News Abortion

Louisiana Rules Would Have Required 30-Day Waiting Period Before Legal Abortion (UPDATED)

Andrea Grimes

Monday night, a spokesperson for the Louisiana Department of Health and Hospitals told Rewire that it will "be rescinding the language regarding the 30-day period for blood tests," and that it intends to "clarify" the building requirements for abortion facilities.

Update, January 28, 9:00 a.m. Eastern: Monday night, a spokesperson for the Louisiana Department of Health and Hospitals told Rewire that it will “be rescinding the language regarding the 30-day period for blood tests,” and that it intends to “clarify” the building requirements for abortion facilities, saying that “the intent of the language on square footage in the rule is to cover prospective facilities or facilities undergoing renovations.” Despite the department’s passage of the rules without input from providers and without a previous public hearing, DHH says it “has already received several public comments regarding the rule.” A public hearing on the new rules has been moved to February 4 at DHH in Baton Rouge at 1 p.m.

New “emergency” abortion regulations in Louisiana require patients to wait 30 days between blood tests and their abortion procedures, according to the state’s Department of Health and Hospitals (DHH), which has also enacted new physical plant requirements, licensing procedures, and staffing rules that may soon have the effect of shuttering all five of Louisiana’s legal abortion providers.

“If these rules go into effect, the Department of Health and Hospitals will have the ability to start shutting clinics down just based on what the size of the facilities has always been,” said Ellie Schilling, a New Orleans attorney who represents several Louisiana abortion clinics. She discussed the most severe of the new regulations with Rewire in advance of a DHH public hearing on abortion facilities in Baton Rouge on Wednesday.

Schilling says the new regulations appear to mirror legislative actions like those recently taken in Texas, which require abortion providers to make extensive physical plant modifications. Schilling also said Louisiana’s new rules severely limit abortion providers’ access to due process in appealing any citations or violations issued to them by DHH, and make it virtually impossible for abortion facility licensees to maintain licenses in good standing if facility ownership changes, or if facilities move locations. These specific new requirements are not, said Schilling, required by statute.

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“They’re tripling the size of what procedure rooms need to be,” said Schilling. “Nobody else has to comply with this, even general hospitals don’t have requirements like this for procedure rooms, separate recovery rooms.” The rules even dictate what specific kind of flooring materials abortion facilities must use.

Louisiana DHH lists the rules as “effective” as of November 20, 2013, but a Louisiana abortion facility staffer told Rewire that state health officials have not yet officially attempted to enforce the regulations, or cite clinics for failing to build newly required enlarged operating rooms and recovery areas. She also told Rewire that the state failed to seek input from any abortion stakeholders, and drafted the rules without notice to abortion providers.

“None of the abortion care providers in Louisiana were aware of these new regulations until they were published as emergency rules,” said Kathaleen Pittman, an administrator at Hope Medical Group for Women in Shreveport. “We were allowed no input in drafting them.”

The new DHH rules say that “this action is being taken to promote the health and welfare of Louisiana citizens by assuring the health and safety of women seeking health care services at licensed abortion facilities,” but some of the regulations directly contradict best medical practices.

For example, DHH requires patients to have certain blood tests run on hematocrit and hemoglobin levels 30 days before their procedures.

“Not only is this unjust for the women, it is contraindicated from a medical standpoint, in that hematocrits should be as current as possible,” Pittman explained.

In fact, the new DHH regulations could decrease patient safety, putting patients at a higher risk of complications. As pregnancy advances, procedures become more involved and more costly, said Ellie Schilling. And because Louisiana already bans abortion after 20 weeks, a patient who seeks a legal abortion at 16 weeks could be forced either to seek an illegal abortion or to forego the procedure altogether after waiting 30 days for a blood test.

“It’s definitely being done as a back-door abortion ban,” said Schilling. “It’s clearly unconstitutional. It clearly creates an undue burden on access.”

Louisiana DHH has scheduled a public hearing on the new regulations for this Wednesday, January 29, at 9:30 a.m., weather permitting. The New Orleans Abortion Fund has more information on the hearing and how to submit written comments to the department.

A DHH spokesperson said she was not immediately able to respond to Rewire‘s inquiries on Monday.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Law and Policy

Anti-Choice Group: End Clinic ‘Bubble Zones’ for Chicago Abortion Patients

Michelle D. Anderson

Chicago officials in October 2009 passed the "bubble zone" ordinance with nearly two-thirds of the city aldermen in support.

An anti-choice group has announced plans to file a lawsuit and launch a public protest over Chicago’s nearly seven-year-old “bubble zone” ordinance for patients seeking care at local abortion clinics.

The Pro-Life Action League, an anti-choice group based in Chicago, announced on its website that its lawyers at the Thomas More Society would file the lawsuit this week.

City officials in October 2009 passed the ordinance with nearly two-thirds of the city aldermen in support. The law makes it illegal to come within eight feet of someone walking toward an abortion clinic once that person is within 50 feet of the entrance, if the person did not give their consent.

Those found violating the ordinance could be fined up to $500.

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Harassment of people seeking abortion care has been well documented. A 2013 survey from the National Abortion Federation found that 92 percent of providers had a patient entering their facility express personal safety concerns.

The ordinance targets people seeking to pass a leaflet or handbill or engaging in “oral protest, education, or counseling with such other person in the public way.” The regulation bans the use of force, threat of force and physical obstruction to intentionally injure, intimidate or interfere any person entering or leaving any hospital, medical clinic or health-care facility.

The Pro-Life Action League lamented on its website that the law makes it difficult for anti-choice sidewalk counselors “to reach abortion-bound mothers.” The group suggested that lawmakers created the ordinance to create confusion and that police have repeatedly violated counselors’ First Amendment rights.

“Chicago police have been misapplying it from Day One, and it’s caused endless problems for our faithful sidewalk counselors,” the group said.

The League said it would protest and hold a press conference outside of the Planned Parenthood clinic in the city’s Old Town neighborhood.

Julie Lynn, a Planned Parenthood of Illinois spokesperson, told Rewire in an email that the health-care provider is preparing for the protest.

“We plan to have volunteer escorts at the health center to make sure all patients have safe access to the entrance,” Lynn said.

The anti-choice group has suggested that its lawsuit would be successful because of a 2014 U.S. Supreme Court decision that ruled a similar law in Massachusetts unconstitutional.

Pam Sutherland, vice president of public policy and education for Planned Parenthood of Illinois, told the Chicago Tribune back then that the health-care provider expected the city’s bubble zone to be challenged following the 2014 decision.

But in an effort to avoid legal challenges, Chicago city officials had based its bubble zone law on a Colorado law that created an eight-foot no-approach zone within 100 feet of all health-care facilities, according to the Tribune. Sidewalk counselor Leila Hill and others challenged that Colorado law, but the U.S. Supreme Court upheld it in 2000.

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