10/1/2006 - October 2006 Educational Update - Proposed Strengthening of Abortion Clinic Regulations

AN EDUCATIONAL UPDATE FROM THE SOUTHEAST LAW INSTITUTE™, INC. To: SLI Supporters Date: October 2006 From: A. Eric Johnston Re: Proposed Strengthening of Abortion Clinic Regulations Abortion clinics are regulated by the state of Alabama as “abortion or reproductive health centers.” Sections 22-21-20, et sequel, 1975 Code of Alabama, authorize the Alabama Department of Public Health (“ADPH”) to promulgate regulations necessary to provide the appropriate medical standard of care. Recent events, such as the closing of the Summit Medical Clinic in Birmingham and the restrictions on the Montgomery abortion clinic, Reproductive Health Services, have demonstrated the need for closer scrutiny and more restrictive regulation of Alabama abortion clinics. There are many Alabama medical and health related regulations in order to assure the highest standard of healthcare and the protection of persons. Most clinics, physicians and other healthcare providers meet those high standards due to malpractice insurance requirements. However, many abortion clinics and the physicians who practice there do not have malpractice insurance and there is no incentive to meet those higher standards. Consequently, the burden falls on the state to be sure the clinics are meeting an appropriate standard of healthcare. As a result of deficiencies, the ADPH proposes new regulations for A.C.C. Rules 420-5-1-.01, et sequel to include: - The clinic medical director must assure the clinic meets the higher standard of care. - Physicians working in the clinic shall be board eligible or board certified in obstetrics and gynecology. - The abortionist is responsible for insuring adequate patient follow-up care. He must be available for contact with any physician who is rendering care for later complications. The clinic must develop and follow a policy of communication with outside physicians, such as with emergency room physicians. - The physician must remain on the premises until all patients are discharged. Circuit riding abortionists do abortions and leave patients without follow-up care. - The abortionist is responsible for insuring adequate follow-up care. A physician with admitting privileges at a hospital within the same standard metropolitan statistical area as the clinic must be available 24 hours a day, 7 days a week. If the abortionist cannot meet this requirement, there must be another physician contracted with who does. This includes the physician having staff privileges at the local hospital. If that physician is not available, the clinic cannot do abortions. - Clinics must have 24 hour answering services with the possibility of being connected directly to a physician, registered nurse, or other qualified person. Clear protocols must be developed by the medical director to cover the need for immediate care and physician instructions. - Only physicians and properly credentialed nurse practitioners and physician assistants may prescribe or order medications. Orders must be immediately documented in writing and signed. Abortifacients shall only be prescribed by a physician and administered by a qualified person under the direct supervision of the physician, meaning the physician must be in the building. Standing orders may not be used to prescribe controlled substances or abortifacient medications. These are among the most significant of the changes in the regulations. Perhaps, as early as November 2006, these regulations will be addressed in a public hearing. Members of the public will have an opportunity to respond to the regulations. If you are interested in reviewing the proposed regulations or participating in the public hearing, please contact Rick Harris at the ADPH, 334-206-5366. We will be reviewing the regulations closely and making any further recommendations. These proposals are a significant step to address problems which have existed in abortion clinics in Alabama for sometime. These problems have been recently documented and, fortunately, have acted as a catalyst to promote better healthcare for women who go to abortion clinics. The second step in the process of providing this increased standard of healthcare is for the ADPH to enforce the regulations. This means it must more frequently inspect the clinics. The regulations will provide the more stringent requirements necessary for protecting women, but the ADPH must enforce those regulations. Knowing what we know from recent events, it will be derelict for the ADPH not to begin regular inspections of abortion clinics. Because the abortion industry does not regulate itself, it is incumbent that the state do so. We continue to be encouraged by these developments, but we will continue to insist that the ADPH follow through.

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