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Los Angeles Times (US), September 10,, 2007

Judge weighs abortion standard

Missouri would regulate facilities that commonly offer early terminations, even by pill, as centers for outpatient surgery.

By Stephanie Simon

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."

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stephanie.simon@latimes.com

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