Defending and disputing plan for changing Pa. abortion regulations
November 16, 2011By Taunya English
Taunya English's story is part of a project on health in the states, a partnership between WHYY, NPR and Kaiser Health News.
Pennsylvania lawmakers are considering stricter regulations for health centers that perform abortions.
The legislation seems stalled, but there's still a lively and contentious debate over how clinics should be run.
Most abortions in Pennsylvania are performed in medical offices. State Rep. Matt Baker, a Republican from Tioga County, says it's time to change the rules.
"This is a surgical procedure. Why in the world should they be exempt from what everyone else under the sun has to comply with?" Baker said.
Baker and supporters want clinics to follow the same rules that govern ambulatory surgical centers, those outpatient facilities where you might go for colon screening or joint surgery.
Baker says he consulted with doctors and nurses before drafting the bill.
"Most of them that have worked in the health-care arena have absolutely no problem with what we are doing here, and the comment that I often hear is 'It's about time,'" he said.
Gosnell clinic conditions prompt action
Last year, a federal raid uncovered a string of health violations at a West Philadelphia clinic. Later, a grand jury investigation cataloged decades of unsafe practices and filthy conditions.
Baker listed the finding from the report: "Litter boxes in patient rooms, flea-infested cats wandering freely through the facility. Patients expected to await procedures and recover from abortions on blood-stained lounge chairs."
Clinic owner Kermit Gosnell now faces drug and murder charges. Baker said the Gosnell case is proof that the state's current rules aren't sufficient to protect women.
Gov. Tom Corbett stepped-up clinic inspections when he took office this year, but Baker's plan goes further. Under the proposed rules, to keep offering surgical abortions, most Pennsylvania clinics would need to add staff, larger exam rooms, wider hallways and hospital-grade elevators.
Gynecologist Sherry Blumenthal says the Baker bill goes too far, but said the state does need a better plan to root out 'bad doctors.'
"There were rules in place, but the Philadelphia Department of Health and the state Department of Health did not enforce those rules," said Blumenthal, chair of the Pennsylvania chapter of the American Congress of Obstetricians and Gynecologists.
"They dropped the ball," she said. "Gosnell should have been shut down years ago."
Baker calls the proposed surgi-center requirements "common-sense" patient safety improvements. Opponents say the facility rules would cost too much and do nothing to prevent common abortion complications–or the crimes discovered at the Gosnell clinic.
Opponents lining up
Jennifer Boulanger, executive director of the Allentown Women's Center, said her clinic has nothing to hide.
"We welcome inspections," she said. But she opposes the Baker bill.
"Representative Baker has not been able to articulate how it would make the woman more safe to have 8-foot hallways and a 400-square-foot operating room," she said. "And why? He is not a doctor. He has no idea what he's talking about."
Abortion providers report adverse events to Pennsylvania's patient safety board, but neither the board nor the health department calculates complication rates. Without agreed-on state data to document health risks, the abortion-rules debate is slippery.
In 2008, the Pennsylvania Patient Safety Authority reviewed adverse events for common gynecological procedures including dilation and curettage, known as D&C, and dilation and evacuation, called D&E. The review tracked incidents when those procedures were used for abortion as well as disease diagnosis and treatment.
"Studies show that these procedures have relatively low complication rates and can be performed safely in multiple clinical settings," states the advisory report.
"What people don't understand is how abortions are done and how simple they are," Boulanger said. "I'm going to speak very frankly; an abortion is a five-minute procedure."
Questioning the data
Richmond, Va., gynecologist John Seeds advises the Virginia Christian Alliance and supports his state's effort to regulate clinics under surgical center rules. He's convinced the change would make women safer.
"Some of it is anecdotal. Until there is mandatory, supervised reporting of complications, you're kind of stuck with people like me who see complication of abortions in our ER and in our clinics that may or may not be reported or recorded," said Seeds. "There are lots of people on both sides of the issues who recognize that the data is flawed.".
"The reason that we no longer track abortion complications rates--on a big, nationwide level--is because it was proven to be extraordinarily safe in the '70s and it's only gotten safer since," said reproductive health expert Tracy Weitz, a professor at the University of California, San Francisco.
Weitz says Pennsylvania's draft rules buck the trend that moves health care into the community where it's more widely available.
Kimberlee Evert, who leads Planned Parenthood of Western Pennsylvania, said she believes the Baker legislation is designed to block abortion.
"One of the strategies, if you will, is to try to require us to become ambulatory surgery centers to drive up the cost significantly. It will make it way more expensive for providers, as well as for women to access," Evert said.
A matter of safety or politics?
Baker said his bill is about patient safety not politics, but Evert said the bill treats abortion unfairly.
"It's really singling out the abortion procedure because it is controversial, not because it is more risky," she said.
Weitz said the proposed surgi-center rules would not apply to many common in-office gynecological surgery procedures or care for a miscarriage.
"The same clinical technique would be used to evacuate the uterus; that service can continue to be done in a doctor's office," Weitz said. "But if that same technique is done for the purposes of an induced abortion, then it would go into a surgical center."
Planned Parenthood and other abortion providers worry the proposed requirements will shutter clinics and delay care for women.
Boulanger said a response is in the works.
"Well, if this passes tomorrow, we file a lawsuit, hopefully we get an injunction," she said.
Baker, who said he's open to negotiation, said he intends to push for a House vote on his legislation this month.