Advocates Say Proposed Abortion Clinic Regulations Political, Would Curb Access

By Amanda Iacone, Virginia Statehouse News Tuesday, September 06, 2011

RICHMOND - A 250-square-foot operating room ... a staff shower area ... a canopy-covered entrance.

These are just a few of the requirements the state of Virginia says are needed for abortion clinics to provide safe, sanitary conditions and protect the health of women who will seek abortion services.

In draft regulations released just over a week ago, the Virginia Department of Health would direct the state’s 22 abortion clinics to comply with architectural guidelines used for new hospitals and outpatient surgical centers.

To make these structural changes would be costly and likely impossible for clinics that lease space, according to a coalition of clinics and abortion rights supporters in Virginia.

Abortion rights supporters said the clinic regulations would be among the toughest in the nation and could push Virginia behind Kansas and Nebraska for policies that limit a woman’s reproductive rights.

With the adoption of the regulations, Virginia would join 30 other states that use regulations to control and limit the availability of such services.

Jessica Honke, policy director for Planned Parenthood Advocates of Virginia, said the regulations would not protect the health of female patients but only serve to shut down clinics. That would reduce the availability of not just abortion services, but cancer screenings and sexually transmitted disease testing. In Virginia, 30,000 women and men took advantage of these services last year at Planned Parenthood clinics statewide.

The Richmond-based Family Foundation has been working to regulate the state’s abortion clinics for several years. The anti-abortion organization argues that regulations are needed because there is no way to track medical complications stemming from abortions, said spokesman Chris Freund.

The Family Foundation also wants to ensure that licensed doctors are handling the procedures.

“No one knows what’s going on. These regulations will help clear that up,” Freund said.

The threat that a health department inspector could visit the clinics at any time also will ensure that clinics operate safely and meet the state’s requirements, he said.

Gov. Bob McDonnell said this week the Health Department's regulations are a response to a bill he signed into law earlier this year. The law requires the state to draft emergency regulations to treat clinics as hospitals, if they perform five or more first trimester abortions a month.

Second trimester abortions are regulated separately in Virginia and must be performed in a hospital.

McDonnell, who opposes abortion, said because of the invasive nature of the procedures, it is best if they are done in a hospital, even in the first trimester.

He denied claims that the law mandating the new regulations is an attempt to shutter abortion clinics.

“It is in the interest of health,” he said.

Politics versus medicine
But the draft regulations would not further protect women’s health and many of the structural requirements go beyond what is necessary for a gynecological procedure, said Jordan Goldberg, state advocacy counsel for the Center for Reproductive Rights, which focuses on legal challenges to pro-abortion rights.

Some of the requirements specify the type of air conditioning and heating systems the clinics must use. Others require surgical suite-style hand washing areas, known as scrubbing stations, that aren’t necessary for a gynecological procedure, Goldberg said.

A quarter of all first trimester abortions are performed via medication; others require anesthesia while the tissue is removed surgically.

Clinics are required to have disaster plans and infection control measures as well as meet certain staffing requirements, Honke said.

Cost estimates to meet the architectural guidelines aren't available. But Planned Parenthood spent $4 million two years ago to renovate a clinic in Central Virginia and that modern facility will not meet the strict guidelines, she said.

Most of the Richmond Women’s Medical Center  clinic space pre-dates the new architectural guidelines by a few decades and don’t have the 5-foot-wide corridors the architectural guidelines require. But those wider corridors don’t improve the safety of the abortion procedure itself, said Jill Abbey, director of the center, which also operates clinics in Roanoke, Charlottesville and Newport News.

The clinics provided 3,500 abortions last year. They also offer standard gynecological exams, Abbey said.

“We are very disappointed in Gov. McDonnell. This was an opportunity to put in some good medical regulations instead of putting in political regulations to forward his anti-choice agenda,” Abbey said.

Freund argued that wider doors and hallways are needed to accommodate ambulance gurneys should a paramedic need to provide emergency aid to a woman going into cardiac arrest.

But he said some structural requirements in the law could be changed if the clinics can convince the board of health they are not medically necessary.

Regulating abortions from coast to coast
The real meat of the regulations comes in the form of following guidelines laid out by a private coalition of architects, doctors and engineers for the construction of all new medical facilities from hospitals to doctors’ offices.

Today, abortion clinics are treated as a doctor's office, following the same regulations as doctors who perform laser eye surgery or liposuction.

The number of invasive procedures performed in doctors’ offices has grown over the decades. And some states, like Delaware, are considering regulations that would apply to all in-office invasive procedures, including abortion, said Elizabeth Nash, a public policy associate with the Guttmacher Institute, a reproductive health and rights research organization.

Maryland is drafting regulations that focus on medical care, not specific structural designs for the clinics, Nash said.

Pro-abortion rights supporters said the regulations being drafted in Virginia would mirror South Carolina regulations approved in the mid-1990s. The South Carolina rules required specific room temperatures and required 250 square feet of surgical space if general anesthesia is administered, Nash said.

Virginia "is really working to reduce access to abortion,” Nash said. “But the commonwealth is not doing much to reduce the need for abortion.”

Of the almost 30 states that have abortion specific regulations, the laws vary widely, she said.

Some states only regulate the use of general anesthesia during abortion procedures. Others have regulations regarding later trimester abortions and differentiate between surgical and medical abortions, Nash said.

Twenty states have no abortion-specific regulations. But the clinics are required to comply with rules governing out-patient facilities such as ensuring professional licensing, being subject to medical board oversight, following state building codes and providing a complaint process for patients, she said.

Other concerns
The draft requirements also include general statements about the need to provide a sanitary environment and the control processes for handling medical waste, having back-up emergency medical care available to patients at local hospitals and the need for licensed physicians to perform abortions and anesthesiologists to administer anesthesia.

Virginia’s clinic operators are concerned that the proposed regulations don’t protect patients’ privacy because they would allow health inspectors to walk in and review patient records, said Planned Parenthood’s Honke.

The regulations also don’t require health inspectors to wear a badge or identify themselves, which could open the door for “extreme activists” to harass patients pretending to be inspectors, Honke said.

Clinic operators also are concerned with language that would allow the clinic’s licenses to be revoked for any violation, she said.

Some clinics may have a tough time convincing local hospitals to give their physician admitting privileges or to sign an emergency care agreement because of the stigma of being connected to an abortion clinic, Nash said.

Such strategies have been used in other states to limit the number of abortion clinics, she said.

Despite those issues, clinic operators agree with many of the requirements in the draft. They plan to provide feedback to the Health Department before the board votes Sept. 14 on whether to advance the regulations to the attorney general and governor’s offices for review.