Los Angeles
Times (US), September 10,, 2007
Judge
weighs abortion standard
Missouri
would regulate facilities that commonly offer early terminations,
even by pill, as centers for outpatient surgery.
By Stephanie
Simon
A first-trimester
surgical abortion takes about two minutes. After, patients at
the Planned Parenthood clinic here walk down a dimly lighted hall
to a small, spare recovery room, where they rest in recliners,
a box of tissues by each chair. Most are cleared to go home after
15 minutes.
Thousands
of women have safely ended pregnancies at this clinic since it
opened in 1987. Conservative lawmakers in Missouri say abortion
patients deserve better.
They have
enacted the most far-reaching regulations in the nation -- dictating
the physical layout, staffing and record-keeping policies of any
facility that performs five or more abortions a month, including
private doctors' offices that regularly prescribe the abortion
pill.
The law, which
a federal judge is to review today, would force the immediate
closure of at least two of Missouri's three abortion clinics,
plus a private medical practice near St. Louis run by a doctor
who offers first-trimester terminations in his office. Those facilities
would need extensive renovations to comply with the law; the requirements
could include widening hallways, raising ceilings, installing
locker rooms, rerouting plumbing, and creating surgical suites
stocked with emergency resuscitation equipment, even when no surgery
is performed on-site.
Several states
impose similarly rigorous standards on providers of second- and
third-trimester abortions. Missouri is the first to try to extend
them to clinics and private offices that only provide the abortion
pill, which has been used by nearly 800,000 women nationwide to
end early pregnancies.
The law would
put providers of five or more abortions a month in the same regulatory
category as outpatient surgical centers that perform a wide range
of procedures, some under general anesthesia, including tonsillectomies,
cardiac catheterization, hernia repair, cataract removal and colonoscopy.
When he signed
the bill in July in the sanctuary of a Baptist church, Republican
Gov. Matt Blunt called it "one of the strongest pieces of
pro-life legislation in Missouri history."
Abortion-rights
groups call it alarming. If upheld, the law could inspire similar
tactics in other conservative state legislatures; Missouri has
long been regarded as a pioneer in developing antiabortion strategy.
"This
is really a case to watch," said Belinda Bulger, deputy legal
director of NARAL Pro-Choice America. "The anti-choice movement
has discovered that this is a good tactic for them. . . . It certainly
has us concerned."
Planned Parenthood's
clinic here in central Missouri performs about 600 first-trimester
abortions a year, drawing patients from areas several hours away.
Surgical abortions take place in two small exam rooms as the patient,
often sedated with a Valium, lies on a padded table, her feet
in stirrups. The recovery room, painted blue, is crowded, the
vinyl recliners positioned so close to one another, patients could
hold hands.
Planned Parenthood
official Peter Brownlie recently asked an architect to assess
the cost of bringing the clinic into compliance with the eight
single-spaced pages of regulations affecting everything from sink
design to bathroom ventilation to spacing of beds in the recovery
room.
The estimate:
around $1 million. The clinic's annual budget is $780,000, with
a quarter of that spent on abortion; the bulk goes for gynecological
exams and contraception.
Brownlie said
he did not object to opening his abortion clinics to state health
inspectors, who had no jurisdiction before the new law passed.
But he cannot afford extensive renovation in Columbia or in Kansas
City, where a clinic serves a mostly low-income clientele on the
edge of downtown.
"This
is ludicrous," said Brownlie, president and chief executive
of Planned Parenthood of Kansas and Mid-Missouri. "There's
a desperate quality to it."
Both the American
College of Obstetricians and Gynecologists and the National Abortion
Federation, a trade group representing abortion providers, say
first-trimester surgical abortions can be safely performed in
a private physician's office, much like vasectomies.
"How
is expanding the doorway size going to improve women's health?"
asked Michelle Trupiano, a statewide lobbyist for Planned Parenthood.
Backers of
the law respond that women seeking abortions -- just like those
getting colonoscopies -- deserve to be treated in modern facilities
with doors wide enough to accommodate gurneys and paramedics in
case of emergency.
"We're
applying the same standards of healthcare to abortion clinics
as we are to other medical facilities," said Pam Fichter,
development director of Missouri Right to Life.
The law was
supposed to take effect in late August, but a federal judge issued
a temporary restraining order after Planned Parenthood filed suit.
A full hearing is set for today.
To defend
the law, Missouri Health Director Jane Drummond has retained a
Christian law firm that usually handles religious liberty cases.
The nonprofit Alliance Defense Fund was founded more than a decade
ago by several heavyweights on the Christian right, including
James C. Dobson of Focus on the Family. Drummond has said she
turned to the group -- which took the case for free -- because
she does not trust Missouri Atty. Gen. Jay Nixon to defend the
clinic regulations.
In a letter
to Nixon -- a Democrat who plans to run for governor next year
-- Drummond wrote that the law "is very pro-life while you
are radically pro-abortion." Nixon has said he intends to
work with the Alliance Defense Fund.
Brownlie is
hopeful that the courts will strike down the law at least as it
applies to practices (such as his group's clinic in Kansas City)
that end abortions only by medication.
Women who
choose that option generally expel the fetus in the privacy of
their own homes, as in a miscarriage. The provider's role is limited
to counseling, handing the woman two pills, and doing an ultrasound
a week later to verify the womb is empty. Nationally, many family
practitioners and gynecologists prescribe the pill, even when
they do not offer surgical abortions.
In his temporary
restraining order, District Judge Ortrie D. Smith said it did
"not make a lot of sense" to require a full surgical
suite in such cases.
The state's
attorneys plan to argue that anyone who induces an abortion by
any means -- including medication -- must be prepared to handle
complications, rather than send a patient in crisis to an emergency
room. "These standards would make the situation much safer"
because they would allow for "continuity of care," said
Dale Schowengerdt, legal counsel for the Alliance Defense Fund.
In reviewing
the law, Smith will be bound by a 1992 U.S. Supreme Court ruling
that says states cannot put an "undue burden" on women
seeking abortions before the fetus is viable. Planned Parenthood
contends that the standards are burdensome because they will drive
providers out of business and make abortion less accessible.
But there's
a lot of room for judicial interpretation.
"What
may be an undue burden for one judge may not be for another,"
said Carl Tobias, a law professor at the University of Richmond
in Virginia. "It's a very flexible standard."
--
stephanie.simon@latimes.com
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