How to close abortion clinics under the guise of women's safety

From the outset, state Sen. Donna Campbell was eager to help Texas pro-lifers pick up where they left off in 2011. During last year’s heated campaign to unseat Jeff Wentworth, she hammered the “liberal, pro-choice Republican” for voting against Texas' infamous sonogram law, which, among other things, requires that doctors describe the development of the fetus to women seeking an abortion before making them arbitrarily wait 24 hours for the procedure.

By December, Campbell flanked Gov. Rick Perry during his press conference announcing the scientifically-dubious push to outlaw abortions after 20 weeks, saying, “How tragic to think that these babies suffer from pain, a cruel and unnatural death” — never mind that 2005 Journal of the American Medical Association study indicating “fetal perception of pain is unlikely before the third trimester.”

Not only did Campbell co-author and file the Senate's version of the so-called “fetal pain” bill, she's fixed her name to two other measures certain to please her pro-life base.

One, which she co-authored, bans “affiliates” of abortion providers (re: Planned Parenthood) from participating in or providing any materials to public school sex-ed courses (critics contend that other components of the bill would create more barriers to teaching sex ed in Texas). The other, which she stepped up to champion last week, truly carries the water for the anti-abortion movement this session.

Authored by Sen. Bob Deuell and co-sponsored by Campbell, two of the most zealous anti-abortion evangelicals in the Lege, SB 537 would force all Texas abortion clinics to comply with regulations governing surgical centers. If passed, abortion providers in Texas would drop from 42 to just five next year, immediately restricting where women can access abortion services while the making procedure more costly.

Deuell and Campbell bristle at any notion they're engaged in a backdoor ploy to restrict abortion in Texas, claiming the bill is about keeping Texas women safe. Either they're lying, as some pro-choice advocates suggest, or they're conveniently forgetting the broader nation-wide efforts of their anti-abortion brethren.

Campbell, a New Braunfels tea partier, took an impassioned tone during the contentious Health and Human Services Committee hearing last week. When one witness, a man, took to the dais to oppose the bill, Campbell seethed.

“You are a man, and I would like to see you arguing the point that we need to lower the standards on colonoscopies for men or penile things like that,” she said. “You are here arguing to decrease, or to stop improving, safety for women.”

Critics, however, argue SB 537 draws from the national conservative playbook on how to restrict access to abortion care; the landmark 1973 Supreme Court ruling in Roe v. Wade forbids states from banning the procedure outright. “This is part of a larger strategy of making abortion inaccessible, whether they're willing to admit that or not,” Heather Busby, executive director of NARAL Pro-Choice Texas, told the Current.

The Guttmacher Institute, which researches and compiles data on abortion, reports that since the 2010 midterm elections, legislatures in 24 states passed a record 92 provisions restricting abortion access. In Virginia, Kansas, Pennsylvania, and Mississippi, new laws mirroring Texas' SB 537 have threatened to shutter most, if not all, abortion clinics in those states by making it too costly for many providers to stay open.

Under SB 537, Texas abortion clinics would be required to meet standards that apply to the state's 416 ambulatory surgical centers, outpatient clinics that provide anything from plastic surgery to endoscopy.  Under the law even non-surgical, drug-induced abortions would be performed at such centers. To stay open, Texas abortion clinics would have to invest in major facility upgrades — most of which deal with room size, hallway width, air ventilation and lighting — and buy costly anesthesia and sterilization equipment.

Deuell and Campbell, both physicians, suggest Texas women suffer from botched abortions in facilities with lax safety standards. “We are trying to minimize deaths that have occurred in abortion clinics,” Campbell, who did not respond to a request for an interview, said in committee.

According to federal data, abortion is among the safest medical procedures in the U.S., some 14 times safer than carrying a pregnancy to term. The Guttmacher Institute states that fewer than 0.3 percent of abortion patients experience a complication requiring hospitalization. There are more than 72,000 abortions performed annually in Texas, and no abortion-related deaths have occurred since 2001, according to the Texas Department of State Health Services.

The department would not provide state statistics for abortion-related complications.

“For lawmakers to act like they're responding to some safety issue or demonstrated risk, it's fabricated,” said Amy Hagstrom Miller, CEO of Whole Woman's Health, which operates a surgical center in San Antonio and four other abortion clinics across Texas.

The five abortion facilities in Texas that would meet SB 537's new standards were built in reaction to a 2004 law requiring that abortions after 16 weeks take place in a surgical center. When that law passed, none of the state's abortion clinics met the new standards. It took over a year for the state's first abortion-providing surgical center to open. Four more, including Whole Woman's Health in San Antonio, have opened since.

No abortion clinic would on its own choose to become a surgical center, Hagstrom Miller insists. Complication rates at her San Antonio surgical center are no different than at the organization's  abortion clinics, which would likely close if the new law passes.

“The infection rate, the post-op complication rate, they're exactly the same,” Hagstrom Miller said.

The major difference is cost.

When Whole Woman's Health first considered building a surgical center in 2004, “the lowest estimate I got was $1.4 million,” Hagstrom Miller said. The San Antonio surgical center, which opened in 2010, costs $40,000 more per month to operate than the group's abortion clinics. “I'm still losing hand-over-fist in San Antonio,” she told the Current. “We've run at a loss for 2010, 2011, and 2012.”

That cost trickles down to women who need the procedure. In an abortion clinic, women pay on average $540, according to Hagstrom Miller. In a surgical center, the average cost jumps to $1,277.

Last week Deuell wrote off those concerns, saying health care costs have increased across the board and that clinics could “rise to the standard” if they truly wanted to. “Though, I would certainly say abortion is not healthcare,” he added.

Pro-choice advocates insist SB 537 bill adds insult to injury after a bitter 2011 session. To gauge the impact of the last session — when, along with passing the controversial sonogram bill, lawmakers axed two-thirds of the state's family planning budget — the Policy Evaluation Project at University of Texas at Austin surveyed 300 pregnant Texas women seeking an abortion. Half said they were unable to access their usual form of birth control in the three months before they got pregnant.

The state's own health commission says Texas will see nearly 24,000 unplanned births between 2014 and 2015, costing taxpayers some $273 million.

And it's those same poor, rural women who are likely to be further burdened by SB 537, said Amanda Stevenson, a graduate student researcher with the Policy Evaluation Project who testified at the Senate hearing last week. About 1.3 million Texas women would be more than 100 miles away from any of the five remaining abortion providers, Stevenson says.

“If the nearest clinic is so far away, and if it costs that much more, women are more likely to wait for an abortion,” Stevenson said. “Waiting longer is the one thing that we do know increases the risk of complications.”

Or, as Robert Prince, a Dallas-Fort Worth ob-gyn, put it, desperate women could be driven “underground.” “I am one of the few doctors who can remember the carnage that occurred before Roe v. Wade,” Prince warned at the hearing last week. 

Virginia Braun, who operates a Dallas-area abortion clinic, shouted down committee members, calling SB 537 draconian and dangerous. “We have patients sleep in our parking lots with their seven or eight children that they don't even have the money to feed, and you're suggesting that this is not a problem?” she questioned Deuell. “It is a problem, sir. They will take to coat hangers, sir. They will die.”

Campbell, meanwhile, applauded the “conservatives who want to put women's health first.” SB 537, she repeated, was not about restricting abortion but about ensuring patient safety. “Frankly,” she said, “I would expect every woman to be on board.” The committee approved the bill along party lines, sending it to the full Senate for approval.

Earlier in March, at a Senate Education Committee hearing, Campbell was more explicit with anti-abortion furor.

“Fifty million lives are intentionally ended by medical intervention over the last 40 years,” Campbell said before taking one pro-choice advocate to task. “When I hear your argument — you were not aborted. I'm amazed at those who make a point of promoting abortion. They're all alive. Your mom didn't abort you.”

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