Oklahoma Supreme Court rules against restriction on medication abortions
The Oklahoma Supreme Court voted overwhelmingly to strike down a 2014 law limiting abortion-inducing medications.
In a 7-1 decision Tuesday, the court ruled against House Bill 2684, which required doctors to follow a medical abortion process approved in 2000 by the Food and Drug Administration. Although the FDA has since updated to a 2016 protocol, HB 2684 still mandated doctors in Oklahoma follow a procedure approved 19 years ago.
The state Supreme Court determined that following the "sub-standard practices" of the 2000 protocol would place a substantial obstacle to a woman's right to choose to terminate a pregnancy. The court agreed the 2016 protocol was safer, more effective and fulfilled the standard level of care for medically induced abortions.
In 2000, the FDA approved use of the abortion-inducing drug Mifeprex for up to 49 days after a woman's last menstrual period. Within a year of Mifeprex's approval, 96% of medically terminated pregnancies followed an off-label protocol instead, according to the Supreme Court ruling. The American College of Obstetricians and Gynecologists endorsed the off-label protocol as a more effective practice with fewer adverse effects. The off-label protocol could apply up to 63 days after a woman's last menstrual period.
The Oklahoma Legislature passed HB 2684 in 2014, requiring doctors in the state to follow the on-label protocol or be subject to discipline and court-ordered damages.
The Center for Reproductive Rights filed a lawsuit contesting the law on behalf of the Oklahoma Coalition for Reproductive Justice. Nova Health Systems also joined the Oklahoma Coalition for Reproductive Justice as a plaintiff in the case.
“Today’s decision is a critical victory for Oklahoma women and their doctors,” said Autumn Katz, senior counsel at the Center for Reproductive Rights. “Women deserve access to safe medication abortion regardless of what state they live in. This law would have required women to follow a decades-old practice that is no longer the standard of medical care. Today’s ruling elevates science over politics and ensures that Oklahomans who decide to end a pregnancy can continue to get the care they need.”
Senate President Pro-Tem Greg Treat said it was “not surprising” the court ruled against HB 2684. Treat, R-Oklahoma City, called the Oklahoma Supreme Court “one of the most pro-choice courts in the nation” in a statement Tuesday.
“This measure was intended to protect the health and safety of women who sought a medication abortion by requiring the abortionist to follow the instructions on the pill bottle,” he said. “To most Oklahomans that seems reasonable, but to the Oklahoma Supreme Court it represents an undue burden.”
The FDA's 2000 protocol required a physician to administer one dose of 600 milligrams of Mifeprex and a 400-milligram dose of a second drug, misoprostol, two days later. The patient would then have to come for a follow-up visit after 14 days.
State law didn't update to the FDA's 2016 protocol, which allowed Mifeprex up to 70 days after a woman's last period. The 2016 rules also reduced the medication dosage and allowed patients to self-administer the drug without a health provider's supervision.
"It’s crucial that patients receive truthful, accurate, evidence-based information about their health care,” coalition Co-Board President Danielle Williams said in a statement. “This restriction was sold as a measure to protect women’s health, but in reality it would have forced doctors to administer triple the necessary dose of medication abortion drugs. It is a stark reminder that many anti-abortion policies come at the direct expense of women’s health care, so we are very glad the Oklahoma Supreme Court ruled against this restriction."
Attorneys defending HB 2684 argued the medication posed a greater risk to women after the 49-day period.
A pro-life doctor from Michigan, Donna Harrison, submitted a statement in the case, expressing concern for an increased risk of bleeding. Her concern was based on a practice bulletin from the American College of Obstetricians and Gynecologists that reported the risk of bleeding might be lower among women who take the abortion medication within the 49-day window.
The plaintiffs countered with evidence from medical experts who found the 2016 protocol to be safe and effective.
Doctors who worked with the FDA and the American College of Obstetricians and Gynecologists reported the new protocol caused little to no significant health-related problems. Dr. Daniel Grossman stated in court documents that the 70-day period gives women more time to discover a pregnancy and decide whether to terminate it.
Grossman also noted the longer period gives more patients an alternative to surgical abortions. Some women prefer a medication abortion as a less-invasive and more private option, the doctor stated.
The Supreme Court agreed the updated FDA rules were the “superior protocol.”
"We have found nothing in the record which shows the risks are significantly increased at all by waiting 70 days, especially when combined with lower dosages," the court found. "Given the FDA's rigorous review, it would be unimaginable that the FDA would revise and update a protocol to one less safe or less effective than the original it approved 16 years earlier."
Vice Chief Justice Richard Darby was the only dissenter to the ruling. Only eight justices decided the case, as the court still has a vacancy from the appointment of Justice Patrick Wyrick to be a federal judge in Oklahoma City.