Skip to main content

Why requiring "hospital admitting privileges" for doctors at reproductive-health facilities is irrelevant in contemporary health care. [Not that anti-choicers care about that, of course...]

To be an abortion provider in Texas, you have to have “admitting privileges” at a hospital within 30 miles of the facility. That restriction, which recently was first overturned by one judge and then, within days, upheld by the conservative Fifth Circuit Court, is essentially a fraud. Texas is not the only state taking this tack–see Mississippi–but it’s the most recent.

So far, in most mainstream media reports, the effect of the admitting-privileges restriction has been well documented: It’s going to force almost all abortion clinics in Texas to close, making—as anti-choice advocates have hoped for—abortions infinitely more difficult to get and leaving thousands of women– with legitimate reasons to terminate their pregnancies in a way sanctioned by law—with no good options.

Left unmentioned in most media reports is an examination of the term “admitting privileges” itself. Obviously, the admitting-privileges gambit is another ploy to make abortions harder—in some areas virtually impossible–to get, but what is less known is that the concept of admitting privileges is an antiquated notion that is mostly irrelevant in contemporary medical care.

Here’s a formal definition of admitting privileges, from

Admitting privilege is the right of a doctor, by virtue of membership as a hospital’s medical staff, to admit patients to a particular hospital or medical center for providing specific diagnostic or therapeutic services to such patient in that hospital. Each hospital maintains a list of health care providers who have admitting privileges in that hospital.
Anti-reproductive-rights advocates and legislators would have us believe that, if a medical emergency occurs during an abortion, the doctor in charge needs to have admitting privileges at a nearby hospital in order to ensure the safety of the woman. On the surface, that argument sounds plausible.  But, in reality, it’s a fraudulent concept—and proponents know that.

Why? Because, when there’s an emergency, admitting privileges become irrelevant. Under a 1986 federal law known as EMTALA, hospitals are required to provide care to anyone who needs emergency care [with or without insurance, by the way.] This requirement includes pregnant women who need a life-saving abortion, are in labor, or are suffering the effects of a botched abortion. [Sadly, in 2011, a bill was passed in the U.S. House of Representatives that would have allowed hospitals to turn away patients arriving in the ER in need of a life-saving abortion or other medical help related to abortions. Fortunately, that bill went nowhere, but the fact that it was introduced at all is very disturbing. Opponents of that inhumane notion called it the “Let Them Die” bill.]

Think of it this way: If you’re walking down the street and have a heart attack, it doesn’t matter who your personal doctor is, or whether he/she has admitting privileges at a hospital within 30 miles of where you are: You can be taken to any hospital emergency room, get admitted, and receive treatment, even if your doctor isn’t there, and even if you don’t know a doctor within 30 miles of the hospital.

Also, if a woman is at home and experiences a pregnancy-related emergency, emergency responders will transport her to the closest hospital, regardless of where her doctor has “admitting privileges,” and—again, under federal law–she’ll be cared for there, no admitting-privileges questions asked.

It’s also important to realize that the notion of admitting privileges does not jibe with contemporary norms in inpatient hospital care. Today, many hospitals employ 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.

So, does the admitting-privileges requirement make abortions safer, as anti-reproductive-freedom legislators would have you believe? Well, of course we want abortions to be safe—and in the vast majority of cases under Roe v Wade—they are, as opposed to what happened in the back-alley, pre-Roe-v-Wade era, when abortions were illegal, unregulated and often dangerous. Given the current state of emergency care and federal law governing such care, the admitting-privileges requirement doesn’t do much to enhance safety. In fact, it may have the exact opposite effect, making legal, safe abortions more difficult to obtain and putting women at even more risk

Originally posted to Lefty on Wed Nov 06, 2013 at 02:49 PM PST.

Also republished by Abortion and Pro Choice.

Your Email has been sent.
You must add at least one tag to this diary before publishing it.

Add keywords that describe this diary. Separate multiple keywords with commas.
Tagging tips - Search For Tags - Browse For Tags


More Tagging tips:

A tag is a way to search for this diary. If someone is searching for "Barack Obama," is this a diary they'd be trying to find?

Use a person's full name, without any title. Senator Obama may become President Obama, and Michelle Obama might run for office.

If your diary covers an election or elected official, use election tags, which are generally the state abbreviation followed by the office. CA-01 is the first district House seat. CA-Sen covers both senate races. NY-GOV covers the New York governor's race.

Tags do not compound: that is, "education reform" is a completely different tag from "education". A tag like "reform" alone is probably not meaningful.

Consider if one or more of these tags fits your diary: Civil Rights, Community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, Media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don't fit in any of these tags. Don't worry if yours doesn't.

You can add a private note to this diary when hotlisting it:
Are you sure you want to remove this diary from your hotlist?
Are you sure you want to remove your recommendation? You can only recommend a diary once, so you will not be able to re-recommend it afterwards.
Rescue this diary, and add a note:
Are you sure you want to remove this diary from Rescue?
Choose where to republish this diary. The diary will be added to the queue for that group. Publish it from the queue to make it appear.

You must be a member of a group to use this feature.

Add a quick update to your diary without changing the diary itself:
Are you sure you want to remove this diary?
(The diary will be removed from the site and returned to your drafts for further editing.)
(The diary will be removed.)
Are you sure you want to save these changes to the published diary?

Comment Preferences

  •  You make some very good points. Thank you. (7+ / 0-)
    •  The GOP runs on hoaxes. (5+ / 0-)

      And each hoax is supported with dozens of lies.

      On the other hand, technically, a fraud is a type of theft. Stealing money. Stealing something of value.

      A GOP Hoax: That Hospital Admitting Privileges Make Abortions Safer

      The worst of it with these hoaxes is that they warp the ordinary citizens' perceptions of how the world works.

      Paranoia is heightened. And the more paranoid symptoms a person exhibits, the more likely they are to vote Republican.

      Lee Atwater fell into that one by serendipity. He'd aimed at racial hatred, hit both targets.

      •  Welfare queens, massive voter fraud, (3+ / 0-)

        the rich make more jobs when given more tax breaks, more guns being carried by common citizens makes us safer, Iraq had WMDs and threatened our security, public insurance/healthcare will leave you without healthcare and kill you via death panels, etc.

        They only win battles by lying - it does seem that some portions of Independents and moderate conservatives are slowly realizing that the lies are part of an ongoing war for selfishness of the privileged few, at least.  We need to keep throwing anvils.

        "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

        by wader on Wed Nov 06, 2013 at 05:44:10 PM PST

        [ Parent ]

  •  It's not about safety, (13+ / 0-)

    it's about a sneaky method of making women's healthcare decisions harder.

    If I ran this circus, things would be DIFFERENT!

    by CwV on Wed Nov 06, 2013 at 03:12:10 PM PST

  •  Well said. You crystalize the essential (7+ / 0-)

    truths and falsehoods that pervade this issue.

    With the Decision Points Theater, the George W. Bush Presidential Library becomes the very first Presidential Library to feature a Fiction Section.

    by Its the Supreme Court Stupid on Wed Nov 06, 2013 at 03:13:17 PM PST

  •  As you note, Texas isn't the only place... (9+ / 0-)

    ...where this is going on. The last abortion clinic in Mississippi is only open because a judge blocked the admitting privileges portion of a state law. Alabama has similar legislation. So does Wisconsin. So does North Dakota.

    Don't tell me what you believe, show me what you do and I will tell you what you believe.

    by Meteor Blades on Wed Nov 06, 2013 at 03:15:02 PM PST

  •  Actually, what it's about is using legislative (4+ / 0-)

    means to insure or assure a monopoly. Health clinics are in competition with hospitals, which, because of the drop in the birth rate, are finding their income stream restricted. So, in typical binary fashion, they reason that, if they restrict off-site providers, the patients will have to come to them and, if they end up in the emergency facilities, that's also a boon. After all, the recent drop in auto fatalities also reflects a drop in injurious accidents with live bodies and that's something else that's putting a crimp in the revenue stream.
    The problem is having made medical/surgical care a profit-motivated enterprise. The entreprenuers built all kinds of facilities that have to be used at a certain rate to cover the "nut." Some medical facility operators have counted on ancillary services like nutrition programs and exercise facilities (including spas) that the Medicare Advantage insurers were happy to cover. But, the ACA has put the kabosh on that. Health club fees, like country clubs are going to go up, if they lose their subsidies.
    Young retirees are aging and tend to value frills less and less.
    "Patient directed health care" was a notion that tried to disguise that, at base, medical/surgical services are a disutility -- something people would rather not have, but need.

    •  Hmm, hadn't thought of it that way (2+ / 0-)
      Recommended by:
      Horace Boothroyd III, john07801

      Thanks for adding this perspective.

      Life's a dance you learn as you go; sometimes you lead, sometimes you follow.

      by gloriasb on Wed Nov 06, 2013 at 03:26:09 PM PST

      [ Parent ]

    •  This may be a secondary benefit; the primary one (8+ / 0-)

      Is to prevent women & their doctors from making their own decisions.

      nosotros no somos estúpidos

      by a2nite on Wed Nov 06, 2013 at 03:30:58 PM PST

      [ Parent ]

    •  also note that hospitals are one of the permitted (0+ / 0-)

      monopolies as in many rural areas, independent practice no longer exists while all the local docs are hospital employees, even those in community practice

      •  Yes, I'm coming to believe that all monopolies are (1+ / 0-)
        Recommended by:

        pernicious, even when they appear as so-called "specialization."  Diversity and variety aren't the spice of life, they're the very essence of organic existence. Uniformity is not beneficial, nor is it an evolutionary goal. Multiplicity is what guarantees the persistence of organic existence.
        Some humans like monopoly situations because they are lazy. A captive market is easy to serve.

    •  Hang on (0+ / 0-)
      The entreprenuers built all kinds of facilities that have to be used at a certain rate to cover the "nut." Some medical facility operators have counted on ancillary services like nutrition programs and exercise facilities (including spas) that the Medicare Advantage insurers were happy to cover. But, the ACA has put the kabosh on that. Health club fees, like country clubs are going to go up, if they lose their subsidies.
      Are we expected to be unhappy that the fees for health clubs/spas set up solely to gain income for a private company are no longer being subsidized, albeit indirectly, from the public purse? Presumably at the moment the only people who can use them have the ability to pay, not the millions of those uninsured prior to ACA.

      We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

      by Lib Dem FoP on Wed Nov 06, 2013 at 05:13:34 PM PST

      [ Parent ]

      •  Some people are unhappy. They invested in a (1+ / 0-)
        Recommended by:
        Calamity Jean

        cash cow and now she's gone dry. Clinics and walk-in surgeries are eating their lunch. Requiring hospital affiliation worked with midwives. Why not set up the same requirements for premature terminations?
        Money is not always the motivation, but when we're discussing a profit-driven enterprise, "follow the money" is probably wise.
        Religious and moral objections are a handy subterfuge. How much community support would doctors get if they complained about lost revenue?
        As far as the vaginal probes are concerned, that's just another instrument they're looking to sell by the gross. I can't see them sterilizing them in an autoclave. We know that the big profit margins are realized on materials and supplies.

        •  To some extent (0+ / 0-)

          I agree that there should be emergency/intensive care facilities readily available although as has been pointed out this does not require that the doctors performing the abortion are affiliated with a particular hospital.

          Ideally abortions should be safe, readily available, early and rare (and not the family planning first choice it became in the Soviet Union for example). Too often they are late in the pregnancy because of lack of the other factors and become increasingly comparatively unsafe and intrusive. So I can see the logic of having appropriate facilities available.

          The flip side of this in the context of paid for services is that emergency rooms are used to avoid having to provide for catastrophies - a view I get from the way cosmetic surgery private practices and even private hospitals in the UK exploit NHS emergency/intensive care to reduce their costs and cover them when they screw up.

          Actually there is a very good argument for exercise facilities to be part of the preventative care regimen. Many GP surgeries in England have arrangements with the local council's swimming pool or gym to be able to "prescribe" a course of exercise for patients. (Part of the "Olympic legacy" is that all over 60s can access these council facilities free) Again, I am not sure if the hospital is appropriate for that because of its accessibility compared to a local pool or gym.

          We will work, we will play, we will laugh, we will live. We will not waste one moment, nor sacrifice one bit of our freedom, because of fear.

          by Lib Dem FoP on Wed Nov 06, 2013 at 06:15:12 PM PST

          [ Parent ]

  •  I would like to point out that having a doc apply (6+ / 0-)

    for privileges at a hospital mean he has to be reviewed by the administration and medical staff.  Should he be turned down for any reason, the information goes into the National Practitioner Data Bank, which has become the major technique employed by many administrators to keep docs in line.  A negative entry into the Data Bank can damage a physician's career.

    I am suggesting that having possible out of state physicians subject to medical staff and administration review by local hospitals may easily result in a denial of privileges which is then a reportable event.

    If one is not in the trenches, he may not realize this is an indirect assault on the individual physician's license.  This is an assault designed to punish doctors who perform this procedure by possibly damaging their professional careers or even by having their licenses revoked.  This may seem far fetched until we remember some abortion providers have even been threatened with arrest by law enforcement for murder of the fetus or assault on the mother by virtue of the surgical procedure  

Subscribe or Donate to support Daily Kos.

Click here for the mobile view of the site