Closing arguments and testimony conclude in trial to challenge Indiana abortion law

The trial in the latest legal challenge to Indiana’s near-total abortion ban concluded Friday with closing arguments from both sides.

Owen County Special Judge Kelsey Blake Hanlon will now weigh questions about specific elements of the law.

The almost total ban only allows abortion if there is a “serious risk to the health” of the pregnant person; if there is a lethal fetal abnormality up to 20 weeks after fertilization; and in cases of rape or incest, but only up to 10 weeks.

The amended complaint says the definition of “serious health risk” is “unconstitutionally narrow.”

Lori Martin represents a group of abortion providers who filed the amended lawsuit. She said doctors need flexibility to present the full scope of care so patients can choose the treatment that best fits their personal risk tolerance, and highlighted expert testimony.

“Dr. Caldwell was very clear that women are going to die under the restrictions of SB 1, and that is a terrible outcome for Hoosier women.”

Dr. Amy Caldwell is one of the plaintiffs in the case and is one of two doctors in the state still performing procedural abortions. In closing arguments, the plaintiffs highlighted Caldwell’s testimony, saying she had to deny care because of the uncertainty the law’s language creates for providers.

Indiana Attorney General James Barta represented the defense and said the law is reasonable and constitutional.

“(The exceptions) allow doctors the freedom to use reasonable medical judgment to intervene and terminate a pregnancy, if that is truly necessary to save a life or prevent a serious health risk,” Barta said.

Several medical experts testified that the law uses language without a clear medical definition.

The defendants argued that there was a reason for using non-medical language. In his closing argument, Barta said avoiding medical jargon allows laws to broadly cover risks. He said doctors know how to use the language.

Allyson Slater represented the plaintiffs and said the law forces doctors to make “impossible decisions” about when a patient qualifies for care.

“Often those patients face really serious health risks,” Slater said. “But doctors are afraid and don’t want to make decisions that could jeopardize not only their medical license, but also their freedom.”

While the defendants said the exception gives providers enough room, the plaintiffs’ experts identified concerns about how this exception applies to patients who have a life-threatening condition or health risk in the future, leading doctors to try to guess when a patient becomes “sick enough” to qualify.

Indiana law also explicitly excludes “psychological or emotional conditions” from its definition of “serious health risks.”

READ MORE: Exclusion of mental health in ‘health or life’ exception focuses on second day of challenge to abortion law

The second part of the amended complaint also said that the requirement that all abortions be performed in hospitals or outpatient surgical centers is also unconstitutional.

Barta said in his closing argument that experts testified that serious complications from a surgical abortion may require tools that are only available in a hospital.

Melissa Shube is an attorney for Planned Parenthood Federation of America and represented the plaintiffs. She said the requirements limit access to care.

“People deserve to access care in their own communities,” Shube said. “And it’s part of the reason why our challenge to hospital requirements is so important.”

In addition to providing care in a hospital setting, Caldwell, the plaintiff provider, also has an active contract to provide abortion care with Planned Parenthood. He said he can no longer fulfill the contract because of hospital requirements set out by law.

Caldwell also expressed concerns about the cost and accessibility of care with the requirement. Caldwell said a procedural abortion in a hospital can cost about $8,000, while one in a clinic costs about $500, and care is still safe outside of a hospital setting.

Court documents filed by providers say more than 8,400 abortions were performed in Indiana in 2021. More than 98 percent were performed in abortion clinics and the rest in hospitals.

They also said the near-total ban on abortion clinics makes it more difficult to receive legal care in Indiana. The court documents said that “based on information and belief, no hospitals outside of Indianapolis currently offer abortion services.” Many pregnant people in Indiana who have legal access to abortion services would have to seek them outside the state.

The Indiana Supreme Court’s 2023 ruling on the near-total ban said it did not violate the state constitution. But the court left the door open to challenges over specific details, including this lawsuit.

Referring to that decision, the defendants criticized the lack of a specific scenario in the lawsuit. Barta said the decision was “clear” and that challenges to the “life or health” exception must have a specific circumstance to evaluate.

“It’s not enough to imagine a hypothetical scenario in which someone could claim that the law infringes on their constitutional rights,” Barta said.

Planned Parenthood Great Northwest, Hawai’i, Alaska, Indiana, Kentucky; Every options; and an Indianapolis-based obstetrician-gynecologist filed the lawsuit.

Abigail is our health reporter. Contact them at [email protected].