Post-Roe, WA is a health care ‘sanctuary’ — for both patients and providers

Growing up in Corpus Christi, Texas, Sarah Villarreal saw a lot of teenagers and very young women getting pregnant.

“I was actually the first in my family to graduate high school without a child,” she said.

Dr. Villarreal said that’s what motivated her to become an OB/GYN: giving people access to contraception and reproductive care options that she didn’t even know about as a teenager.

But then Texas started restricting access to abortions.

“I wasn’t really feeling like I could safely practice,” she said, “and I felt like I was losing a lot of the joy that I had in my job previously.”

Since the Supreme Court ended Roe and abortion became illegal or severely restricted in many states, health care providers — especially ones who focus on obstetrics — are deciding what to do next. Some are moving to states like Washington, where they can legally terminate pregnancies. Others are staying put and trying to help their patients get to Washington when they need or want an abortion. In both cases, Washington is playing an increasing role as a destination for both patients and providers.

Villarreal said, not long after Texas banned all abortions after the sixth week of pregnancy, a patient came into the ER. She was pregnant and she had a uterine infection, which can be fatal.

“If left untreated, it could get to that,” Villarreal said. “That’s the whole thing with their laws is like, how long am I supposed to wait? Am I waiting until she’s needing a blood transfusion, or septic to the point where she could have a seizure?”

Villarreal said she knew the patient needed an abortion, but she hesitated.

“Anyone can report you,” she said. “And so it really is a scary situation. It’s this whole thing of what we call ‘C.Y.A.’ — cover your ass. No one wants to practice medicine like that.”

While she was trying to figure out what to do, the patient miscarried, Villarreal said. But she didn’t feel safe in Texas anymore. And it wasn’t just abortion: The state was threatening to restrict gender-affirming care as well.

She decided to move to Seattle.

“I was heartbroken,” she said. “I think the thing that really affected me the most was I was doing a lot of transgender care. And I realized that I left a lot of patients without a willing provider. And that was really, really hard. I really felt like I was abandoning my patients.”

Providers aren't just moving their practices from Texas to Washington. It’s too early to have any data about how many providers are moving to a new state because of the Supreme Court’s Dobbs ruling, but the American College of Obstetricians and Gynecologists says, anecdotally, it is happening.

Others are staying where they are: some because they support the new laws — others because they want to fight those laws, and refer patients out-of-state for abortions.

That’s what Dr. Caitlin Gustafson has decided to do. She practices family medicine with obstetrics in a small town in Idaho.

“This is my home; these are my patients,” Gustafson said in an interview.

Before the Supreme Court’s ruling, Gustafson provided abortions at a Planned Parenthood and also offered abortions in her day-to-day practice.

When people come to her wanting to terminate a pregnancy, “these are generally people that I do know really well,” Gustafson said. “The majority of abortion patients are already parents. There’s a good chance that I’ve already delivered their previous children or take care of their children.”

Gustafson said, now, instead of providing abortions herself, she sees her primary role as giving patients information: “What their options are, where they can go, have frank conversations about their particular situation,” she said. “It’s more important than ever to be that advocate that patients know is going to stand up for them and the health care that they need.”

Some of her patients have traveled to Washington for abortions.

Back in Seattle, OB/GYN Sarah Villarreal has settled into a townhouse in the Rainier Valley.

She said, at her job here, she feels like she can give her patients more options than she could back in Texas.

“I definitely don’t feel that fear,” she said. “And, just, you feel like you’re doing the right thing for your patients.”

Even so, she’s not sure she wants to stay.

“I was doing a lot of good where I was,” she said. “I feel like here in Seattle, providers like me are a dime a dozen. My patients don’t need me the way that they needed me in Texas.”

So, Villarreal said, she’s not sure when, but she might go back. Texas will always be home for her.