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They came to Michigan for an abortion. Now, that's uncertain too.

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Doctors say the current legal limbo surrounding abortion in Michigan couldn't have come at a worse time; patients are flooding in from other states. Now, some doctors are asking them to make plans elsewhere.

On Monday morning, Dr. Audrey Lance had a clinic full of patients when the call came: Michigan's Court of Appeals had ruled an injunction blocking the state's 1931 abortion ban from taking effect did not apply to local county prosecutors — several of whom have said they would prosecute abortion providers under the old law. "We had to immediately halt what we were doing," Lance said.

Ultrasounds, counseling sessions — everything froze. Similar scenes played out in clinics and health care systems around the state, as doctors frantically huddled with legal teams to figure out what the ruling meant for them.

That uncertainty still plagued providers Monday evening, after an Oakland County Circuit Judge issued a temporary restraining order at about 5 p.m., once again blocking enforcement of the ban — at least for now. And several clinicians said the legal limbo couldn’t have come at a worse time, as patients from states like Ohio, Wisconsin, and even Texas flood into Michigan clinics.

Growing waitlists, and a surge in demand 

Those patients are increasingly desperate. There was the young girl who drove seven hours with her mom from Milwaukee for an appointment, then turned around and drove the seven hours back home, Lance said. There was the recent patient who cut her off in the middle of going over the medical risks of abortion. "She said, 'It's fine, I don't care what the risks are. You could shoot me in my uterus, and that would be fine. I just cannot have another child right now.'"

At the University of Michigan's Michigan Medicine, the number of patients coming in from out of state has increased dramatically, leading to a 20% to 30% increase in patients overall. Many of these patients had appointments canceled in other states after the U.S. Supreme Court overturned Roe v. Wade, said Dr. Lisa Harris, a University of Michigan OB-GYN and professor. That includes one patient who found out she was pregnant at the same time her young son was diagnosed with a life-threatening malignant tumor.

"He requires surgery and chemotherapy and radiation," Harris said. "And she found herself pregnant, realizing she couldn't continue the pregnancy and care for her son with all his medical needs. And [she] had her appointment in another state canceled at the last minute. It took her a couple of weeks to find care with us in Michigan, and ultimately she had her abortion procedure the day before her child was about to have major cancer surgery."

A day of legal uncertainty

After the Court of Appeals ruling Monday morning, Harris said doctors at the University of Michigan had to tell patients they had no idea if they'd be able to get the abortions they were scheduled for. "We are telling them that [Tuesday] or Wednesday, when their procedures would happen, we may not actually be legally able to provide that care. And we understand how crushing that likely feels to them. And we are going to ask them to begin looking for care out of state, likely in Illinois."

Meanwhile, Planned Parenthood of Michigan insisted it would continue to provide abortions.

"We believe that the Court of Appeals order is wrong," PPMI President and CEO Paula Thornton Greear said in a press conference.

Planned Parenthood said the appeals court ruling couldn't be enforced immediately to give attorneys time to file appeals. "Any prosecutor who attempts enforcement before— before that period of time would be acting outside the law and they should be held in contempt."

By late Monday afternoon, Governor Gretchen Whitmer had asked the Oakland County Circuit Court to intervene. “Michiganders will suffer an irreparable injury if Defendants are permitted to enforce MCL 750.14, a near-total ban on abortion that violates the Michigan Constitution,” Whitmer’s filing said.

Around 5 p.m., the court granted her request. Judge Jacob Cunningham issued a temporary restraining order, once again blocking enforcement of the 1931 ban “until further Order of the Court.” Cunningham also ordered Whitmer’s legal team, as well as attorneys representing local county prosecutors, to convene for a hearing on the issue on Wednesday.

Making medical decisions because of legal limbo 

But that still leaves some doctors unsure what to tell their patients. By 7 Monday night, Harris still said she couldn’t comment as to whether abortions would go forward the following day. “Can’t comment until I know more,” Harris said via text. “Still much uncertainty about what law, T[emporary] R[estraining] O[rder] will do."

At Northland Family Planning Centers, Lance said for now, they’re going to stop providing abortion care at their Sterling Heights clinic, because it’s in Macomb County. “And the Macomb county prosecuctor has clearly stated he wants to prosecute [abortion providers under the 1931 ban],” she said Monday evening. “So we thought it would be the safest thing not to see patients there, because this was still so unclear. … We are supposed to see patients there on Friday, and I don’t know what we’re going to do about that yet.”

The appointments originally scheduled for the Sterling Heights clinic will be moved to their Southfield location, Lance said. “We’re taking in these legal interpretations as they’re still being worked out.”

Meanwhile, patients have been calling to ask what’s going to happen. “Of course they’re very upset at the situation,” said Lance. “It's confusing even to lawyers, let alone a layperson who is just trying to figure out if their appointment is still booked or not.”

All the legal uncertainty could make some patients feel like they need to rush to get an abortion while it’s still legally available in Michigan, Harris said. “We have patients who get diagnoses of serious genetic or anatomical illnesses in their babies,” she said. “We have people with serious underlying medical illnesses for whom it's not safe to continue a pregnancy. And in those situations, we really encourage people to take the time that they need to make a decision."

Those should be decisions made for medical reasons, Harris said, not because a patient is worried about how long a temporary restraining order will last. “Even if we do find that we have a … window before this order is enforced, it's going to mean that patients need to make a decision in that window.”