Introduction (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:24):
And good morning, everyone, or good afternoon, whenever you’re listening. welcome to another audition of Health Law Talk. We are very excited to have you here listening to this podcast. in the studio today, Conrad Meyer and Rory Bellina to very accomplished healthcare lawyers who are going to help you navigate some of the wonderful healthcare policy and healthcare regulation that’s going on currently in today’s world. And today, Rory, today. Very interesting. reproductive rights post dos, right? Yeah.

Rory Bellina (00:56):
Yeah. Today’s gonna be a really good topic. I think it’s very timely to do, and we’ve got a lot of insight into

Conrad Meyer (01:02):
This. Yes. and, you know, aside from the the ruling itself, we’re looking at this from a total healthcare perspective. So what, what is the sequela in, in terms of postops with the trigger laws in some states? And what are some of the issues that could pop up that people really, providers might not be aware of, and people who are going through their, their, the, the reproductive issues, whether it’s you know, an unwanted pregnancy ivf maybe a failed a failure to thrive on, on a fetus. You know, what are their, what are their options now relative to Postops? Sure.

Rory Bellina (01:45):
And, and I think we could start with, I know we were talking about this beforehand, is what was the landscape pre dos and then

Conrad Meyer (01:51):
Postops? Yeah. So, so, you know, pre dos there was the the national, you have, you know, Roe v. Wade had the, basically a national right to an abortion. and I know that various states had challenged that. and, and, and there was a lot of different you know, exceptions to that with respect to you know rape, incest even failed failure to thrive on fetuses and embryos. with ivf you had something called selective reduction where if you had implanted more than one embryo into, in, in, into, into a woman for the purposes of, of giving birth, and one of those embryos or both of them took, but then one you know, they both grew and you had twins, or even split, had triplets that could threaten the life of the mother. You could do what’s called selective reduction. And that was still okay in some states. So you know, a lot of things changed postops because of the trigger laws. And, and, and you know, what I’m talking about,

Rory Bellina (02:57):
And, and Dobbs, I think just for everyone, everyone listening was kind of the case per se, that I guess you could say overturned everything. And so

Conrad Meyer (03:04):
Well, didn’t overturn everything, it just punted it back to the states.

Rory Bellina (03:07):
Correct. I think that, that you hear, or at least I heard in the media that this this case overturned. It, it, you’re right, it wasn’t an overturned, it was a, we’re returning this to the state’s rights, and a lot of states, Louisiana included, had these trigger laws, per se, that were going to go into effect immediately, kind of in anticipation that this was gonna

Conrad Meyer (03:29):
Happen. And, and there was 13 states, just to be clear. So there were 13 states that had trigger laws that were ready to go into effect the moment that Dobbs, or the moment that the Supreme Court had overturned Roe. and so now, you know, there’s been a extensive analysis of these 13 states, and their trigger laws, one goes back to 1931. So I mean, we’re not gonna go into each of those states Sure. Not for this episode. but it, it does change the landscape for reproductive rights with respect to individuals who were going through these various issues that we thought we would broadly discuss. and, and I guess one of the, the, the, the first things, you know, really issues that kind of like you, you don’t think about, right? So for example, contraception, I mean, you know, the Plan B pill, is that considered an abortion? Is that, is that now because of a trigger law gonna be banned, where someone might have to go across the state line to another state that doesn’t have this to be able to get a plan B pill? Right.

Rory Bellina (04:29):
Right, right. And, and like you mentioned, there’s not, it’s not very clear what is considered terminating a pregnancy or terminating a life. You know, every state kind of has a different definition or explanation of what is considered conception, what is considered life, what is considered a viable fetus. So it becomes very complicated not only for the providers, for the physicians that are dealing with these questions, but just for the, the general public where they, they don’t know. And, and I mean, we’ve seen in, in the news recently, I believe there’s someone in Louisiana who had to travel to New York for this is, you know, if you, if you’re in the situation where you find out that you are pregnant, or if you decide that you have an incident and you want to take the Plan B pill what do you do? It’s almost like you have to, you know, you talk to your doctor, but your doctor doctor’s gonna wanna talk to their lawyer. Mm-hmm. , it becomes a whole process. And, and, you know, we hear about this, the, the big headline stories of, you know, doctors are not performing abortions because even if, if it, even if the mother’s life is at risk because they’re concerned that it, it doesn’t meet the criteria. So there’s a lot of moving parts, and it’s evolving, and I think that providers and patients especially are, are having to figure this out on, on the fly.

Conrad Meyer (05:50):
Well, here, here’s another thing. Let me, let me, let me, let me confuse you, or really the provider even further cross border battles. So in other words, let’s just say for example, Texas, which has a ban, Okay? Now that, that Dobbs when in effect they have a ban, but somebody wants to travel to across the state line to another state for an abortion that doesn’t have a ban. And now Texas is saying that, Well, if you go to another state for the purposes of an abortion, we’re gonna come after you. But there’s nothing in the trigger law that says that, that they can do that. So, so can Texas or any other state, I’m just not picking on Texas, Right? Sure. Any other state that has a trigger law that, that that’s now in effect that bans abortions, and that person crosses a state line into another state that doesn’t have a ban, can that home state then take action, legal action against the provider and the patient?

Rory Bellina (06:47):
Yeah. And when I saw that, that was really interesting to me, because most of the, the rules, you know, across the states specifically in Louisiana for telemedicine, for example, it’s all about where the patient is located, right? Like that is, so if you’ve got a patient that’s located in Louisiana, and if the telemedicine visit and the doctor’s out of state, it’s considered a visit in Louisiana. So when I saw that a patient traveling out of state to Illinois to have an abortion performed, Right? Does Texas have any action over a Texas resident who has a legal medical procedure in Illinois?

Conrad Meyer (07:23):
I, I

Rory Bellina (07:24):
Don’t think so. I don’t know what, I don’t know what the,

Conrad Meyer (07:25):
Well, I mean, I’m the court, right? Man, my, my gut tells me from a jurisdictional perspective, there’s no personal jurisdiction if it’s not written in the statute. I don’t know how Texas can enforce a Texas law, Right. On an individual in another state that does an action in another state. You

Rory Bellina (07:41):
Know what I mean? Correct. Illegal action. Correct.

Conrad Meyer (07:43):
So, so think of the sequela from that. I mean, think about that. If you go it, how, say you go to another state, not for an abortion, but for something else. Sure. Right. So does that mean that if you, you know, Texas has a, a a, a death penalty, a death penalty state, but then the individual goes to, I don’t know, a non death penalty state and kill someone, does that mean that Texas can bring a death penalty criminal action against the individual for killing someone outta state

Rory Bellina (08:11):
Again? Yeah. I don’t, I don’t see how they could do that, because doesn’t, there was no action in the state. So, but it’s really interesting that the, the Texas has taken that position, and I presume it’s more for political reasons than any,

Conrad Meyer (08:23):
It’s not just Texas though, Let me just say that. It’s not just Texas. They have other cross border battle states that are doing the same thing, that are looking at legal action against people and providers. So, I mean, imagine a doctor, like you just said, in Illinois. In Illinois, who does the procedure

Rory Bellina (08:38):
In

Conrad Meyer (08:38):
Illinois, Right? Who’s licensed by the Illinois board, not Texas. Right. How in the world could Texas have jurisdiction over that

Rory Bellina (08:48):
Provider? I don’t see it.

Conrad Meyer (08:49):
I don’t see it. Sorry. You can, you can posture on the podium in front of a TV all day long, but I just don that would open. Do you know the can of worms that would open up, I mean, just think about it legally, if you did that, and or somehow if that was magically allowed, like you could wave a magic wand and say, I am going to get you if you go to another state. That’s crazy.

Rory Bellina (09:09):
Absolutely. Yeah. I just,

Conrad Meyer (09:11):
I’m sorry,

Rory Bellina (09:12):
I don’t, I don’t see the, the relation, but, but

Conrad Meyer (09:15):
It’s there. I mean, they’re talking about it, you know, , I mean, so, so cross border battles. So you have to look at whatever states you’re in. I mean, I’m going back to our purpose, right? Sure. The providers look at what your state law or your state is saying, especially from your medical board. I mean, your, your, your local medical board should be pushing out, you know, at least guidance right? For you Right on on this. Because if they’re not, I mean, I think if, especially if you’re a physician who, who practices this Sure. In this area, you’re gonna be in trouble. Sure. You won’t know what

Rory Bellina (09:48):
To do. You need some guidance. Absolutely.

Conrad Meyer (09:49):
Yes. Yes. So interestingly you know, I saw this reference the other day to Tala. Okay. So, and what happens now, , if you go and you present to the emergency room, and we all know what AMALA is, Okay. But for our, our listeners you know, do you want to, you want to give a quick, I mean Sure. Inala, so they understand what that is.

Rory Bellina (10:15):
Yeah. SOTA was put in a place in it, the full acronym is emergency treatment. em, emergency, I, I honestly, I don’t remember.

Conrad Meyer (10:24):
Emergency medical treatment access something, labor something,

Rory Bellina (10:27):
Access something, something, something, something, something like that. We

Conrad Meyer (10:29):
Just

Rory Bellina (10:29):
Call ’em Tata. Yeah. It’s this long acronym, But basically it was kind of an anti patient dumping regulation that was put in a place because you saw a lot of and it also required that if you were to show up to an emergency room hospital, right. That you had to be stabilized and or treated and or transferred out. There’s different criteria and steps to that. But it was kind of dubbed the, the anti patient dumping act. Right. and so that, that’s the, the general premises that if you are let’s say your arm was cut off or something like that, and you go into an emergency room and it’s a hospital, it has a valid emergency room, and they take emergency patients, they can’t deny you services based on your ability to pay or inability to pay. Right. And they have to stabilize, treat and or transfer you out. They can’t just dump you somewhere else because they know that you’re not gonna be

Conrad Meyer (11:18):
Able to pay for it. Well, they have to screen you Correct. And do a screening. They required to do a screening and, and determine whether or not you’re in an emergency medical condition. Correct. So if you’re, you’re in an emergency medical condition, again, same thing. Render treatment regardless of the ability to pay to stabilize you and transfer you to a higher level of care, right? Correct. here’s the issue with him. So think about this, because remember, it also involves pregnancy. If you’re an active labor, okay. And you present to the emergency room. Now remember the emergency room is, is any hospital that’s literally advertising the emergency. Correct. They have the emergency sign out. Correct. They’ve got that. So, so pe So, so John put John Doe, Jane Doe looks at it and say, Hey, that’s an emergency room. Then you’re, you’re bound by Amala, Right?

(12:04):
Right. So they present in active labor under amala, then only, you know, during the screening, they have to determine labor. Right. And determine if that’s an emergency medical condition or not. So what if, and here’s the inala thing, going back to reproductive rights, Right? You know, the whole purpose of this. What happens if you’re in a, in a state that has an abortion ban, but you present to an an with no, with no exception, like no life of mother, no life of child, no anything exception, a strict ban. Mm-hmm. . Okay. But you present to the ER and you’re screened and you’re pregnant and you’re in an emergency medical situation, and the doctor determines that that requires an abortion. What happens next? What preempts

Rory Bellina (12:52):
Yeah. I mean, it, it, again, this goes back to the state question, and I’m, I’m just familiar with Louisiana, because that’s where we’re here, is that yeah, by statute, there’s certain criteria that physicians are allowed to provide abortions under, and it’s, it’s different medical medical justifications and medical reasons. So I think that is what is gonna come into play and kind of govern the decision. The physician is gonna have to know, almost have kind of a cheat sheet in his or her pocket saying, Okay, here’s what’s going on. Is this covered under the statute for me to be able to perform this abortion or not?

Conrad Meyer (13:29):
Well, the question is really, does EMTALA preempt state law or the state trigger law apply? You follow me? In other words, what, what, what law trumps what does the Amala law requiring emergency action to stabilize the patient? So if the physician determines that the patient’s in an emergency me or emergency medical condition, it’s pregnant mm-hmm. , and in order to save the life of the patient, that they must abort the baby, but they’re in a trigger ban state. So the state law prevents that. So what law would trump the federal Amala law to save the patient

Rory Bellina (14:03):
To stabilize

Conrad Meyer (14:03):
Correct. Or the state law trigger ban? I mean, do you see the, the, Yeah. And as a provider, you would have No, I mean, you, do you think

Rory Bellina (14:11):
You’re, Well, you don’t have the time to figure this out or to call in-house counsel or, or Yeah. You don’t have the time to figure that out when you’ve got a, a mother who’s potentially bleeding out in, in your er.

Conrad Meyer (14:23):
Right. So do you see the con? So that’s an al conundrum. Sure. You know, and so that’s why I think

Rory Bellina (14:30):
In Louisiana’s statute, I don’t believe it has a, it’s got some emergency criteria. No,

Conrad Meyer (14:37):
It does. It’s life of mother, life of child. I

Rory Bellina (14:39):
Believe it’s got those, but it’s still, it’s still not as clear as it could be or really should

Conrad Meyer (14:44):
Be. I think some of the states, some of the 13 states that have that sugar ban, you know, from postops, like even more strict an absolute ban. Right. So when you have the absolute ban, you know, I mean, what I mean, if you’re the provider, I mean, I think they would just go ahead and do the, do the abortion for the life of the mother. Right? I mean, I would think that’s what they would do under emtala. And then wait to see what the court does. I mean, see if the see if the court actually, you know, does the does the what you call it,

Rory Bellina (15:14):
We didn’t find out there’s any action by you from the medical board

Conrad Meyer (15:17):
Or, or someone sues you, Right? Because you did the abortion.

Rory Bellina (15:21):
Yeah. Yeah. I mean, yeah. That, that, those are all possibilities.

Conrad Meyer (15:25):
So, so, you know, interestingly, one of the things that, that I found out and that, that was interesting to me on reproductive rights, cause it’s not just about abortion too ivf so in, in, in, in vitro fertilization, which is very interesting, states have different laws regarding that. They’re very, you know, friendly IVF states, they’re very unfriendly IVF states, for example, Louisiana does not, I find is a very unfriendly IVF state. Meaning, in other words you know, it only helps the couple. So if you’re, if you’re a couple that is unable to generate eggs, you know, or sites for, for your own children or, or, or if you have a medical condition in your sperm isn’t, isn’t, isn’t you’re unable to generate sperm adequately enough to, to, to fertilize and have your own children. if you wanted to get a, an egg donor or a sperm donor in Louisiana, they don’t allow that.

(16:21):
Really? Nope. They don’t allow that. You can’t do it. you know, you would, you, you, you would it’s a prohibition. And interestingly enough, if you, if you did secure a surrogate to carry a child in Louisiana, you would have to go through the adoption process in order to have your own baby. So, which is, which is very interesting. Cuz for example, Mississippi and Texas don’t have that problem. I mean, very Texas are very IVF friendly, very surrogate friendly. Mississippi seems to be the same way, but we don’t have that. And so from a reproductive rights standpoint, you know, kind of pivoting here for a second you know, it’s really interesting and why I, I lump this in mm-hmm. on the abortion side is because a lot of times families who, or you know, parents or couples who want to have children sometimes implant more than one embryo.

(17:16):
Okay. So for, so for example, you know, they want the greatest success or the greatest chance of success to have a child. Okay? Okay. And, and so in order to achieve that success, they will say, Okay, instead of just planning one embryo, I’m gonna have a greater chance of success if I plant two. Okay. Sometimes even three. Now, IVF doctors now have, have seemed to kind of sway away from that. They don’t wanna do that. Sure. but, and, and the reason is, is because of the problem I’m, I’m about to bring up. And the problem is, is that there is a chance if you implant one, Right. Which would be okay, everybody wants that, that that one embryo could divide and have and create two. So you could have actually two baby Sure. Two kids have twins. If you put implant two, there is a chance that it could, it could, it could multiply into three or even four. Sure. And at that point, when you have triplets or, or, or quadruplets, right. You know, it really, really comes into play that the health of the mother is in real, you know, could be in jeopardy. Because the likelihood of, of triplets in quadruples reaching term, reaching a term of birth is, is it decreases because there’s just not enough room. So what, So they have to do, you know, they have, there’s an issue

Rory Bellina (18:30):
There. That’s what, that’s what I’m asking. I wanna go back to something you said earlier in this. Yeah. So Louisiana with either sperm donation or egg donation, what’s the status on

Conrad Meyer (18:39):
That? That you, you can’t, you cannot actively go out and, and, and seek a donor in Louisiana for gaits. In other words, I can’t, if I, if I am unable to, to, to generate sperm, or my wife is unable to do egg generate eggs because of whatever medical reason Sure. Or age. we cannot go out and secure a donor as of now in Louisiana to, to be able to donate their gaits to help us have children.

Rory Bellina (19:08):
So how do these, what do these clinics do that are here?

Conrad Meyer (19:12):
Like they refer you outta state?

Rory Bellina (19:14):
So all the fertility clinics in Louisiana Yeah. Essentially refer you outta state

Conrad Meyer (19:19):
If you want to go that route. Yes.

Rory Bellina (19:21):
Interesting. Okay.

Conrad Meyer (19:22):
Now, if you, now what they, what is allowed, in other words, if, if if I gave and donated my sperm or your partner donates her own egg, you can do IVF that way. Okay. But I can’t go out to Tulane or Loyola. Right. Or some university like lsu, any, any place and advertise, Hey, if they’re healthy females who wanna donate their eggs, I can pay X amount of money. That’s not gonna happen.

Rory Bellina (19:47):
Okay. And so all the fertility clinics, even in Louisiana, if you were to go to fertility clinic and say, I want to have a child. I would like to procure sperm donation. I’m a female, I make my own eggs, I want the sperm donation. That’s not that you’re sending outta state for that? Yes. Okay.

Conrad Meyer (20:05):
Yes. Because they, because Louisiana has a prohibition on that.

Rory Bellina (20:08):
So you go outta state to have

Conrad Meyer (20:10):
The, the donation,

Rory Bellina (20:11):
The donation or the implantation made, and then you come back here for your treatment.

Conrad Meyer (20:15):
Yes. So in other words, let’s say for example, let’s say for example, you wanted to get a don a sperm donor because you’re a single mom and you don’t have a couple,

Rory Bellina (20:22):
A single per Okay.

Conrad Meyer (20:23):
A single P person. Right. Or, or you’re a male. You’re a male and, and you want to have a child. You don’t have a, you don’t have a significant other, or you’re a couple and you’re unable to have children for whatever medical reasons.

Rory Bellina (20:33):
Okay? Okay. All right. I’m following

Conrad Meyer (20:34):
You. Can’t you, you would have to go to like a, like we went to, you know, like, like, like Texas, Right?

Rory Bellina (20:40):
Texas or Mississippi or

Conrad Meyer (20:41):
Mississippi. Right? Okay. And, and, and then, and then there, you know, are clinics there that would allow sperm donors and egg donors and they have whole programs? Sure. I mean, you’re talking about people who vet, you know, vet people through various medical and social to determine if there would be a qualified sperm donor or qualified egg donor. They have companies that do this. Okay. And then you would work through your fertility clinic and a a donor company to secure what you

Rory Bellina (21:08):
Need. Okay. So, and you have to physically travel out of state Yes. Yes. For the implantation to happen.

Conrad Meyer (21:14):
Correct. And, and for the birth, I mean the real, the implantation Yes. Because it’s prohibited here in Louisiana. Right. All right. But so and, and for the birth, remember now, because if you, you know, let’s just say Jane Doe say you’re a man, a couple or a woman you know, who couldn’t carry a child for whatever reason. Right? All right. Men obvious, you know, couples for their age or whatever medical reason, or a woman who might for the age or other medical reasons, cannot carry Sure. A gestational child to, you know, gestational carrier to birth. So you’d have to hire a surrogate, Okay. And say you did that. If you did that in Louisiana, okay. And you went and you did your, your, your ivf you know, donor in Texas or whatever, and they did a what’s called a frozen en embryo transpo or a live transfer. Meaning, in other words, once they get the game, eats from the donors or the couple or whoever, Right? And they fertilize them in the pet dish. Right? Right. And they form embryos, they grow ’em out for so many days. Okay. Then that surrogate that you, you know, have located usually have companies that do this, but okay. Would go to Texas or whatever, and they would get implanted with the

Rory Bellina (22:25):
Embryo. Okay. All right. And following.

Conrad Meyer (22:27):
Okay. So then that person say, that person’s not from Texas, say that person lives in

Rory Bellina (22:31):
Louisiana. In Louisiana. Yeah. I like that example.

Conrad Meyer (22:33):
Okay. It’s right across the border. So the problem is, is if that individual give birth in Louisiana, there is nothing in Louisiana law that would allow the intended parents,

Rory Bellina (22:48):
The, the, the parents who the, the husband or whoever it may be, that

Conrad Meyer (22:52):
Essentially husband, wife

Rory Bellina (22:52):
Or couple that essentially paid for all this, paid for

Conrad Meyer (22:55):
All this. Right? Okay. There’s nothing in Louisiana Law, and it’s a prohibition in Louisiana that, that, that they cannot, they, those parents or those individuals will not be on the birth certificate if that woman gave birth to the child in Louisiana.

Rory Bellina (23:07):
Okay. So they’re not on the birth certificate. What if they’re, I assume there’s contracts involved in this, right?

Conrad Meyer (23:13):
Yeah.

Rory Bellina (23:14):
Numerous tons of numerous legal contracts. Absolutely. Is that the, I wanna go back to the example of the surrogate giving birth in Louisiana. And you have a contract for this with the couple who’s essentially paying for all this. Yes. When that mother gives, when the surrogate, I wanna make sure I use the right terms. When the surrogate gives birth in Louisiana. Is, are, is the surrogate contractually obligated to what’s the word give up for adoption? Yes. The baby.

Conrad Meyer (23:43):
Yes.

Rory Bellina (23:43):
So the contract is valid in binding in Louisiana.

Conrad Meyer (23:48):
That’s remained to be seen. Okay. Okay. Because it, it, I don’t think it’s ever been challenged. Okay. but I know that there’s no hospital in Louisiana that would ever put the original intended parents’ names on the birth

Rory Bellina (24:00):
Certificate. So your, their names aren’t on birth certificate. So

Conrad Meyer (24:02):
You have to go through adoption.

Rory Bellina (24:04):
So you would have to go through the, from the surrogate. And my concern would be that

Conrad Meyer (24:07):
Your name’s

Rory Bellina (24:07):
Went on the burst buffer. If you walk through this whole process, you’re the couple who Yes. Can’t carry. You go through one of these companies, you hire a surrogate I know this is very expensive. You pay for the implantation in Mississippi or Texas and the surrogate comes back here, gives birth Yep. In Louisiana,

Conrad Meyer (24:28):
And decides not to want to get the baby up.

Rory Bellina (24:29):
Yeah. What happens there? That’s, And then she says, I’m not, I’m not putting up this baby that you essentially paid for, for adoption. That’s what happens there.

Conrad Meyer (24:37):
That’s the problem. And that’s, that’s a risk I would think.

Rory Bellina (24:41):
So, so, okay. So what’s the alternative? You give birth in Mississippi and what happens there?

Conrad Meyer (24:45):
You find a surrogate in a, in a surrogate friendly state. So for example, Mississippi right. In a surrogate friendly state. So if you execute a contract in Mississippi, cuz Mississippi does allow this amazingly, I

Rory Bellina (24:56):
Mean, amazingly in Mississippi,

Conrad Meyer (24:57):
Right? Mississippi right. You would think Mississippi. Really?

Rory Bellina (24:59):
Yeah. They’re almost more conservative than Louisiana.

Conrad Meyer (25:01):
I mean, no, it, it un unbelievably. So the state of Mississippi allows this to happen.

Rory Bellina (25:08):
So upon birth in Mississippi, same example by the surrogate, what

Conrad Meyer (25:11):
Happens? Well, we’re gotta walk back a little bit cause Mississippi has a couple of other steps. Okay. So in other words, you sign the contract with the surrogate. Okay. Whether it’s a couple or a single parent, Right. You must get a Mississippi judge to issue an order blessing that, that contract, Sorry? The

Rory Bellina (25:29):
Contract. So, Oh wow.

Conrad Meyer (25:30):
Okay. So once the Mississippi judge issues the order that it’s a valid contract, okay. That order along with the contract is given to the hospital where the birth will take place. Okay. That order instructs the hospital to put the intended parents on the birth certificate for vital records. So, so then you walk if, if you’re the intended parent or parents, right? You walk out the hospital with your child with the birth certificate that’s gonna be in your

Rory Bellina (25:57):
Name. So you’re, you’re essentially the judge is ordering Yes. The hospital essentially skip the process of adoption that that’s, that’s cut out. There’s no adoptive process. Right. It’s your child because

Conrad Meyer (26:08):
The court has blessed this. Yes.

Rory Bellina (26:10):
Interesting. Yes.

Conrad Meyer (26:11):
Isn’t that inter And, and it doesn’t happen in Louisiana.

Rory Bellina (26:13):
That’s really interesting. So

Conrad Meyer (26:15):
I know we kind of taken a pivot on this. No,

Rory Bellina (26:16):
No. This is

Conrad Meyer (26:17):
From reproductive rights. It’s

Rory Bellina (26:18):
Interesting. So, so what is, in your experience in this, this is very new to me, what is, is it, is it strictly religious or political in nature? Why Louisiana’s a little bit?

Conrad Meyer (26:29):
I think it’s, it’s conservative think, I think it’s both. I mean, I think our, our brothers and sisters right up in the north, in the north Louisiana are very sure are very religious. And I’m not, I mean, of course I’m, I’m very religious. I’m very Catholic, so I understand. So they’re, I I think it’s a lot to do with that. And also, I, I don’t know if any of our representatives have really delved into this area of the law. So I don’t know if they’re really cognizant of what, in other words, of the technology of how things have advanced. Sure. you know, so I, I could see some ignorance or just lack of understanding or lack of awareness. Yeah.

Rory Bellina (27:05):
And if, and if a, if a constituent’s not bringing this up to you, if it’s not an issue, then, you know, why are you gonna write a bill to, to change this, to get, you’re not slaughtered in the house for the Senate. You’re not from the, like you said, the more conservative parishes,

Conrad Meyer (27:19):
You know, And then interesting. So

Rory Bellina (27:20):
That’s really interesting. And I, I, I was really unaware of the relationship between fertility clinics having to refer out to,

Conrad Meyer (27:30):
So, so if you’re a fertility clinic here

Rory Bellina (27:32):
In Louisiana, In

Conrad Meyer (27:33):
Louisiana,

Rory Bellina (27:34):
You can, and someone, a female walks in and says, I want a sperm donor. I don’t wanna get, for whatever reason I wanna have a child on my own. Yeah.

Conrad Meyer (27:40):
You gonna have to go outta state.

Rory Bellina (27:41):
They’re gonna, they’re gonna set you up as a client and everything.

Conrad Meyer (27:45):
Yeah. They’re, they’re gonna test on you and make sure that you are capable. Like in other words, you are what you say and you wanna have a child. Sure. And, and maybe, you know, you know, check your oh, sites to make sure that you can produce oh, an oh site for fertilization and then refer you out to a state probably Texas because it’s right next door. Right. It’s very, very friendly for

Rory Bellina (28:06):
The implant.

Conrad Meyer (28:07):
No, for the donor

Rory Bellina (28:08):
To receive, for the donation or the, and,

Conrad Meyer (28:11):
And subsequent implant in Texas.

Rory Bellina (28:14):
Okay.

Conrad Meyer (28:14):
Because remember now, let’s just say if it’s the individual, say that person can gestationally carry,

Rory Bellina (28:19):
That’s, that’s my example. Yes. So

Conrad Meyer (28:21):
In other words, so based on your example, that person would go to Texas, get the donor sperm, have the IVF done in Texas, Okay. Do the implantation in Texas, but then come back to hit her house and carry the baby to term. And when she bears the baby, it’ll have her name on

Rory Bellina (28:35):
It. So everything else after the implantation

Conrad Meyer (28:38):
Will

Rory Bellina (28:38):
Be fine, can occur in Louisiana.

Conrad Meyer (28:40):
It’s when you have a surrogate that that’s the

Rory Bellina (28:42):
Surrogate is different. It’s different. Interesting. And it’s all about for surrogacy where the birth takes place. It’s not where they carried the child. I mean, it’s all about physically they have to, even if your surrogate’s living in Louisiana, when she becomes due, she needs to go across the border.

Conrad Meyer (28:58):
Yeah. I mean, I’ve never, look, I’ve never challenged that. I’ve never tested that. Sure. You know, but I know, like I know that the, the Mississippi court order for example, in that exam, in that Mississippi example that is, that is directing the hospital to follow the mm-hmm. , the, the gestational carrier contract. Got it. And you got, so you got multiple in terms of reproductive issues. And, and now we’re focusing on ivf is you’ve got the, the fertility clinics. You’ve got who a lot of times also run a separate side. Hus not a hustle, but a side business of, of donors. Sure. So the fertility clinics in, in a very IVF friendly state are gonna gonna be going donor programs. So the Yeah. They’re gonna be out like screening donors, both, you know, sperm and egg and, and, and, and incorporating that. It’s a, this is a huge business, I’m sure. Yeah. This is a massive, massive business.

Rory Bellina (29:54):
Is any of this,

Conrad Meyer (29:55):
You’re talking tens and thousands of dollars of money.

Rory Bellina (29:58):
I was gonna say, that’s what my next question was. Is any of this covered by insurance? Ah,

Conrad Meyer (30:03):
I mean, there, there are very, very, very few policies that would ever cover ivf Okay. And, and there, and there’s been ways to attack it. I mean, there’s been ways, I mean, because they do say that infertility can be considered a diagnosis. Right, Right.

Rory Bellina (30:19):
Right.

Conrad Meyer (30:19):
So, so I know there’s been challenges to it. I know there’s been discussions about it, but I mean, I, I don’t know of many, if any Sure. Insurers that would ever carry just because of the sheer

Rory Bellina (30:33):
Cost. Now, let’s say your implanted, I assume your insurance covers your labor and delivery and maternity. Right.

Conrad Meyer (30:42):
That’s different. So, so in other words, I mean, I think even a surrogate mm-hmm. , you would have insurance cover, you know, I I I’ve seen some insurance companies, they won’t cover the ivf. Right. But they will cover the surrogate delivery cost.

Rory Bellina (30:55):
Okay. And whose policy? The actual surrogate?

Conrad Meyer (30:58):
No well, that’s a good

Rory Bellina (31:01):
Question. Meaning, meaning, here’s my thought. If you’ve got a surrogate who you, you makes their job out of this, per se, let’s say, Cause I know a lot of surrogates do this more than once, right? Yes. Yes. So let’s say that this person, this is not a good expression, but like, this is their job. They, they’re surrogate and they just, I

Conrad Meyer (31:16):
Wouldn’t call it a job. I would call it a

Rory Bellina (31:18):
Calling. A calling. Okay. The surrogate has this calling to continue to carry Yes. Children for couples. Yes. Is that surrogate’s Blue Cross policy gonna cover all these you know, weekly, monthly visits to labor? Cause I feel like that that’s not, it’s not an overused, but I mean

Conrad Meyer (31:38):
No, their policy would cover that. You as the intended parent under the gestational carrier agreement would cover the deductibles of whatever policy that person had. Okay. You know, and I think, I think there is a

Rory Bellina (31:51):
I’m just surprised the insurance companies are willing to do that because most people have, you know, two to three kids on average. Well,

Conrad Meyer (31:57):
They can’t stop it. I mean, what, what mean, in other words, if you’re under the policy and you’re covered individual covered beneficiary. Right. And you’re pregnant regardless of who child is.

Rory Bellina (32:06):
That’s true. That’s true. I just, I, I could see the insurance company saying, Wait a second. Like, you’re, you’re you’re having too many kids. You’re making money on this now. Like, we’re

Conrad Meyer (32:14):
Not, How, how would that look?

Rory Bellina (32:15):
Right. You’re right. And insurance companies aren’t hurting, so Yeah, that’s fair. I just didn’t, I just didn’t know what, I didn’t know if that was an exclusion or something where

Conrad Meyer (32:23):
No, no, no, no. I mean, I think you have the, you gotta cover the deductible. Right, Right. But I still think that, that it’s, it’s, it would be covered under the policy. It would be covered as a covered a covered expense. Sure. you know, it just, they can’t, I don’t think it’s They can, they can’t stop, stop that.

Rory Bellina (32:39):
So Interesting.

Conrad Meyer (32:41):
Interesting. I mean, well, I gotta tell you, it, it, it’s, it’s, it’s not only interesting, it’s, it’s, it’s one area of the law that literally has numerous legal issues and ramifications mm-hmm. that most people aren’t even aware.

Rory Bellina (32:57):
And I think that this area, the whole reproductive rights, if, if you look at any area of medicine, I, I’d venture to say that the re the whole reproductive field is probably the biggest medical area that is influenced by religion and politics over anything else. I

Conrad Meyer (33:15):
Mean, you have the religious right that would say that, you know, the Vatican is against ivf. Correct. You would have some Catholics that would say, and, and, and not some, but a lot of Catholics would say, Well, divine intervention, if, if the Lord gave someone the ability to build and create this Sure. Then it’s divine intervention and therefore it would be acceptable.

Rory Bellina (33:36):
And it’s not just, I don’t think it’s just Catholics. I think it’s, you’ve got, you’ve got religions all across the state, wherever you may be that believe that, you know, none of this should happen. So they’re not gonna write a bill, they’re not gonna sponsor a bill, and they’re gonna kill any bill that comes across. So, so the law is never gonna catch up with it. As opposed to other states that are more progressive, where they, they see the medical need for this. How, you know, people are progressing and, and, and why they really do

Conrad Meyer (34:06):
Need it. Oh, really? The is I think one of the, the, the, the issues that has not been addressed yet. And, and, and, and I’ll be candid with you, I don’t know how often it happens. Sure. But it’s still an issue and it’s a selective reduction.

Rory Bellina (34:17):
And you can explain that.

Conrad Meyer (34:18):
So if you get a situation where you’ve got more than one embryo implanted and both are growing, or one has divided into two, or if you put two, two is divided into three or whatever. Okay. And as the babies continue to develop, what happens in, in a couple situations, what happens if one of those fetuses now as it grows, fails to thrive and you have a situation where the fetus is causing harm to the other fetuses, and you have to selectively reduce, or the fetuses are getting so big that there’s no choice. You have no choice but for the safety in health of the mother, and, and you have, you have to pick one. You know, I mean, what do you,

Rory Bellina (35:00):
That’s technically an abortion,

Conrad Meyer (35:01):
Right? That’s correct. So what do

Rory Bellina (35:03):
You do? And what ha here’s this is, you don’t have to answer this. Cause I don’t think there is an answer to this. If you’re in, like you said, Mississippi, you’ve got this contract, right. And the, the embryo split, and now you’ve got more than one and it could potentially harm. I, I don’t, I’m assume these contracts probably contemplate for this, but they do, if, if, if the mother or the surrogate is at risk, you know, or let’s say the parents want all, they want the triplets, but the surrogate doesn’t want to carry the triplets. I mean, what happens there is that in the contract

Conrad Meyer (35:36):
It is and, and it’s, I mean, amazingly it’s contemplated in these agreements, in these gestational agreements where the surrogate makes the call, the surrogate makes the call, Okay. Along with her husband or Okay. Or if she’s not married, the surrogate herself is the sole person that could make that call with advice or input from the intended parents. Okay. but ultimately it, it lies with the surrogate.

Rory Bellina (35:58):
The surrogate. Correct. And, and then again, if, if it’s too many in the surrogate, but then the surrogate, now the surrogate in Mississippi is traveling to Illinois for an abortion, it’s just,

Conrad Meyer (36:08):
But do you see the conundrum amount? Yeah. So, so if the, if the state law in effect does not allow an exception for life of mother. Right. Right. Or if there’s a failure to thrive or there’s an issue in terms of a disability or, or whatever with the fetus in utero. Sure. The state law doesn’t have an exception for that. Well then what do you do?

Rory Bellina (36:28):
Sure. Or what if it’s really not life of mother? What if the surrogate just doesn’t want to carry oh three? But I mean, I I, the issues are endless because you’ve got possibly a Louisiana couple with a Mississippi surrogate who’s having to travel to Illinois for an abortion. It’s just, it’s, it’s crazy. Three states, three different sets of laws. It’s, it’s

Conrad Meyer (36:51):
A lot. And how can you, and, and just think about the couple, Right. Who has probably spent, you know, close to six figures to have this child that medically they’re not able to have. Sure. And a surrogate who wants to help Sure. Is now faced with a terrible decision to make. you know, and then they’re in a state that doesn’t even allow that type of, you know, the bands that sort of scenario from ever, from ever occurring. Right. So anyway,

Rory Bellina (37:24):
Look, and they’ve got that Mississippi contract that was just blessed by a judge, but in Illinois it’s not gonna be valid. I mean,

Conrad Meyer (37:30):
It’s, No, no. So it’s, it’s, look, it’s, it’s, the whole purpose of the show today was to talk about the issues Sure. And is a good issue. Spots. Now we’ve sort of pivoted to IVF at the end.

Rory Bellina (37:41):
No, but I mean, it’s all under reproductive rights.

Conrad Meyer (37:43):
It’s under reproductive rights. So when you look at the posts, when you’re looking at ivf, when you’re looking at emala, when you’re looking at border battles, when you’re looking at, I mean, we are in for a legal conundrum Sure. On all of the issues that are gonna have to be, you know, I think they’re gonna have to be either worked out in the courts. Sure. You know, or the, the individual state legislature’s gonna have to do something to address all of these issues.

Rory Bellina (38:10):
And I think that, like, like I mentioned earlier, this is a very political and out of any field of medicine, how we said this is a very political and religious, I think that in the practice of medicine, you know, most physicians or the kind of the rules and regulations are similar that various boards of medical licensure, board of medical examiners, whatever the state calls it, it, that they pretty much follow the same set of rules. But this is that one field of medicine where every state is different, you know, and I think that that’s really important, difficult for the providers, difficult for the patients because, you know, most states follow kind of the same rules on telemedicine. They follow the same, the same rules on elective procedures. You know, this is state by state and it’s really, really interesting.

Conrad Meyer (39:00):
And, and the sad thing is, is that when you look at the scenarios, just the brief ones that we talked about today, most people really don’t understand. And even providers are, I think providers who are in the trenches. Most of your ob GYNs, you know, who are doing this, fertility physicians, you know or turtle fetal, you know, specialists Sure. Who are involved with this type of work you know, are, are, are, are gonna be confused. They’re, they’re not gonna know. all they wanna do is practice medicine. Right. You know, that. So, and then you got people who ultimately are also confused because I could tell you this, it, it’s a very stressful emotional Sure. Especially on the IVF side journey. Sure. And, and I’m sure it is for the, you know, I’m sure it, it’s extremely stressful for patients on, on postops on on the abortion issue. Sure. So, so anyway, it’s, it’s, it’s definitely

Rory Bellina (39:56):
Yeah. I mean these fertility clinics must have to give you some sort of, Do they refer people out for legal advice?

Conrad Meyer (40:01):
Because this is, It is. They do, I mean, I know they, I know they do. I mean, I’ve talked to a couple of fertility lawyers in Texas and and even in Mississippi who they don’t really go as fertility lawyers. They call themselves family. They just like a family lawyers, but they, but they know about the fertility issues. So you know, who, who have helped formulate these contracts.

Rory Bellina (40:21):
Sure,

Conrad Meyer (40:21):
Sure. So I, I, I think, you know, it’s, it’s another step in the process of how to navigate some of these very complex legal issues that a lot of times I think the news media or others just either don’t cover or, or legislators just simply just fail to address. Right. Because they just don’t understand the complexities of, of how, how the ripple effect, Right. Yeah. Of what happens when you’re dealing with some of these issues.

Rory Bellina (40:48):
Yeah, man. Very interesting topic today.

Conrad Meyer (40:51):
Well, great. Well look, thank you very much. any final thoughts, Roy, before we close out?

Rory Bellina (40:55):
No, no. I think this was a, this was a really good topic and like I said, it, it’s the one field of medicine that I feel is different state by state. It’s got so many religious and political factors in it that, that really kind of overlay on the actual medical aspect of it. it, it’s just, it’s, it’s evolving, especially ops. Well,

Conrad Meyer (41:17):
Look what I wanted to say this, you know, and I know we’ve talked about this before we close out listeners, if you have any comments, requests, anything like that, please send us an email directly. We don’t have that, that bulletin board or a blog that you can just sort of post comments on. So the only way we get feedback and the only way we get comments is if you send us an email. So Roy, what do, can you tell the listeners what the email is? Cause I don’t if I forgot

Rory Bellina (41:42):
The email with the email podcasts with a plural podcasts – podcasts@chehardy.com and it’s also gonna be listed in the description for the podcast show as well.

Conrad Meyer (41:51):
Fantastic. So everyone, please, we really appreciate, you know, your thumbs up, that five star rating, and we really appreciate you sending us your comments and request. this is another episode of Health Law Talk, Rory Bellina and Conrad Myers signing off until the next one. Enjoy.

Rory Bellina (42:05):
Thank you.

Speaker 1 (42:08):
Thanks for listening to this episode of Health Law Talk, presented by Chehardy Sherman Williams. Please be sure to subscribe to our channel. Make sure to give us that five star rating and share with your friends, Chehardy Sherman Williams is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does this podcast establish an attorney client relationship. Reference to any specific product or entity does not count as an endorsement or recommendation by Chehardy Sherman Williams. The views expressed by guests on the show are their own, in their appearance, does not imply an endorsement of them or their entity that they represent. Remember, please consult an attorney for your specific legal issues.