High Country Politics - Feb 1, 2023 - Government News from the American West

Anti-Abortion Groups vs. the FDA | Colorado legislators seek big boost in Special Education funding | Catholic hospitals no longer performing tubal ligations after Dobbs decision | Cannabis legalization seems to be okay | RJD2 is the Concert Pick of the Week

Welcome to High Country - politics in the American West. My name is Sean Diller; regular listeners might know me from Heartland Pod’s Talking Politics, every Monday.

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DENVER (AP) 

COLORADO NEWSLINE: Anti-Abortion Groups vs. the FDA

BY: LINDSEY TOOMER - JANUARY 31, 2023 3:45 AM

Reproductive rights advocates in Colorado were feeling optimistic following the U.S. Food and Drug Administration’s decision to expand access to the abortion pill mifepristone in early January — but a federal lawsuit filed just 10 days later has made the future of medication abortions uncertain. 

On Jan. 3 the FDA issued a decision that allows the abortion drug mifepristone to be picked up at a pharmacy if the patient has a prescription, eliminating a previous requirement that the drug be given directly from a health care provider. 

Dr. Kristina Tocce, medical director at Planned Parenthood of the Rocky Mountains, said the FDA’s decision is a “really big breakthrough” that should increase access across the country. 

América Ramirez, program director for the Colorado Organization for Latina Opportunity and Reproductive Rights, said it’s exciting to see expanded access and agreed it could be beneficial for people across the state, especially the Latina community. 

U.S. Rep. Diana DeGette, a Denver Democrat who co-chairs the Congressional Pro-Choice Caucus, said during a recent press conference with news reporters that the caucus is working with the Biden administration to ensure the U.S. Postal Service will be able to deliver abortion medications when prescribed by an out-of-state doctor. 

Karen Middleton, president of Cobalt, a Colorado-based reproductive rights advocacy organization, said the FDA’s decision will be particularly beneficial for Coloradans outside of the Denver metro area, so long as their pharmacies are willing to participate. But, she said while this is a positive step forward, there are still too many “bureaucratic and cost barriers” for those seeking abortion care.

“We’ve known for years that medication abortion care is overwhelmingly safe and effective,” Middleton said in an email. “We hope that Colorado pharmacies, especially in rural areas, will make it available to patients as soon as possible and without bureaucratic delay.”

But anti-abortion groups have sued to stop pharmacies from filling prescriptions for mifepristone, and the case will likely go all the way to the Supreme Court. 

The lawsuit argues the FDA “exceeded its regulatory authority” in approving the use of mifepristone and misoprostol to end a pregnancy, and seeks a preliminary and a permanent injunction that would remove the FDA’s approval. That would imply that Congress should decide, which is of course, dumb.

Attorneys for the U.S. Justice Department said there are no examples in history where a court has second-guessed a determination from the FDA that a drug is safe and effective. 

Karen Middleton said the lawsuit was the anti-abortion groups’ only choice, as they “know that they’ll lose at the ballot box” since purple and red state voters repeatedly voted to protect abortion rights in 2022. 

“That’s why these radicals are bringing legal challenges in Federal District Courts with conservative judges — to weaponize the legal system to end legal abortion access,” Middleton said. 

Fawn Bolak, a spokesperson for Planned Parenthood of the Rocky Mountains, called the lawsuit a “politically-motivated attack” that has “no basis in science,” as the drug has been used safely and legally since it was approved by the FDA more than 20 years ago. This lawsuit is designed to push abortion care further out of reach for the most vulnerable.

“Exploiting the legal system in an attempt to prevent people from accessing safe, essential health care is unconscionably cruel. Rest assured PPRM will continue to provide safe and legal abortion care to our patients — no matter the outcome in this case.”

CHALKBEAT COLORADO: Education Committee backs big boost in Special Ed Spending

Colorado would fund special education at the levels lawmakers promised back in 2006, under legislation recommended unanimously Friday by a special committee on school finance.

The special education bill would reimburse districts $6,000 for each student with what’s known as a Tier B disability, and who requires more intensive support for students to be successful in school. 

These include dyslexia, autism spectrum disorders, developmental delays, deafness, blindness, emotional disabilities, and traumatic brain injuries, among others. 

The bill also calls for Tier B funding to increase every year by the rate of inflation.

Both the federal and state governments require school districts to provide a “free and appropriate” education to all students, including those with disabilities, but they pay just a fraction of the cost. That won’t change with this bill.

School districts would still bear about two-thirds of the additional cost of providing special education services, but a few years ago, the state was paying less than half of what it had promised. 

The new bill would add $40.2 million in special education funding to next year’s budget, bringing the total to at least $340 million, a 13% increase. The amount could be more, depending on how lawmakers handle requirements to respond to inflation. The bill could also get scaled back, in future budget committee negotiations.

The special education bill, sponsored by state Sens. Rachel Zenzinger (D-Arvada) and Barbara Kirkmeyer, a Brighton Republican, along with state Reps. Kipp and Lisa Frizell, a Castle Rock Republican, will be the only bill to come out of the Interim Committee on School Finance this session.

Sen Zenzinger, who also chairs the Joint Budget Committee and serves on the interim committee on school finance, sounded a note of caution even as she signed on as a prime sponsor of the funding increase bill. 

“We’ll put it out there as what we’d like to see, and we’ll see what’s available to us in the budget,” she said.

Bureau Chief Erica Meltzer covers education policy and politics and oversees Chalkbeat Colorado’s education coverage. Contact Erica at [email protected].

COLORADO SUN: Catholic hospitals crack down on contraception

Jennifer Brown

4:00 AM MST on Jan 31, 2023

Colorado has one of the least restrictive abortion laws in the country, but health care advocates say women in rural and mountain towns often lack reproductive health care access

When the only hospital in Durango with a maternity ward decided that it would no longer let women get their tubes tied, there was no public announcement. 

Mercy Hospital’s website doesn’t spell it out, either. 

Instead, a read-between-the-lines statement added to the Centura Health hospital’s website in September noted that Mercy is “responsible for conducting itself in a manner consistent with the ethical principles of the Catholic church ministry.” 

The hospital had recently completed a “re-education” of hospital staff and board members regarding the church’s ethical and religious directives, it said, adding that “patients are fully informed of all treatment options.” 

Doctors who deliver babies at Mercy said they were told that beginning April 15, they can no longer provide post-cesarean-section tubal ligations - a sterilization procedure in which the fallopian tubes are cut. 

Women who have decided not to have more children often have their tubes tied immediately after a C-section, when they are already under spinal anesthesia, sparing them from the risk, cost, and hassle of scheduling a separate second procedure.

The hospital already prohibited tubal ligations after vaginal births, but had been allowing them after C-sections because of the undue burden it placed on patients.  

It’s been up to obstetricians to tell their pregnant patients that they will have to go elsewhere for permanent birth control. 

Dr. Kimberly Priebe, who delivers 90-100 babies a year and has been an obstetrician-gynecologist in Durango for 20 years said “Patients are furious. This decision undermines our patients’ trust in Centura.” 

Mercy’s prohibition of sterilization comes as health care advocates across the country are concerned about diminishing reproductive rights after the Supreme Court overturned Roe v. Wade.

Even in Colorado, a state with statutory protection for abortion and one of the least restrictive abortion laws in the country, women are losing access to reproductive health care, particularly in rural and mountain areas where there is only one hospital in town.

Mergers that have joined Catholic health systems with secular or protestant systems have created a confusing health landscape for patients seeking abortions or birth control.

Centura Health, formed in 1996 by the merger of Catholic Health Initiatives and Adventist Health System, has 16 hospitals in Colorado and three in Kansas. The Catholic hospitals, including Mercy, follow the Catholic directives, while the Adventist hospitals do not. 

In Denver, doctors affiliated with Centura Health can steer patients who want their tubes tied to nearby hospitals. But in Durango - and other towns with just one hospital - that’s not an option. 

Sophia Mayott-Guerrero, senior organizing strategist with ACLU of Colorado said “We really are seeing a trend with hospitals, insurance companies, pharmacies, other health care entities, discriminating against people by denying basic care … all in the name of religion. The main target is reproductive access, including birth control, emergency contraception, sterilization and abortions.

“We can’t really consider access to reproductive health care in Colorado universally protected until everybody in every corner of our state has access. There’s often this perception that everybody in Colorado has access to abortion and to reproductive health care and that is just fundamentally untrue, especially in the rural parts of the state where you just don’t have additional options.”

It’s unclear why Mercy Hospital had been allowing tubal ligations after C-sections and what led to the change. CommonSpirit Health, the Catholic owner of Mercy and other Catholic hospitals, said they had no updates to provide. The Diocese of Pueblo, which includes all of southern Colorado, referred questions to Centura Health. 

Centura Health officials would not give an interview about the change at Mercy, or explain why it’s happening now, considering that Mercy has been Catholic since it was founded. 

The only exception is for women predisposed to cancer

After the latest “reeducation” of the Catholic directives, Mercy said it would allow tubal ligations post C-section for only one reason — if the woman has a genetic predisposition to ovarian or breast cancer. — Dr. Kimberly Priebe, Four Corners Obstetrics and Gynecology said “This is a very small number of women, and what an arbitrary exception.”

“What about women with hypertension, diabetes, blood clotting disorders, uterine abnormalities, and the many other risk factors that can make pregnancy deadly? It seems the Catholic church does not want a woman dying of cancer but during pregnancy is OK?”

With the new Mercy policy prohibiting tubal ligations after C-section, doctors will send those patients to the local surgical hospital, though they are concerned about overwhelming the center. 

And, doctors say, forcing women to schedule the procedure separate from their hospital delivery puts them at unnecessary risk, disrupts their lives with more time away from work, and costs the health system more money. 

The Medicaid billing rate for a doctor performing a tubal ligation post C-section is a $90 add-on and takes about 10 minutes, doctors said, not including anesthesia and facility fees.

Patients who go to Animas Surgical Hospital for a standalone tubal ligation would likely have to pay thousands of dollars for the procedure. The hospital’s cash-pay price for the procedure for people without insurance is $9,900.

“Patients do not understand how a health care option can be refused when our hospital gets public money and purports to put patient care first,” Dr Priebe said. 

Pregnant patients in Summit County also face tough choices. Like in Durango, the only hospital is Catholic.

St. Anthony Summit Medical Center in Frisco, part of Centura Health, does not provide tubal ligations. 

Dr. Amy Tomlinson, an OB-GYN in Summit County, has had to explain to hundreds of patients that they cannot get their tubes tied at the hospital where they plan to give birth. 

“Usually, honestly, it was a huff and a sigh and an eye roll,” she said. “Sometimes it was a jaw drop and a shake of the head. But I think women are so used to being second-class citizens in this society that I don’t think it was ever terribly surprising to people.”  

Summit County women have the choice of delivering at St. Anthony and then getting their tubes tied later at another hospital, or driving more than an hour to Denver to deliver their baby so they can have the procedure at the same time. And for women who already have a C-section scar on their uterus, it’s especially dangerous to ask them to drive that far in labor, Tomlinson said. 

“The Catholic position is, ‘If you don’t like it, you can go somewhere else,’” she said. “Well, it’s not like you can go across town when your hospital is the only one in a tri-county radius. We essentially become an island during snowstorms up here. Even if a patient wants to go elsewhere, she may not be able to get there. And then you are asking women to drive an hour or more while they are laboring. Why would we put women at risk for rupturing their uterus or for giving birth on the side of the road?”

Tomlinson, who is opening her own practice but in the past worked at High Country Healthcare, recalled that while removing severe scar tissue from the uterus of a patient at St. Anthony Summit, she had to ask permission from the bishop to place an IUD in the woman’s uterus in order to keep it open and prevent pain. The woman had in the past had a tubal ligation so she was already sterile, but the Catholic hospital still required her to get permission to place the birth-control method, called an intrauterine device. 

And in 2010, Tomlinson gave a presentation to the St. Anthony Summit board to persuade them not to prohibit treatment of ectopic pregnancies. In the post-Roe v. Wade era, doctors across the nation have reported confusion about whether treating an ectopic pregnancy — which is when a fertilized egg implants in the fallopian tube instead of the uterus — is considered an abortion. 

In another large hospital system - SCL Health - Saint Joseph Hospital in Denver and St. Mary’s Medical Center in Grand Junction — operate under the ethical and religious directives, meaning they do not provide sterilizations. 

Two of SCL’s secular hospitals — Lutheran Medical Center in Wheat Ridge and Good Samaritan Medical Center in Lafayette — also operate under the same compliance with Catholic directives, said Gregg Moss, spokesman for SCL Health.

Moss referred The Colorado Sun to an SCL Health webpage that explains the Ethical and Religious Directives for Catholic Health Care Services - they were first published by the U.S. Conference of Catholic Bishops in 1948.

The hospital system’s webpage does not specifically mention birth control, tubal ligations or abortions, but says that in today’s society, Catholic hospitals are “pressured to provide medical procedures that are contrary to Catholic teaching.” 

“And by refusing to provide or permit such medical procedures, Catholic health care affirms what defines it: a commitment to the sacredness and dignity of human life from conception until death,” it says.

Mannat Singh, executive director of the Colorado Consumer Health Initiative, excoriated the choices being made by Catholic hospitals. 

“It is a basic human right to seek, or refuse, reproductive health care, and we will continue to work to ensure there are no barriers to seeking that care,” she said.

COLORADO SUN: Well, it ain’t a gateway drug.

John Ingold

3:55 AM MST on Jan 31, 2023

Last year, a study came out showing that marijuana legalization in Colorado likely increased cannabis use among adults in the state.

Because of the novel methods the researchers used to examine the question, the study was perhaps the best answer to date on one of legalization’s biggest impacts. But it also left an even bigger question unanswered: If adults are consuming more cannabis and more frequently, is that bad?

Now, in a follow-up study by the same team, the researchers have come to an answer: it doesn’t seem to be.

 Stephanie Zellers, one of the researchers, said “At least from the psychological point of view, we really didn’t find that legalized cannabis has had a lot of negative influence, which I think is important.”

Zellers recently graduated with a Ph.D. in psychology from the University of Minnesota, but she began her doctoral work at the University of Colorado before transferring when her thesis adviser changed jobs. She had originally been interested in neuroscience research, but the necessity of using live lab animals for the work was off-putting.

And, in the Colorado-to-Minnesota connection, she found a trove of data that could be used in never-before-tried ways.

The data are from longitudinal studies of twins in Colorado or Minnesota. Researchers in both states followed the twins over long periods of time, collecting information about their behaviors, including their cannabis use.  The survey information, then, creates an ideal scenario for study: It is thorough, it has built-in controls for variables like socioeconomic status, and it helps account for genetic differences.

“That twin component really allows us to rule out what could be noisy variables — cultural differences, family differences, things like that,” Zellers said.

On top of that, because Colorado has legalized marijuana and Minnesota hasn’t (at least so far) — and because some twins born in Minnesota moved to Colorado and vice versa — the data provide an ideal opportunity to study the way legalization in Colorado a decade ago has influenced people’s behavior ever since.

The original study, published last fall, simply asked whether twins living in legal-marijuana states use marijuana more than twins living in prohibition states. And the answer is yes — about 20% more, according to the research.

That answer was interesting, but “Really what people care about is: Is legalization harmful,” she said.

To answer that question, the team came up with 23 measures of what they call “psychological dysfunction.” This includes things like substance-use disorders, but also financial woes, mental health distress, community disengagement, and relationship issues. 

The team looked at data on more than 4,000 people — 40% of whom live in a legal-marijuana state.

Zellers said what the researchers found was unexpected: They basically found nothing.

“Obviously the cannabis use increases, but we didn’t see an increase in cannabis-use disorder, which is a little surprising,” she said. “We didn’t really see changes in how much people were drinking or using tobacco. No large personality, or workplace, or IQ differences, or anything like that.”

People in legal states did not report using illegal drugs at higher rates. Researchers also didn’t find a link between marijuana legalization and psychotic behavior.

They did find one difference, though. People living in a state where recreational marijuana use is prohibited reported higher rates of alcohol-use disorder and more specifically one symptom of the condition: They were more likely to report using alcohol in situations that were dangerous or harmful, such as driving drunk.

To Zellers and other researchers, the study provides valuable information for the ongoing debate over whether cannabis legalization is a good idea. But it’s not the final word.

CU psychology and neuroscience professor John Hewitt, one of the study’s co-authors, said in a statement that “Our study suggests we should not be overly concerned about everyday adult use in a legalized environment, but no drug is risk-free. It would be a mistake to dismiss the risks from higher doses of a drug that is relatively safe in small amounts.”

This highlights one of the study’s big limitations. Zellers said most of the people included in the twins data are relatively light cannabis users. The sample size for heavy users is small.

“Our sample is an adult community sample broadly characterized by low levels of substance use and psychosocial dysfunction,” the researchers write. This limits our ability to generalize relationships between legalization, outcomes and risk factors for the individuals at greatest risk.”

Zellers said she and her colleagues are hoping to publish another study based on their data — but this one will be less concerned about the impacts of marijuana legalization as a policy. 

Instead, it will try to look at how much cannabis people have used over their lifetimes and then score that against the same measures of psychological dysfunction “to see if, not the policy, but the actual substance itself has an effect” 

And if YOU want to see about substances and their effects, don’t miss the unsolicited concert of the week

CONCERT PICK OF THE WEEK: RJD2 with just 2 upcoming dates - Friday Feb 3 at the Music Box in San Diego, and Saturday Feb 4th at the Gothic Theatre in Denver. There should also be lots of fun stuff in lots of fun places this weekend for Bob Marley’s birthday, February 6.

Welp, that’s it for me! From Denver I’m Sean Diller. Original reporting for the stories in today’s show comes from the Colorado Newsline, Colorado Sun, Chalkbeat Colorado, and Denver’s Westword.

Thank you for listening! See you next time.

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