I appreciate the review and support the changes proposed to comply with other best practices and requirements of similar VA non-hospital medical facilities where medical procedures are performed (e.g., oral surgery, plastic surgery, colonoscopies,,etc). I support the recommendations proposed by the American Congress of Obstetricians and Gynecologists in their comments. Emergency rooms are required to provide service to those needing those services regardless of the facility they may have used prior, and all medical physicians/providers should be willing to provide detailed information to ER as necessary for treatment. Admitting privileges should not be required. The cost benefit in removing overly restrictive (and discriminatory vs other medical facilities in the state) requirements in construction or onerous and needless requirements on the medical personnel at those facilities would be enormous in construction cost prevention.  The removal of these discriminatory requirements would benefit the state by preventing the closure of needed medical facilities and allow the continuation of consultation and medical procedures (that may include abortion as well as other medical services) to women in their neighborhoods or nearby regions. Cost benefit to VA transportation costs in providing access locally and not mandating additional wear and tear on roads or highways in seeking medical treatment at great distances from home.  Cost benefit in the continued employment of medical and support personnel in providing needed consultation and medical services to women on their health.  Additional benefit:  women do not undertake these consultations and needed services lightly.  They are stressed and having onerous and unnecessary restrictions placed on their personal medical decisions places them in a position of higher risk of stress while traveling longer distances on public highways to obtain medical care that federal law dictates they are entitled to obtain.

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