Women’s Health in Jeopardy in Virginia:
Governor McDonnell and Attorney General Cuccinelli Legislate Women’s Health Care and Abortion Without Consent of Virginians, Against Medical Experts’ Counsel
June 15 vote by the Virginia Board of Health makes forced regulations permanent; the 20 Virginia women’s health care centers that provide abortion care face danger of closing
Richmond, VA, June 11, 2012 – Against medical expert counsel and without public approval, Governor McDonnell (R) and Attorney General Ken Cuccinelli (R) on June 15 will push through proposed permanent regulations that may shut down women’s health centers that provide breast and cervical cancer screenings, critical ongoing healthcare, and abortion services to women in Virginia. If approved by the Virginia Board of Health on June 15, the draft permanent regulations move closer to becoming final law, threatening safe and legal affordable abortion available to women in Virginia for almost 40 years.
Currently, none of the 20 Virginia women’s health care centers targeted by McDonnell and Cuccinelli meet the administration’s proposed regulations, which do not apply to any other outpatient medical service in the commonwealth, including vasectomies, dental surgery, liposuction and more. The draft permanent regulations require women’s health care centers to meet forced building construction requirements used for hospitals, despite the medical designation of abortion as an outpatient procedure.
“The McDonnell administration is continuing to wage war against women. These are the most restrictive proposed forced state regulations of abortion to date – if they pass, Virginia will be an example for the rest of the country about how to work around the people and the law to end legal abortion,” said Tarina Keene, executive director of NARAL Pro-Choice Virginia and head of the Virginia Coalition to Protect Women’s Health.
The regulations were drafted by the Virginia Department of Health, but Attorney General Cuccinelli recommended substantial changes in a process that illustrates a new trend in creating ideologically-driven state law through the regulatory system, despite lack of public approval. When the regulations become law, they will be enforced by the Virginia Department of Health, which incorporates counsel from Attorney General Cuccinelli. Despite the administration’s official public statement about “safety and wellbeing of patients” as rationale for the regulations, Attorney General Cuccinelli has stated publicly to at least one pro-life organization that the goal is to “end abortion in America” (see video interview with Pro-Life News from May 8).
The concerns of medical experts and Virginia residents have been dismissed by the McDonnell administration’s Department of Health:
- Medical experts and practicing OB/GYNs have denounced the regulations publicly. One prominent member of the draft regulations’ advisory committee, Dr. James Ferguson II, chairman of the Department of Obstetrics and Gynecology at the University of Virginia, stated in an interview, "I don't know where they [the draft regulations] got changed, but ultimately they were different, more stringent and more restrictive - and several of them, at least, unnecessary…I asked, 'Do we have evidence there are problems in this area? Are women getting sick and are women dying?' And the answer was no," as quoted in the Richmond Times-Dispatch (December 2011).
- Former Virginia health commissioner, Dr. James Kenley, stated in a letter to the Board of Health on February 15, 2012, that “[the] regulations, specifically the time and resources required to physically alter health centers for no medical reason, are likely to increase financial barriers for patients as well as reduce women’s ability to find a health care provider. The current temporary regulations require extensive, medically unnecessary and inappropriate renovations to meet building standards intended only for the design and construction of new outpatient surgical hospitals, not existing health centers. Even existing hospitals are not expected to meet new building requirements during the regulation process, and yet abortion providers are being singled out for no medical reason.” Practicing physicians from across the state have publicly voiced similar concerns.
- Despite an accelerated “emergency” regulatory process declared by Governor McDonnell that limited opportunities for public input, Virginians indicated their disapproval of the draft regulations; more than 6,000 Virginians signed a petition to strongly denounce the regulations, and more than 35,000 U.S. residents from across the country also signed the petition.
- The majority of Virginia voters (61%) believe abortion should be legal “all” or “most” of the time, according to a May 2012 Washington Post survey; registered Virginia voters’ approval for accessible legal abortion is up 13 percent since May 2011, according to survey trend data from the Post.
- In a New York Times editorial on June 5, 2012, James T. Breeden, MD, president of the American Congress of Obstetricians and Gynecologists, wrote, “Politicians were not elected to, nor should they, legislate the practice of medicine or dictate the parameters of the doctor-patient relationship….These laws were not grounded in science or evidence-based medicine….Our message to politicians is unequivocal: Get out of our exam rooms."
Timeline and key facts about the draft permanent regulations of women’s health care centers that provide abortion services in Virginia:
- In 2011, through an unrelated bill (SB 924), the Virginia House of Delegates changed the classification of women’s health care centers that provide first-trimester abortion (at least five performed per month) from “outpatient offices” to “hospitals.” This amendment was made by Rep. Kathy Byron, the same member of the Virginia legislature who proposed a new ultrasound requirement in 2011.
- This change led to the drafting of “emergency” temporary regulations last fall, and now permanent regulations that require existing women’s health centers to come into compliance with three chapters of a manual called the 2010 Guidelines for Design and Construction of Health Care Facilities within the next two years. The guidelines are intended to apply only to new construction, not to existing facilities, and this is how they are applied to every other health care facility in Virginia. They include:
- Building 5-foot wide public hallways throughout the women’s health care centers
- Constructing hospital-like treatment rooms up to 150 square feet in size
- Adding new covered front entrances, public telephones, public bathrooms and drinking fountains in waiting rooms, requiring new plumbing to accommodate
- Incorporating specific new ventilation systems
- Against medical counsel, the Department of Health’s draft regulations’ building requirements also do not make the distinction between medically-induced abortion and an outpatient procedure; medically-induced abortion is completed with oral medication in a doctor’s office.
- The draft guidelines also include provisions that compromise patient and health care center confidentiality, including allowing state inspectors to remove patient records from facilities.
- Inspectors are also permitted to arrive at health care centers with only an hour’s notice at any hour of the day, seven days a week, a provision that is a burden to health care managers who work on a 9-to-5 schedule. No other medical procedure is regulated individually in this way in Virginia; physicians ultimately decide the appropriate setting for every other surgical procedure performed in Virginia.
- Cost projected by the Department of Health for a 5,000 square-foot women’s health center:
- Estimated cost of moderate renovations: $650,000
- Estimated cost for major renovations: $2.6 million
- Additional cost per patient: up to $250 per procedure, a 71 percent increase (based on an average of $350 per procedure)
- In some cases, women’s health care centers will be forced to build entirely new buildings, which may be cost-prohibitive.
Just one month ago, the governor of Minnesota vetoed a less restrictive TRAP bill, stating in his veto message: “The legislation targets only facilities which provide abortions. If regulation of clinics were the concern, the bill should have required licensure of all clinics, not just a select few…no clinic or procedure should be the focus of special and unique regulatory requirements.”
After the June 15 vote by the Virginia Board of Health, the regulations will move through a public comment period – on the way to veto or approval by Governor McDonnell, expected in early 2013.