I am writing on behalf of Hillcrest Clinic, a health care facility in Virginia that has been providing safe, high quality reproductive health care to women for almost 40 years.

The range of services we provide includes annual well-woman exams, including Pap smears and breast exams to screen for cancers; contraceptives and contraceptive counseling; pregnancy testing; options counseling for women with unwanted pregnancy; referrals for adoption or prenatal care; medication abortion through eight weeks of pregnancy; and surgical abortion through the end of the first trimester. Our medical staff includes two obstetrician/gynecologists with decades of experience, including over 15 years of experience in providing abortion care; RN's and LPN's; and counselors specializing in women's health. We see approximately 2,300 patients a year, a vast majority of whom are low-income women. Our clinic receives referrals from health departments in the Tidewater area, Eastern Shore, and northeast North Carolina, private physicians and college clinics.

Because we provide first-trimester abortion care to more than five patients per month, Hillcrest is subject to the emergency regulations that the Board of Health promulgated at the end of 2011, and we will be subject to the permanent regulations that the Board is considering now. On behalf of Hillcrest, our staff, and our patients, I urge the Board to ensure that the permanent regulations are based on appropriate medical standards and that they contain strong protections for patient and provider confidentiality and safety. There are three crucial areas of concern.

First, the Board should ensure that physical plant requirements are consistent with the requirements applied to all other health care facilities. The temporary regulation that establishes physical plant requirements for health care facilities that provide abortion care (12 VAC 5-412-380) is a major departure from the way that health care facilities are typically regulated. To my knowledge, there is no other category of health care facility that is uniformly subjected to standards for new construction; instead, regulations appear to establish one set of physical plant requirements for existing health care facilities and another set of physical plant requirements for new construction of health care facilities. This failure to distinguish between new and existing health care facilities is incredibly burdensome and medically unnecessary. First-trimester abortion has been provided safely in office-based practices such as ours for decades; surgical abortion is one of the safest surgical procedures available in the United States and medication abortion is safely and widely provided in office-based settings throughout the country. The trend in medical services has been to provide safe care in the least sophisticated facility that is appropriate, because doing so reduces the costs and stresses to patients while increasing efficiency and other positive outcomes. (See S.J. Carlan, M.D. et al., Office-based Surgery and Cost Avoidance in an Obstetrics and Gynecology Residency Program, 5 Am. J. Managed Care 1179 (1999)). The physical plant requirements in the temporary regulation contravene this trend, imposing hospital-level standards that are inappropriate to an office-based setting. The expense and effort required to comply with new construction standards are significant, and could qu

ite possibly be so substantial that we would be forced to close our doors. Reducing the number of health care facilities that can provide a full range of reproductive health care services to women in Virginia is absolutely not in the interest of women’s health.

The Board should ensure that any physical plant requirements in the permanent regulations reflect the medical realities concerning the safety of first-trimester abortion care. At an absolute minimum, the permanent regulations should allow existing health care facilities to remain in their current locations without conformity to new construction standards unless and until they undertake significant renovations.

Second, the Board should design permanent regulations that provide the highest levels of patient confidentiality. All patients have an expectation of privacy in their medical records, but confidentiality is especially crucial for patients seeking reproductive health care services. Anti-abortion groups have a history of seeking patient information in order to deter women from obtaining abortion care. Moreover, patients are routinely harassed by anti-abortion extremists who stand outside of Hillcrest for that express purpose. The permanent regulations must ensure that patient information is protected: inspectors assessing a health care facility’s compliance with regulations should have access only to patient records that have been redacted of all patient identifying information and any documents containing patient information should not be allowed to be removed from the health care facility. Similarly, the permanent regulations must protect the confidentiality and safety of the health care professionals who care for women seeking abortion care and other forms of reproductive health care. There is a long history of intimidation, harassment, and violent attacks against those of us who provide abortion care. Hillcrest has experienced a bombing, an arson, and a shooting over the years, not to mention the daily harassment by protestors, and we are, accordingly, very attentive to security. It is absolutely essential that the confidentiality of facility information, including ownership information, employee files, and all other personnel materials is explicitly assured in the regulations.

Finally, the Board should create permanent regulations that use the same standards for variances that apply to all other health care facilities. The temporary regulation for health care facilities that provide abortions allows temporary variances only if a specific regulation would be "an impractical hardship unique" to the clinic. By contrast, the standard for every other health care facility is to allow permanent waivers on a finding that the regulation "would be clearly impractical … provided safety and patient care and services are not adversely affected." There is no medical need to have more restrictive standards for variances only for health care facilities that provide abortion care. And because of the extreme burdens that the physical plant requirements impose, allowing permanent variances would actually benefit patients by allowing health care facilities like Hillcrest to stay open and providing safe care. The permanent regulation for variances should use the same standards that are applied to all other health care facilities.

For over 38 years, Hillcrest Clinic has been assisting women and their families facing unexpected pregnancies. When women choose when they are ready to provide for a child, the entire family and society benefit. Being prepared to parent translates into more opportunity for education, employment, adequate health care and overall psychological well-being for parents and children. The choice to terminate an unintended pregnancy can be one of the most empowering life choices a woman makes. It may mean that she can leave an abusive relationship, continue to care for the children she already has, take back control after a sexual assault, or continue treatment for a chronic illness. Each patient’s situation is unique and is treated with dignity and respect. We at Hillcrest have consistently and historically been a safe haven for women facing crisis pregnancies. We ensure that women have access to quality medical care at affordable prices. The community has relied on Hillcrest to be here for women and their families seeking our help. I urge you to create permanent regulations that allow us to continue to be there for our community.

Thank you for your consideration of these comments. I am also requesting a public hearing on the proposed regulations later in the process.

Sincerely,

Suzette Caton

Hillcrest Clinic, Administrator