NC senators passed a bill containing sweeping restrictions on abortions after a long and emotional debate on the Senate floor, watched by hundreds of protestors.

By Rose Hoban

On a party-line vote, state senators passed a bill to enact a number of sweeping changes to North Carolina’s abortion regulations that could have the effect of closing down many of the state’s 36 abortion providers.

Protesters filled the Senate gallery Wednesday morning to listen to lawmakers debate sweeping abortion changes Wednesday morning. Photo credit: Rose Hoban
Protesters filled the Senate gallery Wednesday morning to listen to lawmakers debate sweeping abortion changes. Photo credit: Rose Hoban

The Family, Faith and Freedom Act, introduced late Tuesday and tentatively passed Tuesday evening, would place tighter regulations on clinics, restrict many health plans from offering coverage for the procedure, ban sex-selective abortions and require doctors to be present during all phases of an abortion, among other provisions.

The Senate gallery was filled to overflowing with abortion-rights supporters who had gathered for an impromptu rally and protest that began as the Senate convened at 9 a.m. A large crowd stood outside the doors of the gallery during the debate, many listening in via their cell phones.

Lt. Gov. Dan Forrest, who presides over the Senate, repeatedly chided spectators, warning them not to talk or wave their hands during the debate, lest he order the galleries emptied for the remainder of the session.

One spectator was arrested as she shouted in the Senate chamber after the vote was completed.

Abortion opponents, on the other hand, were pleased.

“This is a great victory for the unborn and women in our state. This new law will protect women from unsanitary conditions in abortion clinics,” said Tami Fitzgerald, head of the North Carolina Values Coalition.

Tightening restrictions on clinics

Advocates say one of the primary restrictions on abortion access contained in the bill are new regulations that would require abortion clinics to come up to the same standards as ambulatory care centers, which perform surgeries ranging from Lasik eye surgery to colonoscopies to arthroscopic surgery. Many of those procedures require full anesthesia, which require the clinics to have complex plumbing and fire-safety standards.

The abortion-policy research organization the Guttmacher Institute estimates that about 33,000 abortions are performed annually in North Carolina.

People protesting the Senate's plan to enact sweeping restrictions on abortion access outside the front of the legislative building in Raleigh.
People protesting the Senate’s plan to enact sweeping restrictions on abortion access outside the front of the legislative building in Raleigh. Photo credit: Rose Hoban

According to Planned Parenthood of Central North Carolina head Melissa Reed, about half of abortions performed by her organization in North Carolina are done via “medical abortion,” using a combination of pills and no sedation to complete the procedure. Usually, a woman takes the first medication, mifepristone, in the clinic and gets sent home with another, misoprostol, to take two days later.

“You can imagine why a woman might not want to go back for the second set of pills,” Reed said. “She’d rather take them at home.”

Surgical abortions are performed using light, if any, sedation.

According to the Guttmacher Institute, similar physical plant restrictions have been passed in 26 states, many of them in the South, including Alabama, Florida, South Carolina and Virginia.

In Alabama, three of the state’s five clinics face closure of abortion services if the regulations go into effect, said Nora Spencer, vice president for external affairs for Planned Parenthood of the Southeast. She said the new regulations were to go into effect July 1, but a judge issued a temporary restraining order delaying some of them by two weeks.

Statutes are entangled in the legal system in Virginia as well. Nonetheless, Reed said, two private clinics, of that state’s 20 clinics, have shuttered their doors.

“The Planned Parenthoods in Virginia are looking forward to spending several hundred thousand dollars per health center to upfit our buildings to meet these onerous and unnecessary requirements, none having to do with patient safety,” she said.

Reed pointed out that one of the closed clinics, in Norfolk, served many military women, who have a higher rate of unplanned pregnancy than in the general public, according to a study released this week.

At present, only one clinic providing abortions in North Carolina, in Asheville, meets the surgical center standards that would be required under the proposed law.

“All of you are welcome to visit Asheville; you’ll enjoy your stay there,” said Sen. Martin Nesbitt, who represents Buncombe County. “But I don’t think people from down here ought to have to travel to Asheville to get quality health care and to exercise their constitutional right to choice.”

Abortion researchers said the jury is still out on how such regulations affect the number of abortions performed in a state.

“This last wave where we’ve seen these restrictions become law have gone into effect in 2011,” said Elizabeth Nash, the state issues researcher from Guttmacher, who noted implementation was delayed by court challenges.

“We don’t have much data to say much of anything about how they’ve affected access.”

Nash said restrictions often take several years to get through the regulatory process.

That would be the case in North Carolina. The bill orders planners at the Department of Health and Human Services to propose regulations to the legislature no later than January 2014. Then it would take time for those regulations to make it into law and affect clinics. The process could take several years.

Fitzgerald said she couldn’t know when the regulations would go into effect. “That’s up to the legislature and their relationship with HHS,” she said.

Nash said in Virginia and in Tennessee, where one clinic closed in 2012, clinic providers end up making decisions about whether or not to close as the regulatory process plays out.

“Suffice it to say that the types of restriction being considered in North Carolina, some are very restrictive and have the potential to close clinics,” she said.

Echoes of Philadelphia

Recent horror stories from the abortion clinic run by Dr. Kermit Gosnell in Philadelphia were told throughout the debate on the bill, which ran to almost two hours on the Senate floor.

HB 695 box

Bill supporter Warren Daniel (R-Morganton) spent several minutes reading from the grand jury indictment of Gosnell, who was subsequently tried and convicted on several counts of murder.

“Gosnell’s facility fell far below the basic minimum standards of care that any patient having a surgical procedure should expect to receive,” Daniel read. “There’s no justification for denying abortion patients the protections available to every other patient of an ambulatory surgical facility and no reason to exempt abortion clinics from meeting these standards.”

Daniel also read a story from the Charlotte Observer about a clinic in Charlotte that was cited with problems.

Opponents of the bill noted that the fact that the clinic was closed and forced to improve procedures is proof North Carolina’s oversight is better than that of the health department in Philadelphia, which allowed Gosnell to practice despite numerous complaints by patients. According to grand jury documents, the Pennsylvania Department of Health “conducted sporadic, inadequate inspections for 13 years, and then none at all between 1993 and 2010.”

“There’s a big difference between … what was happening there and what we do,” said Spencer. “There’s really no comparison.

“I think these laws are enacted under the guise of patient safety, but they really offer no additional safety for women.”

Spencer noted that both medical and surgical abortions have been found to be safe; a recent study calculated that the procedures are safer than childbirth.

Sen. Ben Clark (D-Raeford) argued that North Carolina’s inspection regimen is more stringent than what was shown in the Pennsylvania case. He said a Charlotte case showed that state inspectors were following through on problems and complaints, while acknowledging that there would always be cases where providers didn’t abide by the rules.

“We can cite circumstances and situations  in which guidelines and policies were violated. But … here no one has been able to cite one instance – and there have been a lot of abortions that have taken place in this state – in which an abortion clinic operating as required by North Carolina standards has caused health issues for our women,” Clark said. “And when they’re not followed, we have a remedy for  that: Put them out of business.”

Daniel complained that two years could pass in North Carolina between inspections by health regulators; however, Reed said her clinics are inspected at least annually.

“Sen. Daniel has a box of complaints and citations about clinics in North Carolina that he was given by the Department [of Health and Human Services],” said Sen. Trudy Wade (R-Greensboro). She noted women with complaints about their care need to bring them to the state Medical Board.

“I’m not sure how many complaints there are by the Medical Board, but they have sanctioned some doctors,” Wade said.

Medical Board spokeswoman Deena Konkel said her agency receives as many as 1,300 complaints a year about doctors of all kinds and investigates several hundred of them. She and her legal staff went through complaints from the past six years.

“Out of several hundred public actions taken each year, staff were able to recall three cases specifically dealing with abortions below standard,” Konkel said. “Two of those cases were problems based on actions taken by other state boards and one occurred to a patient living in North Carolina.”

The doctor in the third case was disciplined in 2010 and recently had his license suspended.

Some protesters outside the Senate chamber said they were there because in the pre-Roe v. Wade world things were worse.

“We may go back to a time that I remember when my best friend in college came back and hemorrhaged in her bed and we had to take her to the hospital at a time when there was no safe abortion in this county,” said protestor Barbara Crane, 64, from Chapel Hill, as she held back tears.

“Her life was saved, she went on to have a wonderful marriage and family later in her life and she became a teacher, and she’s had a great life. Having the abortion at that time was a very important choice for her to be able to make.”

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...