Monday, May 12, 2014
Take heed, non-Texans, and keep a close eye on your own statehouses unless you want to wind up like this. We are all exhausted and dreading September, when the next provision of the 2013 state legislature kicks in.
(WOMENSENEWS)--Often, patients wait five or six hours to see me. I don't like the situation, but ever since the "privileges" requirement took effect Oct. 31, 2013, I have been the lone abortion provider for our Texas clinic.
Lawmakers argued that requiring every provider to have hospital admitting privileges would make abortion safer.
But the argument was specious. Abortion has a 99 percent safety record, according to the Atlanta-based Centers for Disease Control and Prevention. It is so safe that we rarely admit anyone to the hospital, so over time, many abortion specialists lost privileges. (To maintain privileges you have to bring business to the hospital and admit a certain number of patients a year.)
All the privilege requirement does is shut down clinics. There are no medical reasons for these laws. For patients' safety, we already have plans in place in case of an emergency.
The American Congress of Obstetricians and Gynecologists and the American Medical Association both opposed this legislation. But politicians--not medical experts--wrote this law with the goal of making safe, legal abortion hard or even impossible to access.
It's working. All hospitals in the Rio Grande Valley refused even to give applications to abortion providers, so those clinics closed, leaving women seeking abortions to drive to San Antonio or Corpus Christi, the cities with the closest abortion clinics. The trip involves not only three or more hours of driving each way, but also crossing a border patrol checkpoint.
None of this makes anything safer for any patients.
Emergency rooms in the Rio Grande Valley are seeing women with complications from surgical abortion, even though for two months, there has been no legal abortion clinic in that area. I can only wonder where such women received their abortions, and how risky their procedures were.
Hospitals meanwhile are cutting off access by cutting off privileges. That happened abruptly to one doctor late last month in north Texas.
In another incident, anti-abortionists pressured a Dallas hospital into revoking privileges of two other doctors on March 31, but that action was stayed by a judge.
An El Paso physician was less lucky. On April 16 a federal judge in Austin declined to reinstate her admitting privileges.
At a remaining Dallas clinic, it now takes six weeks to get an abortion appointment; one could make a joke here about planning ahead for your unplanned pregnancy.
All Texas clinics are swamped. One clinic I know of sometimes sees patients until midnight.
Providers are getting hassled by the bureaucracy as auditors at the Department of State Health Services are increasingly being replaced by hostile political flunkies. There's a form we fill out for every procedure, and the Health Services department recently asked one clinic to redo all of last year's because the date in the lower right margin said 2012 instead of 2013. At another clinic, state auditors are demanding to see prior, unsuccessful applications for hospital admissions.
So we are all exhausted and all dreading September, when the Ambulatory Surgical Center provision kicks in, another requirement by the 2013 Texas Legislature. This one says all clinics that provide abortion must be surgical centers with hallways this wide, X number of sinks, Y number of janitor closets, air ventilation systems appropriate for operating rooms. Given the prohibitive expense of making these changes, how many clinics will be left?
None of this has anything to do with improving patient care. Patient care is making sure women have safe, compassionate, respectful treatment, and that is what my colleagues and I focus on every day.
The 2013 legislature also required that physicians use the 14-year-old regimen on the printed drug label of the medication abortion pill. This brings more expense, more side effects, a lower success rate and four--count 'em, four--separate clinic visits.
Under this regimen, patients sometimes experience their abortion in the car on the way home, because instead of being permitted to take the pills in the comfort and privacy of their own homes, they must receive the medicine personally from me at the clinic. En route, they might additionally suffer the common medication side effects of nausea, vomiting and diarrhea.
Many doctors cringe at this setup and therefore don't provide the medicine at all, so we get patients from all over, pilgrims in search of Mifeprex. (We educate thoroughly, let women know what to expect and, well, if that's still what the patient wants to do, then we respect her decision. This is what patient autonomy means.)
Take heed, non-Texans, and keep a close eye on your own statehouses. Texas' 2013 package contained many elements but often was summarized journalistically as the "20-week ban"--the other stuff was harder to encapsulate. Yet ultimately, those other elements had far more impact, because most abortions happen before 12 weeks. Don't let admitting privileges requirements fly in under the radar. And Texans, please vote for a pro-choice governor in November.
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