Abortion clinic regulations get more detailed

? If a woman has an abortion in Kansas, the room temperature will have to comfortable — between 68 and 73 degrees, in fact — under a new state health department rule taking effect in July.

The room where the abortion occurs also will have to have at least 150 square feet, excluding “fixed” cabinets, and come with its own janitor’s closet with 50 or more square feet. The provider will be required to keep 13 types of drugs on hand, along with blood pressure cuffs for adults, children and even infants and premature babies. Patients will have to remain in a recovery room for at least two hours afterward.

The new regulations for abortion providers in Kansas are more specific in places than they are for hospitals and ambulatory surgical centers, and more detailed than the rules for most clinics and offices in which doctors perform many surgical procedures.

The new regulations will be scrutinized closely in coming weeks, perhaps in court. The Kansas Department of Health and Environment is imposing the rules under a new state law, also taking effect July 1, establishing a special licensing process for abortion providers.

‘Safe, reliable health care’

The rules set requirements for room sizes and the number of bathrooms and janitor’s closets for each abortion provider, and list required medications and equipment.

“Implementing the new regulations has been consistent with the work KDHE is already doing to ensure Kansans have safe, reliable health care in all facilities within KDHE’s purview,” said department Secretary Robert Moser, himself a physician.

The state’s three abortion providers, all in the Kansas City area, view the regulations as unnecessary and burdensome by design. Gov. Sam Brownback is an anti-abortion Republican, and abortion opponents pushed the law through the GOP-controlled Legislature.

The providers need a special license from the health department to keep performing abortions as of July 1. A Planned Parenthood of Kansas and Mid-Missouri clinic in Overland Park underwent a two-day state inspection last week, and an inspection of the Women’s Health Center, also in Overland Park, is set to start Wednesday.

The health department rejected a license for the Aid for Women clinic in Kansas City, Kan., without an inspection, based on information it included in its application. Abortion rights supporters fear the other two providers won’t get licenses either, however their inspections turn out.

“The right to abortion services in Kansas is at stake,” said Cheryl Pilate, Aid for Women’s attorney.

Different standards

The health department regulates more than 230 hospitals and ambulatory surgical centers, which include the Planned Parenthood clinic. The state’s other two abortion providers are among dozens of other offices and clinics falling under rules for office-based surgeries set by the State Board of Healing Arts, which regulates physicians.

Pilate said Aid for Women disclosed in its application that its clinic needs extensive renovations to comply with the health department regulations for abortion providers.

The health department’s regulations for hospitals and surgical centers don’t include specific room sizes. Instead, they’re tied to standards from the American Institute of Architects for medical facilities, which call for at least 360 square feet of unrestricted space for surgery rooms. But those standards apply to new construction.

Specific room-temperature requirements don’t appear in the standards for hospitals, surgical centers or office-based surgery sites. For abortion providers, the regulations even differ for procedure rooms and recovery rooms, where the temperature must be between 70 degrees and 75 degrees.

Joseph Kroll, the director of the health department bureau that drafted the regulations, said it tried to set a “gold standard” for patients.

But abortion rights supporters contend the real goal is to keep existing providers form performing abortions and to make it impossible for doctors to open new abortion clinics.

“The state of Kansas has taken itself to shut down abortion providers,” said Julie Burkhart, founder of the political action committee Trust Women.

National Abortion Federation guidelines

Mary Kay Culp, executive director of the anti-abortion group Kansans for Life, said the Kansas regulations draw on standards set by the National Abortion Federation, the professional association for providers.

“If they are the model medical clinics they always claimed they are, these regulations should not be a problem,” Culp said.

The federation’s latest clinical policy guidelines touch on some of the same subjects as the new Kansas regulations, such as controlling infections and managing medical risks. They also recommend drugs and equipment to be used in particular circumstances.

But the federation’s guidelines focus more on individual procedures and don’t discuss clinic buildings. In standards for post-operative care, the federation says patients can’t be discharged until they are mobile, their pulse and blood pressure are stable and their pain and bleeding are under control. But the standards don’t set a minimum time in the recovery room.

The health department’s standards for surgical centers also don’t set a minimum recovery time. They say a patient who has received anesthesia “shall be discharged in the company of a responsible adult,” though the attending physician can waive the requirement.

There is no specific recovery-time guideline in the office-based surgery rules, either.

Providers and abortion rights advocates equate first-trimester abortions — the vast majority of those performed in Kansas — with other, minor office-based procedures. Dr. Herbert Hodes, who performs abortions at the Women’s Health Center, said the most common procedure there can be done in 2 minutes or less.

“It’s certainly less complicated than pulling all four wisdom teeth,” he said.

But a conflicting view of abortion led the backers of the new regulations to push for the law under which they were drafted. And Kansas will have significantly different rules for abortion providers than for physicians performing other office-based surgeries, or for surgical centers and hospitals.