Abortion’s Not in Kansas Anymore?

[Jump to Update.]

When I reach Dr. Ronald Yeomans on his cell phone Thursday evening, he is out fishing—just as his wife Helen has said he would be. After all, Dr. Yeomans has put in two long days at work. On Wednesday and Thursday he saw more than twice the usual number of patients at his abortion clinic, Aid For Women, in Kansas City, Kansas. 

But then, this has been an unusual few weeks. Since mid-June, Dr. Yeomans (and the other abortion providers in Kansas) have found themselves scrambling to see as many patients as possible before today; as of July 1, these facilities will not be able to offer abortion services until they show compliance with new regulations handed down only weeks before. 

“They gave us the regulations on something like June 20 or June 21,” recalls Dr. Yeomans. “Operating rooms have to be a certain size. The area of the lavatory has to be a certain size. You have to have a separate area for the employees to get dressed in. They even directed that there had to be a janitor’s closet and it had to be a certain size. Just all kinds of requirements: doors have to be a certain width, hallways have to be a certain width.

“They’re passing it off as being about safety, but it’s a blatant attempt to get rid of legal abortion in the state,” he said.

Dr. Yeomans’ criticisms are shared by other advocates for safe, legal, and accessible abortion. Sometimes referred to as “TRAP laws” (which stands for “targeted regulation of abortion providers”), these types of regulations require abortion providers to meet specific licensure requirements that differ from the requirements for other outpatient surgical facilities, like eye surgery centers, outpatient cosmetic surgery centers, etc. Prior to the May signing of HSub for SB 36, the bill mandating new licensure standards for abortion clinics, Kansas abortion facilities were licensed as part of this more general class of ambulatory surgical centers, or ASCs. Twenty-one states, now including Kansas, impose targeted licensing requirements on abortion clinics for abortions performed during any stage of pregnancy.

Critics of TRAP laws claim that such rules bear no relation to patient safety and are offered in bad faith. The intent, they say, is not to make abortion safer, but to make abortion unavailable, thereby skirting abortion’s legality.

“The anti-choice agenda across the country is to cut off women’s access to abortion services by any means necessary—even if it means unfairly and unconstitutionally singling out abortion providers and holding them to different and more stringent standards than other medical providers,” said Nancy Northup, president and CEO of the Center for Reproductive Rights. The Center, a global legal advocacy organization dedicated to women’s reproductive health, is filing a federal lawsuit on behalf of two other Kansas abortion doctors affected by the new requirements.

“The regulations in Kansas are extremely rigid and have nothing to do with medical safety. Neither hospitals nor ambulatory surgical centers are held to these standards. In addition, this was a bogus licensing process in which our clients were expected to make extensive building renovations and do it in two weeks’ time,” said Northup.  

But proponents of the new regulations claim that the safety standards for Kansas abortion clinics have been too lax, and that the changes were motivated by a concern for patient safety.

David Gittrich is the State Development Director for Kansans For Life, a non-sectarian organization that first approached pro-life legislators about introducing a clinic licensing bill. Gittrich became involved in the pro-life movement in 1980, after a friend insisted he watch a film about abortion. “He would not let me say ‘no’ to his invitation,” Gittrich recalled in an email, “even to the point of driving 20 miles to pick me up and take me to the showing. I was working to build a playground for school children at the time and I couldn’t believe that anyone would kill a baby—particularly in such a gruesome manner.”

Nevertheless, Gittrich emphasizes that an overriding concern here is for the safety of the patients, claiming that Kansas abortion clinics have never had to meet adequate standards of safety. “The abortion industry rarely has to open its doors for inspection,” he said. “We would be delighted if abortion clinics had the same restrictions as Ambulatory Surgical Centers, which are much higher than those they are being inspected for right now.” Moreover, he said, “if you read the new law, the standards are not very restrictive—every medical facility could probably pass inspection.”

KFL Legislative Director Kathy Ostrowski points out that the Kansas Health Department used other states’ licensure requirements as a guide, eventually following Arizona’s and Texas’ regulations most closely. A blog post on KFL’s web page, however, suggests that “most provisions in the new Kansas law were taken from the published standards of the National Abortion Federation.”

“I am quite sure that most of the provisions are not from our Clinical Policy Guidelines [CPGs],” said Sharon Levin, Vice President and General Counsel for the National Abortion Federation, an organization whose mission is to ensure safe, legal, and accessible abortion.

“Our clinical policy guidelines are evidence-based and set the standard for quality care in North America. These onerous and wide-reaching guidelines from Kansas, on the other hand, aren’t based on evidence and impose unnecessary and unreasonable rules—like dictating room temperature and the size of the janitorial closets—that are clearly just there to make it more difficult for abortion providers to remain open and for women to access the abortion care they need,” Levin stated.

“Obviously NAF is very upset that the opponents of abortion in Kansas are trying to use our CPGs to legitimate these onerous regulations,” she continued. “The purpose of our CPGs is to make sure that women get safe abortion care. The purpose of these regulations is to make sure that women don’t get safe abortion care.”

The NAF’s 2011 clinical policy guidelines are 55 pages long; longer than the new Kansas regulations. Like the Kansas standards for abortion clinics—and, for that matter, the Kansas standards for other outpatient surgery centers—the NAF policy guidelines cover various aspects of patient care. There are standards and recommendations for infection control, ultrasounds, taking a patient’s medical history, documentation, proper surgical procedures, anesthesia, emergency resuscitation, control of excessive bleeding, and the maintenance of safe and clean facilities.

What NAF’s guidelines do not spell out, though, are the most controversial items in the new Kansas regulations: rules mandating a separate private dressing room for staff; the fifty-square-foot janitorial closet; and acceptable temperature ranges for different parts of the facility. (The new rules state that each procedure room must be kept between 68 and 73 degrees Fahrenheit at all times, and each patient recovery area must be kept between 70 and 75 degrees Fahrenheit at all times. (See section 28-34-134 of the bill, requirements (1) and (2).) 

By contrast, the Kansas Department of Health licensing survey for other ASCs contains no mention of room temperature. Nor does the Risk Management Survey Report for ASCs. 

The Kansas regulations for freestanding childbirth centers do specify room temperature, but stipulate only that the entire facility must stay between 68 and 90 degrees Fahrenheit. (Licensed birth centers are intended for low-risk laboring women. They offer only three minor surgical procedures: episiotomy, laceration repair, and circumcision.)

For all these reasons (the appearance of a double standard for abortion facilities; the speed with which the new regulations were handed down and compliance mandated; and the perception that the new regulations are intended to get around federal law), the measure has been controversial.

In a recent editorial, the Kansas City Star criticized Governor Sam Brownback for signing the bill, claiming that “[t]he move reflects the same disdain for Kansans that Brownback has shown in other areas of running the state… Abortion is a divisive issue, with strong beliefs on both sides. But Kansans deserve an open, honest discussion, not underhanded maneuvers.”

As for Dr. Yeomans, he chalks it up to theocracy. “I’m thinking of printing up some bumper stickers,” said Dr. Yeomans. “Kansas: Theocracy in Action.” Neither Dr. nor Mrs. Yeomans are hostile to religion per se. In fact, Mrs. Yeomans told me, they have hosted dinner discussions for seminarians in their home. In the days before Roe v. Wade, their clinic assisted a clergy group that helped women procure legal abortions. 

But it’s been a very long two days for Dr. Yeomans, between filling his schedule with patients and filing an injunction to challenge the new law. So one could perhaps understand why, when I asked him about the role of religion in Kansas abortion politics, Dr. Yeomans’ voice sounded weary and frustrated. “We’re dealing with a right-wing theocracy: very right-wing fundamentalists and some Catholics. A group of extreme legislators trying to enact their religious beliefs on everybody else.”

When I asked a similar question to Gittrich via email, he replied, “There is a God-given dignity to every human being—women, as well as the child in the womb. Neither have any dignity or safety inside an abortion clinic. From the foundation of this country, religion is the basis for our laws. Thou shalt not kill is [sic] a law that we have been violating recently and it is our goal to restore protection (and dignity) to every innocent human being.”

He later added, “Everyone in our office rejoiced at the thought of no abortion mills in Kansas… Life is God’s gift to us personified in babies.”


UPDATE: Late Friday, Carlos Murguia, a federal judge, temporarily blocked the new Kansas licensing regulations for abortion clinics. Dr. Robert Moser, appointed by Brownback as Secretary of Health and the Environment, said that his office would uphold the law. Judge Murguia’s temporary ruling was based on the fact that the plaintiffs would likely succeed in arguing that they were denied due process, based on the swiftness with which they were required to show compliance with the new rulings.

The AP also reports that the Department of Health and the Environment plans to implement restrictive TRAP laws, possibly identical to the ones blocked by Murguia, on a schedule that would make them permanent. In order to be permanent, the regulations would have to take effect only after a period of public comment. By contrast, the regulations sent out in late June could be applied so quickly only because the agency described them as temporary.

Correction: This story originally stated that all three Kansas abortion clinics, including Aid For Women, were licensed as ambulatory surgical centers. In fact, only the Planned Parenthood clinic is licensed as an ambulatory surgical center; the other two clinics are, according to the AP, overseen by the Board of Healing Arts, which licenses individual physicians. We regret the error.