Turning To ‘Plan B’ New Emergency Contraception Law Goes Into Effect; Hospitals Brace For The Change

A new law requiring all hospitals to provide emergency contraception (EC) to all female rape victims has gone into effect in the Bay State, prompting some uncertainty and controversy among health care providers.

The law, which was passed in mid-September after a legislature override of Gov. Mitt Romney’s veto, went into effect on Wednesday, Dec. 14.

It stipulates that all hospital emergency departments in the state offer EC, also known as ‘Plan B’ or ‘the morning after pill,’ to victims of sexual assault, and also allows pharmacists to dispense the drug to women of all ages without a prescription, through a collaborative agreement with a physician.

Confusion has surrounded the legislation in recent weeks, as hospitals scramble to get a firm handle on the new reporting and documentation requirements the law will necessitate, and wait for further guidance from the Department of Public Health (DPH), which has been charged with drafting official regulations and was still in the process of finalizing those regulations at press time.

Rules and Rulings

Paul Wingle, a spokesperson for the Mass. Hospital Association (MHA), said adhering to the new EC requirements creates a new hurdle for all Massachusetts hospitals in the Bay State.

“Hospitals now have a new need to train staff, produce materials, and update forms,” he said. “And the guidance from the DPH has been delayed. When the state doesn’t respond right away when a new law like this is put into effect, it puts hospitals in a difficult spot.”

Wingle did say the MHA is currently developing a set of recommendations, with the assistance of legal counsel, for the Commonwealth’s hospitals, to assist in the implementation of DPH guidelines.

Adding to the controversy surrounding the new EC law, though, was the governor’s recent flip-flop on a proposed exemption provision for Catholic and other privately owned hospitals on moral or religious grounds. One day after he made the proposal, Romney recanted the opt-out offer, requiring all hospitals to offer EC to rape victims regardless of a facility’s position on the practice.

Romney said the change of heart was spurred by closer examination of the law and an older piece of legislation, which barred the state from forcing any private hospital to dispense any contraceptive devices or information. His legal advisers, he said at a press conference in early December, found that the new law superseded its predecessor.

Proponents and Opponents

The news was encouraging to backers of increased EC availability statewide, such as the Massachusetts Emergency Contraception Network, a partnership with a strong Western Mass. presence comprised of several organizations including Ibis Reproductive Health, Jane Doe Inc., NARAL Pro-Choice Massachusetts, Planned Parenthood League of Massachusetts, government agencies, pharmacists, and health care providers. However, the network concedes that the battle is not likely over, in part because it is still unclear what could happen to any hospital that refuses to comply with the law.

“We will continue our work to make sure that rape survivors are not forgotten as the new emergency contraception law goes into effect,” said NARAL Pro-Choice Massachusetts Executive Director Melissa Kogut. “What’s lost in the debate about access to EC at private hospitals are the women behind the sound bites … Women don’t choose where they’re victimized and are often not able to choose the hospital where they’re treated. Should women be denied the care they need because of the so-called moral objections of an institution?”

Wingle added that it will be difficult for the state to monitor any hospital’s compliance with the EC law right away, due to the time needed to implement new policies.
“Rape kits need to be changed, and new forms and information won’t be included in the kits until the spring. We can only assume the law is being implemented in all hospitals until evidence shows us otherwise,” he said.

He did note that any hospital choosing to defy the law publicly might do so in order to bring the issue before the courts. But to date, most hospitals in the Commonwealth have been mum on the legislation and their positions regarding it.

There are currently eight hospitals in Massachusetts owned and operated by religious entities, including Springfield’s Mercy Medical Center, part of the Sisters of Providence Health System (SPHS). A ninth facility, St. Vincent’s in Worcester, retains a Catholic-based care model despite ownership by a non-religious company.
SPHS has declined to comment on the new law or its requirement that all hospitals comply regardless of past policies. In addition, Baystate Health, the largest health system in the region and the parent organization of Baystate Medical Center, the largest acute care hospital in western New England, has also chosen not to comment on the controversial aspects of the new law.

Adding to the Ranks

Massachusetts is the eighth state to implement the EC availability law in emergency rooms, joining California, Illinois, New Mexico, New York, New Jersey, South Carolina and Washington. The Commonwealth also joins Alaska, California, Hawaii, Maine, New Mexico, New Hampshire and Washington in legalizing the ‘collaborative practice agreements’ that allow pharmacists to dispense EC without a prescription to any woman.

The pill works by releasing a high dose of hormones that prevents a fertilized egg from being implanted on the uterine wall. Women can take the pill up to five days after sex to prevent a pregnancy, however experts say the sooner the drug is taken, the more effective it will be.

Jaclyn Stevenson can be reached at stevenson@healthcarenews.com