On a recent Saturday morning at Hope Medical Group for Women in Shreveport, La., Kathaleen Pittman was preparing for a day of procedures, as a couple dozen patients sat quietly in the waiting area.
Her clinic is challenging a law passed by Louisiana's state legislature in 2014, which requires doctors who perform abortions to have admitting privileges at a local hospital in case of an emergency. The case, June Medical Services, LLC v. Gee, is scheduled to go before the U.S. Supreme Court next year, and the court's decision has the potential to chip away at existing precedent protecting abortion rights.
"The whole process of trying to obtain privileges is crazy," Pittman says. "It's time-consuming. It could be a process of a few months to actually years. There are no guarantees."
Admitting privileges: unpredictable, sometimes impossible to get
Pittman has been working here since the early 1990s, when she started as a part-time counselor. Pittman says if the law stands, it would leave few doctors in Louisiana who perform abortions.
The clinic currently has two doctors performing abortions — one who has admitting privileges, and one who does not. Pittman says the other doctor has been trying for years to get admitting privileges, without success. She believes concerns about the politics and stigma around abortion have made getting privileges difficult.
"We have discovered that not all hospitals will just outright deny privileges," Pittman says. "They just won't take any action, which is the same thing. But it's not in writing. So what do you do?"
Not only are admitting privileges hard to get, but the U.S. Supreme Court has ruled that requiring doctors who perform abortions to obtain them doesn't provide any substantial medical benefit to patients, but it does put a major hurdle in the way of patients seeking abortions. In its 2016 opinion, Whole Woman's Health v. Hellerstedt, the court said a Texas law, which included a hospital admitting privileges requirement, "poses a substantial obstacle to women seeking abortions, and constitutes an 'undue burden' on their constitutional right to do so."
"What's on the line is the continued protection by the Supreme Court of access to abortion services," says Nancy Northup, president and CEO of the Center for Reproductive Rights, which is representing the Hope clinic. "And what's on the line is the Supreme Court's integrity, because nothing has changed since they rendered their decision in 2016."
A changing court and existing precedent
What has changed is the makeup of court since that 5-to-3 decision in 2016. Justice Anthony Kennedy, often the swing vote on abortion, has retired, and President Trump has named two justices — Neil Gorsuch and Brett Kavanaugh — to the bench.
Northup warns that the law could force most of the state's few remaining clinics to shut down, and "open the floodgates" for similar rules elsewhere.
Louisiana Solicitor General Liz Murrill is defending the law. She says the case isn't about the legality of abortion – that was decided under the Roe v. Wade decision in 1973, she notes. Instead, Murrill says it's about letting states set the conditions for the procedure.
"I don't think Roe was correctly decided," she says. "But that's not my decision. That's the law of the land, and this case isn't going to change it."
Abortion rights opponents who helped push through the law, such as Ben Clapper of Louisiana Right to Life, are hoping the court will allow state regulations like Louisiana's to stand. He argues abortion clinics should be regulated at the same level in Louisiana as a type of outpatient facilities called ambulatory surgical centers.
"There's no constitutional right to an unsafe abortion in America," Clapper says. "And we think if ambulatory surgical centers have this set of rules when it comes to privileges, then abortion facilities should have the same set of rules. And if a physician can't meet those rules, then the same practice should apply that they shouldn't be able to operate in those arenas."
At a crisis pregnancy center in Slidell, outside New Orleans, Cindy Collins counsels women against abortion and offers free baby clothes, diapers, and other assistance to new and expectant mothers. Collins says she had several abortions as a young woman in the 1970s, experiences that inspired her to become an opponent of abortion rights.
Collins testified in favor of the hospital admitting privileges bill when it was working its way through Louisiana's state legislature in 2014.
"Women deserve [for their doctors to have] emergency admitting privileges, even if it's just one woman," Collins says. "...I believe it's very important. [It] would bring up a level of accountability.
The medical consensus
But several major medical groups say hospital admitting privileges are not necessary for abortion providers and provide virtually no medical benefit to patients. In a friend-of-the-court brief earlier this month, the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association, the American Academy of Pediatrics and others, say abortion is a safe procedure, and that there's no medical reason to require doctors who perform abortions to have privileges.
"It is a very rare instance where a patient would have a complication — and even more rare in a case where they would need to be hospitalized," says Dr. Maureen Phipps, ACOG's CEO.
In such cases, Phipps, says, a woman should go to the nearest hospital for treatment.
"Serving God before man"
But in this conservative, Bible-belt state, those arguments don't always carry the day – even with Democrats, such as State Sen.-elect Katrina Jackson. She sponsored the bill as a state representative in 2014.
Jackson says her views on abortion are deeply tied to her Christian beliefs, and acknowledges they're at odds with those of most members of her party.
"But it didn't matter...because what I had told my district when I ran, I told them I was against abortion," Jackson says. "I told them that I wasn't perfect, but I was going to do everything I could to serve God before I serve man in the legislature."
Jackson describes herself as a "whole-life Democrat," which, she says, means supporting affordable housing, public funding for healthcare, and criminal justice reform. She insists that while she opposes abortion, the goal of the law she sponsored has always been to protect women, not ban the procedure.
"This wasn't about whether or not abortion was legal," Jackson says. "It was just common sense."
A "taboo, overwhelming process"
At the clinic in Shreveport, none of the women in the waiting room want to talk to a reporter.
"It's already a taboo, overwhelming process for young women here in Louisiana," says Lillian Newton, 30, who started working here more than a year ago, after having two abortions at the clinic herself. She worries about what will happen if the law is upheld.
In a region with many restrictive abortion laws and a declining number of clinics, Newton says the women she counsels often travel a long way to get here.
"We've had patients who drive from Mississippi, from Arkansas, from Oklahoma," Newton said. "We've seen patients from make four- or five-, six-hour trips."
Newton says if Louisiana's admitting privileges law is allowed to stand, even if abortion remains legal, it will be harder for women here – and beyond – to get one.
The case is set to be argued before the U.S. Supreme Court on March 4, with a decision expected just months before the 2020 election.
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