The following research on HB57/TRAP is the culmination of a ton of research & hard work from Julie Slama, an Alabama women’s rights activist. Many thanks to her for letting me share her post from our women’s group. This is what we are up against with this so-called “Women’s Health & Safety Act”. There will be a public meeting on this February 6th at 9AM in the House Health Committee at the Alabama State House. We need all Alabama women that believe this is just another way to reverse Roe vs. Wade to show up for support! There is a LOT of info here, so the text is behind the jump.
Alabama has only 3 clinics in the state (*update, 5): Birmingham, Tuscaloosa, Mobile, Huntsville and Montgomery.
- This is not an Alabama bill. There is pre-written legislation [Insert name of State] available from Americans United for Life: Changing Law to Protect Human Life State by State, and some parts of this bill adhere closely to that. However, HB57 exceeds even their standards by quite a bit in some instances, for example by requiring that ALL physicians in the clinic have admitting privileges, rather than the current standard of one.
[ The employment of at least one (1) physician with admitting privileges at an
accredited hospital in this state and within thirty (30) miles of the licensed
abortion clinic. —Abortion Clinic Regulations 2012, AUL]
see full text here: http://www.aul.org/wp-content/uploads/2012/01/Abortion-Clinic-Regulations-2012-LG.pdf
Currently, only two States impose the Surgical Care Facility standards of HB57 : Missouri and Virginia.
–a bit of history from Virginia “I live in Virginia. Many people, me included, have trouble separating the regulations themselves from the circumstances surrounding their passage. The regulations were a pet project of Victoria Cobb, a powerful anti-abortion (not pro-life by my definition, just anti-abortion) lobbyist in Virginia who not-so-coincidentally happens to be married to the highest deputy health official in McDonnell’s administration. The fact that they were fast-tracked as “emergency regulations” looked like a power play because no health organization, patient advocacy organization, doctor or medical organization advocated for the regulations nor had there been any recent emergencies, news stories or other activity. The regs were generated, promoted and advocated for by pro-life groups, spearheaded by Mrs. Cobb’s group, that have no primary interest in making abortion safer; only in making it illegal. The regulations were “emergency fast tracked” immediately after Republicans achieved majority in both branches of the Virginia legislature…” [comment by “Deege” in “VA Governor McDonnell Passes Health Regulations for Abortion Clinics-]
full story here: http://liveactionnews.org/va-governor-mcdonnell-passes-health-regulations-for-abortion-clinics-abortion-advocates-outraged/
and some fallout from VA: Karen Remley, Virginia Health Commissioner, Resigns Over Abortion Clinic Regulations [Huff Post Politics, 1/29/13]
Full story here: http://www.huffingtonpost.com/2012/10/18/karen-remley-virginia-abortion_n_1982118.html
HB 57 is a standard TRAP law, whereby state legislatures successfully bypass the Supreme Court, and in the process place overwhelming and medically unnecessary burdens on women’s clinics and abortion providers. The goal is not to ensure safety; the goal is to effectively end abortion. In the process, women’s constitutional rights are trampled, physicians are threatened with criminal proceedings, and medical practice is scripted by legislators with no medical training.
- Sponsor background:Mary Sue McClurkin (R-43) is ALEC’s State Chairman for Alabama, and a member of Briarwood Presbyterian Church, a fundamentalist, creationist mega-church in the Birmingham area that has been in the forefront of the fight to end choice for decades. They were one of the earliest sponsors of clinic terrorism as well – marshaling groups of protesters to harass and intimidate women outside clinics in the Birmingham area. As a body, the church is strongly Republican, its membership drawn primarily from wealthy professionals.She has an “A” rating from the NRA, and a “96%” from the Christian Coalition. She supports state-funded vouchers to send children to any private or religious school, and abstinence-only sexual education programs.
Last year she was on the House Education Committee and supported HB 133, which would have granted high school credit for taking classes in Creationism and other religiously-oriented subjects outside school. [Alabama’s 2012 Creationism Bill Creeps Ahead 3/1/12 ] That Bill was “Indefinitely Postponed” last year, but I wouldn’t be surprised to see it resurrected now that Mike Hubbard has named McClurkin to Chair the House Education Policy Committee this year.
She also voted for SB10 last year, prohibiting insurance from covering abortions, and in 2011 voted for HB18, prohibiting abortions after 20 weeks.
She owned a Butane Company until 2001, now owns McClurkin Enterprises, LLC, and sits on the Board of Baptist Health Systems. Coincidentally(?) Baptist Health Systems owned a 35% share in Trinity Hospital when McClurkin managed to grandfather in a brand new piece of legislation that allowed Trinity to win its case in a dispute with St. Vincent’s and Brookwood Hospitals. [Birmingham News Editorial: OUR VIEW: Changing the state health-regulatory process is a good thing, but it’s troubling to talk of changing the rules in the middle of the game already in progress 4/30/11] Trinity is now owned wholly by CHS, a company that is being accused by Tenet Healthcare of over-billing Medicare in its aggressive admissions policy compared to its peers. It was subpoenaed by Medicare… [wiki: Community Health Systems]
HB 57 by Section:
Bill Text: “To require physician involvement in an abortion performed at an abortion or reproductive health center; to define terms and express legislative intent; to require certain standards in nursing care, post-operative and follow-up care; to require the father’s name be reported to law enforcement in certain circumstances; to require the Board of Health to adopt rules and to provide criminal and civil penalties for failure to comply; and in connection therewith would have as its purpose or effect the requirement of a new or increased expenditure of local funds within the meaning of Amendment 621 of the Constitution of Alabama of 1901, now appearing as Section 111.05 of the Official Recompilation of the Constitution of Alabama of 1901, as amended.”
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. This act shall be known and may be cited as the “Women’s Health and Safety Act.”
This bill is not at all about women’s health and safety. It is about preventing abortions by placing unreasonable financial burdens on clinics, providers, and patients.
Section 2. (a) The Legislature finds all of the following:
(1) That the percentage of abortion or reproductive health centers that have been subject to adverse licensure action vastly exceeds the percentage of facilities in any other category that have similarly been subject to adverse licensure actions. This alarming level of regulatory non-compliance among abortion and reproductive health centers in Alabama puts abortion patients at unreasonable risk.
Using national data from the Pregnancy Mortality Surveillance System, CDC identified 12 abortion-related deaths for 2008. [CDC: Abortion Surveillance — United States, 2009 Surveillance Summaries November 23, 2012 / 61(SS08);1-44] Among the 48 reporting areas that provided data for 2009, a total of 784,507 abortions were reported. [CDC]
(2) At abortion or reproductive health centers, patients are often treated in a manner inconsistent with a traditional physician/patient relationship.
As the Bill fails to define that relationship, this is mere verbiage.
(3) Abortion or reproductive health centers are not operated in the same manner as ambulatory surgical treatment centers or physician offices.
Patient Care. All patient care must be rendered in accordance with all applicable federal, state, and local laws, these rules, and current standards of care, including all professional standards of practice. [Alabama Dept. of Public Health, Division of Licensure and Certification for Abortion or Reproductive Health Centers 420-5-1]
(4) Abortion involves not only a surgical procedure with the usual risks attending surgery, but also involves the taking of human life.
Death of an unborn child who is “quick” (fetus is moving) can be murder, provided there was premeditation, malice and no legal authority. Thus, abortion is not murder under the law. [LAW.com legal dictionary]
(5) Abortion is a highly personal and very sensitive procedure which results in stress and concern for the patient that is unique to the decision to have an abortion.
And bills like this are making it more stressful, guilt-ridden, financially burdensome, and impossible to obtain every day.
(6) Abortion is a very profitable procedure most often engaged in by stand-alone clinics without many of the safeguards found in a traditional physician/patient relationship or other medical care setting.
In 2009, the median charge for a surgical abortion at 10 weeks’ gestation was $470; but since most U.S. women obtain abortions at facilities with lower charges, the average amount paid was $451. The median cost for a medication abortion was $490 and women paid an average of $483. [Guttmacher Institute, 2009] The average cost of a colonoscopy, without health insurance, is approximately $3,081. [Buzzle]
(7) Because abortion and reproductive health centers do not currently provide the level of personal contact found in many (? ed.) physician/patient relationships and in other medical care settings, it is necessary for the Legislature to mandate the personal presence and participation of the physician in the process.
Why? The Bill does not establish why the current standards of practice mandated by the AL Health Dept. are incompatible with satisfactory patient outcomes.
(8) Moreover, because abortion or reproductive health centers have often failed (? ed.) to meet acceptable standards of medical care, it is necessary for Legislature to enact reasonable and medically appropriate health and safety standards for all abortion and reproductive health centers, and to provide effective enforcement mechanisms and disincentives for centers that are unable or unwilling to meet these requirements.
According to the CDC, the were 784,507 abortions performed in the US in 2009. Of those, 12 resulted in death. In contrast, deaths per 1,000 American children as a result of vaccination was 7.8. [Watchdog USA]
Section 3. As used in this act, the following terms shall have the following meanings:
[what follows are mostly standard definitions with two noteworthy exceptions. Any other variance will be addressed in subsequent comments.]
NOTED:
*”For the purposes of this act, a “lethal anomaly” means that the child would die at birth or be still born.”
**(5) DISPENSE. To sell, distribute, administer, leave with, give away, dispose of, deliver, or supply a drug or medicine to the ultimate user or the user’s agent.
Section 4. [for comparison i have listed the current Health Dept. Codes beneath each section.]
(a) Only a physician may perform an abortion.
**Current practice is ALREADY in line with this section. Only physicians perform these procedures.
“1. a requirement that the outside covering physician shall be available to treat and manage all complications that may reasonably arise as a result of an abortion;” [Current Health Dept. Code 5-20-1]
(b) During and after an abortion procedure performed at an abortion or reproductive health center, a physician must remain on the premises until all patients are discharged. The discharge order must be signed by the physician. Prior to discharge from the facility, the patient shall be provided with the name and telephone number of the physician who will provide care in the event of complications.
**They ALREADY do this, because a physician must sign the discharge order.
Current Alabama Health Dept. Administrative Code: 420-5-1:
“4. At all times when patients are in the facility, there shall be at least one staff member on the premises who has the knowledge, skills and abilities to operate the emergency equipment. Protocols shall be in place to ensure ongoing training of staff in the use of emergency equipment, the management of emergencies and the indications for emergency transport.”
(c) Every physician referenced in this section shall have staff privileges at an acute care hospital within the same standard metropolitan statistical area as the facility is located that permit him or her to perform dilation and curettage, laparotomy procedures, hysterectomy, and any other procedures reasonably necessary to treat abortion-related complications.
The current requirement of ONE is sufficient for the purpose. As the covering physician, any patient would be admitted without problems.
Current Alabama Health Dept. Administrative Code: 420-5-1: (c) Necessity of Physician with Admitting Privileges: A facility may not perform abortions unless the outside covering physician described in subsection b or a substitute physician with the qualifications described in subsections (b)(1) and
(b)(4) is available to provide patient care. If a facility receives notice that no facility physician or outside covering physician will be available, it must stop performing abortions no later than 72 hours before the physician’s unavailability.
Section 5.
At all times during procedures in an abortion or reproductive health center, nursing care shall be under the supervision of a registered professional nurse currently licensed in Alabama. (shortened for brevity)
Nursing care is usually under the supervision of an RN, unless there is a Nurse Midwife or Nurse Practitioner on site who can take that task. Both are more advanced degrees than RN. If there is an adequate staff of physicians onsite, some facilities may employ an LPN (I don’t know their policies – will check) instead as a cost-saving measure. Recovery times are quick and post-op complications rare.
Section 6. All patient care in an abortion or reproductive health center must be rendered in accordance with all applicable federal, state, and local laws, State Board of Health rules, State Board of Medical Examiners rules, and current standards of care, including all professional standards of practice.
This is mere verbiage – what else are the rules for if not to be followed?
Section 7. Only a physician may give, sell, dispense, administer, or otherwise prescribe an abortion-inducing drug. Because the failure and complications from medical abortion increase with advancing gestational age, because the physical symptoms of medical abortion can be identical to the symptoms of ectopic pregnancy, and because abortion-inducing drugs do not treat ectopic pregnancies but rather are contraindicated in ectopic pregnancies, the physician giving, selling, dispensing, administering, or otherwise providing or prescribing the abortion-inducing drug must first examine the pregnant woman in person and document, in the woman’s medical chart, the gestational age and intrauterine location of the pregnancy prior to giving, selling, dispensing, administering, or otherwise providing or prescribing the abortion-inducing drug.
This mostly makes sense. Gestational age needs to be ascertained before giving these drugs. HOWEVER, to insist that an MD physically hand them the pill is ridiculous. RNs and LPNs hand out meds in hospital ICUs every day without the presence of a physician. This is another cost-adding measure – nothing more.
Section 8. Physicians performing abortion procedures in abortion or reproductive health centers shall conform to the rules for office-based surgery of the Alabama State Board of Medical Examiners, shall meet the standards prescribed in the rules for “office-based procedures – moderate sedation/analgesia,” and shall meet all other requirements in those rules, including the recommended guidelines for follow-up care, requirements for recovery area, assessment for discharge, reporting requirements, and registration requirements.
Here we go – let the cash registers ring
Section 9. An abortion or reproductive health center shall be classified as ambulatory health care occupancy and shall meet all standards in the NFPA 101 Life Safety Code 2000 edition, or such standards in any later edition of the NFPA 101 Life Safety Code that the Board of Health may adopt for facilities classified as ambulatory health care occupancy. Not later than 180 days after the effective date of this act, each licensed abortion or reproductive health center shall submit to the Department of Public Health architectural drawings and plans and sprinkler system plans and such other materials as may be required to show compliance or prospective compliance with the applicable life safety code…etc.[abbreviated]
Heere’s Johnny – they have 6 months to rebuild the facility, etc., meet all codes, or LOSE THE LICENSE
“The 2000 edition Life Safety Code is regarded as law in many states and jurisdictions throughout the United States.
Widely adopted, and required in every accredited hospital nationwide, the Life Safety Code is a core document that references nearly 50 other important codes and standards–such as the National Electrical Code®, NFPA 13: Installation of Sprinkler Systems, and NFPA 72®: National Fire Alarm Code®. The 2000 NFPA 101 links all these critical codes and standards together, to cover all the bases for safety in any occupancy.”
It also costs $93.00 for a PDF.
EVEN VIRGINIA GAVE THEM TWO YEARS TO COMPLY:
“Under those rules, Virginia clinics would have two years to comply with architectural requirements some operators say will cost them hundreds of thousands of dollars in structural upgrades to meet.” [The Virginian-Pilot, 9/15/12]
Read more: http://hamptonroads.com/2012/09/virginia-board-approves-tougher-abortion-clinic-rules
“We have almost 40 years of data to suggest abortion is a remarkably safe clinical procedure,” she says. “[APESA] is really designed to restrict access.”
Weitz says that in order to reach the status of ambulatory surgical center, facilities providing abortions need expensive upgrades such as construction, additional staff to maintain higher nurse-to-patient ratios, and a host of medications that clinics don’t really need if they’re not performing any medical procedures other than abortions. [Philadelphia Weekly, 2/2/11]
Section 10. (a) Any minor child under the age of 16 seeking an abortion from an abortion or reproductive health care facility shall be asked by the physician performing the abortion or his or her agent to state the name and age of the individual who is believed to be the father of the unborn child. While the minor child may refuse to provide the father’s name and age, she should be encouraged to do so by the physician or agent consistent with the physician’s legal obligation to reduce the incidence of child abuse when there is reason to suspect that it has occurred.
Good luck with this one
(b) In addition to any other abuse reporting requirements that may apply to the staff of an abortion or reproductive health center, if the reported age of the father is two or more years greater than the age of the minor child, the facility shall report the names of the pregnant minor child and the father to both local law enforcement and the county department of human resources. If the pregnant minor child is less than 14 years old, the name of the minor child shall be reported to the Department of Human Resources, regardless of whether the father is two or more years older than the minor child. The receipt of reportable information by any member of a facility staff shall trigger the requirement for the facility to report such information. Nothing in this section shall be construed to constructively repeal any other provisions of law requiring parental consent before an abortion procedure is performed.
Nice – they’ll stay home in droves now
Section 11. The Board of Health shall publish amended rules for abortion and reproductive health care centers that are consistent with this act within 180 days after the effective date of this act. Such rules shall take effect within the time frame required by the Alabama Administrative Procedure Act.
Section 12. (a) Any person other than a physician who performs or attempts to perform an abortion, including the prescription, dispensing, or administration of abortion- inducing drug, shall be guilty of a Class C felony.
Including the RN or LPN who hands her a pill with a Doctor’s order, just as she would in any ICU. Overkill, anyone?
(b) Any person who prescribes, dispenses, or administers an abortion-inducing drug without first examining the patient in person shall be guilty of a Class C felony.
Got the nurse again!
(c) The administrator of an abortion or reproductive health center who knowingly and willfully permits the facility to be operated in a manner that violates Section 4, Section 5, Section 6, or Section 7 of this act shall be guilty of a Class C felony.
So operating a substandard facility carries an identical penalty to handing a patient her physician-prescribed pill. Seems fair…
(d) The administrator of an abortion or reproductive health center who knowingly and willfully violates Section 10(b) of this act shall be guilty of a Class A misdemeanor.
See HB3 currently in House Judicial- SYNOPSIS: Under existing law, certain persons and entities, such as hospitals, physicians, teachers, and day care workers, are required to report suspected child abuse or neglect to a law enforcement official or the Department of Human Resources. Also under existing law, a person making a good faith report in a child abuse or neglect investigation or case is immune from all civil and criminal liability. A person who fails to make a report is guilty of a misdemeanor.[abbreviated]
Section 13. Any person who can demonstrate personal injury, including physical injury, emotional distress, or mental anguish, where such injury has resulted from the failure of an abortion or reproductive health center to conform to the requirements of this act, may maintain a civil action for damages against the abortion or reproductive health center and against the administrator of the facility.
For the first time, the GOP is begging people to sue. Elsewhere and everywhere else, they are busy trying to make it impossible – unless you provide abortions. Death by torte?
Section 14.
(a) The failure of any physician, nurse practitioner, physician assistant, registered professional nurse, or licensed practical nurse to conform to the requirements of this act or any rule or regulation adopted under provision of this act may be grounds for adverse licensure action, up to and including license revocation.
Still going for those nurses – is it because they are mostly women, or because they don’t have the power of the AMA behind them?
(b) Any abortion or reproductive health center that is found to have provided an abortion, in a manner that violates this act or any rule or regulation adopted under the provision of this act, may be subject to adverse licensure action, up to and including license revocation.
So, if there’s a surprise inspection 6 months later and those new sprinklers aren’t working, or there’s one less square foot in the hallway, they are history.
Section 15. Upon application by the Department of Public Health, a circuit court or any judge thereof shall have jurisdiction for cause shown, to grant a temporary restraining order, a preliminary injunction, a permanent injunction, or any combination of those remedies, restraining and enjoining any person from violating the provisions of this act and any rules promulgated thereunder. Any temporary restraining order, preliminary injunction, or permanent injunction shall be issued without bond. This remedy is in addition to any other remedies available to the Department of Public Health.
Get the right Judge and swift “justice” will follow.
BOND: A bond for good behavior requires the defendant to post bond by giving money or property to the court to hold. The defendant will lose this money or property if he violates the judge’s order. The court may also find the abuser in contempt of court for violating an order. —[Women’s Law.org]
Section 16. (a) Nothing in this act shall be construed as creating or recognizing a right to abortion.
We got that idea. However, the Supreme Court begs to differ.
The rest just says that again regarding various other laws. In other words, they aren’t rewriting existing regulations not specific to this bill.
Section 17. The Alabama Legislature, by joint resolution, may appoint one or more of its members to intervene as a matter of right in any case in which the constitutionality of this act or any portion thereof is challenged.
Some eager young gun from the Legislature will defend it to the death if necessary – hopefully in an election year.
Section 18. Any provision of this act held to be invalid or unenforceable by its terms, or as applied to any person or circumstance, shall be construed so as to give it the maximum effect permitted by law, unless such holding shall be one of utter invalidity or unenforceability, in which event such provision shall be deemed severable herefrom and shall not affect the remainder hereof or the application of such provision to other persons not similarly situated or to other, dissimilar circumstances.
In other words, just because we mopped the floor with your Constitutional Rights doesn’t mean we can’t get you, my pretty. The sprinklers better work.
Sections 19 & 20 are just standard language. 19 says they can force people to spend more money because they’ve invented a new crime. 20 says when it would take effect if passed.
—————————————————————————————————————-
Email Contact info for the Alabama House Health Committee members:
jimmcc@windstream.net,
Mike.millican@alhouse.gov,
Jim.mcclendon@alhouse.gov,
John.knight@alhouse.gov,
jimpattersonhd21@gmail.com,
jim.patterson@alhouse.gov,
bsketa@aol.com,
benjamin.treadaway@alhouse.gov,
April.weaver@alhouse.gov,
pwlee@graceba.net,
paul.lee@alhouse.gov,
becky.nordgren@alhouse.gov,
joe@hubbardcoleman.com,
joe.hubbard@alhouse.gov,
Ronald.johnson@alhouse.gov,
Berry.forte@alhouse.gov,
laura.hall@alhouse.gov,
Ed.henry@alhouse.gov,
elainebeech83@gmail.com,
elaine.beech@alhouse.gov,
dchesteen@panhandle.rr.com,
donnie.chesteen@alhouse.gov
Phone Contact Info for the Alabama House Health Committee Members:
Jim McClendon (CHAIR): (334) 242-7768, (205) 467-2656
Mike Millican (VICE CHAIR): (334) 242-7534, (205) 921-3214
– Fax: (334) 353-3350
John Knight (“Ranking Minority Member”): (334) 242-7512, (334) 834-7445 (home), (334) 229-4286 (work)
Elaine Beech: (334) 242-7702, (251) 847-2604
Donnie Chesteen: (334) 242-7742, (334) 684-2196 (home), (334) 449-1040 (cell)
– Fax: (334) 684-1899
Berry Forte: (334) 242-7553, (334) 687-9985 (home), (334) 616-1272 (cell)
Laura Hall: (334) 242-7688, (256) 859-2234 (work), (256) 539-5441 (district phone?)
– Fax: (256) 539-5444
Ed Henry: (334) 242-7736, (256) 260-2146 (district)
– Fax: (256) 260-2144
Ronald Johnson: (334) 242-7777, (256) 249-9489 (home)
Joe Hubbard: (334) 242-7707, (334) 263-2420 (home), (334) 832-1001 (work)
Paul Lee: (334) 242-7675, (334) 792-9682 (home)
– Fax: (334) 793-5232
Becky Nordgren: (334) 353-9032, (256) 546-1378 (home), (256) 328-1653 (cell)
– Fax: (256) 240-7216
Jim Patterson: (334) 242-7531, (256) 975-7990 (work)
Allen Treadaway: (334) 242-7685, (205) 566-6835 (home), (205) 254-1720 (work)
April Weaver: (334) 242-7731
Fax numbers are listed on a separate line. The first number after every name is the Montgomery office number, subsequent ones are either work, home, or cell.
Girl In The 'Gump 