Written by Imani Gandy for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Hospital surgery with team

Forced hospital admitting privileges don’t protect women seeking abortions.

Last week, a federal judge in Wisconsin extended a temporary restraining order that prevented Wisconsin’s latest legislative attempt to reduce women’s access to safe abortion care—by requiring abortion providers to obtain admitting privileges from a local hospital—from going into effect.

Section 1 of Wisconsin Act 37 (SB 206), which was proposed by the Wisconsin legislature on June 4 and hastily signed by Republican Gov. Scott Walker on July 5, requires that physicians who provide abortion services have admitting privileges at a hospital within 30 miles of the location where the abortion is performed. The law was enacted ostensibly to reduce the risk to patients who suffer serious complications during an abortion, and to prevent abortion providers from abdicating their duty of care and leaving such women to fend for themselves. In reality, however, these laws place a substantial obstacle in the path of a woman seeking an abortion and contravene the constitutional principles set forth in Planned Parenthood v. Casey.

At first blush, these laws may seem sensible enough, especially if you believe that abortion is a dangerous procedure and providers should have hospital admitting privileges in case something goes horribly awry. Such is the concern of anti-choicers pushing for the Wisconsin law, as Susan Armacost, legislative director of Wisconsin Right to Life, noted in a July 5 statement. “Apparently, Wisconsin’s abortion clinics don’t believe their abortionists need to have hospital privileges at a hospital located within 30 miles of their clinic … or anywhere at all,” she said. “Currently, when a woman experiences hemorrhaging or other life-threatening complications after an abortion in Wisconsin, the clinic puts her in an ambulance and sends her to a hospital ALONE where she is left to her own devices to explain her medical issues to the emergency room staff. The abortionist who performed the abortion is nowhere to be seen. This deplorable situation must change.”

But documents submitted to the federal court in Wisconsin overseeing the case paint a very different picture of the admitting privileges law. According to Dr. Douglas Laube, a board-certified OB-GYN since 1976, the admitting privileges requirement is “medically unjustified and will have serious consequences for women’s health in Wisconsin.”

As Dr. Laube explained to the court, abortion is one of the safest medical procedures in the United States, alarmist claims to the contrary notwithstanding:

The risk of death associated with childbirth is 14 times higher than that associated with abortion. The risk of death related to abortion overall is less than 0.7 deaths per 100,000 procedures. (As a point of comparison, Dr. Laube states that the risk of death from fatal anaphylactic shock following use of penicillin in the United States is 2.0 deaths per 100,000 uses.) Less than 0.3% of women experiencing a complication from an abortion require hospitalization.

Abortion is an extremely safe procedure that rarely results in serious complications, and despite anti-choicers’ vehement efforts to cloak such laws in feigned concern for maternal health, current medical practices are such that risk to patients won’t be reduced by restrictive rules requiring admitting privileges.

When something goes wrong during a surgical abortion and hospitalization is required, the practical reality is that if a patient is transported by ambulance to a hospital, the EMT will make the decision about which hospital the patient should be taken to. Similarly, in cases of medical abortion, if a pregnant person experiences medical complications at home, she will likely be transported by ambulance to the nearest hospital, and not necessarily to the hospital nearest to the abortion clinic, or to the hospital for which, under the new act, the abortion provider will be required to have admitting privileges.

Moreover, such requirements do not account for modern practices for inpatient hospital care. Currently, typical hospital practices seek dedicated staff physicians to provide inpatient care, and whether an abortion provider has admitting privileges at a particular hospital plays little or no role in determining which hospital may be best suited to care for the patient.

Ultimately, as U.S. District Judge William Conley noted in his ruling,

[T]here is little likelihood that a doctor’s admitting privileges to a hospital located within 30 miles of the clinic where the abortion is performed will have any substantial impact on that doctors ability to affect the patient’s treatment once admitted to treating hospital.

Quite simply, it does not matter whether an abortion provider has admitting privileges for a local hospital.

For all of Wisconsin’s claims, therefore, that these regulations are “reasonably related to ‘the preservation and protection of maternal health,’” it seems clear that is not the case. Indeed, as the court pointed out, the legislative history of Act 37 revealed no medical expert speaking in its favor, or articulating a legitimate medical reason for the admitting privileges requirement.

In response to the evidence submitted to the court that the admitting privilege restrictions serve no purpose in advancing maternal health, Wisconsin admitted that serious complications rarely result from a pre-viability abortion. Nevertheless, Wisconsin argued that the requirement for admitting privileges at a hospital within 30 miles of the location of the abortion would reduce risk to the patient. But Judge Conley wasn’t buying it. He wrote, “Aside from the claimed need for ‘continuity of care,’ counsel was unable to offer any support for this position, which does not bear even superficial scrutiny on the current record.”

Judge Conley seems to understand what pro-choice advocates know to be true: The real purpose of the law—like similar pending legislation in Alabama, Mississippi, and North Dakota—is not to protect maternal health, but to prevent women from exercising their constitutional right to choose an abortion, through forced closure of the clinics subject to targeted regulation of abortion provider (TRAP) laws, by making it virtually impossible to do so.

Public domain photo by Staff Sgt. Bernardo Fuller / Army Medicine.