Repro-Brief: Indiana Takes a New Approach to Eliminating Abortion Access

Robin Marty

Allen County, Indiana's attempt to overregulate its single abortion provider shows a new approach being taken in the war on access to the procedure.

Editor’s Note: This article was updated on Tuesday, June 15 at 3:33 pm to correct an error.  Allen County has only one surgical abortion provider, not the full state of Indiana.

This year it seems as if every state has taken a new and novel approach to attempting to restrict abortion access.  Nebraska has mental health screenings and abortion bans after the 20th week.  Oklahoma has, among other methods, a new invasive survey that can potentially give away your identity if you seek the procedure.  Florida, like many states, is pushing mandatory ultrasounds.  Alaska is working on a parental notification statute.

But Allen County, Indiana has done something completely different from the norm.  They have taken the fight straight to the abortion practitioner.  Singular.

The county has only one doctor who provides surgical abortions. Rather than regulate the number of hoops that women need to go through to obtain his services, the Allen County department of health has changed regulation in order to literally run the doctor out of town.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

From the Fort Wayne Journal Gazette:

Fort Wayne’s lone surgical abortion provider is suing to stop a new county ordinance from being enforced.

Dr. George Klopfer, operator of Fort Wayne Women’s Health, is challenging a county law that requires doctors who don’t live in Allen County or surrounding counties or who don’t have admitting privileges to area hospitals to provide contact information to area emergency rooms and the local health department.

Klopfer lives in Illinois but is based out of South Bend. He also performs abortions in Fort Wayne and Gary.

Dubbed the “Patient Safety Ordinance,” anti-choice advocates claim it is necessary due to a high number of “botched abortions” being performed by Dr. Klopfer.  The accusation comes from 2007 from local obstetrician/gynecologist Dr. Geoff Cly, who says he has treated “several” of Klopfer’s patients in 2007, and has been contacting legislators and testifying in favor of the ordinance ever since.  In 2008, Cly testified to two patients of his who had retained tissue (which he learned about only when they went to the emergency room due to the complications, as “patients many times are embarrassed to tell us they are considering a termination“).

A 2009 version of a regulation bill, which was debated at the state level, included requiring doctors to have privileges at various hospitals, despite the fact that witnesses testified both that it was incredibly difficult to get these privileges and that it would not provide additional quality assurance anyway.  The bill also specifically referred only to abortion providers.  That bill was passed in the Senate but defeated in the House.

Due to the failure of the bill, Allen County states that they were forced to pass an ordinance locally in order to protect “patient safety.”

After the state legislature looked at a bill to require a similar registration from abortion practitioners but county officials moved ahead when the bill failed.

Allen County Commissioner Nelson Peters move forward and told the News-Sentinel newspaper, “It’s intended to enhance patient safety, and perhaps now the state will have to get involved.”

Cathie Humbarger, executive director of the Allen County Right to Life Committee, told the paper her group supports the new measure, which it reportedly helped write.
“The best way to do this would be at the state level,” Humbarger said, “but if not, we’re thrilled it’s happening at the local level. That’s government at its finest.”

In the wake of the lawsuit filed by Klopfer, the usual groups have come out to provide legal assistance during the case, with Center for Reproductive Rights assisting the state ACLU to represent Klopfer, and the Alliance Defense Fund offering to defend Allen County for no cost.  The lawsuit alleges that the new ordinance would violate the privacy of both the doctors and patients.

Among other things, the ordinance would require out-of-town providers of abortion and other medical services to give contact information to other area health providers. The lawsuit claims the ordinance also would give health officials unlimited access to patient medical records and violate those patients’ right to privacy.

Failure to comply could result in closure of the provider’s facility, a $1,000 fine or both.

Courthouse News Service explains the issues with the ordinance in more detail.

Fort Wayne-Allen County enacted a law that unconstitutionally invades women’s privacy and restricts access to abortion, a women’s clinic claims in Federal Court. Fort Wayne Women’s Health clinic claims the law gives the county unrestricted access to patient records, and illegally restricts doctors who live outside the county from working in hospitals there.

The Fort Wayne-Allen County Department of Health now requires that “itinerate” physicians submit 24-hour contact information to emergency rooms and urgent care centers in the county, name an alternate “physician designee,” and give the county full access to patient records.

The ordinance, which took effect June 1, restricts the rights of patients seeking “reproductive health care,” who expect that their personal files will remain confidential, the clinic and a co-plaintiff doctor say.

If a complaint arises, the law gives the Allen-County Health Officer the power to review the facility’s records, and gives the officer unlimited access to the records of patients “who have undergone similar care,” according to the complaint.

The law does not require that the patient information then remain confidential, according to the complaint.

Klopfer has announced that he will be complying with the ordinance while his lawsuit is pending in order to avoid the fines.  As he and his clinic are registered with the state, he states he already supplies emergency contact information to his patients and has a written procedure for providing emergency medical care and contact numbers, per state rules.

If Klopfer is already providing a majority of the information required, and is complying with the ordinance while he is pursuing his lawsuit, why does it really matter that it exists at all?  As we’ve seen with ultrasound laws, mandatory waiting periods, and other abortion roadblocks, once one new type of law gets enacted in one state, it then quickly multiplies across the country, with duplicate ballot measures and laws being proposed throughout the nation.

Indiana is by no means the only state that has a situation with an out of state doctor coming into the state to provide access for women who wish to terminate their pregnancies.  For example, South Dakota has no abortion providers, and has providers brought in from other states.  A similar move in that state would make access even more difficult.  And, as states find the number of clinics and providers dwindling with every year, it could become an issue for even more states down the road.

Additionally, the idea of unrestricted access to the records of abortion patients continues a troubling trend started in Kansas when the Attorney General Phill Kline tried accessing private medical records to attack Dr. George Tiller during his anti-choice witch hunt.  It is one of the key issues that will likely be challenged in Oklahoma in regards to the “Statistical Reporting of Abortions” law which recently passed.  The threat of violating a patent’s privacy, letting her believe she could be found out, shamed, or some other way punished for her choice is key in anti-abortion intimidation.

Fighting ordinances like the “Patient Safety Ordinance” is necessary because if abortion fights can be moved to and decided by such a a small locality what looks like only minor encroachment can actually shift the entire landscape when it comes to access.  What just one county does seems so unimportant in the bigger picture when it comes to fighting for reproductive justice.  Plus, if that one county is the only access in a state, suddenly the whole scene has changed.  And when 87 percent of the counties in the United States have no abortion providers, that change can be devastating for the women who need assistance.

Culture & Conversation Family

‘Abortion and Parenting Needs Can Coexist’: A Q&A With Parker Dockray

Carole Joffe

"Why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place?"

In May 2015, the longstanding and well-regarded pregnancy support talkline Backline launched a new venture. The Oakland-based organization opened All-Options Pregnancy Resource Center, a Bloomington, Indiana, drop-in center that offers adoption information, abortion referrals, and parenting support. Its mission: to break down silos and show that it is possible to support all options and all families under one roof—even in red-state Indiana, where Republican vice presidential candidate Gov. Mike Pence signed one of the country’s most restrictive anti-abortion laws.

To be sure, All-Options is hardly the first organization to point out the overlap between women terminating pregnancies and those continuing them. For years, the reproductive justice movement has insisted that the defense of abortion must be linked to a larger human rights framework that assures that all women have the right to have children and supportive conditions in which to parent them. More than 20 years ago, Rachel Atkins, then the director of the Vermont Women’s Center, famously described for a New York Times reporter the women in the center’s waiting room: “The country really suffers from thinking that there are two different kinds of women—women who have abortions and women who have babies. They’re the same women at different times.”

While this concept of linking the needs of all pregnant women—not just those seeking an abortion—is not new, there are actually remarkably few agencies that have put this insight into practice. So, more than a year after All-Options’ opening, Rewire checked in with Backline Executive Director Parker Dockray about the All-Options philosophy, the center’s local impact, and what others might consider if they are interested in creating similar programs.

Appreciate our work?

Vote now! And help Rewire earn a bigger grant from CREDO:

VOTE NOW

Rewire: What led you and Shelly Dodson (All-Options’ on-site director and an Indiana native) to create this organization?

PD: In both politics and practice, abortion is so often isolated and separated from other reproductive experiences. It’s incredibly hard to find organizations that provide parenting or pregnancy loss support, for example, and are also comfortable and competent in supporting people around abortion.

On the flip side, many abortion or family planning organizations don’t provide much support for women who want to continue a pregnancy or parents who are struggling to make ends meet. And yet we know that 60 percent of women having an abortion already have at least one child; in our daily lives, these issues are fundamentally connected. So why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place? That’s what All-Options is about.

We see the All-Options model as a game-changer not only for clients, but also for volunteers and community supporters. All-Options allows us to transcend the stale pro-choice/pro-life debate and invites people to be curious and compassionate about how abortion and parenting needs can coexist .… Our hope is that All-Options can be a catalyst for reproductive justice and help to build a movement that truly supports people in all their options and experiences.

Rewire: What has been the experience of your first year of operations?

PD: We’ve been blown away with the response from clients, volunteers, donors, and partner organizations …. In the past year, we’ve seen close to 600 people for 2,400 total visits. Most people initially come to All-Options—and keep coming back—for diapers and other parenting support. But we’ve also provided hundreds of free pregnancy tests, thousands of condoms, and more than $20,000 in abortion funding.

Our Hoosier Abortion Fund is the only community-based, statewide fund in Indiana and the first to join the National Network of Abortion Funds. So far, we’ve been able to support 60 people in accessing abortion care in Indiana or neighboring states by contributing to their medical care or transportation expenses.

Rewire: Explain some more about the centrality of diaper giveaways in your program.

PD: Diaper need is one of the most prevalent yet invisible forms of poverty. Even though we knew that in theory, seeing so many families who are struggling to provide adequate diapers for their children has been heartbreaking. Many people are surprised to learn that federal programs like [the Special Supplemental Nutrition Program for Women, Infants, and Children or WIC] and food stamps can’t be used to pay for diapers. And most places that distribute diapers, including crisis pregnancy centers (CPCs), only give out five to ten diapers per week.

All-Options follows the recommendation of the National Diaper Bank Network in giving families a full pack of diapers each week. We’ve given out more than 4,000 packs (150,000 diapers) this year—and we still have 80 families on our waiting list! Trying to address this overwhelming need in a sustainable way is one of our biggest challenges.

Rewire: What kind of reception has All-Options had in the community? Have there been negative encounters with anti-choice groups?

PD: Diapers and abortion funding are the two pillars of our work. But diapers have been a critical entry point for us. We’ve gotten support and donations from local restaurants, elected officials, and sororities at Indiana University. We’ve been covered in the local press. Even the local CPC refers people to us for diapers! So it’s been an important way to build trust and visibility in the community because we are meeting a concrete need for local families.

While All-Options hasn’t necessarily become allies with places that are actively anti-abortion, we do get lots of referrals from places I might describe as “abortion-agnostic”—food banks, domestic violence agencies, or homeless shelters that do not have a position on abortion per se, but they want their clients to get nonjudgmental support for all their options and needs.

As we gain visibility and expand to new places, we know we may see more opposition. A few of our clients have expressed disapproval about our support of abortion, but more often they are surprised and curious. It’s just so unusual to find a place that offers you free diapers, baby clothes, condoms, and abortion referrals.

Rewire: What advice would you give to others who are interested in opening such an “all-options” venture in a conservative state?

PD: We are in a planning process right now to figure out how to best replicate and expand the centers starting in 2017. We know we want to open another center or two (or three), but a big part of our plan will be providing a toolkit and other resources to help people use the all-options approach.

The best advice we have is to start where you are. Who else is already doing this work locally, and how can you work together? If you are an abortion fund or clinic, how can you also support the parenting needs of the women you serve? Is there a diaper bank in your area that you could refer to or partner with? Could you give out new baby packages for people who are continuing a pregnancy or have a WIC eligibility worker on-site once a month? If you are involved with a childbirth or parenting organization, can you build a relationship with your local abortion fund?

How can you make it known that you are a safe space to discuss all options and experiences? How can you and your organization show up in your community for diaper need and abortion coverage and a living wage?

Help people connect the dots. That’s how we start to change the conversation and create support.

This interview has been edited for length and clarity.

CORRECTION: This article has been updated to clarify the spelling of Shelly Dodson’s name.

News Health Systems

What Happens When a Catholic-Run Clinic Comes to Your Local Walgreens?

Amy Littlefield

“It causes us great concern when we think about vulnerable populations ... [who] may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, told Rewire.

One of the largest Catholic health systems is set to begin running health clinics inside 27 Walgreens stores in Missouri and Illinois next week. The deal between Walgreens and SSM Health has raised concerns from public interest groups worried that care may be compromised by religious doctrine.

Catholic health systems generally follow directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, contraception, tubal ligations, vasectomies, and fertility treatments.

“We are concerned that the clinics will likewise be required to follow the [directives], thereby severely curtailing access to important reproductive health services, information, and referrals,” MergerWatch, the National Health Law Program, and the American Civil Liberties Unions of Illinois and Missouri wrote in a letter to Walgreens on Wednesday. They also sent a letter to SSM Health.

In a statement emailed to Rewire, Walgreens said its relationship with SSM Health “will not have any impact on any of our current clinic or pharmacy policies and procedures.”

SSM Health emailed a statement saying it “will continue to offer the same services that are currently available at Walgreens Healthcare Clinics today.” If a patient needs services “that are beyond the scope of what is appropriate for a retail clinic setting, they will be referred to a primary care physician or other provider of their choice,” the statement read.

A spokesperson for SSM Health demurred when Rewire asked if that would include referrals for abortion care.

“I’ve got to check this part out, my apologies, this is one that hadn’t occurred to me,” said Jason Merrill, the spokesperson.

Merrill later reiterated SSM Health’s statement that it would continue to offer the same services.

Catholic health systems have in recent years expanded control over U.S. hospitals, with one in six acute-care hospital beds now in a Catholic-owned or -affiliated facility. Patients in such hospitals have been turned away while miscarrying, denied tubal ligations, and refused abortion care despite conditions like brain cancer.

Catholic health systems have also expanded into the broader landscape of outpatient services, raising new questions about how religion could influence other forms of care.

“The whole health system is transforming itself with more and more health care being delivered outside the hospital,” Lois Uttley, director of MergerWatch, told Rewire. “So we are looking carefully to make sure that the religious restrictions that have been such a problem for reproductive health care at Catholic hospitals are not now transferred to these drug store clinics or to urgent care centers or free-standing emergency rooms.”

Walgreens last year announced a similar arrangement with the Catholic health system Providence Health & Services to bring up to 25 retail clinics to Oregon and Washington. After expressing concerns about the deal, the ACLU of Washington said it received assurances from both Walgreens and Providence that services at those clinics would not be affected by religious doctrine.

Meanwhile, the major urgent care provider CityMD recently announced a partnership with CHI Franciscan Health–which is affiliated with Catholic Health Initiatives–to open urgent care centers in Washington state.

“We’re seeing [Catholic health systems] going into the urgent care business and into the primary care business and in accountable care organizations, where they are having an influence on the services that are available to the public and to consumers,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Rewire.

GoHealth Urgent Care, which describes itself as “one of the fastest growing urgent care companies in the U.S.,” announced an agreement this year with Dignity Health to bring urgent care centers to California’s Bay Area. Dignity Health used to be called Catholic Healthcare West, but changed its name in 2012.

“This is another pattern that we’ve seen of Catholic health plans and health providers changing their names to things that don’t sound so Catholic,” Lois Uttley said.

 

In the letters sent Wednesday, the National Health Law Program and other groups requested meetings with Walgreens and SSM Health to discuss concerns about the potential influence of religion on the clinics.

“It causes us great concern when we think about vulnerable populations, we think about low-income people… people who… may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the Reproductive Rights Project of the ACLU of Illinois, told Rewire.

The new clinics in Walgreens will reportedly be called “SSM Health Express Clinics at Walgreens.” According to SSM Health’s website, its initials “[pay] tribute” to the Sisters of St. Mary.

“We are fairly forthcoming with the fact that we are a mission-based health care organization,” Merrill told Rewire. “That’s something we embrace. I don’t think it’s anything we would hide.”

 

Tell us your story. Have religious restrictions affected your ability to access health care? Email stories@rewire.news

credo_rewire_vote_3

Vote for Rewire and Help Us Earn Money

Rewire is in the running for a CREDO Mobile grant. More votes for Rewire means more CREDO grant money to support our work. Please take a few seconds to help us out!

VOTE!

Thank you for supporting our work!