[NYTr] Missouri: Fetus Fanatics Take Aim at 1st Trimester Abortions

[All the News That Doesn't Fit]

LA Times - Sep 10, 2007 via rick kissell
http://www.latimes.com/news/nationworld/nation/la-na-abortion10sep10,1,4090012.story?coll=la-headlines-nation


Missouri abortion law under review

Facilities that regularly provide first-trimester terminations --
including the pill version -- may be regulated as outpatient surgical
centers. 

Two of the state's three clinics would have to close. 

By Stephanie Simon
Los Angeles Times Staff Writer

COLUMBIA, Mo. --- A first-trimester surgical abortion takes about two 
minutes. After, patients at the Planned Parenthood clinic here walk
down a dimly lighted hall to a small, spare recovery room, where they
rest in recliners, a box of tissues by each chair. Most are cleared to
go home after 15 minutes.

Thousands of women have safely ended pregnancies at this clinic since
it opened in 1987. Conservative lawmakers in Missouri say abortion
patients deserve better.

They have enacted the most far-reaching regulations in the nation -- 
dictating the physical layout, staffing and record-keeping policies of 
any facility that performs five or more abortions a month, including 
private doctors' offices that regularly prescribe the abortion pill.

The law, which a federal judge is to review today, would force the 
immediate closure of at least two of Missouri's three abortion clinics, 
plus a private medical practice near St. Louis run by a doctor who 
offers first-trimester terminations in his office. Those facilities 
would need extensive renovations to comply with the law; the 
requirements could include widening hallways, raising ceilings, 
installing locker rooms, rerouting plumbing, and creating surgical 
suites stocked with emergency resuscitation equipment, even when no 
surgery is performed on-site.

Several states impose similarly rigorous standards on providers of 
second- and third-trimester abortions. Missouri is the first to try to 
extend them to clinics and private offices that only provide the 
abortion pill, which has been used by nearly 800,000 women nationwide
to end early pregnancies.

The law would put providers of five or more abortions a month in the 
same regulatory category as outpatient surgical centers that perform a 
wide range of procedures, some under general anesthesia, including 
tonsillectomies, cardiac catheterization, hernia repair, cataract 
removal and colonoscopy.

When he signed the bill in July in the sanctuary of a Baptist church, 
Republican Gov. Matt Blunt called it "one of the strongest pieces of 
pro-life legislation in Missouri history."

Abortion-rights groups call it alarming. If upheld, the law could 
inspire similar tactics in other conservative state legislatures; 
Missouri has long been regarded as a pioneer in developing antiabortion 
strategy.

"This is really a case to watch," said Belinda Bulger, deputy legal 
director of NARAL Pro-Choice America. "The anti-choice movement has 
discovered that this is a good tactic for them. . . . It certainly has 
us concerned."

Planned Parenthood's clinic here in central Missouri performs about 600 
first-trimester abortions a year, drawing patients from areas several 
hours away. Surgical abortions take place in two small exam rooms as
the patient, often sedated with a Valium, lies on a padded table, her
feet in stirrups. The recovery room, painted blue, is crowded, the
vinyl recliners positioned so close to one another, patients could hold
hands.

Planned Parenthood official Peter Brownlie recently asked an architect 
to assess the cost of bringing the clinic into compliance with the
eight single-spaced pages of regulations affecting everything from sink
design to bathroom ventilation to spacing of beds in the recovery room.

The estimate: around $1 million. The clinic's annual budget is
$780,000, with a quarter of that spent on abortion; the bulk goes for 
gynecological exams and contraception.

Brownlie said he did not object to opening his abortion clinics to
state health inspectors, who had no jurisdiction before the new law
passed. But he cannot afford extensive renovation in Columbia or in
Kansas City, where a clinic serves a mostly low-income clientele on the
edge of downtown.

"This is ludicrous," said Brownlie, president and chief executive of 
Planned Parenthood of Kansas and Mid-Missouri. "There's a desperate 
quality to it."

Both the American College of Obstetricians and Gynecologists and the 
National Abortion Federation, a trade group representing abortion 
providers, say first-trimester surgical abortions can be safely 
performed in a private physician's office, much like vasectomies.

"How is expanding the doorway size going to improve women's health?" 
asked Michelle Trupiano, a statewide lobbyist for Planned Parenthood.

Backers of the law respond that women seeking abortions -- just like 
those getting colonoscopies -- deserve to be treated in modern 
facilities with doors wide enough to accommodate gurneys and paramedics 
in case of emergency.

"We're applying the same standards of healthcare to abortion clinics as 
we are to other medical facilities," said Pam Fichter, development 
director of Missouri Right to Life.

The law was supposed to take effect in late August, but a federal judge 
issued a temporary restraining order after Planned Parenthood filed 
suit. A full hearing is set for today.

To defend the law, Missouri Health Director Jane Drummond has retained
a Christian law firm that usually handles religious liberty cases. The 
nonprofit Alliance Defense Fund was founded more than a decade ago by 
several heavyweights on the Christian right, including James C. Dobson 
of Focus on the Family. Drummond has said she turned to the group -- 
which took the case for free -- because she does not trust Missouri 
Atty. Gen. Jay Nixon to defend the clinic regulations.

In a letter to Nixon -- a Democrat who plans to run for governor next 
year -- Drummond wrote that the law "is very pro-life while you are 
radically pro-abortion." Nixon has said he intends to work with the 
Alliance Defense Fund.

Brownlie is hopeful that the courts will strike down the law at least
as it applies to practices (such as his group's clinic in Kansas City)
that end abortions only by medication.

Women who choose that option generally expel the fetus in the privacy
of their own homes, as in a miscarriage. The provider's role is limited
to counseling, handing the woman two pills, and doing an ultrasound a
week later to verify the womb is empty. Nationally, many family
practitioners and gynecologists prescribe the pill, even when they do
not offer surgical abortions.

In his temporary restraining order, District Judge Ortrie D. Smith said 
it did "not make a lot of sense" to require a full surgical suite in 
such cases.

The state's attorneys plan to argue that anyone who induces an abortion 
by any means -- including medication -- must be prepared to handle 
complications, rather than send a patient in crisis to an emergency 
room. "These standards would make the situation much safer" because
they would allow for "continuity of care," said Dale Schowengerdt,
legal counsel for the Alliance Defense Fund.

In reviewing the law, Smith will be bound by a 1992 U.S. Supreme Court 
ruling that says states cannot put an "undue burden" on women seeking 
abortions before the fetus is viable. Planned Parenthood contends that 
the standards are burdensome because they will drive providers out of 
business and make abortion less accessible.

But there's a lot of room for judicial interpretation.

"What may be an undue burden for one judge may not be for another,"
said Carl Tobias, a law professor at the University of Richmond in
Virginia. "It's a very flexible standard."