,” administering abortion pills to a pregnant woman without her consent.
“The prescription shall bear a diagnosis or diagnostic code indicating that the drug is being prescribed for a purpose other than to cause an abortion in violation of the provisions of this Act,” the newsletter states.
The person who wrote this has never spent time in a labor unit.
LDH provided a copy of the memo. Lighting fixtures Late Friday afternoon, LDH said the guidance had been issued to health care providers earlier in the day. The department “distributed the memo and guidance to health care providers through various channels, including through statewide communications,” LDH spokesman Kevin Litten said.
Four doctors Lighting fixtures Those contacted after receiving the memo were not yet aware that LDH had issued any guidance.
New Orleans Health Commissioner Dr. Jennifer Aveño received a copy of the memo from LDH after speaking with reporters, and she said she doesn’t know how the information will be shared with doctors across Louisiana.
Aveño said the state health department has two main ways to quickly communicate with health care providers if needed. One is a Health Alert Network message that immediately alerts doctors, and the other is a message sent through the Louisiana Medical Examining Board, which keeps a database of all medical licenses in the state. As far as she knows, neither has ever been used before.
The new law requires states to educate health care providers about how the reclassification of the two drugs will affect treatment protocols.
““This is not helpful,” Dr. Stacey Holman, director of maternal and child services at Touro, said after reviewing the document.
Secure storage is not practical
The memo suggests storing misoprostol and mifepristone (the latter not used for postpartum hemorrhage) in secure automated administration systems. Holman said these very large machines would not be kept in patients’ rooms.
“Many patient rooms are not near these systems, so there will still be delays for patients who need medications urgently,” she said.
The LDH suggestion to store designated medications in a locked area of the obstetric bleeding cart “might be good in theory.”
“However, doing this safely in accordance with the additional regulations now imposed on these medications would require an oversight process that would require more extensive record-keeping and pharmacy personnel,” Holman said. “This is unlikely to be a viable solution for most hospitals, especially those in areas where access is critical.”
The letter was read by a family medicine obstetrician who practices at a rural Louisiana hospital after being contacted by a reporter. She asked not to be identified because she is not authorized to speak on behalf of the hospital.
“I’m very confused,” she said. “I don’t understand much of the document. It doesn’t really clarify anything. What is a safe zone?”
She referred to an automated medication dispensing system her hospital calls Pixis, which she said is a very expensive piece of equipment. She said it would not be economically feasible for her hospital to have multiple Pixis machines on each floor.
“We can’t afford hospital beds with proper stirrups, and we can’t even keep lidocaine on hand,” she said, adding that her hospital currently uses what she calls “blood collection boxes” — small plastic boxes closed with zip ties.
The rural doctor added that her unit’s Pixis is in a locked room down the hall from the delivery room. The machine only opens with a confirmed order from a pharmacy. At night and on weekends, her hospital must contact pharmacies far away.
“If a woman is vomiting liters of blood, it takes longer for the in-house pharmacy to administer the medication,” she said. “They’re often covered in blood.”
Aveño said she expects more guidance from LDH. She was one of 50 doctors who signed an Aug. 22 letter seeking more information about the new law signed by Gov. Jeff Landry in May.
“They answered some of the questions we raised in our letter but not others,” said Aveño, the emergency physician. “We asked for specific instructions on prescriptions so they would be legal and most likely prescribed for medically necessary purposes, but they never answered that question.”
“They appear to be addressing some of the inpatient access issues, but I’m checking with my pharmacy colleagues to see if some of the things they’re proposing are things that can be implemented right away or if they require significant effort on the part of each hospital.”
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Touro’s Holman said he also wants more guidance.
“It could take weeks or months to develop and approve policies and procedures that account for this,” Holman said. “We only have 23 days to figure this out, test and implement solutions, and educate our physicians on how to continue to provide safe care to our obstetrics and gynecology patients.”
Pressure mounted on LDH to provide guidance this week. Illuminator The report states: prompted the statement Vice President Kamala Harris’ campaign has criticized former President Donald Trump for the Louisiana law, saying it would further restrict access to reproductive health care.
“Trump has left doctors desperately searching for solutions to help patients at the mercy of politicians who think they know better,” said Sarafina Chitica, a spokeswoman for Harris-Waltz.
This story has been updated to include a response from a health department spokesperson regarding the distribution of the guidance.
