In order to enact the "Partial-Birth Abortion Ban Act" (HB 1113), a bill banning "something to do with abortion," the Arkansas General Assembly declared an emergency and proclaimed the passage of the bill immediately necessary for the preservation of the public peace, health, and safety.

On Tuesday, February 10th, 2009, HB 1113 cleared a state House of Representatives committee after a dazzling display of third world potentate tactics from the bill's sponsors, including the invocation of a "state of emergency" that required the Governor to take action on it or the bill would become law by default.  On February 19, 2009, the state Senate passed HB 1113 by a vote of 30-3 vote. And last Friday, February 20th, Gov. Mike Beebe signed the bill into law.  The bill provides no definition for the procedures it is banning and contains penalties as high as 6 years in jail for physicians performing the unidentified procedure.

Any and all Arkansas politicians who voted for HB 1113 are in dereliction of duty and should be prosecuted for criminal incompetence. Here are but three reasons why.

One: The Emergency Which Dare Not Speak Its Name

There's a bit of difference between a scary ghost story told around the campfire and a medical procedure that's just been declared a scary public threat by politicians.  One of these two requires a basis in reality.

To figure out what exactly Arkansas politicians deem an imminent threat to public peace, health, and safety you have to divine the medical meaning, if any, behind the propaganda term "partial-birth abortion" and its whimsical description found in HB 1113.

Deconstructing propaganda might be a fun intellectual exercise for politicians but it's an incompetent way to set the medical standard of care or decide if physicians are guilty of a felony and get to spend up to 6 years in jail.

Unfortunately, Arkansas politicians can't be bothered to take their job seriously. So we, together with the pregnant women whose health will be adversely affected by this bill, their families, and their physicians are left to guess exactly which surgical abortion technique HB 1113 bans.

Briefly, we have three possibilities:

Dilatation and Curettage (D&C): In this procedure, usually performed before 14 weeks estimated gestational age (an early term abortion), first the cervix is dilated, then the pregnancy is evacuated by mechanically either by scraping out the contents (sharp curettage), vacuum aspiration (suction curettage), or both. 

Dilatation and Evacuation (D&E): Usually performed after 16 weeks gestational age, a D&E involves dilation of the cervix, then mechanical destruction and evacuation of fetal parts, followed by large-bore vacuum curettage.

Intact D&E or Dilatation and Extraction (D&X): This technique is usually indicated after 20 weeks and is similar to a D&E, except, and this is the key difference, an intact extraction of part of the fetus takes place over the cervix. These procedures  are conducted in the case of either a maternal or fetal indication, including for women with uterine scarring or preeclampsia, or for fetal anomalies such as hydrocephaly.

Q: So, which one of these three distinct techniques is banned under HB 1113? 

A: Who knows?

The legislation itself does not provide definitive guidance.  For example, in its definition of "partial-birth" abortion, the legislation says, "in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the female." This scenario can happen in an induced abortion, a D&E, or a D&X.  So, a "partial-birth" abortion is, what?

Or its fantasy description of an abortion procedure - "the physician blindly forcing a sharp instrument into the base of the unborn child's skull while he or she is lodged in the birth canal."

To understand the problems with the above paragraph you need to know that with termination, as opposed to term labor, you don't achieve a fully dilated and effaced (thinned out) cervix.  A partially dilated and effaced cervix will not accommodate the fetal skull, and this is why you have to reduce it. A trapped head is a true emergency. The cervix has large blood vessels and could tear leading to catastrophic bleeding.

Now, three problems. One, you collapse the skull in order to effect delivery, not to kill the fetus (or, for that matter, because you like poking sharp instruments into fetal skulls). The state of the fetus -- intact or dismembered -- is not the deciding factor. If it were, there'd be no need to reduce the skull of a dismembered fetus. Two, the maneuver is not blind, it's guided. And three, you reduce the size of the skull in utero, in order to facilitate passage through the cervix, not in the vaginal canal.

Note to Arkansas politicians: Just because you are not required to be responsible or competent when enacting legislation doesn't mean the same applies to physicians taking care of patients.

Bottom line, it's impossible to tell from reading HB 1113 what exactly it bans. The most you can say is that it's something to do with the medical procedure of abortion.  This level of ignorance and sloppiness is irresponsible when dealing with medical matters.

Two: The Phantom Emergency

If you're going to yell fire in a crowded theater you better make sure there's actually a fire. And if you're going to declare something to do with a medical procedure an imminent threat to the citizens of your state you better make sure you have evidence that the threat actually exists.

State Rep. Dawn Creekmore (D) who sponsored HB 1113 said she is worried that Congress might overturn a 2003 federal law that also bans something to do with abortion. Fretting over future fantasy Congressional actions is not evidence that there's a public threat.

Neither is a lack of information. According to Martha Adcock, an attorney for the Family Council, which assisted Creekmore in writing the bill, "no information is available on whether any of the 4,844 abortions performed in the state in 2007 would have been covered under the bill."

Note to Arkansas politicians: The proper response to not having any information on whether a made-up medical procedure is performed in your state is the exact opposite of declaring a public peace, health, and safety emergency and enacting a bill banning the procedure.

And since Ms. Adcock mentioned the 2007 Arkansas abortion data, let's clarify something.  Her power to awe with propaganda is restricted to Arkansas politicians, and doesn't extend to anyone who values reality. 

If we look at the available data, excluding the one case with an unknown estimated gestational age, there were 4,698 surgical abortions in Arkansas in 2007.  Of these, 4,239, roughly ninety percent, were performed between 7 and 14 weeks estimated gestational age and involved a D&C.  Another 459, or about 10 percent, were performed between 15 weeks to 20 weeks estimated gestational age and involved a D&E.

No procedures were performed for 21+ weeks. More importantly, no D&Xs.

Unlike Ms. Adcock and her Family Council outfit, we might not have the power to draft legislation, but we are blessed with the "look at data and interpret" special power. We can observe that federal law already bans the procedure that supposedly puts Arkansas into a state of emergency.  And we realize that if your bill bans a procedure done for an estimated gestational age of 20 weeks or more and your statistics show that there were no abortions done more than 20 weeks, that tells you that your legislation bans a procedure not done in your state.

Bottom line, based on their actions, it's clear that Arkansas politicians don't take their jobs, not to mention their constituents, seriously.

Should any of the bill's sponsors wish to prove otherwise, all they have to do is to:

1) Have Rep. Dawn Creekmore define the banned procedure and explain why it, unlike its "delicate" alternatives -- a D&E (dismemberment), a torn cervix, the major abdominal surgery of a Cesarean section -- is a brutal procedure.

2) Show that any D&Xs were performed in Arkansas in 2007 to begin with. [Hint: D&Xs are illegal under federal law.]

And for extra credit:

3) Justify why, when it comes to pregnant patients, being on the brink of death is a prerequisite for being permitted access to proper medical care.

4) Explain why [a] female upon whom a partial-birth abortion is performed is exempt from prosecution but a pregnant Ob/Gyn who performs the abortion is not.

On that last point. According to HB 1113, all involved with something to do with the medical procedure of abortion -- physicians and lay people alike -- are considered criminals, except for the pregnant women undergoing the procedure, by virtue of the state of their uterine lining.

So, when a pregnant Ob/Gyn performs whatever it is that HB1113 bans, based on the state of her uterine lining that Ob/Gyn should not be held responsible for her actions. Yet HB 1113 contains no such exemption. Why not?

Three: The Lying Liars and the Lies They Tell

In medicine, unlike politics, lies have consequences. As a physician, if you lie to your patients you are endangering their health and you are guilty of malpractice, and deservedly so. You should be allowed nowhere near those who entrust their health to you.

Unfortunately for the people of Arkansas, as a politician you get to lie to people unencumbered by a concern for the patients' health or, for that matter, by professionalism or the truth.

Here's what Arkansas politicians say, on the official legislative record mind you, are the risks associated with something to do with the medical procedure of abortion:

SECTION 3. EMERGENCY CLAUSE. It is found and determined by the General Assembly of the State of Arkansas that partial-birth abortion poses serious risks to the health of a female undergoing the procedure; that those risks include, among other things: an increase in a female's risk of suffering from cervical incompetence, a result of cervical dilation making it difficult or impossible for a female to successfully carry a subsequent pregnancy to term; an increased risk of uterine rupture, abruption, amniotic fluid embolus, and trauma to the uterus as a result of converting the child to a footling breech position and a risk of lacerations and secondary hemorrhaging due to the physician blindly forcing a sharp instrument into the base of the unborn child's skull while he or she is lodged in the birth canal, an act which could result in severe bleeding, brings with it the threat of shock, and could ultimately result in maternal death.

Since the medical literature is silent on the risks of fantasy procedures, let's assume for the sake of the discussion that "partial-birth" abortion refers to D&X (intact D&E). Here's the actual information about D&X from the literature, medical experts, and medical professionals under oath:

The court concluded, for example, that "[e]xperts for both sides labeled . . . inaccurate" Congress's finding that intact removal increases the risk of uterine rupture, abruption, amniotic fluid embolus, and trauma to the uterus. Similarly, the trial court found that experts for both sides agreed that intact D&E "does not involve the capricious and erratic use of instruments," thus undercutting Congress's finding that the procedure poses an increased risk of maternal laceration and bleeding....
...
Evidence presented at the New York trial also contradicted Congress's finding that removing the fetus intact in a D&E increases a woman's risk of cervical incompetence, which can lead to pre-term birth in subsequent pregnancies...

But wait, there's more.

Not only does the medical evidence refute politicians' "finding" that D&X (D&E with intact removal) presents serious increased risks to women, it actually points to the safety advantages of the procedure:

The New York trial record supports the safety advantages of intact D&E based on three demonstrated facts: (1) D&Es of all variations have safety advantages over induction abortions, (2) D&Es with intact removal have safety advantages over D&Es with dismemberment, and (3) these safety advantages are especially important for women who are particularly vulnerable to catastrophic complications by virtue of their already compromised medical states.

Bottom line: If you're an Arkansas politician, you should know that coming up with a fantasy medical risk profile won't mask the fact that you're so incompetent you have to rely on the kindness of strangers to divine the exact nature of the threat you're alleging. 

So there you have it, three reasons why the Arkansas politicians who enacted HB 1113 are in dereliction of duty: 1) they don't know what medical procedure they're banning, 2) they have no data to back up their claims, and, 3) they try to pass off lies as legitimate medical information.

Don't get me wrong, there are a lot more problems with HB 1113 than the ones I just mentioned. For example, as a patient your confidentiality is not guaranteed. The bill says it's irrelevant if you do not consent to the disclosure of your medical information. It's the grown-ups (by definition, everybody but you and your physician) who get to make these decisions.

My point is that there needs to be a basic competence requirement for any politician with totalitarian inclinations who wants to play doctor and ban safe and effective medical procedures.

Otherwise we keep ending up with legislation like HB 1113 -- where the politicians' personal belief that everything to do with the female reproductive system is scary and quite off-putting, and pregnant patients are enough to declare a state of emergency.

As a politician you have a duty to your employers, the taxpayers, to conduct yourself and their business in a professional manner. Even when legislating matters as trivial as medical care for pregnant patients.