HJNO Nov/Dec 2024

HEALTHCARE JOURNAL OF NEW ORLEANS I  NOV / DEC 2024 49 For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com administer misoprostol and mifepristone once the new law goes into effect. They specifically asked for help on the use of misoprostol in the inpa- tient setting, and “how to ensure it will be readily and quickly available in commonly used obstetric hemorrhage carts.” “This is a nationally recognized guideline to emergently treat life-threatening postpartum hemorrhage and it is critical that providers are aware and have access to medication without delay,” the doctors wrote, requesting Abraham’s advice be communicated well in advance of Oct. 1. They had not heard back as of Monday. The Louisiana Department of Health, the state Board of Pharmacy and Attorney General Liz Mur- rill did not return requests to explain how they plan to educate health care providers and assist them in making sure care for Louisiana women is not disrupted. A provision in the new law calls for doctors to be educated on how to comply. “This is a bad drug to be a controlled sub- stance,” says Dr. Jennifer Avegno, director of the City of New Orleans health department and an emergency room physician. “We are putting women’s lives at risk by denying them immediate access to a life-saving drug.” Avegno adds, “The OB providers that I’ve spo- ken to are very concerned and very upset about the way this will change their practice, and I don’t blame them.” She likened the situation to delay- ing a patient in anaphylaxis access to an EpiPen or removing medicine from a crash cart in an emergency room. “When you need to give blood to a crashing patient, do you want it right there or do you want to have to call somebody to have them walk it down from the blood bank?” said Avegno, who thinks the new law could lead patients to lose more blood. “Ultimately it will be OK,” Avegno said, adding that doctors will use heroic measures to stop as many tragic outcomes as they can. “But for some people, having that delay or being forced to take a drug that is not the best indication for them will worsen outcomes.” Louisiana is among the worst states in terms of maternal mortality and morbidity, and Black women are disproportionately at risk of dying due to complications with pregnancy or childbirth. But the state has successfully been reducing death rates due to postpartum hemorrhage. “The state has done really good work on reduc- ing maternal mortality through hemorrhage over the last several years by very deliberate mecha- nisms,” Avegno said. “And [with this new law] we run the risk of backsliding.“ Dr. Jane Martin, a maternal fetal medicine spe- cialist in New Orleans, agrees. “The frequency of severe maternal morbidity and mortality related to postpartum hemorrhage (PPH) has decreased when you look at the last few decades,” Martin said. “What has changed is the push for hospitals and systems to have protocols in place, which I think is what’s brought these bad PPH outcomes down.” Martin points to a report that shows, from 2016 to 2019, severe maternal morbidity due to hyper- tension and postpartum hemorrhage decreased by almost 40% in Louisiana, solely due to stan- dardization of processes. “But it’s literally taken years, if not decades for hospitals to have these protocols function as well- oiled machines,” Martin said. “When we change these protocols that work so well, we are intro- ducing a significant opportunity for errors, lapses and delays in care, and worse maternal outcomes solely because we are messing with a process that works well and now has to be re-learned.” When asked about the status of misoprostol at its hospitals, Ochsner Health System said it is “working to get more information about the postpartum hemorrhage carts and additional impacts of the new regulation.” A spokesperson said communications about the impacts of the new state law will be shared with their physicians in the weeks ahead, and that Ochsner will provide official comment once that has occurred. Ochsner did not disclose whether the medica- tion has been preemptively removed from carts and kits at their hospitals. The health system owns or operates 46 hospitals in the Gulf South region. LCMC Health runs eight acute care hospitals in the New Orleans area that the new law would impact. Dr. John Heaton, its president and chief medical officer, provided this statement: “Maternal health is a top priority for our com- munity of patients. We are dedicated to foster- ing collaborations with physician leaders, nurs- ing leaders, and pharmacy leaders to develop innovative solutions that comply with all legal standards. We are committed to safe care of the highest quality in our birthing hospitals.” Holman, director of maternal child services at Touro, said that as the largest birthing hospital in the LCMC system, her hospital is working to support others in the system to determine their protocols. “We don’t want to scare the patients, but we certainly want to make sure people understand that this is a big deal,” Holman said. “Our goal is to minimize how much we impact the logistics of each hospital, but every hospital will be impacted in some way. “We are not going to put patients in harm’s way. We are going to figure out solutions to this, but we’re going through a lot of steps and figuring out a lot of things for a medication that is actu- ally safe.” Wendy Couvillon, NP, Joins Terrebonne General Pediatric Care Terrebonne General Health System welcomed Wendy Couvillon, NP, as a provider at Terrebonne General Pediatric Care. Couvillon joins Jill Sutton, MD, to offer primary care for children and adoles- cents from birth through 18 years of age. Couvillon earned a Bachelor of Science in nurs- ing and a Master of Science in nursing at Nich- olls State University in Thibodaux, Louisiana. With 29 years of experience as a registered nurse, she has dedicated four of those years to serv- ing patients at Terrebonne General. She is cer- tified in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Neonatal Wendy Couvillon, NP