updated: LOUISIANA IS ABOUT TO CLOSE ITS ABORTION CLINICS AND NO ONE IS TALKING ABOUT IT

EDIT 1/29/14: DATE AND ROOM CHANGE -- the hearing is now TUESDAY, FEB 4 AT 1PM, Room 173. Email fight4RJLA@gmail.com for info or to get more involved.


Oh, Lawd. I am online bright and early to share this news uncovered by some fellow abortioneers in Louisiana. It's scary and needs immediate attention, so please forgive this hasty reblog (from the folks at New Orleans Abortion Fund, with their permission) and take action quickly: show up for the hearing on Wednesday, or write a letter/email for DHH by Tuesday -- see details in purple below.
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URGENT: Hearing on "backdoor abortion ban," new clinic regulations in Louisiana

It may not be easy to get excited over 21 pages of Louisiana Department of Health and Hospitals regulations, but you'll want to hear about this!

Just before Thanksgiving, the Louisiana Department of Health and Hospitals (DHH) issued new "emergency" regulations that overhauled the existing regulations on abortion clinics. These 21 pages of rules give DHH the authority to immediately shut down a clinic without opportunity for appeal, even for simple infractions. Clinics have stated that they would be unable to meet the burdensome and excessive requirements, and this would lead to the closure of all five clinics in Louisiana.

DHH's new regulations are another manifestation of the "TRAP" (Targeted Regulation of Abortion Providers) laws that are sweeping the country. They represent an effective ban on abortion, especially for the low-income women that NOAF serves, who cannot afford to travel. Here are some examples of new provisions:

• Patients must have documented in their charts that hemoglobin and Rh factor lab tests were performed at least 30 days prior to the abortion procedure. This means that some patients will risk being beyond the 20 week deadline in Louisiana (and earlier than that at most clinics) to have an abortion, and will add to the procedure costs for all patients, as they will have to wait an additional month.
• Each clinic who is applying for a new license must submit a "certificate of need" to the State proving the need for their services. In many other circumstances, such as any change to the location or the ownership of an existing clinic, existing clinics must apply for a brand-new license and (re-)satisfy the certificate of need requirement. The subjective nature of these requirements allows the State to severely restrict new licenses and will provide the State with a mechanism for refusing to allow existing clinics to renew their licenses to operate.
• There is no right to appeal deficiencies to any unbiased body outside of the Department of Health and Hospitals. Therefore, every deficiency that a clinic is cited with will be allowed to stand, and those deficiencies are often later used to revoke a clinic’s license on the basis of being a “repeat” offender.
• The new regulations require that all facilities have very specific square footage requirements that are far larger than any currently operating abortion facility. They would be prohibitively expensive to construct, and the requirements have no medical necessity. If the regulations are allowed to go into effect, no clinic will be in compliance on the day the regulations are implemented, and the State will have the ability to shut down every existing abortion clinic in the State.

These regulations were originally enacted without public comment and with no clear indication of need. There will finally be a hearing on Tuesday, February 4 at 1:00pm in Room 173 of the Bienville Building, 628 North 4th Street in Baton Rouge. The New Orleans Abortion Fund and members of allied organizations will be testifying and presenting written comments from advocates, providers, and women who have recently obtained abortions at affected clinics at the public hearing.

The people of Louisiana need your support! Please consider attending this hearing and/or submitting written comments. We have created talking points and a sample letter [PDFs]. Feel free to copy and paste (and re-format if needed!), but please consider adding your personal thoughts.

Hearing details:

Wednesday, January 29, 2014 at 9:30am - get there early; we are packing the place!

Bienville Building, Room 118, 628 North 4th Street, Baton Rouge, LA 70802
NOTE: NOAF and our allies are wearing purple!

If you cannot attend the hearing, we can print and hand-deliver your written comments at the hearing -- you MUST include your full name and address. Email your letter to abortionfundnola@gmail.com by Monday, February3 at 8:00pm CST. 



Thank you! Together, we can fight back!

SOS Midwest

Basically.

Midwest abortioneers and others-- did you see this? This Ohio bill will require abortion providers to obtain hospital admitting privileges BUT ALSO specifically prohibit them from making such arrangements with any public hospital or even any doctor employed at one. Funnily enough, in the US the largest operator of non-public hospitals is...the Catholic Church.

Even before these new tighter restrictions are voted on, one Toledo clinic has just closed due to these issues and another is expected to do so soon. You can read more details at the Salon article.

Ohio's provider landscape will look something like this, I guess:

I've been thinking about this issue a lot since the admitting privileges strategy seems to be increasingly popular in the past 1-2 years (and alarmingly effective) in the quest to eliminate providers -- but this is the first state hospital requirement I've seen where state hospitals would be explicitly off-limits in your efforts to comply with the state's hospital requirement. That feels like some next-level, Vonnegut-Kafka-MontyPython type shit (cause I can't decide whether to laugh then cry, or cry then laugh).

If you work in a hospital or ED setting, I want to hear about it: Has the topic of admitting agreements with abortion providers ever arisen in your hospital? And while we're at it, what about emergency treatment for pregnant intakes (including urgent abortion care) more generally?

Images from: The Notebook, Toothpaste for Dinner

The Great Macy's Fourth of July Abortion Sale: Get 'em while you can! (offer valid only in Mississippi until 7/11/2012)

This is actually a breadline, not a bank run or a premodern Black Friday. But when I thought about it, the breadline matched the vibe of the clinic waiting room better than those. People are there -- with their spouse, mom, kid, infant -- because they really need to be. 

So...

Remember my last post, where I was kinda sick and tired of legislators playing doctor (and not in the sexy way) (but also, is playing doctor actually sexy to anyone?), and I was writing about the last abortion clinic in Mississippi being legislated out of existence, and about Rep. Bubba Carpenter, and how he was talking in what I imagine is a too-bad-so-sad wah-wah voice about how the other side talks way too much about "some poor pitiful women" who might risk their health and lives trying to end their pregnancies by any means available, and I think I might have blacked out shortly after that as an internal defense mechanism?

Yeah, I know: oof. But let's talk about Mississippi some more!

So the bill passed and was signed by the governor and its stipulations include that abortion providers must have hospital admitting privileges -- something Bubba Carpenter noted was notoriously difficult for anyone to obtain, not just abortion providers -- and that means that this last clinic in Mississippi, which has not been able to secure admitting privileges, will have to close. But then, since as Bubba Carpenter noted this law is not trying that hard to be constitutional, a judge stayed the new law until a court hearing planned for July 11 -- giving the clinic a reprieve of, uh, about a week.

And here's something that interests me as an abortioneer.

But it has also created a rush of women from across Mississippi wanting to have abortions. The clinic's three doctors normally perform about 40 abortions a week, but received more than 100 calls in one day last week from women trying to schedule appointments. Two of the doctors live out of state and will fly in to perform abortions this week, said Diane Derzis, the clinic owner.

"What women are hearing is, You may not be able to have an abortion soon," she said. "If you're pregnant and you don’t want to be, you’re thinking, 'By God, I've got to get in there fast.'"

Seems kind of weird, doesn't it? Like a run on the banks, as my arm candy quipped. You'd think that the need for abortion care is pretty much static over the course of a year, since pregnancy can occur in any season and any abortion clinic is the potential provider for at least several million people of reproductive capacity. But demand for services really does seem to have a certain flux to it. While I can't remember hearing of a run on the clinics (though I guess it's not hard to understand), I have noticed other ups and downs and maybe patterns.

I've mentioned before that I had many clients who were able to finally secure their abortion care when their tax refund came back -- and even some who specifically filed early in order to make sure they raised enough money before they reached 12 weeks when the fee would start progressively increasing. Those patients were very resourceful and very on top of it. And I sympathized with their certainty that they made little enough to be owed a refund -- my full-time job qualified me for both a tax refund and assistance from an emergency abortion fund should I ever need it.

But demand also seems to drop on holidays, especially big ones. It's hard to seek an appointment while hosting extended family, driving to grandma's, juggling your parents' or grown children's multiple Thanksgivings after a divorce, entertaining your school-aged kids at home, or arguing with your teenager about sharing the family car over winter break. You don't have as much privacy, time, or energy for taking care of yourself. Shit's hectic.

Then, weeks after a holiday, demand bounces back to levels even higher than before. Phones ring off the hook at the emergency abortion fund, they ring all day although you have multiple phone lines and someone answering every line. Same thing happening at the clinic, which is also jam-packed with people -- you have to bring more chairs into the waiting room -- and clients want to know what is the point of making an appointment if you still have to wait all damn day. (The answer is you struggle with turning people away from care, and wish there was such a thing as walk-in care, but in your state there's a law requiring advance appointments so pregnant people can take time to "cool off" and think hard about their impulsive and flighty decisions. As Sarah Silverman says, maybe they're not as hungry as they think they are.)

I say "weeks" after a holiday but we'd often remark that it seemed to be about four to six weeks after a holiday. Kind of joking, because that's how long it takes from fertilization (four) or last normal menstrual period (six) to the earliest point in pregnancy that most clinics are able to offer abortion care. Kind of not joking, because it really happened. At least three years I noticed that after a December-January lull, we'd have the most insane February and March. That's the time of year that I first became an abortioneer, actually. At first I thought that was just how it was -- that we'd have 100 appointments per day forever. (On the plus side, a lot of those were double-bookings or ambivalent patients who ended up going to another clinic for prenatal or abortion care. We didn't actually check that many patients in per day.)

I could surmise that stereotypically hectic and overburdened times (Thanksgiving/Christmas) or stereotypically romantic times (New Year's/Valentine's) or stereotypically hedonistic times (spring break, New Year's again) lead to unintended pregnancy. And surely the delaying of one's own needs during family-heavy holidays would explain part of the resurgence of appointment requests afterward. But I don't really know and I don't think there's any way to find out on a large scale. It'd be interesting, though, to ask individual women to recount the story of what prompted them to seek abortion care when they did, and why. If only such questions weren't so politically loaded, so likely to suggest there's a right and a wrong answer, maybe we'd hear a lot of honest and interesting stories.

Some days I can't bear to look

I know I haven't been around much. Frankly, keeping up with the insane and nonstop political assaults on abortion and related care has been nearly too much to bear. You'd think I'd be writing nonstop, because SO MANY FEELINGS, but at times the feelings kinda drain my emotional energy. I know some of my co-bloggers have been feeling that same drain, lately, in various ways -- and I bet fellow abortioneers in the field have, too.

So it seems almost futile to single out one law and one group of politicians. But if any law has earned that, I guess it'd be the latest restriction out of the magnolia state. Mississippi, come on down!

Maybe you've heard? The lawmakers who passed Mississippi's House Bill 1390, while claiming to be motivated by a desire to protect women from dangerous abortion providers, are also cheering the fact that the bill will have the effect of shutting down the only existing legal abortion provider in the state.

Sen. Kenny Wayne Jones (D-Canton) asked Sen. Dean Kirby (R-Pearl), who chairs the Senate Public Health Committee*, whether ending abortions in the state would force women to resort to dangerous, back-alley abortions.

"That's what we're trying to stop here, the coat-hanger abortions," Kirby replied, in reference to the abortions provided at the clinic in Jackson. "The purpose of this bill is to stop back-room abortions."

*I would also like to call your attention to the fact that Sen. Dean Kirby chairs the Senate Public Health Committee. Presumably, that is a Senate committee on public health. But maybe it's...a Senate committee against public health? I guess the title isn't super specific.

Oh, speaking of the Legislative Brotherhood Against Public Health, see also the breathtakingly cavalier Rep. Bubba Carpenter announcing afterward:

"We have literally stopped abortion in the state of Mississippi. Three blocks from the Capitol sits the only abortion clinic in the state of Mississippi. A bill was drafted. It said, if you would perform an abortion in the state of Mississippi, you must be a certified OB/GYN and you must have admitting privileges to a hospital. Anybody here in the medical field knows how hard it is to get admitting privileges to a hospital.

"It's going to be challenged, of course, in the Supreme Court and all -- but literally, we stopped abortion in the state of Mississippi, legally, without having to-- Roe vs. Wade. So we've done that. I was proud of it. The governor signed it into law. And of course, there you have the other side. They're like, 'Well, the poor pitiful women that can't afford to go out of state are just going to start doing them at home with a coat hanger.' That's what we've heard over and over and over.

But hey, you have to have moral values."

Wow. Was that a sneer I just heard? And then...a shrug?

He has a point, right? Sure there might be some poor pitiful women who can't afford to go out of state for their medical care and end up injured or dead using coat hangers and home remedies -- but aren't we pro-choice people (the other side) just talking about those women to score political points? I mean, why else would you bother talking about them? We say it over and over and over because we don't have better talking points, I guess. But hey! Those deaths are so trivial we can mock them and the people who talk about them.

(Later, Rep. Carpenter also shrugged off his coat hanger 'quote' as "just some language that some of the African-Americans used.")

(You thought I made up that last bit, didn't you? But no. He really did. I mean, it sounds like he's saying that therefore those accounts amount to nothing worth examining? But hey! That's okay, because African-American women (and other black women, and other women of color) definitely don't have even more experience with unsafe abortion than white women.)

Gosh, wonder why I feel so tired?

Even sadder times: Bad doctors, system failures, lost lives

Terrible news. Kermit Gosnell has made the news again. You might remember, we wrote about him in March when his medical office was discovered to be practicing abortion in improper ways and under unsafe conditions.

Now he has been charged with multiple counts of murder. I'm warning you, the story is long, sad and gross; also, both the article and the grand jury report have some unsourced descriptions and apparent speculation. But ignore those and the allegations are still clear. Investigators say that some of the wrongdoings are too old to press charges or too many files have been destroyed to amass sufficient evidence; nevertheless, from the evidence they did gather, they're charging Gosnell and several other people with the deaths of seven prematurely-delivered infants and one woman who sought his services. In fact, because of how much the piece (and all the headlines and abbreviated news pieces going around) lingers on the dead newborns, it's easy to miss the few lines mentioning that he and his staff caused the deaths of at least two women and injuries for many others.

Gosnell's lawyer, while maintaining that everyone's innocent until proven guilty and the case must have its day in court etc, also apparently attempted to mitigate Gosnell's actions by saying he "served patients in a low-income city neighborhood for decades." Would he really have us believe this is what serving the underserved looks like? It's not even like this happened in the middle of nowhere, Wyoming. It's west Philly. It's devastating that society, our insurance system and Medicaid laws, state regulators and medical services have abandoned some women to a situation where they can't obtain the safe, legal and ethical care available a few miles from them. The other side of the tracks may as well be the other side of the world.

Another stupid thing to say:

State regulators ignored complaints about Gosnell and the 46 lawsuits filed against him, and made just five annual inspections, most satisfactory, since the clinic opened in 1979. The inspections stopped completely in 1993 because of what prosecutors said was the pro-abortion rights attitude that set in after Democratic Gov. Robert Casey, an abortion foe, left office.

It strikes me as fucked up and crazy that someone would blame this disaster on a "pro-abortion rights attitude." No pro-choice person wants women to be injured and killed because they sought abortions! In fact, many people are pro-choice because they're aware that women risking injury and death is part of the status quo for most times and places in which abortion is illegal. If there were actually a pro-abortion-rights attitude in Pennsylvania government, they'd have been collaborating with experts who actually care about improving the quality of abortion care.

In fact, if more states did exactly that, then we wouldn't have situations like this in Pennsylvania on the one hand, and state agencies like Louisiana's shutting down clinics for no cause simply to prevent abortions on the other hand. (As Robin Rothrock -- RIP -- said at that time, "No one in their right mind would think the state of Louisiana is interested in quality abortion care. It is interesting that the state sees itself as an expert on these issues when it does not provide any such care, and when it prohibits use of any public dollars for abortion care, including training.")

The most frustrating, haunting thing in all of this is summed up by an excerpt from the March article:

More than a decade ago, CHOICE, a Philadelphia abortion referral service, contacted the state medical board about Gosnell because some of his patients had called CHOICE with appalling stories, said Brenda Green, the organization's executive director. "We were told that we could not file a complaint. It had to be a patient. It could not be a third party," Green said.

Reproductive health activists and Gilbert Abramson, a lawyer who filed the 2008 case that was later dropped, said they urged Gosnell's patients to file complaints with the state. But when the women learned that they would have to provide medical records and other forms, plus attend a hearing in Harrisburg, they changed their minds.

As Rob wrote at Abortion Gang yesterday, states keep getting the oversight wrong. Many states harass providers baselessly. Yet Gosnell was a concern of pro-choice advocates and case managers for years, but the medical board said only an actual patient could file a complaint. Apparently, the state can pursue an abortion clinic relentlessly and routinely without a particular basis, but review of a doctor in private practice (any doctor, not just an abortion provider) must be prompted by a patient. If this is true (confirm, anyone?), I just don't understand it.

The purse strings are so close, yet so far: Abortion coverage and DC sovereignty

Yellow = no lifesaving needle-exchange programs. White = go for it!

I used to live and work in Washington, DC, a place where you'd think people are powerful and have the ability to make important decisions. But the city of the District of Columbia is not the same as what people call "Washington" when they are thinking of Congress and the White House and the Supreme Court and, you know, the halls of power.

Not everyone knows that the residents of DC do not have a single vote in Congress. (They have one non-voting delegate in the House of Representatives, Eleanor Holmes Norton.) Also, not everyone knows that until 1973, DC did not even have an elected mayor or city council, but was directly administered by federally-appointed commissioners -- and Congress can take away that privilege at any time. Congress also has the power to decide how the District can and cannot spend its own income, i.e. money raised from city taxes. Of course, if DC were a state, this would all be very unconstitutional, but the Constitution dictates that the District of Columbia be governed in this way.

It might seem very arcane or very trivial -- why would senators and House reps from other parts of the country care to get involved in someone else's city budget issues, and if they did would their decisions really be so bad for residents anyway? Unfortunately, the residents of DC do indeed feel the repercussions of this lack of sovereignty, repercussions which often hit the poorest among us the hardest.

Every year, Congress writes and passes a new federal budget. And every year, members of Congress use DC as a place to make cheap political statements about where they "stand" on "issues." A timely example: since the late 1990s, DC was prohibited from using its own money to pay for needle exchange programs to combat the spread of HIV, while several of the "real" states were supporting such programs using not just their own funds but federally-allocated funds as well! Basically, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable; meanwhile, the Washington Post reports that "At least 3 percent of District residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a 'generalized and severe' epidemic".

In 2007, Congress finally reversed that ban, but now the House is considering a bill with an amendment that restricts where DC can locate needle exchange sites: they cannot be "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, university, public swimming pool, park, playground, video arcade or youth center." The image you see at the top of this post is a map [pdf] 0f what those restrictions would look like: in the white parts it's OK to provide clean needles in exchange for used ones, but not in the yellow parts. (And, um, the blue is water.) How many people can that possibly reach?

OK, so what does this have to do with abortioneering?? As you might guess by now, abortion is another favorite controversy to take out on the residents of DC. Until 1988, the District was using some of its own funds to include abortion coverage as a Medicaid benefit. Since that year (with a brief break 1994-96), Congress has prohibited the District from spending any of its own revenue to pay for abortions, despite the fact that its residents and city council clearly appear to favor it. Again, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable. This year it appears that the Democratic majority in Congress may finally reverse that position and allow DC the choice to resume covering some abortions, and the city probably will choose to do so.

When I worked in DC, most of my clients were on Medicaid, and the vast majority of those were not from jurisdictions that allocated funds for abortion care. They were on Medicaid because their government acknowledged they were too poor to afford health care, but they were going to have to afford an abortion all on their own. Yet abortion care is a part of health care, and we don't suddenly get richer when we have an unwanted pregnancy! It broke and still breaks my heart to know that so many of my neighbors are getting screwed over by people who go to work just a couple blocks or a couple miles away from them.

Living in the nation's capital, you constantly pass monuments, walk right by the White House, and see other stuff that should make you feel like huge decisions are being made in your backyard; yet all that proximity never gets you any closer to meeting those decisionmakers or participating in those decisions. In fact, aside from the euphoria of Election Day and Inauguration, I doubt any of my clients ever thought about the federal government. So maybe it's no wonder that Congresspersons are making terrible decisions about the drug addicts, pregnant women, gay couples and cancer patients of DC as though the latter lived in some tiny shit village thousands of miles away that no one expected Congresspersons to care about in the first place: they don't feel any closer to the residents of their host city than their hosts do to them.

Yes, Congress legally can do all these things. But it still feels like your landlord showed up at your door, set up camp in your nicest bedroom, then went around to all the other rooms and shat on the carpets. Don't forget rent is due on the first.




EDIT: Also, don't you love it when the House minority leader posts a "Statement of Republican Policy" on the party's more-or-less official site for Congressional workings (hosted at a .gov address) and it's got typos and bad logic and unflattering cut-n-paste aesthetics and everything?!

Irresponsible and noncompliant

It's Friday morning, I went into work ready for my week to be over. It was a typical Friday, quite a few people were still scrambling to raise money for their 2 or 3 day procedure that had to start on Friday or would increase in price again, by as much as $300 or $400.

A seventeen-year-old young woman came in for the second time in hopes of getting her abortion. The first time she showed up, she was unaware of parental consent requirements and she was sent home because she didn’t have a parent with her. She was given the information about parental consent and judicial bypasses, a means of getting a court order stating a minor is mature enough to have an abortion without the consent of her parent. It is then up to her to find a way to communicate with her parents or begin the process of getting a judicial bypass.

This patient showed up with out any parent or anyone for support and was at least 13 weeks pregnant. At that point she was told, you can’t do this on your own, state law mandates that you go through extra hoops because you are a few months shy of legal adulthood. Now as she sat in the waiting room one of the clinic staff members, who had to communicate with me about financial assistance for the abortion, made a couple very disturbing comments. I talked to him about her total cost and if we should wait on the ultrasound before completing financial assistance.

“She’s really rather irresponsible.” The staff member rattled this statement as he described her first visit to the clinic alone. I was quite taken aback and told him I would talk to her once he completed the ultrasound. I planned to try and step in and help counsel her through the remaining steps to prepare for her procedure. He then told me, “well, she’s really not going to be very compliant.” I didn’t know how to respond to my colleague. I was appalled and yet in the moment there was nothing I could say. I quickly set up the financial assistance without the ultrasound and told him to let me speak directly to her if anything changes.

In my mind, this young woman is 17 and pregnant and what a mind-boggling situation to be in. Especially if she doesn’t want to stay pregnant and now she’s under time constraints to maneuver through laws, regulations, and counseling appointments. She was told, you're running out of time but you still have to talk your parent into supporting your decision or else talk to a judge.

The word "compliance" infers that the woman is weak and subservient. The idea that she needs to be compliant, or yield to those in authority is ridiculous. I realize my colleague is probably exhausted and burnt out, but patients must be treated as human beings. Patients need to be empowered to understand how to access health care that is dictated by laws and policies mandating parental consent and 24 hour waiting periods. Our patients are confused, angry, sad, relieved, broke, burnt out, tired, they are a lot of things, but noncompliant and irresponsible are not accurate descriptors.