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In State Records, Little Evidence to Back Stricter Abortion Laws
In their successful push this summer for strict new regulations on abortion facilities and the doctors performing them, proponents said the legislation was needed because conditions at existing facilities made it unsafe for women seeking to terminate pregnancies.
But a Texas Tribune review of state inspection records for 36 abortion clinics from the year preceding the lawmakers’ vote turned up little evidence to suggest that the facilities were putting patients in imminent danger. State auditors identified 19 regulatory violations that they said presented a risk to patient safety at six licensed abortion clinics that are not ambulatory surgical centers in Texas. None of the violations was severe enough to warrant financial penalties, according to the Department of State Health Services, which deemed the facilities’ corrective action plans sufficient to protect patients.
And between 2008 and 2013, the Texas Medical Board, which regulates the state’s physicians, took action against just three who performed abortions — all for administrative infractions that did not involve criminal practices or late-term abortions.
“The point of this legislation was to make abortion inaccessible,” said Amy Hagstrom Miller, chief executive officer of Whole Woman’s Health, which operates five abortion facilities in Texas. “It wasn’t about safety, because there is no safety problem around abortion in Texas.”
Although most of the state’s recent inspection findings point to administrative errors as opposed to medical ones, abortion opponents have not been deterred. Beginning Oct. 29, Texas will ban all abortions after 20 weeks of gestation and require abortion facilities to have a physician with admitting privileges at a hospital within 30 miles. In a year, additional rules will require abortion facilities to meet the structural guidelines for ambulatory surgical centers, which include wider hallways and preoperative and postoperative waiting rooms.
Emily Horne, a lobbyist for the anti-abortion group Texas Right to Life, said the conditions auditors found in the last year could have easily led to women getting sick or injured, and a “lower standard of care” could result if inspectors “find these problems and do nothing about them.”
“The clinics need to be safer,” she said. “You can’t advocate for more abortion that is unsafe.”
Among the violations auditors found at the facilities, which get surprise inspections annually, were expired or unlabeled medicine, and instances in which medical staff failed to follow proper infection control procedures. In one case, auditors found that a sterilization machine was not working properly and that nurses were not trained to recognize the problem. On another occasion, a bleeding patient was transferred to a hospital in a private car instead of by ambulance.
Most of the violations auditors found were at the Whole Woman’s Health facility in Beaumont, which took immediate steps to fix the problems and had its correction plan accepted by the state.
A health department spokeswoman could not say whether those violations were linked to patient complications, citing confidentiality rules.
But state health officials have not shied away from making Texas abortion facilities pay for their shortcomings. In 2010, they levied a $119,000 fine against Planned Parenthood Trust of South Texas for failing to acquire licenses for three facilities that began prescribing abortion-inducing drugs in 2005.
Mara Posada, a Planned Parenthood spokeswoman, said the organization was under the impression that it did not have to obtain licenses for those facilities because surgical abortions were not performed there — and the organization did have a license for the facility that offered them.
The state also levied several smaller fines, ranging from $200 to $500, against clinics that failed to post their licensure numbers on their Web sites, misreported the age of gestation or failed to return a corrective action plan on time, among other violations.
The fact that most of the state’s recent inspection findings point to administrative errors as opposed to medical ones has not deterred abortion opponents.
One group, Operation Rescue, has accused a Houston doctor of performing illegal, late-term abortions as recently as 2011. Harris County officials and the Department of State Health Services are investigating those allegations, but previous inspection reports have revealed no violations that presented a safety risk.
Abortion rights advocates say that even if the investigation uncovers wrongdoing, the doctor was operating an ambulatory surgical center that would have met the requirements of the new law. They and medical experts argue that the new regulations will lead to the closing of most of the state’s legal abortion providers, resulting in more women seeking dangerous, illegal options.
Since January, nine abortion clinics have closed, and another facility has stopped performing abortions. Two of those that closed were Planned Parenthood clinics that operated until this month; state auditors found no violations there in their last inspections. Only six of the state’s remaining 38 abortion facilities currently meet the structural requirements of ambulatory surgical centers, and it is unclear how many have a physician with hospital admitting privileges. “The goal of the bill is to improve patient safety for the woman and the child,” Ms. Horne said.
Between 2000 and 2010, five women died in Texas from abortion-related complications; the most recent death occurred in 2008. More than 865,300 abortions were performed during that period, making Texas’ abortion-related death rate, 0.58 deaths per 100,000 abortions, slightly lower than the national abortion death rate of 0.7 per 100,000.
Abortion rights advocates say that is 14 times lower than the risk of carrying a pregnancy to term; opponents argue that every abortion comes with a terrible cost, the death of a fetus.
During his research on the impact of Texas’ 2011 family planning financing cuts, Dr. Daniel Grossman, a principal investigator on the University of Texas at Austin’s Texas Policy Evaluation Project, said he found no evidence that Texas’ licensed abortion facilities had unsafe conditions. The one safety issue he has identified is the practice of self-induced abortion — women without easy access to abortion clinics trying to terminate pregnancies themselves. (The university is a corporate sponsor of The Texas Tribune.)
“This additional burden is just going to be too much for some women,” Dr. Grossman said. “I think it’s very, very likely that abortion self-induction is going to go up, and that’s definitely going to be bad for women’s health.”