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Issue in Texas Abortion Debate: What's an Ambulatory Surgical Center?

Ben Philpott
A surgical suite in the San Antonio ASC abotion clinic.

A bill that would regulate and restrict abortion in Texas has been approved by a House committee and is expected to be approved by the full House next week. Debate over the bill has played out between protestors in the halls and grounds of the Capitol as much as it has between lawmakers.

So this week we’ve tried to take a step back from the emotional protests and focus on what’s in the bill. On Tuesday’s segment we heard from supporters of the abortion bill, like Texas Right to Life director Elizabeth Graham, who said the legislation would make abortions safer.

“When we talk about safe, we find that abortion clinics are not up to par. They don’t have hallways, many of them, that are wide enough for gurneys to fit through," Graham said. "So when there is a botched abortion or an abortion complication, the abortion clinics are ill-equipped to respond to an emergency situation.”

Today we’ll hear from abortion providers who dispute those concerns about safety. Austin gynecologist Christian Sebastian is on the local Planned Parenthood community board. She points to the part of the bill that would require abortion doctors to have admitting privileges at a hospital no farther than 30 miles away from their clinic.

Sebastian said the proposal doesn’t make sense because some women are driving 100 miles or more to get to one of the state’s 42 abortion clinics.

“They’re generally going home after their procedure. And wouldn’t necessarily, if they had a complication, be coming to the hospital that was adjacent to where the termination was actually performed," Sebastian said.

During Tuesday’s committee hearing the Texas Hospital Association said their members aren’t likely to grant those admitting privileges anyway. Amy Hagstrom Miller is president and CEO of Whole Woman’s Health, which has abortion clinics in five Texas cities. At the hearing, she said hospitals have a financial reason to reject an abortion physician looking for admitting privileges: hospitals grant privileges to doctors who can bring in business.

“Abortion hardly has any complications, period. We’re not revenue generators for hospitals. We don’t bring business to the hospital as abortion providers," Miller said.

Then there’s the provision of the bill that would require abortions to only be performed in facilities that meet the standards of an ambulatory surgical center, or ASC. Miller has one of the five ASC abortion clinics already up and running in Texas. I took a tour of the San Antonio facility in April. Once we got past the lobby, the facility looked much more like an emergency room than a doctor’s office –including the bright red line that divides the sterile surgical suites from the rest of the center.

“And you see basically an operating room suite that looks like we’re doing brain surgery right. I mean, there’s giant lights on the wall. There’s a big operating room table. There’s a full anesthesia machine. This room is about three or four times the size of a procedure room that would be in an abortion facility," Miller said as we toured one of the clinic surgical suites.

Miller said ASCs, with physical requirements including wide doorways, separate janitors’ closets, and environmental controls that keep rooms cold and blankets warmed to specific temperatures, were created for surgeries.

“Abortion is a procedure. It’s not really a surgery. There’s not any incisions, there’s not any stitches. The procedure itself takes maybe five or 10 minutes. So it’s not like an operation that has multiple physicians where the patients knee is open or her belly is open for a sort of more invasive that this sort of ambulatory surgical center was really devised for," Miller said.

And then there’s the cost. Miller said it would have cost her one and a half million dollars to build the center she leases in San Antonio. And it took her six years to find an ASC that was about to close its doors so she could come in and lease it.

The facility costs her $40,000 more a month to operate than her other abortion clinics. She said if the abortion bill becomes law, the cost of upgrading abortion facilities will be too big and the number of clinics in Texas will drop from 42 to 5.

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