One month after new regulations took effect for Pennsylvania abortion facilities, most providers have only temporary licenses as they grapple with the complicated new rules — and the massive costs associated with obeying them. Two Pittsburgh facilities have already shut down.
Passed by Harrisburg Republicans and signed by Gov. Tom Corbett late last year, Act 122 went into effect June 19. The measure reclassified freestanding facilities that perform surgical abortions, treating them as "ambulatory surgical facilities" with much stricter requirements, and requiring licensure by the state.
At least two facilities — Allegheny Women's Center, in East Liberty, and a division of Magee Women's Hospital of UPMC — have closed voluntarily as of June, according to the state. UPMC officials did not respond to calls for comment by press time; a number for the Women's Center was disconnected.
So far, only one clinic in the state is fully licensed under the new rules, while others are operating under temporary licenses. Five facilities — each of which provides abortions using only local anesthetic — have been given three-month licenses, and only require accreditation by a national agency to fully comply with state regulations. Another eight facilities that perform abortions with sedation have been granted six-month licenses; these must comply with a host of new requirements, including having a hospital-grade elevator. Among these are Planned Parenthood of Western Pennsylvania, which operates a facility Downtown, and Allegheny Reproductive Health Center, in East Liberty.
"Our doors are open today ... but the regulations are burdensome," says Planned Parenthood spokeswoman Rebecca Cavanaugh. "But no matter what it takes, we'll stay open."
During the debate over the bill in 2011, providers and advocates argued that the financial cost of onerous personnel or construction regulations would force facilities to close their doors or pass the cost onto the patients, making abortions even more inaccessible.
"Because providers don't have full licenses yet, it's still an open question about what the impact will be," says Susan Frietsche, senior staff attorney with the Women's Law Project, which acts as counsel to Allegheny Reproductive Health and several other clinics in the state. "We're not done yet."
In any case, she says, "It'd be very daunting for new providers to come forward in this regulatory climate." And not all of the costs can be calculated in dollars and cents.
At the Philadelphia Women's Center, "my ability to develop new programs that would help the community is severely limited by the time spent on this," says Curtiss Hannum, director of center affairs and development. While she doesn't have a cost estimate on what compliance will cost, the center's investment "has been pretty significant," she says. "And we haven't done any construction yet."
The Department of Health has granted the facility a provisional license and several exceptions, but the center is still working through the remaining requirements. As required by the law, the center has hired an architect to prepare an elaborate blueprint of the facility to submit to the state. But although it intends to pursue one, Hannum says it's uncertain if the facility can afford to get a full license; upgrading the center's HVAC system alone could cost $300,000 based on preliminary quotes, she says.
The Department of Health is granting exceptions to some requirements on a "case-by-case, location-by-location basis," says health department spokeswoman Christine Cronkright.
The law does allow the department to grant exceptions in cases where requirements "would create an unreasonable hardship and an exception would not ... endanger the health, safety or welfare of a patient." But the Law Center's Frietsche says that so far, the Health Department's decisions have seemed "arbitrary."
According to Cronkright, Act 122 regulations "have had a very smooth implementation. We're very confident we can work with the facilities."
But surgical abortion providers question what will happen after their provisional licenses expire in December. Penalties for non-compliance vary from submitting and following a plan of correction to full closure. "It depends on the severity and the frequency of the violations," Cronkright says.
Some providers contacted by City Paper did not wish to speak on the record about their concerns, for fear of jeopardizing their license applications. But Hannum says the process has been cordial: Many DOH staff, she says, "have been educating themselves" on abortion care.
"The feeling hasn't been a political one. It's ‘How do we figure this out?'" Hannum says. "It has been frustrating, though. ... When we ask, ‘What piece of the guidelines apply to us?' they're figuring it out, too."
And she admits it's been hard to overlook the fact that the regulations were pushed by anti-choice legislators, who often made little secret of their desire to put clinics out of business.
"This is frustrating on a good day and maddening on a bad day," Hannum says. "It's so disheartening knowing where this came from. It was from such a disingenuous place."