Abortion restrictions being considered in NC have led to closures, lawsuits in other states

cjarvis@newsobserver.comJuly 19, 2013 

Rep. Alma Adams of Guilford County waves a coat hanger as she debates the controversial abortion bill Thursday, July 11, 2013, in the N.C. House.

CHUCK LIDDY — cliddy@newsobserver.com Buy Photo

  • Where North Carolina’s bills stand

    House Bill 695: Would require abortion clinic standards be “similar” to those of ambulatory surgical centers, and require doctors to be present when abortion-inducing drugs are taken. Passed by the Senate. Sent to the House Ways & Means Committee.

    Senate Bill 353 : Would require abortion clinic standards be applicable to ambulatory surgical centers where “applicable,” and require doctors to be present only for the first dose of an abortion-inducing drug; subsequent doses could be taken at home. Passed by the House. Sent to the Senate Rules Committee.

    What’s next : The Senate can either pass the House bill as is, amend it and send it back to the House, or send it to a conference committee of the two chambers to work out a compromise. Senate leaders say they expect to vote on one of the bills this session. Less likely, the House could approve the Senate bill, amend it or send it to a conference committee. The governor has said he will sign the House bill.

  • What’s happening in other states

    • 28 states have laws or policies regulating abortions that abortion-rights advocates say go beyond patient safety.

    • 26 states require clinics meet standards of ambulatory surgical centers.

    • 15 states have requirements on clinicians that abortion-rights advocates say are unnecessary, such as requiring a clinic to have a relationship with a nearby hospital, including admitting privileges for doctors.

    • So far this year: Alabama and North Dakota have enacted laws requiring abortion providers to have admitting privileges at local hospitals. Ohio prohibited public hospitals from entering into transfer agreements with abortion clinics for emergencies. Alabama adopted standards matching those of ambulatory surgical centers. Indiana expanded that requirement to centers where only abortion-inducing medication is given. Alabama, Indiana, Louisiana and Mississippi enacted laws prohibiting telemedicine by requiring a physician to be in the same room as the patient for the medication. Texas enacted a ban on abortions after 20 weeks of pregnancy, admitting privileges for doctors, ambulatory surgical center standards, and restrictions on abortion-inducing medication.

    Source: Guttmacher Institute

    For an interactive map of who is getting abortions and where in North Carolina, see the interactive map at North Carolina Health News: http://www.northcarolinahealthnews.org/

— North Carolina would join a growing number of states imposing more stringent restrictions on abortion clinics if it enacts one of two bills still pending in the final days of the legislative session.

No one really knows what either of the bills would do if one became law since both require regulations that haven’t yet been written. But similar bills are increasingly showing up in other states, and are forcing some clinics to close or spend hundreds of thousands of dollars on upgrades.

Abortion-rights advocates contend that either of the bills could put clinics out of business because of unnecessary restrictions. Republican lawmakers and abortion opponents say the current regulations are outdated.

While GOP lawmakers in this state and elsewhere insist they’re only concerned about women’s health and safety, the restrictions have become part of an effective nationwide strategy to make abortions as difficult to get as possible.

Forty-three provisions restricting abortions have been enacted across the country in the first half of this year, according to the Guttmacher Institute, the second-highest number ever. The institute supports abortion rights, but is widely regarded as providing authoritative research on the issue.

While the strategy has been employed for years, the recent surge may be due in part to a single person: The name Dr. Kermit Gosnell has been repeatedly invoked throughout the abortion debate in North Carolina and echoed in statehouses across the country. In May, the Philadelphia abortion doctor was convicted of murder in the deaths of three infants, involuntary manslaughter for a patient’s overdose death, and violating state abortion laws. He is serving three life sentences.

“Gosnell can never be allowed to happen here in North Carolina,” Sen. Warren Daniel, a Republican from Morganton, told a legislative committee earlier this month.

Dan McConchie of Americans United for Life, an anti-abortion group that helps legislatures craft clinic regulations, said the Gosnell case has become a rallying point because lawmakers now wonder whether their clinics are safe. He said the Gosnell trial came too late for most legislatures to react because they have shorter sessions than North Carolina does, but he anticipates additional legislation on the horizon.

“I know a lot of legislators are very much interested in looking at, over the summer and fall, deciding what to do next year to ensure the standards for clinics in their states are of adequate nature, that they don’t have a situation like Kermit Gosnell happening, that they have adequate enforcement,” McConchie said Friday.

McConchie said the Gosnell case has spurred some state health agencies to give a higher priority to inspections, and that has led to some closings, including in Illinois. North Carolina has closed two clinics this year, but says it has enough personnel to inspect them only every three to five years.

Others say Gosnell is simply a convenient tool in the fight against legal abortions. The issue with Gosnell was ineffective enforcement of regulations that were already on the books.

The N.C. Department of Health and Human Services says it doesn’t have sufficient inspectors. The agency also has concerns about the Senate’s abortion bill, particularly a provision requiring abortion clinics to be upgraded to the same standards as outpatient surgery centers. DHHS says one such center in the state performs abortions, but the other 16 clinics might have to close because they can’t afford to upgrade.

The House version of the bill was rewritten to require abortion clinics to upgrade only to meet ambulatory surgical center standards that are applicable. Its sponsor says the wording was softened to ensure that the law doesn’t close clinics but protects health and safety. But abortion providers and their organizations are skeptical.

Clinic closings

Clinics have closed in other states. Two clinics closed in Virginia following recent legislation there.

Planned Parenthood says it is spending hundreds of thousands of dollars on each of its three health centers in Virginia to put in new heating and air conditioning, deeper sinks with foot pedals, widening emergency exit doors, and installing aluminum awnings, according to Melissa Reed of Planned Parenthood Health Systems.

She said two of the clinics were built to the higher surgical center standards at the time, but aren’t allowed to be grandfathered in. Other clinics have closed in recent years in Pennsylvania and Tennessee. Mississippi’s only clinic would close under a new law passed there, which has been put on hold by a lawsuit.

“The end goal here is to burden clinics and to have real potential to close clinic doors,” Elizabeth Nash of the Guttmacher Institute said Friday.

She said the full impact of recent legislation hasn’t had time to play out yet, often because the regulatory process is complicated. Virginia is just now finalizing its clinic rules after a two-year process, she said. The types of regulations coming out of legislation in the past couple of years have also been more restrictive than in previous years, Nash said.

Structural restrictions on clinics, and requiring abortion providers to have relationships with nearby hospitals – such as admitting privileges and transfer agreements – are the major trends in the past couple of years, she said.

Rewriting the rules on abortion clinics doesn’t have to be contentious. Maryland has just begun stricter new regulations on its abortion clinics, spurred by publicity over a patient suffering a ruptured uterus and other injuries during an abortion. The regulations require upgrading to outpatient surgery center standards, according to The Baltimore Sun.

But both sides of the abortion issue, including NARAL Pro-Choice Maryland, hailed the new rules for improving safety without restricting access.

Defining ‘undue burden’

As the regulatory strategy spreads, states are pushing the limits of what is legally permissible under the 1973 U.S. Supreme Court case Roe v. Wade, which held that women have a constitutional right to choose abortion in the early stages of pregnancy, in consultation with their doctors. In a 1992 case, the court upheld that right, but said states can regulate abortions if the regulations are reasonably related to women’s health – originally such conditions as parental notification, counseling, and waiting periods – without creating an undue burden.

Courts have been trying to define “undue burden” ever since. Some think that abortion opponents hope to turn one of the lawsuits against state restrictions into a vehicle for overturning Roe v. Wade.

McConchie says the notion of a national strategy to overturn Roe v. Wade might be better answered by the pro-choice side.

“The abortion industry – Planned Parenthood, the ACLU, the Center for Reproductive Rights – each one of them routinely files suit against any sort of law they see as encroaching upon their ability to perform abortions ,” he said. “… It’s out of our hands.”

Nash doesn’t think that’s the end game. “Now the strategy appears to be to enact so many restrictions that it is impossible to access or provide abortion services,” she said.

North Carolina Attorney General Roy Cooper Jr. has come out against the abortion bills pending here, saying they would force clinics to meet excessive requirements and make it harder for doctors to perform abortions. Cooper noted that the General Assembly’s attempt last session to restrict abortions and defund Planned Parenthood – also tactics used in other states – have led to lawsuits.

Jarvis: 919-829-4576

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