DHHS releases proposed abortion clinic rules
Posted December 1, 2014
Updated December 2, 2014
Raleigh, N.C. — North Carolina's Department of Health and Human Services on Monday released its proposal for tighter rules for abortion clinics. The draft rule appears to avoid major changes that could force some clinics to close.
The proposed rewrite of the regulations would increase accountability and oversight at the clinics. Each clinic would be required to have a governing authority board that would meet at least once a year. It would designate a chief executive officer with final authority over day-to-day operations at the clinic.
The proposal would also require each facility to have a designated nursing supervisor, as well as full personnel records, procedure handbooks and equipment manuals on site. Clinics would have to have a defibrillator on the premises and would have to provide patients with a contact number staffed around the clock in case of problems after a procedure.
Under the draft rule, each clinic would have to have a quality assurance board that would meet quarterly to review records, protocols and procedures at the clinic. The board would be required to include at least one doctor.
The rule would require clinics to attempt to set up a formal "transfer agreement" with a nearby hospital to admit patients in case of complications. However, a clinic that is unable to get a hospital to agree to such a deal would still be considered in compliance with the rule, as long as its owner can document that he or she made the attempt. DHHS spokesman Kevin Howell said the requirement is the same as for ambulatory surgical centers.
The rule is the product of 2013's Senate Bill 353, titled the "Health and Safety Act," which made major changes to the state's abortion laws. One section of the law required DHHS to formulate new rules for clinics intended to improve safety for patients.
The rule-making process involved a group of stakeholders that included an abortion provider. Still, abortion rights advocates were concerned the new rules may be used to force clinics to shut down through what they refer to as TRAP, or "targeted regulation of abortion providers."
For example, an earlier version of the North Carolina bill would have required abortion providers to have admitting privileges and "transfer agreements" with a local hospital. Because hospitals are sensitive to protests and political pressures over funding, they often decide not to extend those privileges or sign those agreements, forcing the clinic to close.
Similar laws have resulted in the closure of abortion clinics in several states, including Mississippi, Texas and Ohio.
Another common TRAP provision is to require all abortion clinics to meet the same standards as ambulatory surgical centers. The licensing and engineering requirements for surgical centers, from hallway width to parking spaces, are far more stringent than most existing abortion clinics can meet.
Despite advocates' concerns, the draft rule does not appear to include any such provisions.
Howell said the 18-month rule-making process included plenty of feedback from medical experts, including a representative from the North Carolina Board of Nursing, three OB/GYNs, two provider representatives, a surgeon and two emergency department physicians.
He called the changes "common sense measures" aimed at improving patient care and privacy.
"The proposed rules meet constitutional requirements and comply with Senate Bill 353 by improving patient safety and privacy while preserving access to services,” state Health Service Regulation director Drexdal Pratt said in a statement.
State Planned Parenthood spokeswoman Alison Kiser said the organization's first priority is the health and safety of its patients. She said its legal team is reviewing the proposal carefully.
"Planned Parenthood is committed to providing high-quality, nonjudgmental abortion services to the women of North Carolina and will comply with all regulations in order to keep our doors open to the patients that depend on us," Kiser said in a statement. "We were pleased to have our input sought in the DHHS regulatory process as a trusted health care provider and women’s health care expert. For the past 40 years, the Planned Parenthood affiliates in North Carolina have been committed to serving the health care needs of the 25,000 women, men and young people that come to us every year for high-quality, affordable health care.”
DHHS has scheduled a public hearing on the proposal for Dec. 19. The agency will accept public comments on the draft rule until Jan. 30, 2015. After that, if it's officially approved by the agency, it goes to the state Rules Review Commission. If it wins approval there, it would take effect April 1, 2015.
However, under the state's rule-making statute, state lawmakers have the power to rewrite the rule themselves if 10 people submit objections in writing.
“We believe it’s critical that this rule-making process not be politicized by the same political interests and lawmakers that sought to eliminate access to abortion care in the first place,” said NARAL Pro-Choice NC director Suzanne Buckley.
Bill sponsor Rep. Pat McElraft, R-Carteret, did not immediately respond to a request for comment.