Should Abortion Clinics be Held to Basic Surgical Center Regulations?

The biggest abortion case in almost 25 years is being considered for Supreme Court review.  The Fifth Circuit Court of Appeals case, Whole Woman’s Health, et al. v. Cole, et al., challenged Texas state abortion clinic regulations designed to protect the safety of women undergoing abortion procedures.  These basic, medically-based regulations include physician qualifications, sanitation requirements, and procedures for adequate recovery care and emergencies.  Challengers argue that these requirements are expensive for abortionists and therefore the laws impose an “undue burden” on a woman’s right to abortion.

If the Supreme Court decides to hear the case, it would be the most significant abortion case since Planned Parenthood v. Casey (1997), because it would, among other things, clarify what constitutes an “undue burden” on a woman’s right to abortion under Roe v. Wade.

It is important for Americans to know exactly what this law says and to see for themselves how basic and necessary these types of regulations are for women undergoing an abortion.

Admitting Privileges Requirement

Under the contested law, abortion providers must have admitting privileges at a hospital located within 30 miles of the abortion facility.  Tex. Health & Safety Code Ann. 171.0031

Why should an abortion provider have admitting privileges?  Admitting privileges allow the abortion provider to admit immediately a woman into a hospital in case of emergency complications and consult directly with hospital staff about the abortion and the woman’s medical history.

To apply for admitting privileges, physicians usually have to submit an application with information on their licensing, education and experience, and undergo an interview.  Admitting privileges are usually not granted to physicians who have been or are being sued for medical malpractice.  It is in the patient’s favor for the physician to have admitting privileges.

Abortion Clinic Regulations

The Texas law requires abortion clinics to follow the same minimum standards as ambulatory surgical centers (ASC).  Tex. Health & Safety Code Ann. 245.010.

What is an ASC?  An ASC is a medical center for elective, same-day, non-emergency, out-patient surgeries and procedures.  “Ambulatory” comes from the Latin root “ambulare,” meaning “to walk.”  Patients treated in ASCs are fit to go home after the procedure.

Typical procedures conducted in ASCs include endoscopies and colonoscopies (including removal of identified polyps), orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries.  As most of these procedures are less invasive and less dangerous than abortion, it is medically justifiable that abortion clinics be held to the same health and safety standards as an ASC.

The following is a summary of ASC standards that the Texas law extends to abortion clinics:

• Patient Rights – Patients shall:
  • Be given appropriate privacy;
  • Have the right to make their own health decisions, except when it is not possible for emergency or medical reasons; and
  • Have the right to refuse to participate in experimental research.
• Operating Room, Facility & Physical Plant – Must have the following:
  • Functioning medical equipment: suctioning equipment, basic oxygen management equipment (nasal airways and face masks), blood pressure monitor;
  • An emergency power source adequate to complete the type of surgery being performed;
  • Procedures for disinfection and sterilization following the standards set by the CDC and Association for Professionals in Infection Control and Epidemiology;
  • Elevators and elevator doors large enough for a stretcher;
  • A fire sprinkler system that complies with the requirements of the National Fire Protection Association; and
  • An emergency call system and evacuation plan.
• Quality of Care and Emergencies
  • Personnel shall have the appropriate training and skills;
  • There shall be a written procedure for the immediate transfer to a hospital of patients requiring emergency care beyond the capabilities of the facility; and
  • Medical information shall be accurately conveyed when a patient is transferred to another health care provider.
• Surgery, Anesthesia and Radiology
  • Informed consent of the patient shall be obtained before the operation;
  • Operating instruments shall be sterilized and operating rooms shall be appropriately cleaned before each operation;
  • Surgeries shall be performed only by physicians and health care practitioners licensed to perform such surgeries;
  • Facility shall have anesthesia policies following the standards set by the American Society of Anesthesiologists.  Anesthesia shall be given only under the medical direction of a physician, and only after the operating surgeon has medically examined the patient; and
  • Only trained physicians shall use radioactive X-ray equipment, and proper X-ray shielding must be used.
• Medical Records and Reporting
  • Patient records shall be strictly confidential, securely stored, and readily available upon request;
  • The following shall be accurately entered into a patient’s medical record:
    • Medications given;
    • Result/findings and technique of the operation;
    • Documentation of properly executed informed consent;
    • Record of medical evaluation of the patient before dismissal.
  • Facility shall record and report the following to the Department of State Health Services:
    • Patient deaths;
    • Transfer of a patient to a hospital;
    • Patient complications; and
    • Fires

If you or a loved one were undergoing a surgical procedure, wouldn’t you want the physician and facility to follow these standards?  The Texas case is an opportunity for Americans to re-evaluate the motives of abortion providers; if they are fighting so hard against such basic, medically-based regulations, are they really interested in the health and welfare of the women they serve?