Tuesday, August 5, 2014

Abortion in Alabama

Yesterday, U.S. District Judge Myron Thompson ruled that Alabama’s law requiring abortion-clinic doctors to have admitting privileges at a local hospital is unconstitutional.  Although I admittedly only skimmed Judge Thompson’s 172-page opinion (cut me some slack, I’ve got a three-month-old at home), I want to share my reactions. 

First, many states enacted laws like the one at issue here in reaction to Kermit Gosnell's Philadelphia abortion-practice-of-horrors.  In 2013, Gosnell was convicted of first-degree murder of three infants who had been born alive during botched late-term abortions.  He was also convicted of involuntary manslaughter of a woman who had sought his care in 2009.  State Health Department officials had not stepped foot in his clinic in the past sixteen years.  According to the report of the federal agents who raided the facility, “[s]emiconscious women scheduled for abortions were moaning in the waiting room or the recovery room, where they sat on dirty recliners covered with blood-stained blankets.”

To ensure that women seeking abortions weren’t placing their life at risk like they did at Gosnell’s clinic, states enacted Targeted Regulation of Abortion Providers. These laws regulated aspects of abortion clinics such as the size of the room or corridors (to allow for stretchers in the event of emergencies) and a doctor’s hospital admission privileges.  Most of these requirements apply the same standards to abortion clinics that ambulatory surgical facilities face.

Immediately, these laws were characterized as anti-abortion. This characterization baffled me.  When Wendy Davis donned her famous pink sneakers to filibuster Texas’s consideration of such a bill, she was hailed as a champion for women’s rights. But why? These laws were making it safer to undergo an abortion. They were ensuring that abortion providers were held to the same standard as other surgical facilities. They were providing for continuity of care if women experienced complications after an abortion.  How could it possibly be a victory for women’s rights to prevent or overturn these laws?

Judge Thompson reasoned that Alabama’s law would shut down three of five clinics in the state, thus placing an undue burden on women seeking an abortion. Yet again, laws that promote the safety of women are struck down as conflicting with the all-important availability of abortion.  Abortion is legal.  But it is not an unregulated right.  Not every law regulating abortion is designed to prevent access to it.  Some just attempt to make it safer.  Just because a law is introduced by a Republican or someone with a pro-life record does not mean that it will harm women.  Lawmakers need to read these regulations and consider their actual effect on women before denouncing them.


I do want to note that Judge Thompson’s opinion opened with a chronicle of the violence abortion providers in Alabama have faced—bombings, arson, and threats against their spouses and children.  While it is important for views against abortion to be expressed on the sidewalk and in the legislature, resorting to violence is abhorrent.  Regardless of one’s view on abortion, terroristic threats are always wrong.  For more on this, keep an eye out for Krysten Connon’s forthcoming Oxford University Press book based on her research into the targeted harassment of abortion providers.   

5 comments:

  1. As a caveat, I have not read the opinion... With that said, hospital privileges should not have a relation to providing abortion services. I personally know doctors that perform orthopedic surgery; plastic surgery; MRIs and CAT scans (as well as other general radiology, to include mammography); oral surgery; and basic preventative care without hospital privileges. That's not to say that abortion clinics should be held to any lower standard of care than any other medical provider, only that placing privileges requirements on abortion providers is unnecessary to ensure such standard is met.

    ReplyDelete
  2. James,

    Your point is well-taken with regard to continuity of care. One of the reasons Alabama enacted this law was to ensure continuity of care in the event of complications after the abortion. (The opinion even mentions one instance where a woman arrived at the emergency room with complications after a procedure and the attending physician could not reach the doctor that performed the abortion.) It is difficult for me to imagine a scenario where a woman undergoing abortion needs greater continuity of care than one undergoing orthopedic surgery.

    The other justification was for credentialing purposes, which I find more persuasive. If a hospital is ensuring that a physician is acceptable in her abilities, practices, and treatment of patients, then a situation like the Gosnell debacle is less likely to occur. Women seeking abortions are vulnerable. Many of the women who visited Gosnell’s clinic did not complain to the authorities because they assumed that’s how these clinics were. This law provided an additional layer of oversight. Perhaps the states where your physician-acquaintances practice have decided that this additional layer of oversight is not necessary for people seeking orthopedic surgery, oral surgery, etc. People looking to repair a torn ACL are not as willing to settle for sub-par (and medically unacceptable) care as women seeking abortions.

    That being said, Judge Thompson agreed with you, and he wrote his opinion in a way to deter any appellate court from overturning him.

    ReplyDelete
  3. I will add a little spice to this - - now I know this isn't the case for all hospitals, but there are certain requirements on getting admitting privileges. Just ye being an upstanding doctor you can't have admitting privileges at nearby hospitals. In some instances you have to meet a certain minimum number of admittance - - which really would be against the point, since the goal is/should be that as few people as possible have to be admitted to the hospital in connection with visits to abortion clinics. I was reading the article about the Mississippi clinic doctor who reached out to 13 hospitals, all of whom either didn't respond or told him he couldn't reach the requirements. Likewise, some hospitals choose not to admit such doctors because of religious beliefs or simply because abortion doctors are considered too much of a headache, which really isn't saying anything about their medical proficiency. (Here is one of the articles I read - http://www.dallasnews.com/news/metro/20140609-dallas-doctors-settle-with-hospital-can-continue-doing-abortions.ece)

    I don't think I would disagree with this idea if admitting privileges were more straight forward and even handed, I just don't know if its practical/realistic, especially when considering the more rural areas.

    ReplyDelete
  4. Also lets discuss the fact that that opinion is written in Courier New size like 24 font. hahah. In Calibri 11, it is max 20 pages. Font choice deserves its own post haha

    ReplyDelete
  5. Shark,

    First, good catch on a font. Obviously that judge is not a rookie when it comes to making his opinions impressively long.

    Second, I see your point about the capricious nature of getting hospital admission privileges. But in the article that you linked to, it seems like the laws worked as they should. Texas had enacted a law requiring abortion doctors to have admission privileges, and it had also enacted a law preventing hospitals from discriminating against physicians that perform abortions. When a hospital violated the second law, the physicians were reinstated. It seems like the second law was an effective safeguard against the lack of straightforwardness and evenhandedness that concerns you.

    ReplyDelete