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In the last few years, a glut of laws has been proposed or passed in Pennsylvania that women’s health advocates say threaten to shrink the availability of abortions in the state. But lawmakers say the laws are all about patient safety.
It’s coming up on a year since Act 122 became law. Act 122, first presented as House Bill 574 and Senate Bill 732, is The Department of Health Abortion Facility Oversight Act. The act has roots in the discovery of a gruesome Philadelphia abortion clinic that seemingly operated without any regulation or oversight. Dr. Kermit Gosnell was accused of murdering a patient and killing seven babies born alive during late-term abortion procedures. He had employees who were not trained medical professionals working in squalid conditions.
With their implementation of Act 122 came a host of regulations that have shuttered four clinics in the state and threatened to close others.
Act 122 requires clinics offering abortions to be licensed as ambulatory surgical facilities and be subject to at least one surprise visit from the Department of Health per year. Sue Frietsche is a senior staff attorney at The Women’s Law Project in Pittsburgh and said there are other requirements as well.
"They run the gamut, from personnel and government requirements to infection control standards to emergency procedures to fire safety, size of operating room, what materials the ceilings and floors must be made of, hallway widths, the locations of sinks, the dimensions of the bowl of the sink, they are very, very detailed," she said.
Frietsche said these restrictions focus on architectural details over medical needs and have very little to do with medical function.
That’s not how the Department of Health, which now has the task of enforcing Act 122, sees it. Kait Gillis, press secretary for the Department, calls it a major victory in protecting women’s health.
"Act 122 protects the health and safety of Pennsylvania’s women by increasing the levels of health and oversight over women’s care and making abortion facilities more accountable for the level of care they provide," said Gillis.
Before Act 122 there were 22 freestanding abortion clinics in Pennsylvania. Since it passed, four have closed and most of the remaining, which are mainly clustered near Pittsburgh and Philadelphia, are open with provisional licenses that run out next month.
Planned Parenthood of Western Pennsylvania clinics are running on these temporary licenses. Spokeswoman Rebecca Cavanaugh said they’ve made strides to be compliant with the act. They've gotten waivers for the parking space requirement and for the covered ambulance bay.
They’ve also gotten waivers for the size of the elevators, but Cavanaugh said the effort continues.
"There are so many, we had to get an EKG machine and make sure our physicians were trained, all this kind of stuff, good faith efforts." There are also new requirements on state officials, including the requirement that the state start a hotline to take complaints and investigate all of them.
Another clinic downtown has already closed, as well as one in East Liberty. And Magee Women’s Hospital had to move independent providers in their facility from one wing to another to comply with the act.
Department of Health officials said they are just enforcing the law and they don’t think the Act will limit access to reproductive care around the state. They stress they are just ensuring women’s safety.
In 2009, the last year for which the Department of Health has available numbers, there were 37,284 abortions performed in Pennsylvania. It’s estimated by the Guttmacher Institute that one in three women will have an abortion in their lifetimes.
State Representative Matt Baker introduced the House Bill. He’s the Chairman of the House Health Committee.
He says the bill was a template of recommendations provided by the Philadelphia Grand Jury after the Gosnell investigation and they are not based on legislation in other states. He also said they were not drafted in an effort to shut down clinics.
"That fearmongering, I hoped would stop," he said. "It's false, not true. It's all about patient safety. Adults were dying; babies were being born alive and then killed."
Baker said he was horrified when he read the grand jury report and he didn’t understand how the clinic operated for years without being reviewed or inspected.
"We just felt compelled to protect the health and welfare and enhance the medical treatment… of women seeking medical treatment in these clinics."
Sue Frietsche from the Law Project said there is a growing trend in terms of the number of proposed bills that attempt to limit access to abortion.
Other bills that have been introduced in the Pennsylvania legislature would have prohibited abortion from being placed for purchase on Pennsylvania’s health insurance exchange (part of the Affordable Care Act) and would have required women to see and sign for photos of their fetal ultrasounds prior to an abortion. Those bills did not come up for a vote this fall and would have to be introduced in the 2013-2014 session if supporters want to try again.
Frietsche and other women’s health advocates say they wish legislators would focus on other issues, like job creation. And that they know, at least historically and annecdotally, that when access to abortion care is limited, it often has the opposite effect – women will seek out the care in illegal or unsafe clinics or from rogue providers.