Florida abortion providers fear proposed rules could make state 'next Texas'

Potential measures include expensive new requirements on clinics offering abortions after first trimester and restrictions on Planned Parenthood

On a recent afternoon, Kelly Flynn proudly showed off the abortion clinic in Jacksonville, Florida that she purchased in 2002, when she was just 25.

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“It’s my blood and sweat and tears,” she said, beaming at the plush, neatly arrayed furniture and a wall of construction paper hearts on which former patients had scribbled thank you notes. “I rebuilt this place from the ground up.”

In an instant, her mood turned grim.

“We would just have to close,” she said. “That’s the bottom line.”

Flynn was uttering the concerns of nearly every other abortion provider in the state. In what could amount to the most dramatic reduction in abortion access since Texas slashed its number of clinics in half, lawmakers in Florida are advancing steep new licensing requirements that dozens of the state’s abortion providers say will force them to close their doors.

The proposals are modelled after laws that have shuttered or jeopardized scores of abortion clinics across the south and midwest. One bill calls for the state to impose expensive hospital-like requirements on clinics that offer abortions after the first trimester. Another, HB 1411, which is moving rapidly, would require all abortion clinics to have either a physician on staff with hospital admitting privileges or a transfer agreement with a local hospital – or both, if the clinic offers abortions after the first trimester.

That bill would also place thousands of dollars in new annual fees on abortion clinics and restricts some reproductive clinics – namely those run by Planned Parenthood – from accessing Medicaid funds.

Governor Rick Scott, a Republican who has never vetoed an abortion restriction, is widely expected to sign both proposals if they pass.

“Our providers in Florida are very alarmed,” said Vicki Saporta, president of the National Abortion Federation (NAF). “What we’re looking at, potentially, is Florida becoming the next Texas.”

The precise number of clinics in the crosshairs is unclear. In Texas, where a law requiring admitting privileges went into effect in 2013, the number of abortion clinics has dropped from 41 to 20. A recent modification to an admitting privileges law in Ohio shut down five clinics out of a total 16. Mainstream medical groups have said none of the requirements proposed in Florida – admitting privileges, transfer agreements or ambulatory surgery center rules – are necessary in order to safely perform an abortion, so very few clinics meet the requirements unless mandated by law.

Current Florida law requires clinics that perform second trimester abortions to have admitting privileges or a transfer agreement. But Saporta estimated that the majority of the 30 or so clinics in Florida that are members of the NAF do not perform second trimester abortions.

Missy Wesolowski, a lobbyist for Planned Parenthood of South, East and North Florida, said the same was probably true of the group’s 18 abortion clinics across the state.

“We’re all anxious,” said Flynn. “We’re all scared.”

In this city of 850,000, Flynn’s abortion clinic is one of four. None have been successful in obtaining a transfer agreement from a local hospital – because, Flynn suspects, hospitals don’t want to publicly affiliate with abortion providers. Her only physician with admitting privileges recently quit over harassment from protesters. She is struggling to find another.

Her one-story, powder blue clinic lies two miles off of I-95. It occasionally draws women from as far away as Louisiana - a sign of how profoundly the two proposals before Florida lawmakers could remap abortion access across the south. Although Florida has enacted many laws that abortion rights supporters consider hostile, it has not yet experienced the drastic decrease in abortion providers that has affected its neighbors. The state has 62 abortion clinics, according to a recent count by the health department – compared with about a dozen in Georgia, five each in Louisiana and Alabama and just one in Mississippi.

And those numbers could be eroded even further. Eight states – Alabama, Kansas, Louisiana, Mississippi, Oklahoma, Tennessee, Texas, and Wisconsin – have passed laws requiring transfer agreements, admitting privileges, or ambulatory surgery standards. The laws could close almost two dozen abortion clinics across the region if allowed to go into effect.

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Most of those laws have been challenged and blocked in federal court. In March, the supreme court will consider a challenge to the Texas law , known as HB2. A broad ruling against the state of Texas would result in those laws being struck down.

With the death of supreme court justice Antonin Scalia on Saturday , the chances are low that the three conservative justices will muster a majority to rule in favor of Texas, which would put those laws into effect.

But the court could tie in a 4-4 ruling. In that case, the ruling that is being appealed would take effect. The Texas law would thus go into effect; the laws in Alabama, Kansas, Louisiana, Mississippi, Oklahoma, Tennessee, and Wisconsin would remain blocked until the supreme court issued a decisive ruling – probably not until there were nine justices on the bench once again.

The stakes for abortion access in the south are incredibly high.

“If you take out a map, you can draw a single line through all the states that are affected by this litigation,” Jennifer Dalven, director of reproductive rights litigation for the American Civil Liberties Union, said in a November interview, referring to Kansas, Oklahoma, Texas, Louisiana, Mississippi and Alabama.

And now, Florida. Florida sits in the 11th circuit of courts, where the court of appeals has yet not ruled on this type of abortion restriction. The court tends to lean conservative and could approve Florida’s law.

If lawmakers here were to pass either proposal, Florida would take its place among the legion of southern states primed to shut down dozens of abortion clinics depending on how the supreme court rules.

What I’m trying to do is making sure that when she’s made that choice, it’s a safe choice

State senator Kelli Stargel

In Florida as in other states, sponsors of the abortion restrictions argue that they are not intended not to shut abortion clinics down, but to make the procedure safer.

“I’m not affecting the woman’s right to choose,” state senator Kelli Stargel, who is sponsoring the admitting privileges measure, said recently . “What I’m trying to do is make sure that when she’s made that choice, it’s a safe choice.”

Officials with Americans United for Life, a legal advocacy group that models many of these bills, have argued that the laws do not shut down abortion providers – instead, abortion providers, in their failure to meet the common-sense standards set by hospitals, shut themselves down.

The politics of abortion, however, or the particular bylaws of a hospital, can make it exceedingly hard for an abortion physician to obtain admitting privileges. In a recent brief to the supreme court, a group of 20 medical professionals noted that hospitals usually require applicants for admitting privileges to be experts in inpatient care. This is a hurdle for abortion providers, who specialize in outpatient care and rarely transfer patients to the hospital.

Mainstream medical groups maintain that there is no scientific evidence to show that proposals like those being considered in Florida make abortion, which has a complication rate of only 0.05% to 0.02%, safer than it already is.

“ASC and privileges requirements do nothing to protect the health and safety of women and are incongruous with modern medical practice,” wrote the American College of Obstetricians and Gynecologists and the American Medical Association in another brief . “Scientific literature suggests that the safety of abortions performed in an office setting is equivalent to the safety of those performed in a hospital setting.”

With a lack of scientific evidence behind the measures, abortion rights advocates see a ploy to shut down large numbers of abortion providers.

“Have you seen the regulations?” Dr Christopher Estes, chief medical officer for Planned Parenthood of South, East and North Florida , asked recently in his Golden Glades office, near Miami. He was referring to the states’ ambulatory surgery standards. He held his forefinger and thumb two inches apart.

“The access here is already not great,” Estes said. “We already have people come to us for an abortion that drive hours to come see us.”

In the Jacksonville clinics he supervises, he said, physicians frequently perform abortions for women from Georgia and Alabama. The office we are sitting in draws women from Okeechobee County, several hours to the west, and the Florida Keys, several hours to the south.

“Could we be the next Texas or Mississippi,” he asked, “where we’re down to just a couple of abortion providers – could that happen? We could.

“If other clinics close, and suddenly the number of abortion-providing facilities in the state is cut in half or down to a third, what would happen is exactly what would happen in the other places,” he continued. “Waiting times for appointments go up. How difficult it is to actually get in to the office becomes much more complicated. Those sort of things would happen here too.”

Estes excused himself to see a patient. She had driven from Homestead, an hour and a half south of the clinic.

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