On Friday, the Virginia State Board of Health reversed an earlier decision to exempt existing abortion clinics from a 2011 bill which enforces the same building requirements on these clinics as on hospitals. The 15-member board voted 13-2 in favor of reversing a “grandfather clause” approved in a 7-4 vote in June which would have exempted existing clinics from new and costly renovations in order to comply with the bill. Virginia Attorney General Ken Cuccinelli had refused to certify the June approved exemption, and had warned board members regarding their legal liabilities if the exemption remained. As a result of the decision reversal, existing abortion clinics will be responsible for physical plant requirements such as hands-free faucets and corridor dimensions. Such regulations could put some clinics in danger of closing their doors, according to operators.
While the Attorney General’s engagement with the State Board of Health in the decision process clearly merits attention, the decision reversal should also serve as an opportunity to consider whether it is necessary for abortion clinics to meet new building requirements designed for hospitals. Virginia already requires that abortions taking place beyond the first trimester be performed in a hospital, and state abortion clinics are already subject to the same regulations as physician practices. Consequently, Friday’s decision reversal is specifically requiring the locations for first-trimester abortions to abide by hospital rather than physician physical plant restrictions. But the nature of first trimester abortions takes on a significantly different nature than at later points in pregnancy. During first trimester abortions, injection and tablet medical options are commonly available. Surgical options which require only a local anesthetic are also available. In contrast, medication based abortions are not available during the second semester and beyond, and surgical procedures are more complex. Second trimester abortions are most commonly performed through dilation and evacuation, where the cervix is gradually dilated, and an overnight stay may be necessary. Based on state laws governing office-based procedures and surgery, first-trimester abortions seem to fall easily within the bounds of an office-based procedure and should be subject to the same requirements as similar office-based procedures.
While advocates of the new regulations hailed it as a victory for women’s health and safety, placing additional, and seemingly unnecessary, facilities requirements on abortion clinics without consideration for clinics already in operation puts women’s healthcare in jeopardy. Even if Virginia abortion clinics are able to remain open, which is no guarantee, significant portions of their funding will be diverted to building wider corridors and installing different sinks rather than providing the care for which they are in operation. Politicizing health care and health safety is dangerous for everyone, and the people who will lose the most will be those least able to seek alternate care or influence the debate. There is room for respectful disagreement on issues of abortion, but invoking health safety as a way to advance an ideological agenda is respectful neither of the medical profession nor of the individuals it serves. — Diane Kuhn