It’s a TRAP: Targeting hospital admitting privileges

They’re frequently identified as “Women’s Health and Safety” laws, but a growing number of laws regulating abortion providers are more accurately called TRAP laws — Targeted Regulation of Abortion Providers. They’re aimed at stopping abortion by making them logistically impossible — shutting down clinics — rather than flat-out illegal. You can generally recognize a TRAP law when proponents of the “women’s health” laws are more excited about the clinics that shut down than the clinics that the ones that upgrade their facilities to meet the new standards.

One favorite tool of the TRAP law is a requirement that physicians performing abortions must have admitting privileges at a local hospital. Doctors say the requirement is unnecessary and frequently well-nigh impossible to satisfy. And here’s why:

Many doctors who perform abortions live outside of the state in which they provide services, traveling to different clinics. This is in large part because many communities are hostile to abortion providers, making them disinclined to put down roots and hang their shingle permanently. Many hospitals require that a physician live within 30 miles of said hospital to be granted admitting privileges, which an out-of-area doctor wouldn’t be able to satisfy.

Not all hospitals are willing to grant admitting privileges to abortion providers. A doctor who testified against Alabama’s recent Women’s Health and Safety Act last month (behind a curtain and using a pseudonym for her own safety) said that she had had privileges at a Birmingham hospital when she was on faculty there, but that now that she’s applied as the medical director of a Planned Parenthood clinic her privileges have been denied. “They did not want a relationship with Planned Parenthood at all,” she told the court. “They did not want the political controversies that come with having a relationship with Planned Parenthood.”

Abortions rarely result in hospitalization. The testifying physician, referred to as Dr. Roe, said that of 2,300 abortions performed at her clinic last year, only three resulted in ER trips, including patients who went to the ER on their own. And ER doctors are fully capable of treating any complications from an abortion without needing the abortion provider him- or herself present to manage treatment. A doctor testifying against Wisconsin’s TRAP law noted that less than 0.3 percent of women receiving abortions require hospitalization, and that death from complications of an abortion are less likely than deaths from complications of penicillin. The fun twist: Physicians are generally required to admit a certain number of patients to a hospital within a specific period of time to be granted privileges — and abortions simply don’t have enough complications to require that many admissions.

Patients with medical emergencies are generally taken to the nearest hospital, not their physician’s hospital. Which is as it should be. Whether transported from a clinic or a woman’s own home, the choice of ER will almost always be made by the EMTs in the ambulance. And that decision will be based on medical necessity, not whether the woman’s doctor has admitting privileges. Also, in many cases a woman admitted to a hospital would be treated by a staff physician rather than her own doctor, making the “continuity of care” argument moot.

Physicians who perform far more dangerous procedures than abortion are allowed to work without admitting privileges. Doctors who perform colonoscopies or dental surgery aren’t generally required to have admitting privileges, but those procedures are far more likely than abortions to require hospitalization. Why does it work? Because, as noted above, a patient having a medical emergency is going to be taken to the nearest ER, where they’ll receive care regardless of admitting privileges.

National medical associations oppose the requirement. The American Congress of Obstetricians and Gynecologists and the American Medical Association both say the requirement is medically unnecessary — that “[e]mergency room physicians, hospital-based physicians, and on-call specialists already provide prompt and effective treatment to all patients with urgent medical needs, including women with abortion-related complications.”

State laws already have requirements for abortion providers. Says Jennifer Dalven, the director of the ACLU Reproductive Freedom Project, “Every clinic has to have an agreement with a doctor who doesn’t work at the clinic but is a backup doctor, and that person has admitting privileges” under current laws, providing the “continuum of care” dictated by Alabama’s Attorney General. The Alabama Department of Public Health had asked legislators to take the requirement for admitting privileges out of the Women’s Health and Safety Act — “We were happy with our rules as the governing position on abortion clinics,” says State Health Officer Donald Williamson — but the request was denied.

These regulations, contradictory to the recommendations of state health officials and medical organizations, are passed under the umbrella of improving and helping and protecting women’s health, when all they really accomplish is to make it more difficult for women to receive the health care they really need. States that have passed or tried to pass admitting privilege requirements include Alabama, Louisiana, Mississippi, North Carolina, North Dakota, Oklahoma, Texas, and Wisconsin.

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