AHCA Proposes Rule Revision on Ultrasound Requirements

Back in May, the Agency for Health Care Administration (AHCA) began the process of implementing changes to the rules on ultrasounds given prior to an abortion.  The ultrasound requirement–which provides the woman with the  right to decline to view and hear the ultrasound–was enacted in 2011 as an amendment to sections 390.0111 and 390.012, Florida Statutes.

Earlier this month, AHCA posted its proposed changes to the rule.  As expected, the proposed change to the rule clarifies that section 390.0111 applies and that the ultrasound requirement is non-discretionary for the abortion clinic.  The proposed language is reproduced below, with underlines and strikethroughs marking the changes from the existing rule:

59A-9.025 Medical Screening and Evaluation of Patients Receiving Second Trimester Abortions.

(1) Each abortion clinic that provides second trimester abortions shall formulate and adhere to written patient care policies and procedures designed to ensure professional and safe care for patients undergoing second trimester abortions and shall maintain a medical record for each such patient that records history, care and services. Any abortion clinic that performs second trimester abortions which is in operation at the time of adoption of this rule shall be given six months within which to comply with these patient care policies and procedures for patients undergoing second trimester abortions, to include but not limited to the following:

(a) Admission criteria and procedures;

(b) Identification in the medical record of physician(s) and nurse(s) involved in providing the services offered for patients undergoing second trimester abortions;

(c) Specific details regarding the pre-operative procedures performed, to include:

1. History and physical examination, to include verification of pregnancy, estimation of gestational age, identification of any preexisting conditions or complications; including allergies to medications, antiseptic solutions, or latex; and a complete obstetric and gynecological history.

2. Special examinations, lab procedures, and/or consultations required, to include ultrasonography to confirm gestational age and a physical examination including a bimanual examination estimating uterine size and palpation of the adnexa. The physician shall keep original prints of each ultrasound examination of a patient in the patient’s medical history file. For an abortion in which an ultrasound examination is not performed before the abortion procedure, Uurine or blood tests for pregnancy shall be performed before the abortion procedure.

(2) Laboratory Services.

(a) Laboratory services shall be provided on-site or through arrangement with a laboratory that holds the appropriate federal Clinical Laboratory Improvement Amendments (CLIA) certificate and state of Florida clinical laboratory license issued pursuant to Chapter 483, Part I, F.S.

(b) All laboratory services provided on-site shall be performed in compliance with state of Florida clinical laboratory licensure and federal CLIA provisions.

(3) Laboratory Equipment and Supplies.

(a) All equipment and supplies for the collection, storage, and testing of specimens shall meet the provisions of Rule 59A-7 F.A.C., and shall be maintained according to manufacturer’s instructions and in a manner that ensures accurate test results.

(b) Temperature controlled spaces for the storage of specimens or testing supplies shall be monitored and recorded to ensure that the proper storage temperature is maintained.

(c) All dated supplies and materials shall not be used beyond their expiration date.

(d) Adequate facilities and supplies for the collection, storage and transportation of laboratory specimens shall be available on site.

(4) Rh factor. Rh testing for Rh negative patients shall be conducted, unless reliable written documentation of blood type is available.

(5) All laboratory test reports shall be placed in the patient’s medical record.

(6) All laboratory test and storage areas, records and reports shall be available for inspection by the agency.

(7) If a person who is not a physician performs an ultrasound examination, that person shall have documented evidence that he or she has completed a course in the operation of ultrasound equipment. The physician, registered nurse, licensed practical nurse, advanced registered nurse practitioner, or physician assistant shall, at the request of the patient and before the abortion procedure is performed, review the ultrasound evaluation results with the patient, including an estimate of the probable gestational age of the fetus.

(8) A test for anemia shall be performed.

(9) Each abortion clinic must be in compliance with Section 390.0111, F.S.

Rulemaking Specific Authority 390.012(1), 408.819 FS. Law Implemented 390.0111, 390.012(3)(d), 390.012(4), 390.013 FS. History–New 9-25-06, Amended__________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Kim Stewart, (850)412-4302

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: September 6, 2013

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: May 20, 2013

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Christian Science Monitor Hosts Important Op-Ed Exchange on Effectiveness of Anti-Abortion Groups

This post on National Review nicely summarizes the exchange, which began with this op-ed piece on the Christian Science Monitor arguing that “[p]ro-life groups don’t really protect the unborn.”  The responses, also posted on the Christian Science Monitor, are equally important and worth your attention.

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Judaism and Abortion

Last week, three South Florida rabbis participated in a discussion on, among other things, abortion.  The discussion, reported by the Sun-Sentinel, provided an opportunity for outsiders to understand the abortion issue through the lens of three distinct movements within Judaism.  According to Orthodox Rabbi Moshe Scheiner,

Judaism says that abortion is forbidden, although there are times when it’s permitted.  Judaism does not view abortion as a crime . . . but what God gives us is on loan, so we cannot destroy it.

Meanwhile, the Reform Rabbi Barry Silver suggested that the Bible is silent on abortion and does not indicate that a fetus is a human being.

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Poll: HuffPost/YouGov Confirm Anti-Abortion Trend

Below are the results of HuffPost’s recent poll on abortion and, if you zoom to question #5, the ban on abortions past 20 weeks gestation.  These numbers generally support the anti-abortion trend that has been detected by numerous polls.

These polls would be far more valuable–and likely reflect greater anti-abortion sentiments–if the questions differentiated between abortions procured in the context of a pregnancy that directly threatens the life of the mother and abortions procured under all other circumstances.  It is difficult to gleam from questions like this whether the general public supports or opposes the idea of limiting the right to an abortion in the context of emotional or familiar factors alone.

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Misoprostol and Texas Flea Markets

Bloomberg posted an article with very interesting information on the availability of the abortifacient misoprostol (brand name Cytotec) at Texas flea markets.  Unfortunately, the article leads with the loaded headline, “Texas Threat to Abortion Clinics Dodged at Flea Markets.”

But Texas’ proposed changes in the law have virtually nothing to do with the existence of a black market in abortifacients.  Misoprostol–the same drug used by Florida’s John Andrew Weldon to induce his girlfriend’s abortion–is, like any other drug, illegally available with or without heightened legal requirements.  This is a “back-alley” abortion to be sure, but not the result of controversial abortion restrictions.  By purchasing misoprostol on the black market, one can avoid expensive (but basic) safeguards, such as a prescription requirements, FDA standards, and physician involvement.

Because misoprostol is already available at flea markets today–before the referenced legislative proposals–Texas demonstrates just the opposite of what the headline reports.  In fact, further restrictions on abortion are unnecessary to the existence of a black market.

 

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Wisconsin Abortion Law Partially Enjoined

A portion of Wisconsin’s new abortion restrictions was enjoined until at least July 17, when the federal district court can hold a full hearing on the issue of whether the state can impose a requirement that abortion clinic doctors must have admitting privileges in a hospital within 30 miles of the clinic.  The requirement would, according to Planned Parenthood, effectively shut down two of Wisconsin’s four clinics.

It appears, however, that Planned Parenthood’s problem achieving compliance with this portion of the law is less about the law itself and more about the doctors’ failure to timely secure admitting privileges.  Accordingly, it is likely that the law stands, but with some delay in enforcement to allow doctors more time to comply.

According to Americans United for Life, eleven other states–AL, AR, KY, LA, MS, MO, OH, PA, SC, TX, and UT–have a similar restriction in place.

 

 

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Ohio’s Budget Effectively Defunds Planned Parenthood

Ohio’s House and Senate have chosen a policy that effectively precludes funding for Planned Parenthood, at least as it operates todayThe budget, which is now headed for the Governor’s desk, establishes and funds the “Ohio Parenting and Pregnancy Program.”  Although technically, Planned Parenthood could qualify for funding under the new program, it is highly unlikely that Planned Parenthood would abandon its current model simply to secure funding it doesn’t really need.  From the official bill analysis, here’s what the program does and what it takes to qualify for funding under the new program:

The bill establishes the Ohio Parenting and Pregnancy Program to provide Temporary Assistance to Needy Families (TANF) block grant funds to certain private, nonprofit entities that provide services to pregnant women and parents or other relatives caring for children under 12 months of age that promote childbirth, parenting, and alternatives to abortion and meet one of the purposes of the TANF block grant.  [The Ohio Department of Job and Family Services (ODJFS)] may provide funds to these entities by contract (to the extent permitted by federal law).  In accordance with criteria it develops, ODJFS may solicit proposals from entities seeking funds under the Program. Under the bill, ODJFS may enter into an agreement only if the entity meets the following conditions:

(1) The entity is a private and not-for-profit entity;
(2) The entity is one whose primary purpose is to promote childbirth, rather than abortion, through counseling and other services, including parenting and adoption support;
(3) The entity provides services to pregnant women and parents or other relatives caring for children 12 months of age or younger, including clothing,
counseling, diapers, food, furniture, health care, parenting classes, postpartum recovery, shelter, and any other supportive programs or related outreach;
(4) The entity does not charge pregnant women and parents or other relatives caring for children 12 months of age or younger a fee for any services received;
(5) The entity is not involved in or associated with any abortion activities, including providing abortion counseling or referrals to abortion clinics, performing
abortion-related medical procedures, or engaging in pro-abortion advertising; and
(6) The entity does not discriminate in its provision of services on the basis of race, religion, color, age, marital status, national origin, disability, or gender.

The bill permits an entity that has entered into an agreement with ODJFS to provide some or all of the services through a subcontractor. Under the bill, a subcontract may be entered into with another entity only if that entity meets all of the following conditions:

(1) The entity is a private and not-for-profit entity;
(2) The entity is physically and financially separate from any entity, or component of an entity, that engages in abortion activities; and
(3) The entity is not involved in or associated with any abortion activities, including providing abortion counseling or referrals to abortion clinics, performing abortion-related medical procedures, or engaging in pro-abortion advertising.

The ODJFS Director is required to adopt rules as necessary to implement the Program.

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