“We knew we could offer care that was more private and more appropriate than the emergency department (ED),” Koskenoja said. “Partnering with The Women’s Center of Marquette gave us the additional support and advocacy framework to make this truly patient-centered.”
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ACEP Now: October 2025 (Digital)In addition to clinicians already in the emergency medicine space, the team reached out to family medicine physicians and support staff to help ensure the program could run during off hours. Local grants and non-profit collaborations helped pay for it.
Dr. Brown
“It has been a lesson in community-powered health care,” Dr. Brown said. “We used the resources we had—space, staff, trust—and added just enough structure to make it sustainable.”
Challenges
Starting a program of this magnitude in a rural, politically complex region came with its own set of challenges. From staffing to legal questions, Dr. Koskenoja and Dr. Brown said every step required persistence. Malpractice insurance was a major challenge, as was the process with the carrier to ensure that abortion services were covered. They were initially hesitant, even though medication abortion is within the scope of emergency medicine.
Eventually, after weeks of negotiation, the malpractice carrier agreed to cover abortion care as part of routine emergency practice.
“It required a lot of back-and-forth,” Dr. Koskenoja said. “But having a broker who was willing to make those calls and advocate for us made all the difference.”
Another hurdle was ultrasound access. The clinic didn’t have the transvaginal ultrasound equipment needed to date pregnancies and safely provide medication abortion, so the clinic worked with ACEP member and emergency physician Dara Kass, MD, FACEP, with the FemInEM Foundation to help. FemInEM provided a grant that supported the three-month pilot, including training, community outreach, and program development.
Dr. Kass
“When I heard what Viktoria and Shawn were doing, I knew it needed to be supported,” Dr. Kass said. “This is exactly the kind of clinician-led, community-based innovation we should be scaling. It’s not just about money—it’s about signaling that this work matters. When we invest in clinicians willing to solve systemic problems, we’re saying we believe in them.”
“Political and social risk was also real,” Dr. Brown said. “We had to ask ourselves if we were prepared for protesters, for pushback. But we also knew that patients needed this care now. We couldn’t wait for ideal conditions.”
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4 Responses to “Emergency Physicians Step Up for Women”
October 19, 2025
Justin GallagherI can certainly appreciate the idea of caring for victims of sexual assault, but I find it discouraging that the article writer and ACEP would view abortion as anything but taking the life of a helpless unborn child. I understand that not everyone holds the same moral worldview, but the medical community needs to come back to the center on this sad and divisive topic instead of using catchall phrases like “reproductive healthcare” and “women’s health” to glorify extinguishing people’s lives before they have a chance to speak up for themselves.
November 15, 2025
Monica SaxenaThrilled to see the work that is being done on behalf of Michigan patients by EM docs.
November 15, 2025
Rebecca HAmazing work by Dr Koskenoja and Dr. Brown! This is the type of needs-based medical practice that we are so desperately missing in our communities – driven by those who live there themselves. I applaud and admire their efforts to get women the healthcare services that they so desperately need and deserve. Truly a service to the patients.
In the emergency medicine specialty, it is so important to not allow our personal beliefs affect the care we give – the life-long smoker who develops lung cancer, the IV-drug user who has sepsis from an infection injection site, the assailant who gets injured while committing a crime, the sexual assault victim who becomes pregnant – we are not judge and jury and our job is to provide the care that is required. I deeply respect ACEP and ACOG for remembering the patients that they serve and the importance of giving standard of care treatment, regardless how the patient ended up at our doors.
November 17, 2025
Jailyn AvilaI’m deeply thankful for the work Dr. Koskenoja and Dr. Brown have done for their community. Their model is such a powerful reminder of what emergency medicine is at its core: being there for our patients
What they’ve created in Marquette is exactly the kind of innovation our specialty is capable of. It’s community-driven, evidence-based, and grounded in compassion.
I’m especially grateful for the courage and persistence it takes to build something like this in a rural region with limited resources. It reflects the best of who we are as emergency physicians.
This is the kind of leadership I’m proud to stand behind. Thank you for showing what’s possible when we put patients first!