States are passing hundreds of new abortion restrictions. Here’s what it’s like to operate in one of them.
The Washington Post [article link]
This week, the Guttmacher Institute released an analysis showing a dramatic increase in the number of antiabortion measures enacted by states across the country. Several states have gone from being “friendly” to “hostile” to abortion over just the last five years, including Arizona, which passed a slew of restrictions in 2011. Gabrielle Goodrick is an abortion provider in Phoenix, and describes what it’s been like to operate in a vastly changed legal landscape.
We went from one extreme to the other, and I’ve lived through the whole thing. It’s like I moved from California to Louisiana without moving. Without lifting a finger, I changed states.
I was trained as a family physician here in Phoenix. I rotated through Planned Parenthood here in Phoenix, and I liked what I was doing, so I continued training and working there for the first five years until 1999, and then I opened my own office, Camelback Family Planning. At the time, it was a doctors office. And then I started doing abortions in my office. I was kind of thinking about it, and one of my family practice patients had an unplanned pregnancy. I told her, ‘if you want to come back in two days, we can do it, like any other medical thing.’ So she went home, we did a couple of consent forms, and that was it. Then I started getting referrals. Literally I needed a pulse oximeter to monitor their vitals, a vacuum machine and staff and a recovery room, and the knowledge and skills to do it.
That could never happen now. You have to be a licensed abortion clinic, and have inspections, and all kinds of things that didn’t exist in the year 2000.[Janet] Napolitano was our governor until 2008, so we were protected. It wasn’t that our legislature was different, it’s just that everything was vetoed. And literally within six months of her leaving [to run the Department of Homeland Security] after Obama was elected, I guess the lieutenant governor came up and it was Jan Brewer. That was the start, and it’s been non-stop since. We didn’t have that one key person vetoing, just 10 years of built-up legislation.
Gradually, it just kind of took over my practice. Not only because of patient need, but because of the amount of effort — it just takes over. I have to have RNs now, and monitoring. There’s so much involved in it, so I wouldn’t do that for a few procedures a week. To do more than 5 abortions a month, you have to be a licensed abortion clinic. So now probably 5 percent of my practice is general practice.
Even in the last 4 years, we’ve lost a lot of clinics. There’s 3 Planned Parenthood locations that do medical abortions and surgery. But really in terms of private clinics there are maybe 4 or 5. Texas has a lot of press, but we have no rural providers at all. The only place you can get an abortion is Phoenix and Tucson, and even Tucson is very limited [Note: There is also a Planned Parenthood location in Flagstaff]. People travel from all over the state. We’re not as big as Texas, but we’ve had the law banning nurse practitioners from performing medical abortions. So we caught up very quickly. It was shocking, it was just one thing after another.
When the licensing of the office came into practice, which was in force starting in 2011, it would deter any private office from providing abortions, because who wants to do that, be under such scrutiny. The governor has influence over the health department, the medical board. They appoint people and have their agenda, so you’re targeted. I think that completely eliminated the idea that any office would start offering it. I know a lot of doctors have retired. And some doctors are just working part time here, because they’ve had it, it’s way too much.
“That could never happen now. You have to be a licensed abortion clinic, and have inspections, and all kinds of things that didn’t exist in the year 2000.”
As a doctor, I’m kind of unique, because most of the other clinics in Arizona have always been clinics. Like Planned Parenthood, they have national resources — HR, media people, lawyers. They have policies and procedures, all these things. When you open a medical office, you have charts and equipment and you go, you practice medicine. So that was my situation, and then all of a sudden I’m supposed to develop policies and procedures for everything.
I don’t have an administrator. I’m just a doctor in a solo practice. So for me to make that change was pretty traumatic, when the state comes through [to inspect]. The first time, in 2011, we had coffee in the break room, she looked over my policies, everything was perfect, and that was that. I think they just gave everyone a pass the first year, because they didn’t know what they were doing. And then the next year, they came through, and it was like the Gestapo. I didn’t have a policy for this or that. It was very nasty.
And then this last year they came in March. I felt extremely prepared for them, and it was still very invasive, very hostile. I know Planned Parenthood had a bad time, because they came through with a search warrant. It is not for the safety of the public. It is to harass. They cite you for not following your own policy — which could be, you give the patient their medicine and do the procedure at this time, well, you did it five minutes early, that violates your policy. That’s what they got me on. Planned Parenthood had a policy to do vitals every 15 minutes, and there was one time they did it every 17 minutes, and they gave them a citation.
So it’s very stressful. I have about 20 binders of policies and procedures for everything. It’s all specific for an abortion procedure. And then there’s the 24 hour wait, the information session, the ultrasound that has to be printed, she has to see it. And none of this has done anything to improve the health of the patient. We still have an excellent record, we don’t have complications. Patients were doing fine. Were there problems? No. were there complaints? No.
The waiting period was probably the worst for patients. You have to do the meeting first, it has to be with a physician, you can’t have a nurse do it. That has been an incredible burden on women, and on us. I have to meet with every single patient. The law says we can’t charge for that visit. There’s not good public transportation here in Phoenix. And we’re a huge city. Coming from out of the city, it’s really difficult. And there’s no Medicaid funding for abortion here. Our current fee is $580. We do access the Justice Fund through the National Abortion Federation, for financial aid.
Immediately, my costs all went up because of everything, just expense after expense. So the prices go higher. At Planned Parenthood, the wait now is a week or two for an information session, and another week or two for an abortion, so people are waiting, waiting. All the new laws have completely overwhelmed our systems. We’re the fifth largest city in the county, imagine. It’s pretty rough.
And nothing has changed medically. We’re giving the same care. there’s some extra binders in my office, our charts are now twice as thick. I have to get a notarized document saying I didn’t perform it because of race or sex, because I could be sued by any family member of the patient. We were the first one to pass that law.
I’m pretty motivated. It’s what I do. I love my job. But we’re facing a really hostile legislature this year. We’re pretty sure they’re going to try to pass some hospital-based standards that could affect the physical structure of my office, like hallway widths, which closed most of these places in Texas. I own my office and I could make the changes. But I just have to take it year by year, because every year, there’s new laws.
And now I’m kind of like, what else could they do? And I guess, there’s quite a bit of things they could do. And then it’s like, well are we going to be able to fight this in court? Are we going to get help from the ACLU and the Center for Reproductive Rights? I don’t have the resources to fight. Like the 24-hour in-person consent — Planned Parenthood chose not to fight that, because you can’t, most states have that now. But oh, boy, what a devastating thing.
We did fight the medical abortion thing, went to 9th Circuit Court in San Francisco, we fought that off. That alone would’ve probably have made the waiting periods double, and the cost would skyrocket, and we just don’t have enough providers. Thank God we fought that one. That would’ve devastated all of us.
“And now I’m kind of like, what else could they do? And I guess, there’s quite a bit of things they could do.”
A lot of this is beyond what the typical patient or person would understand. When these laws passed in Arizona, it happened so quickly, that native Arizonans will come in and say ‘I had no idea,’ because they don’t realize they live in a state like Louisiana now. ‘Wow, I didn’t know I had to do all this and that,’ or ‘Wow, when did this all happen?’
I feel like jumping up and down. We are suffering here, women are suffering. It just puts people underground. My numbers are the same as they’ve ever been. It’s harder, it’s more expensive, people come in later.
And it impacts minority women, poor rural women. Women of means, this isn’t a problem. Before Roe v. Wade, rich women could get abortions, you just had to tell two physicians you were suicidal. And it’s the same now.