US appeals court upholds Title X gag rule on doctors


What are the news: The Trump administration’s gag rule that violates the AMA Code of medical ethics by requiring physicians to serve as government spokespersons in discussions with patients under the Title X program, will be allowed to take effect. The U.S. 9th Circuit Court of Appeals, in a 7-4 decision, overturned orders previously made by federal district courts in California, Oregon and Washington.

“WADA is disappointed – and strongly disagrees with – the reasoning behind a federal appeals court’s decision to allow the Trump administration to apply a gag rule to doctors,” the president said. ‘AMA. Patrice A. Harris, MD, MA.

The decision confirms the decision taken last June by a panel of three judges from the same court which lifted a national injunction issued by the district court. WADA appealed against this decision in the case, AMA c. Azar, and asked that it be heard by a larger panel “en banc” of the 9th Circuit.

A brief filed by WADA and its co-complainants included arguments against the gag rule and noted that the Department of Health and Human Services (HHS) “cannot point to a case where Title X funds were misapplied.”

The court rejected the arguments.

In the majority opinion, Judge Sandra S. Ikuta wrote that “there is no ‘gag order’ on abortion counseling” because the rule issued by the HHS in March 2019 only prohibits for doctors to recommend or encourage abortion while allowing them to discuss the risks of abortion and side effects.

Dissenting Judge Richard A. Paez quoted decision of last April by US District Judge Michael McShane. This judge blocked the implementation of the rule by arguing that the gag rule contradicted the Code of medical ethics‘ban on withholding information from patients and called on doctors to “intentionally mislead patients”.

“The majority would take us back to an older world, in which a government bureaucrat could prevent a health care professional from informing a patient of the full range of health care options available to her,” wrote Paez.

The 11 judges heard oral argument in San Francisco on September 23, 2019 regarding the trialoriginally filed by AMA, Oregon Medical Association and others. The case was later consolidated on appeal with other lawsuits that include 20 states, the District of Columbia and medical professionals.

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Why this is important for patients and physicians: The Title X family planning program ensures that everyone has access to basic preventive reproductive health care such as birth control, cancer screening, and screening and treatment for sexually transmitted infections, regardless of their economic status. or insurance. Approximately 4,000 clinics have served 4 million family planning patients each year through the Title X program.

“The judges did not properly consider WADA’s legal arguments or the impact of the decision on health care or the patient-doctor relationship,” said Dr Harris. “This government intrusion and interference requires physicians to violate their ethical obligations – prohibiting open and candid conversations with patients about all of their health care options – if they are to continue treating patients under the Title program.” X. It is wrong for the government to tell doctors that they can only treat this underserved population if they promise not to discuss or recommend all treatment options. “

In overturning previous rulings that delayed implementation of the rule, Paez wrote that “the majority sanctions the agency’s overbreadth and puts their own political preferences before the law.”

Learn with WADA on what you need to know about the title X rule. At the time the complaint was filed, WADA President Barbara L. McAneny, MD, wrote a column on WADA’s leadership views explaining why the administration changes to Title X put women’s health at risk.

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What happens next: Unless appealed to the Supreme Court, the ruling ends proceedings over injunctions over the gag rule and other new HHS regulations. The decision also refers the case to the district court “for further processing in accordance with this opinion”.

In the immediate term, however, Paez predicted that it will be the patients who will feel the greatest impact.

“By overturning the preliminary injunctions, the majority is blessing an executive agency’s contempt for the clear limits imposed on it by Congress,” he wrote. “The consequences will be borne by the millions of women who turn to Title X-funded clinics for life-saving care and the very contraceptive services that have brought down the rates of unwanted pregnancies and abortions.

Dr Harris said WADA would continue to oppose gag rules imposed on doctors.

“As this matter takes the next step, we will continue to fight for open conversations between patients and physicians, the cornerstone of quality health care,” she said.


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