The requirement that doctors in ambulatory surgical centers have “admitting privileges” at a nearby hospital is a standard of patient safety. “Admitting privileges” doesn’t refer to some Old-Boy Network. They are a long-standing practice in American medicine, tied to credentialing of physician skill, competency, and record of safety. They assure a basic level of safety for the patient in the ambulatory facility. And they were not invented by pro-life advocates.
A 2011 report by the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health, recommended that nurses be eligible for hospital clinical privileges. In a 2011 publication, AARP recommended that nurses obtain admitting privileges, noting that “Continuity of care is improved when nurse practitioners (NPs) and other advanced practice registered nurses (APRNs) who care for patients in primary care settings can follow their patients and their families when they are admitted to the hospital.”
The 2011 Procedural Standards for Accreditation of the American Association for Accreditation of Ambulatory Surgery Facilities (AAASF) recommends that ‘each physician using the facility is credentialed and qualified for the procedures they perform” and that “each physician using the facility has core privileges (i.e., hospital admitting privileges) in their specialty at a licensed acute care hospital.”
Admitting privileges are long-standing and pervasive. (Just google “physician credentialing.”) They are a basic and effective means of confirming a doctor’s competence and record of safety. They are required for malpractice insurance. They are required in each state. Every surgi-center or ambulatory surgical treatment center in Texas, for example, is required to have admitting privileges except — until recently — abortion clinics.
And admitting privileges are highly practical. Recognizing the need for timely communication between doctors — especially in an age of electronic records — admitting privileges enable the receiving doctor to get timely medical information and contact with the performing surgeon. They involve the hand-off of critical medical data between doctors when a patient is transferred — intentionally or accidentally — from one doctor to another, including the sharing of medical records and lab results.
Abortion practitioners, however, have long sought independence and separation from hospitals, starting in 1973 when abortion providers asked the Supreme Court to invalidate Georgia’s hospitalization requirements for abortion in Doe v. Bolton. Though the Justices in 1973 had no evidentiary record or reliable data of abortion safety before them, they obliged, based on the myth that “abortion was safer than childbirth.” And in severing abortionists from the credentialed and accountable medical community, the Court directly boosted the proliferation of stand-alone abortion clinics.
But in light of the dangers of abortion to women from substandard practitioners — highlighted by horrific events in locations like convicted murderer Dr. Kermit Gosnell’s “house of horrors” abortion clinic — it is time to hold abortion clinics to the same medical standards as other out-patient surgical facilities.
The need is heightened by abortion clinics’ unique practice of telling patients “Don’t come back here if you have any complications. Go to the nearest emergency room (ER).” Abortionists don’t want to “follow their patients,” by telling them to go to the nearest ER, they want to be done with them. They don’t want to be responsible for complications, and chances are that the provider will be long gone, having flown out of town, since so many are circuit-rider operators.
The notion that abortion is between a woman and “her doctor” died a long time ago. When a woman presents at an ER with a fever and vaginal bleeding, how will the ER doc know that it’s the result of a surgical abortion, a chemical abortion or something else? (The shift from surgical abortions to chemical abortions doesn’t end the need for admitting privileges because chemical abortions carry a significant risk of hemorrhage.)
The Supreme Court is responsible, in large part, for this mess. The Court in Roe v. Wade — without any evidentiary record on abortion or its implications — prohibited States from passing health and safety regulations in the first trimester, when 90 percent of abortions are done.
But the Court — in one of the many contradictions in the Roe decision — also said that “[t]he State has a legitimate interest in seeing to it that abortion, like any other medical procedure, is performed under circumstances that insure maximum safety for the patient.” And the Court also said that the State’s interest in protecting maternal health “obviously extends at least to [regulating] the performing physician and his staff, to the facilities involved, to the availability of after-care, and to adequate provision for any complication or emergency that may arise.“ And the Court assured the public that, “If an individual practitioner abuses the privilege of exercising proper medical judgment, the usual remedies, judicial and intra-professional, are available” (i.e., admitting privileges).
With these statements, the Court was confirming that “privileges” (including hospital privileges) were an obvious, assumed standard of care and that “intra-professional” “remedies” such as denial of hospital privileges — whether by professional organizations or legislation — were entirely appropriate. The “remedy” assumes that hospital “privileges” are an appropriate standard of care to begin with.
Nevertheless, abortion providers will tell the Justices this week that they should be exempt because “data” show that abortion has a low rate of complications. But this isn’t based on any reliable, long-standing data. One study in California showed that at least 6.4 percent of abortion patients — more than 19,000 patients each year in a state that has 300,000 abortions annually — go to ERs for after-abortion care.
Few states tried to apply the same standards to abortion clinics that apply to other surgi-centers before the Supreme Court’s abortion decision in Gonzales v. Carhart in 2007, which gave more of a green light to States protect maternal health. If the Court scrupulously applies its decision in Gonzales, it should uphold the Texas health and safety standards.
At stake in the upcoming abortion case before the U.S. Supreme Court is women’s safety — whether abortion clinics should be exempt from these long-standing patient protections because they feel entitled to be treated differently and because they’ve been exempt for so long.
Clarke D. Forsythe is Acting President & Senior Counsel at Americans United for Life and the author of numerous publications, including Abuse of Discretion: The Inside Story of Roe v. Wade (Encounter Books 2007).