Hospital boards, executives, and hiring committees across Texas are now tasked with answering a question they have never before been asked: which Texas doctors are qualified to provide legal abortion care?
This is the result of one of the four provisions of HB 2, the omnibus anti-abortion law passed in a second special legislative session last summer that drew thousands of Texans to their state capitol in Austin to speak up for reproductive rights. In part, the law requires doctors who provide legal abortion care to obtain admitting privileges at hospitals within 30 miles of where they perform procedures, or prescribe medication to induce abortion.
According to two Dallas OB-GYNs, at least one Texas hospital has already succumbed to outside pressure from anti-choice activists to revoke admitting privileges granted to doctors who perform abortions.
In response, one Austin woman is asking her fellow Texans to remind their community hospitals and doctors that abortion is health care, and the public supports safe, legal abortion care.
Sarah Tuttle, an astrophysicist who also serves on the board of the Lilith Fund for Reproductive Justice, calls her effort a “community campaign” meant to encourage medical professionals to see their abortion-providing fellows as, well, the professional peers that they are.
“Laws like this move decisions about fundamental health care from the public purvey into the private purvey,” Tuttle told RH Reality Check. Her website, Abortion Is Healthcare, contains sample letters that she’s encouraging her fellow Texans to send to their own OB-GYNs, telling them: “It disappoints me to see our abortion providers, even when they are privately supported, publicly abandoned.”
For many Texas hospitals, the decision to grant admitting privileges to doctors is more about the business those doctors might be able to generate than a definitive statement about the quality or skill of the doctors themselves.
Amy Hagstrom Miller, who owns a group of abortion-providing health centers in Texas, Minnesota, and Maryland, said earlier this year that she was forced to close her South Texas clinic when doctors in McAllen, near the U.S.-Mexico border, failed to stand up in support of the abortion providers who worked in her facility there.
Without vocal support from the medical community—many members of which, Hagstrom Miller said, were afraid to come out in support of abortion rights despite referring their patients to her doctors when they needed legal abortion care—doctors are often unable to secure the sponsorships and recommendations they need to obtain privileges at hospitals.
“The thing I’m enraged about is the absolute silence from doctors who referred their patients for abortion,” Hagstrom Miller told RH Reality Check in February, just before HB 2 forced her to close her facilities in McAllen and in Beaumont, Texas.
Hospitals themselves, and the doctors, executives, board members, and staff who are tasked with granting or revoking doctors’ admitting privileges, can be susceptible to coercion and pressure from a vocal anti-choice community that has threatened to picket and protest at hospitals which grant admitting privileges to abortion providers.
Earlier this year, a Dallas hospital suddenly revoked admitting privileges to two abortion providers, telling the doctors in a letter that because they provide legal abortion care at offsite, non-hospital locations, their affiliation with University General Hospital Dallas would create “significant exposure and damages to UGHD’s reputation within the community.”
That letter was written and signed by University General Hospital CEO Charles Schuetz, a Republican political donor. As an entity, University General Hospital, L.P. has donated $105,000 to four different Republican campaigns, including the David Dewhurst Committee—Dewhurst, Texas’ outgoing
lieutenant governor, famously tweeted last summer that shuttering all but a handful of abortion providers in the state, rather than increasing the safety of abortion procedures, was the express intent of the omnibus anti-abortion legislation his party ushered through.
Schuetz’s language concerning his hospital’s “reputation” mirrors language used by Mark Crutcher, an anti-choice North Texas man who told an anti-choice blogger this month that his organization, Life Dynamics, has sent “a letter to every hospital administrator in Texas.” Crutcher’s letter tells hospitals, in part:
the competence and character of practitioners who work at abortion clinics is inevitably beneath the standards insisted upon by most hospitals; hospitals do not want to have their reputations damaged by the stigma that accompanies both abortion and the people who do them …
In November 2013, Life Dynamics also sent a graphic mailer entitled “Hired Killers” to Texas doctors, calling abortion providers “the most prolific killing machine the world has ever known,” and alleging that they are “out to recruit” their fellow medical professionals.
University General Hospital Dallas settled out of court with the abortion providers whose privileges it revoked, after the doctors sued the hospital on the basis of a state law that bars hospitals from discriminating against physicians who provide legal abortion care. The doctors have retained their admitting privileges, though both will be forced to stop providing abortion care at their clinics this September, when the part of HB 2 that requires abortion facilities to operate as hospital-like ambulatory surgical centers goes into effect, leaving a total of six legal abortion facilities open in the state.
Despite the overwhelming safety of legal abortion as a medical procedure—14 times safer than childbirth, aspiration abortion performed before 13 weeks’ gestation has a less than 0.5 percent complication rate for complications that require additional surgical procedures and/or hospitalization, according to the National Abortion Federation—Texas law now requires abortion providers be singled out for scrutiny by the hospital staff and executives, without whose approval Texas doctors cannot perform legal abortion care in off-site, non-hospital clinics.
While state law governs where, and in what type of facility, a wide range of medical procedures may be performed, abortion providers are the only doctors in the state who are uniquely required to have admitting privileges in order to perform this one procedure—whether that involves prescribing medication that induces abortion, or performing an in-clinic abortion.
Mainstream medical associations opposed HB 2’s admitting privileges requirement when conservative legislators proposed it last year; while lawmakers claimed it would raise the standard of care for people who seek legal abortions in Texas, the Texas Medical Association, the Texas Hospital Association, and the American Congress of Obstetricians and Gynecologists (ACOG), did not agree. In fact, ACOG wrote an open letter to Texas legislators opposing the requirements, stating that Texas’ new abortion restrictions would “jeopardize women’s health care and interfere with medical practice and the patient-physician relationship.”
With her Abortion Is Healthcare initiative, Sarah Tuttle told RH Reality Check that she hopes to remind doctors and hospitals that their patients—the people who pay their bills—support legal abortion care.
“It’s easier for health-care providers to say they’re already so wrapped up in regular lawsuits from regular malpractice suits, it has made the medical providers exceptionally risk-averse,” said Tuttle. “When they don’t hear community support, it’s very easy to say, ‘We can’t [publicly support abortion care] right now.'”
Tuttle is encouraging Texans to host letter-writing parties in their homes and worship communities, and to send those letters to their private physicians, general practitioners, and OB-GYNs.
“I’d like us to start reaching out to our everyday OB-GYNs, to hospitals, to dentists, to all the people who support that whole medical infrastructure,” Tuttle said. She herself is starting in Austin, where she lives, asking the dean of the new University of Texas medical school, which is affiliated with the Seton Catholic medical system, to “strive to give our medical students a robust education including compassionate reproductive health care.”
“This isn’t about peer pressure from the outside,” Tuttle said, but about “having a letter writing group at your church or temple or group of friends, saying ‘This is important to us, and I care about what happens in my community.'”