Transcript: Dr. Jamila Perritt

By the time I met this patient, I’ll call her, Diane* I had been practicing medicine for more than 15 years. I was working as an ob/gyn and abortion provider in my hometown, caring for the community where I grew up. There was a voicemail on my office phone when I arrived at the health center that Friday morning. It was someone from the local jail. They had a patient that needed an abortion. Could I assist?

I returned the call and spoke with the medical provider practicing at the jail. Diane was 27 years old and 19 weeks pregnant. She needed an abortion. She had two children, currently in the custody of the state as a result of Diane’s incarceration. The provider went on to explain that Diane had secured a spot for transfer to an inpatient substance use treatment facility but there was one problem: They didn’t take pregnant patients. Diane needed to terminate her pregnancy in order to get a spot at this facility. If she was able to complete treatment, she would be eligible to begin the process of reobtaining custody of her other two children who had been removed from her care. She needed this abortion in order to parent her other children.

Diane was almost at the gestational age limit (20 weeks of pregnancy) for which we could provider her care in our facility. After that she would have to see care out of state. Given her confinement, traveling was not an option. Additionally, her prior pregnancies were performed via cesarean section, putting her at greater risk for complications during her abortion care. It is important to note that abortion is very safe - safer in fact than if Diane was to carry this pregnancy to term and undergo a third c-section but we needed to evaluate the pregnancy she was currently carrying to note the location of her placenta, in particular, before we could feel that this abortion could safely be performed in an outpatient facility. This meant that Diane need to see a high risk/maternal fetal medicine doctor prior to her appointment with me.  I knew this would be tough to arrange, worsened by the fact that we were headed into a holiday weekend, but time was of the essence. If we waited much longer, she would have no option except to carry this pregnancy to term. After calling around, I located a colleague at a nearby hospital that agreed to come in to see her at his practice on his day off. That would give us just 2 more days to get her in to the clinic for care following the ultrasound evaluation. We were cutting it close!

Monday morning came and went without word from my colleague. When I reached out, I was informed that Diane never showed up for her ultrasound. I called the provider at the jail to follow up. Maybe she changed her mind. Maybe she experienced a miscarriage over the weekend. Maybe she was released from custody. These considerations and so many more ran through my mind as I dialed the number. When I reached the provider, I got devastating news. The driver of the van that was assigned to transport Diane to her ultrasound appointment with the high risk doctor learned that the ultrasound was in preparation for an abortion. They refused to take her on the grounds that they were “morally opposed” to abortion. Moreover, they were supported in their “conscientious objection” by the jail leadership. 

I was outraged. I had heard of health care providers being protected under the so called “conscious provision,” (collectively known as the “Church Amendments,” enacted in the 1970s protecting individuals and entities that object to performing or assisting in the performance of abortion or contraception procedures on the grounds that it is contrary to the provider’s religious beliefs), but I had never heard of these provision extending beyond health care providers. Is this allowed? I began making calls to those in power at the jail, escalating my objections to the warden’s office, reminding every person I spoke with that not only was this unethical, it was a violation of Diane’s human rights. Eventually, I was given assurance that a new driver would be found and the appointment will be rescheduled for the following day. The sonogram was done and her appointment for an abortion was scheduled for later that week.

One hurdle was cleared but, at the time, I had no idea how many other challenges would be put in place before the day was done.

The day of Diane’s appointment arrived. I had been in communication with the jail staff the day before to help coordinate her arrival to the clinic to ensure her privacy was protected. We arranged for them to  come in through a back entrance so that Diane wouldn’t have to be paraded through the waiting room in handcuffs, shackles and orange jumpsuit. We prepared a private room for her to await her procedure for the same reasons. Instead of following this protocol, I received a call from the staff reporting that morning reporting that the custodial staff who brought Diane to her appointment were insisting on bringing her in through the waiting room. I immediately went down to speak with them, explained the protocol and insisted they follow the plan we had arranged. After a lot of discussion, they relented but this behavior continued throughout the day. We worked to provide care to Diane in a way that protected her safety, her wellbeing and her dignity. It seemed that they sought any and every avenue to shame, humiliate and punish her. It was an uphill battle. First the guards tried to require that she be shackled during her care. When I refused, they claimed that they were required to be present in the room during her abortion (for my protection). I refused. Finally, they insisted on having the door left open during her abortion, again under the guise that it was for the protection of me and the staff. Once again, I refused. It was at this point that they called the warden to report that I was refusing to comply with their rules and threatened to have her taken back to the jail without having received care. They passed me the phone. By then I had lost the small amount of remaining patience I had left. The call quickly escalated into a shouting match. The state had stripped her of her freedom. They had taken her children and thrust them into a system we know to be broken. They dealt in degradation and were now asking me to be their accomplice in perpetrating violence and harm. I refused to back down. I refused to capitulate. I refused to collude. 

Ultimately, Diane had her abortion and returned to police custody. Like so many patients that I care for, I don’t know what happened to Diane after she left. I wished her well and prayed that things would work out for her.

As health care providers, we have a responsibility, a moral and ethical obligation, to care for our communities. Central to this obligation is the recognition that the systems and structures in which we live, work, and practice are being weaponized against our communities. It is up to us, those who often hold the most power in these systems, to interrupt and disrupt these practices. Cognitive dissonance is not serving us. Ignoring the harm is not serving us. We have an opportunity to use the power and privilege that our white coats provide to not just demand change but to instigate it. Speaking up and speaking out isn’t easy, but it is necessary. This can look different ways depending on the situations and circumstances we find ourselves in. For some, raising a question for “clarification” may be enough to encourage interrogation or introspection of policies and practices. Asking “why” we do the things we do can open the door for a discussion of the unintended consequences, harms or impacts on individuals and communities. In other instances, a more direct and authoritative approach is in order which can result in challenging or confrontational moments. It is critical to remember, in all of these cases, that as powerless as we may “feel” in fighting back against systems and structures that have been deeply entrenched in practices of punishment and harm, as health care providers, we still hold a considerable amount of power in these systems, often more power than that the patient themselves. In the case of Diane, this is especially true and she was in the custody of state, embedded in a system that is designed to demean, subjugate, humiliate and punish those within.

I think about Diane and this experience often, especially as we see more and more people being criminalized in the health care system, often when seeking care. As a physician, I took an oath to “Do No Harm.” I believe that health care, including abortion care, is a fundamental human right-one that does not disappear simply because you are in state custody. Medical spaces are supposed to be sites of care, places where compassion, healing and kindness predominate. I also realize that in this moment, in our health care system, this is simply not the case. In fact, medical facilities continue to be sites of criminalization and health care providers, like me, are acting as agents of the state, proxies for violence, perpetrators of harm. We abdicate our responsibility. We ignore the part we play in facilitating and sometimes initiating criminalization for the patients we care for. This is not medicine. This is not care. 

*This patient’s name has been changed to honor and respect her privacy.