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Admitting Privileges Mandates Create Hurdles for Abortion Providers

Admitting Privileges Mandates Create Hurdles for Abortion Providers

August 11, 2014 — Admitting privileges requirements, enacted in several states, have proven to be "a potent tool" for abortion-rights opponents in their goal of limiting abortion access, the Washington Post reports (Somashekhar, Washington Post, 8/10).

The laws require physicians who perform abortions to have admitting privileges at a nearby hospital. Clinics that cannot meet the requirement are forced to close.

About Admitting Privileges

According to NPR's "Shots," admitting privileges give a physician the right to admit patients to a particular hospital and provide certain services on hospital grounds.

Hospitals typically consider a physician's medical credentials, license and history of malpractice when weighing his or her admitting privileges request. Many hospitals also require that physicians admit a minimum number of patients each year or live within a certain distance of the hospital.

Fifteen states require that abortion providers "have some affiliation with a local hospital," while 11 states have laws that specifically require providers to have admitting privileges, according to the Guttmacher Institute. However, many of the laws are not in effect because courts have temporality blocked them or they have not been implemented yet (Rovner, "Shots," NPR, 8/8).

Compliance Difficulties

Admitting privileges requirements pose a particularly difficult hurdle for abortion providers because often they live too far away from the hospitals or do not typically admit the minimum number of patients. In addition, many religiously affiliated hospitals object to abortion, while other hospitals do not want to be involved with a politically controversial issue.

Physician Willie Parker, who provides abortions at Mississippi's only abortion clinic, said he was not surprised that so many hospitals rejected his application for admitting privileges or did not respond. "For a hospital to [extend admitting privileges], it would be making a conscious decision to take on the state legislature," he said.

More than a dozen abortion clinics have closed under Texas' requirements, at least one closed in Tennessee, and several could close in Oklahoma, Louisiana and Wisconsin if courts allow admitting privileges laws to take effect in those states, according to the Post (Washington Post, 8/10).

Abortion-Rights Supporters, Opponents Debate Motivation

According to "Shots," abortion-rights opponents contend that the laws are medically necessary and that clinics would only close if they are unable to meet basic safety standards ("Shots," NPR, 8/8). Abortion-rights supporters argue that the laws are medically unnecessary because anyone can be admitted through an emergency room (Washington Post, 8/10).

Jeanne Conry, former president of the American Congress of Obstetricians and Gynecologists, said, "Admitting-privileges legislation would impose stricter requirements on facilities where abortions are performed than on facilities that perform much riskier procedures." For example, colonoscopies have a mortality rate 40 times higher than abortion.

Abortion-rights supporters also point out that the reason abortion providers are often unable to meet the minimum requirements for admissions is because so few of their patients require hospitalization.

Meanwhile, Ovide Lamontagne, general counsel for Americans United for Life, said, "Once a physician assumes the responsibility for overseeing the provision of a medical procedure, there's an obligation on the physician to follow the care through to its ultimate conclusion," including any potential emergencies ("Shots," NPR, 8/8).

Legal Landscape

A divide among federal appeals courts over the constitutionality of admitting privileges requirements could persuade the Supreme Court to review the issue, according to the Texas Tribune/New York Times (Edelman, Texas Tribune/New York Times, 8/9).

Elizabeth Nash, states-issues manager for the Guttmacher Institute, said that the laws, if upheld, could have a "huge" effect on clinics compared with other abortion restrictions. "It has just really taken over, in a sense, because it has such the potential for shutting down clinics," she said (Washington Post, 8/10).