UPDATE, 5/28/2015: The bill passed the Senate for second reading Thursday afternoon and will be heard for a final time in the Senate next week.
By Rose Hoban
After a heated debate about the addition of less controversial measures that protect women and children from domestic violence into a bill with abortion restrictions, HB 465 passed out of a Senate judiciary committee Wednesday and is headed to the Senate floor.
The bill passed the House with an increase to the state’s waiting period for an abortion from 24 to 72 hours and requirements for abortion providers to send information to the state Department of Health and Human Services about procedures done after 18 weeks gestation.
But when it reappeared on the Senate side of the building, the bill was renamed the Women and Children’s Protection Act and had added restrictions: only obstetrician/gynecologists would be permitted to do the procedure and those physicians would be required to provide data to the state about their decision-making process for all abortions done after 16 weeks gestation.
But what was frustrating to some senators was how the bill sponsors had added less controversial measures to protect women and children from domestic violence, restrict the movement of sex offenders and amend the definition of statutory rape, among other measures.
“There are a number of sections that would gather unanimous support,” said Sen. Jeff Jackson (D-Charlotte), who introduced Senate bills 418 and 590. “When they weren’t voted on in committee, I simply assumed it was because I was a young member of the minority.”
“The limit of good faith is the inclusion of nonpartisan bills into hyper-partisan legislation for what appears to me to be the purpose of eliciting ‘no’ votes from pro-choice members,” he said, before introducing an amendment to carve out his former bills.
That amendment failed on a voice vote.
Only OB/GYNs
Predictably, most of the discussion of the bill centered around the new abortion requirements, including one that would restrict the provision of abortion to OB/GYNs.
Stacy Boulton, a Raleigh OB/GYN, said the bill would keep “vulnerable women as safe as possible if they do opt for abortion.”
Boulton argued there is a “drastic difference” between medical and surgical training, and compared the training done by OB/GYNs to other practitioners, including family physicians.
“We’re taught what to do when things go wrong surgically; we’re taught to handle emergencies surgically; we know how to stop bleeding, how to monitor and stabilize patients,” she said. She further said that family practitioners and nonsurgical specialties are not qualified to perform abortions.
Boulton acknowledged that complications are rare post-abortion, something that’s supported by the data. According to information compiled by the Guttmacher Institute, which gathers information on reproductive health, overall complications in first-trimester pregnancy – when more than 80 percent of abortions take place – happen in fewer than 0.05 percent of abortions.
That would translate to about 10 complications out of the 19,818 abortions that were performed in North Carolina in 2013. There were no fatalities associated with abortion in North Carolina in that year.
Nonetheless, Boulton argued that’s a reason to restrict the practice to OB/GYNs, something that was supported by Tami Fitzgerald from the N.C. Family Values Coalition.
“I don’t know why anyone would object to that,” said Fitzgerald, who pointed to Boulton’s testimony that non-OB/GYNs do not have the skills to deal with complications.
However, a study published in 2013 in the American Journal of Public Health that followed more than 11,000 abortions concluded that abortion complications were “clinically equivalent” among newly trained nurse practitioners, certified nurse-midwives, physician assistants and physicians. The women in that study all had surgical abortions.
Longer wait times
Like the original bill, Wednesday’s version would lengthen the waiting period for women wishing to obtain an abortion from 24 to 72 hours. Supporters of the bill maintain women need the time to consider what they’re about to do.
“Abortion is oftentimes not freely chosen; it’s often coerced,” said Melinda Snyder, who worked as a physician at the state’s psychiatric hospitals in Butner. She said women needed more time before having an abortion, arguing that many of her former psychiatric patients had been coerced.
“Three days is a totally reasonable time to think and reflect on this,” Snyder said.
“Two extra days of contemplation, time to read through the materials, the information they’ve been given concerning the risks of abortion, gestational age of the baby, just to contemplate an important decision in a woman’s life,” Fitzgerald said. “This decision impacts her for the rest of her life and it ends the life of a baby, so it deserves 72 hours of contemplation.”
But researchers disagree.
“We know that waiting periods are generally unnecessary, since over 90 percent of women have made up their mind to obtain an abortion before making the appointment at the facility,” Elizabeth Nash, a state policy analyst with the Guttmacher Institute, wrote in an email. “A waiting period only delays a woman seeking abortion services.”
And Sarah Preston from the North Carolina ACLU expressed concern that provisions in the bill tripling the waiting period would dissuade women from seeking abortions and physicians from performing them.
“This is constitutionally protected, very safe health care for women,” Preston said.
Many states have a 24-hour waiting period. Three states – Missouri, South Dakota and Utah – have 72-hour waits and Oklahoma has a 72-hour waiting period that will go into effect in November.
Notifying DHHS
Another new provision in the bill would require physicians to send documents and records that justify the doctor’s estimate of the fetus’ gestational age, measurements of the fetus and ultrasound images to the Department of Health and Human Services.
“I assume then that … DHHS will second-guess the doctor’s judgment about the gestational age of the child at the point that he agreed to perform the procedure?” asked Sen. Terry Van Duyn (D-Asheville).
“I don’t see it that way at all,” said Sen. Joyce Karwiec (R-Kernersville). “It’s just the doctor saying this is the age and this is how I determine what the age was.”
But the greater worry for some lawmakers was whether privacy of the patient and the physician would be maintained. Sen. Mike Woodard (D-Durham) questioned how privacy would be maintained and would comply with federal HIPAA law.
Adam Sholar from DHHS said that if a physician follows standard HIPAA rules, it shouldn’t be a problem.
Nonetheless, Sen. Stan Bingham (R-Denton) floated an amendment that would make a physician’s name confidential in the records submitted to DHHS. The measure passed.
Medical community reacts
Mississippi is the only other state with the requirement that an abortion provider be an OB/GYN, and restrictions in that state have been opposed by the American College of Obstetricians and Gynecologists.
ACOG also maintains that restrictions on “a woman’s reproductive choice actually jeopardize her safety and are also attacks on her health,” according to a statement sent to N.C. Health News late Wednesday.
“Research and experience have shown that where abortion is illegal or highly restricted, women resort to desperate, dangerous means to end unwanted pregnancies,” the statement said.
Requests for comment from the N.C. Society of Obstetricians and Gynecologists had gone unanswered by the time of this writing.
But Greg Griggs from the N.C. Academy of Family Physicians (an N.C. Health News sponsor) worried that having the legislature deciding a physician’s scope of practice was outside of its purview and put legislators on a “slippery slope.”
“The North Carolina Medical Board ultimately decides what a physician’s scope of practice should be based on the physician’s training and competence, not a specialty designation,” Griggs told the committee.
“If you begin to limit practice by specialty designation, are you then going to ultimately say that only psychiatrists should treat any mental health issue? Only a dermatologist can treat any skin condition?”
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