National Partnership for Women & Families

In the News

Texas Clinic Spends $3 Million To Comply With HB 2 Building Requirements

Texas Clinic Spends $3 Million To Comply With HB 2 Building Requirements

August 24, 2015 — Two abortion providers in San Antonio spent $3 million on their clinic to make it compliant with the ambulatory surgical center requirements imposed by Texas' omnibus antiabortion-rights law (HB 2), the Texas Observer reports (Garcia-Ditta, Texas Observer, 8/19).


HB 2, passed in 2013, prohibits abortion after 20 weeks' gestation, restricts the use of medication abortion, requires abortion clinics to meet the building standards of ambulatory surgical centers and mandates that abortion providers have admitting privileges at nearby hospitals.

The Center for Reproductive Rights filed suit against certain provisions in the law, including the ambulatory surgical center requirement and whether abortion clinics in El Paso and McAllen should be exempt from the law's admitting privileges requirement. The 5th U.S. Circuit Court of Appeals upheld most of the challenged provisions. The case is currently being appealed to the Supreme Court, which has placed a temporary hold on the ambulatory surgical center requirement while considering whether to hear the lawsuit. There was debate as to whether the Supreme Court order also blocked the law's admitting privileges requirement (Women's Health Policy Report, 8/19).

The state currently has 17 clinics, down from 41 in 2012. Seven of the remaining clinics are not able to meet HB 2's ambulatory surgical center requirement and will close if the high court rules in favor of the law or opts not to consider the case (Women's Health Policy Report, 8/20).

Compliance Process

According to the Observer, abortion providers Alan Braid and Eduardo Aquino previously operated Alamo Women's Reproductive Services. However, they decided to take out a loan to purchase a former radiology clinic and convert it into an abortion clinic compliant with HB 2's ambulatory surgical center requirement to ensure that they could continue providing abortion care. The new center, Alamo City Surgery Center, opened in June.

To be compliant with the ambulatory surgical center requirement, the facility has separate waiting rooms for the clinic and the surgical center, 8-foot-wide hallways, 240-square-foot operating rooms, specialized ventilation systems, specialized fire and safety features, a locker room and shower for staff, and two janitorial closets, at least one of which must be equipped with a faucet and drain. The building had to pass two state inspections before it was allowed to open.

In addition, the surgical center in meeting the standards also has separate post-operative beds for recovery. Individuals in the operating area are required to wear sterile scrub hats and booties. Furthermore, state inspector in a few months will visit the building to review patient records and administrative files. Braid also said he had to hire additional staff.

Meanwhile, according to the Observer, women seeking abortion care first must visit the building's clinic and then visit the building's surgical center after a 24-hour mandatory delay. According to the Observer, Texas requires ambulatory surgical centers for medication abortion, as well.


Braid said he and Aquino decided to buy the property and upgrade it because it was "the only way to ensure we could keep seeing patients and be prepared for when [HB 2] was enforced."

However, he noted, "There is no basis in fact that doing procedures here (is) any safer than doing them in a local doctor's office," adding, "I see the absurdity in all this, the unnecessary waste and obstacles thrown at providers and patients for no reason other than ideology." According to the Observer, research has shown that abortions performed in outpatient clinics are as safe as those performed in ambulatory surgical centers.

Similarly, Dan Grossman, a researcher with Ibis Reproductive Health and the Texas Policy Evaluation Project, noted, "For a [medication] abortion, a woman just has to be handed a tablet. There is no reason to be in a building that's set up for major surgery" (Texas Observer, 8/19).