Weeks after a trigger ban criminalizing providing abortions went into effect in Tennessee, doctors told ABC News the ban created fear, confusion, anxiety and stress among patients and providers.
Physicians from different parts of the state are pushing back against claims made by lawmakers, including Gov. Bill Lee, who say the ban allows exceptions for pregnancies that threaten a woman's life or could cause serious bodily injury, saying this is not the case. Under the law, performing or attempting to perform an abortion is a Class C felony.
Lawmakers are in "complete denial" about what the law says, saying it leaves "no exceptions, whatsoever," Dr. Ashley Coffield, the CEO of Planned Parenthood Tennessee, told ABC News.
The disagreement between some politicians and providers over the ban is about an "affirmative defense" clause in the law that allows physicians being prosecuted for providing an abortion to justify their actions, claiming it was done to prevent the death or permanent bodily harm of a pregnant woman, according to Dr. Amy Bono, a primary care physician in Tennessee.
To utilize the affirmative defense justification, the abortion must be performed or attempted by a licensed physician, the physician must determine the abortion was necessary to prevent the death or serious injury of the pregnant woman, and the abortion must provide the best opportunity for the fetus to survive, unless that threatens the life or could cause serious injury to the pregnant woman, according to the law. The threat to life cannot be related to mental health, according to the law.
Physicians interviewed by ABC News are worried, saying under the law they could still be charged with a felony, even for medically necessary abortions, and say they would only be able to utilize affirmative defense during a trial.
By the time a physician has the chance to exercise affirmative defense, they will have been convicted of a felony and lost their medical license, Dr. Carolyn Thompson, a Nashville physician, told ABC News, adding that they may also have to wait years until the case goes to trial -- so their life would be in shambles.
"A less-scary law would put the burden on the state to prove that the abortion was not medically necessary, and instead, the burden is on the doctor to prove that it was," Coffield said.
This means that when it comes to abortion care options, Planned Parenthood can only help patients find care out of state or provide financial assistance, Coffield said.
Risks and fears
Physicians are worried about what this means they can do to help patients. Doctors interviewed by ABC News said many are afraid of potential prosecution and do not plan on providing abortions, while others, defiantly, plan on giving patients whatever care they need.
OB-GYN physicians and patients are "scared"; doctors feel like there is "a target on their backs," while patients are "asking their doctors, 'Will you save my life if I need you to?'" Bono said.
While some officials, including Nashville District Attorney Glenn Funk, have said physicians will not face prosecution for providing medically necessary care, this is of little comfort to providers.
In a statement released in July, Funk vowed he would not prosecute women who seek abortions or doctors who will provide them after the U.S. Supreme Court's decision to overturn Roe.
"I will use my constitutional powers to protect women, health providers and those making personal health decisions," Funk said.
In a separate statement, Funk condemned the court's decision and said it will "forever stain the Court and this nation."
"I'm not going to risk my freedom on somebody's verbal assurance that I'm not going to be prosecuted for providing evidence based care to a patient," Thompson said.
Thompson said physicians are concerned they won't be able to provide appropriate care to patients who need it.
"It's ironic that the name of this law is the Human Life Protection Act, because they're certainly not concerned about the women's lives," Thompson said.
Dr. Ashley Huff, an emergency room doctor, told ABC News she intends to treat life-threatening emergencies the way she always has.
“No matter what this law states, patients absolutely should not die when we have the ability to intervene,” Huff said.
Half of the nine gynecologists in the state's fifth-largest city, Clarksville, have already provided abortions to manage ectopic pregnancies since the trigger ban went into effect, according to Dr. Tracy Coffey, an OB-GYN practicing in the city.
Bono said physicians are "now going to be caught between a rock and a hard place": either commit a felony by providing a medically necessary abortion, or open themselves up to medical malpractice liability by not providing what could be lifesaving care.
Thompson recalled having a patient's ectopic pregnancy rupture in her office years ago, and she said the patient would have died if she was not in a hospital to receive an abortion.
"If I have a patient who has an ectopic, according to this law, I can either let her die, which is egregious malpractice, or I can take her to surgery and do the evidence-based, acceptable thing and remove her ectopic and save her life. And then be convicted of a felony and go to jail," Thompson said.
Thompson said she knows of a patient who had to wait 10 hours for an ectopic pregnancy to be managed because her physician had to consult with the hospital's lawyers before giving her an abortion.
She also pushed back against rhetoric claiming that managing an ectopic pregnancy is not an abortion, saying it is according to the wording of the law.
Unintended impact of the ban
Physicians are already starting to see the impact the trigger ban is having on women in Tennessee, creating fear, confusion and limited access in a state with one of the highest maternal mortality rates in the country, according to data gathered by the Centers for Disease Control and Prevention.
Nearly all the providers interviewed by ABC News about the trigger ban said they are worried physicians, especially OB-GYNs, will leave the state because of the ban.
"I don't know who they think is going to be doing obstetrics in five years if there's no change to this law," Thompson said.
Physicians are worried about what women who cannot get access to abortion care will do, warning they may get desperate or take measures into their own hands.
Huff said she is already seeing patients who have apparently taken matters into their own hands come into the emergency room, some of whom have been admitted for care.
"I've been practicing for seven years, and I have never seen people come into the emergency department in this situation before," Huff said.
The majority of these patients have apparently self-managed abortions, often using medication, but have experienced complications, largely because they were not under the supervision of a physician. Some of the complications that can arise from self-managing abortions include infections, excessive bleeding or incomplete abortions, Huff said.
Thompson said the trigger ban has opened up Pandora's box, creating a wave of tragedy and trauma for women across the state.
"These legislators had no idea what an absolute disaster that they would be creating," Thompson said. "It will ultimately impact almost every family in this state."
The governor's office did not immediately respond to ABC News' request for comment.