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The real purpose of Wisconsin's admitting privileges 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, by making it virtually impossible to do so.

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.

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.

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Comment Preferences

  •  It may just be greed . . . . (0+ / 0-)

    If a doctor must have admitting privileges at a local hospital within 30 miles of the clinic in order to perform abortions, does that mean the hospital would have reason to add some of their fees to the bill?  It may simply be a matter of greed on the hospital's part.
    Maybe we should make all the private (for profit) hospitals part of the community, run by the local government much like a public utility, with published fee schedules and a set rate of return authorized by the Public Services Commission.

    •  Nope (4+ / 0-)

      Without being treated at the hospital, they cannot add to the charges. That is fraud.

      Having hospital privileges means a doc can admit patients and treat them at the hospital. A doc seeing a patient in a clinical setting outside of the hospital doesn't add any hospital costs or charges to the patient's bill.

      "Reality divorced the wingnuts after the wingnuts were discovered to be fucking goofy." - DWG

      by Jojos Mojo on Thu Jul 25, 2013 at 02:39:53 PM PDT

      [ Parent ]

    •  No. It's malice (1+ / 0-)
      Recommended by:
      Cassandra Waites

      They want to make sure that women who get pregnant, and especially women who are poor and get pregnant, and even more so unmarried women who are poor and get pregnant have no choice other than to either carry their pregnancy to term or seek an illegal abortion as "punishment" for their "irresponsible" (and sinful, but they won't generally say that word out loud though many of them will be thinking it) behavior. It is slut-shaming plain and simple. They have no regard for the mother any more so than they actually have regard for the fetus.

  •  "Hospitalists" (5+ / 0-)

    Many, if not most, hospitals now have staff physicians who treat patients.  I know folks who have spent a week in the hospital and never saw their own doctor, even if s/he admitted them.

    -7.62, -7.28 "Hold fast to dreams, for if dreams die, life is a broken winged bird that cannot fly." -Langston Hughes

    by luckylizard on Thu Jul 25, 2013 at 02:35:31 PM PDT

    •  And sometimes your usual doctor (2+ / 0-)
      Recommended by:
      sfbob, luckylizard

      is the LAST person you want to see in the hospital.

      Why would a woman suffering complications from a procedure that usually has no complications WANT 'continuity of care' from someone who she may consider criminally incompetent at that point?

      I know one of the worst insults in one of my own medical troubles was having to go back to the office of the manipulative dunce what caused it for removal of stitches afterward and having my family pay him for the service of aftercare of something I hadn't actually consented to on top of what he'd previously done.

      And then there was the incident where the hospital-assigned doc for a relative was not the admitting doctor she adored but instead the specialist whose repeated appointment cancelling habits had likely made the situation worse. The entire time he got icy stares from just about every person in the family he dealt with - sure there was 'continuity of care', but when that care was delayed for months that really isn't saying much...

  •  There is more (2+ / 0-)
    Recommended by:
    Jojos Mojo, Cassandra Waites

    Ambulatory surgical centers almost never direct admit patients. The ER is the best place to go to stabilize somebody. Thats what they do. There is no issue with continuity with the multiple levels of redundant communication between providers including the paramedics. The only issue is when the patient is being given out-of-protocol medication or other interventions (like induced hypothermia) that paramedics can't do... so in that case an RN or doc from the sending facility comes along. Its that simple.

    Honestly its stupid to think admitting privileges help. It won't be the admitting doc who cares for the patient at the hospital. It only gives them the possibility of bypassing the emergency department which is not much of a benefit.

    To tweet or not to tweet. I tweet therefore I am.

    by RadicalParrot on Thu Jul 25, 2013 at 05:26:54 PM PDT

  •  Textbook Catch-22 (1+ / 0-)
    Recommended by:

    If an OB-GYN from an abortion provider has few or no patients being admitted in a hospital it is a virtual certainty that they won't be granted admitting privileges at a nearby hospital.

    So even if they wanted to, they wouldn't have admitting privileges.

    Then there is the internal politics of each local hospital. I'm sure anti-choicers would scrutinize the admitting privileges of each doctor and the hospitals would probably never grant admitting privileges to any MD that performs abortions because they don't want to be in the middle of what should be settled law.

    •  Feature, not bug n/t (0+ / 0-)

      “If you can convince the lowest white man he’s better than the best colored man, he won’t notice you’re picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you.” Lyndon Baines Johnson

      by spacecadet1 on Fri Jul 26, 2013 at 06:22:38 AM PDT

      [ Parent ]

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