The “admitting privileges” fraud

To be an abortion provider in Texas, you have to have “admitting privileges” at a hospital within 30 miles of the facility. That restriction, which recently was first overturned by one judge and then, within days, upheld by the conservative Fifth Circuit Court, is essentially a fraud. Texas is not the only state taking this tack–see Mississippi–but it’s the most recent.

So far, in most mainstream media reports, the effect of the admitting-privileges restriction has been well documented: It’s going to force almost all abortion clinics in Texas to close, making—as anti-choice advocates have hoped for—abortions infinitely more difficult to get and leaving thousands of women– with legitimate reasons to terminate their pregnancies in a way sanctioned by law—with no good options.

Left unmentioned in most media reports is an examination of the term “admitting privileges” itself. Obviously, the admitting-privileges gambit is another ploy to make abortions harder—in some areas virtually impossible–to get, but what is less known is that the concept of admitting privileges is an antiquated notion that is mostly irrelevant in contemporary medical care.

Here’s a formal definition of admitting privileges, from

Admitting privilege is the right of a doctor, by virtue of membership as a hospital’s medical staff, to admit patients to a particular hospital or medical center for providing specific diagnostic or therapeutic services to such patient in that hospital. Each hospital maintains a list of health care providers who have admitting privileges in that hospital.

Anti-reproductive-rights advocates and legislators would have us believe that, if a medical emergency occurs during an abortion, the doctor in charge needs to have admitting privileges at a nearby hospital in order to ensure the safety of the woman. On the surface, that argument sounds plausible.  But, in reality, it’s a fraudulent concept—and proponents know that.

Why? Because, when there’s an emergency, admitting privileges become irrelevant. Under a 1986 federal law known as EMTALA, hospitals are required to provide care to anyone who needs emergency care [with or without insurance, by the way.] This requirement includes pregnant women who need a life-saving abortion, are in labor, or are suffering the effects of a botched abortion. [Sadly, in 2011, a bill was passed in the U.S. House of Representatives that would have allowed hospitals to turn away patients arriving in the ER in need of a life-saving abortion or other medical help related to abortions. Fortunately, that bill went nowhere, but the fact that it was introduced at all is very disturbing. Opponents of that inhumane notion called it the “Let Them Die” bill.]

Think of it this way: If you’re walking down the street and have a heart attack, it doesn’t matter who your personal doctor is, or whether he/she has admitting privileges at a hospital within 30 miles of where you are: You can be taken to any hospital emergency room, get admitted, and receive treatment, even if your doctor isn’t there, and even if you don’t know a doctor within 30 miles of the hospital.

Also, if a woman is at home and experiences a pregnancy-related emergency, emergency responders will transport her to the closest hospital, regardless of where her doctor has “admitting privileges,” and—again, under federal law–she’ll be cared for there, no admitting-privileges questions asked.

It’s also important to realize that the notion of admitting privileges does not jibe with contemporary norms in inpatient hospital care. Today, many hospitals employ staff physicians to provide inpatient care, and whether an abortion provider has admitting privileges at a particular hospital plays little or no role in determining which hospital may be best suited to care for the patient.

So, does the admitting-privileges requirement make abortions safer, as anti-reproductive-freedom legislators would have you believe? Well, of course we want abortions to be safe—and in the vast majority of cases under Roe v Wade—they are, as opposed to what happened in the back-alley, pre-Roe-v-Wade era, when abortions were illegal, unregulated and often dangerous. Given the current state of emergency care and federal law governing such care, the admitting-privileges requirement doesn’t do much to enhance safety. In fact, it may have the exact opposite effect, making legal, safe abortions more difficult to obtain and putting women at even more risk.