It's Not About the Ultrasound

Our clinic might close this week. Wisconsinís new abortion law, Act 37, has been delayed by a temporary restraining order (TRO) until a hearing July 17. If the law goes into effect, Affiliated Medical Services will close its doors after 30 years as a Milwaukee abortion provider. Many pro-choice people have expressed concern over Act 37's forced ultrasounds. But in our TRO request, we didn't even address the mandatory ultrasound. The greater problem is the requirement that our physicians have hospital admitting privileges.

First, the ultrasound issue. If you go to an abortion clinic that doesn't insist on an ultrasound, you should walk out the door. It's just bad medicine. Our clinic has always required ultrasounds. It's the most accurate way to date the pregnancy and determine which type of procedure is most appropriate. An ultrasound can reveal cysts, asymptomatic masses, ectopic pregnancies, and molar pregnancies, which all require special attention. And it can tell the patient whether she's pregnant with twins, a factor that may influence her decision.

Act 37 does require an ultrasound, but not a transvaginal one. Wisconsin lawmakers, like those in other states, dropped the transvaginal requirement because of the outrage it inspires. We agree that requiring a transvaginal ultrasound for no medical reason is appalling, catering to conservatives' desires to punish or humiliate patients.

But we do perform transvaginal ultrasounds in cases involving early pregnancy, morbid obesity, or anatomical variants in the uterus. Some women find them uncomfortable, especially if they've suffered assault or abuse. We try to convince them of the medical necessity, and we treat them with respect and sensitivity.

Some well-meaning pro-choice people have called transvaginal ultrasounds a form of rape. This just adds to the patient's anxieties. Please don't tell women that they'll be 'raped' at an abortion clinic. That's a common tactic of the protesters outside our front door. (They also tell patients that we conduct sex orgies and satanic rituals.)

Act 37 requires that every abortion provider have admitting privileges at a hospital within 30 miles of the clinic. It's the newest gambit in the so-called TRAP laws, the targeted regulation of abortion providers. Sen. Mary Lazich, who co-sponsored the bill, claims that admitting privileges would improve the quality of medical care and ensure the patient's safety in an emergency.

In fact, the 30-mile rule could compromise patient safety. If a physician's privileges are at a hospital 25 miles away, must we send a patient there, rather than the hospital that's two miles from our door? In real life, the ambulance service chooses the hospital, determined by the shortest distance, or sometimes by the patient's insurance coverage. The question of admitting privileges never comes up.

Our overall rate of complications is 1.78 percent, which includes everything from minor infections to hospitalization. We handle most of these complications ourselves, and we have medical staff on call 24/7. If we do send a patient to the hospital, we send along a complete copy of her medical record, and our physician calls ahead to brief the attending physician. We follow up with phone calls to both the hospital and the patient. The patient will receive the same care regardless of our physician's admitting privileges.

Some hospitals are reluctant to extend privileges unless a physician can meet a quota of 10 patients per year. Here, our low complication rate works against us. At Affiliated Medical, we transport three to five patients per year, and not all of those are admitted. Other hospitals don't grant admitting privileges to abortion providers because of religious objections, group practice requirements, or simply because they don't want daily protesters in front of their doors.

Perhaps our legislators should also outlaw hospitalists, the staff physicians who oversee inpatient care on behalf of group practices. Your family doctor may never show up at your bedside, even if he or she admitted you. This is not considered abandoning the patient. Abortion clinics are held to a different standard only as a way to shut them down.

Some anti-abortion protesters tell our patients what a dangerous place Affiliated Medical is. When an ambulance appears at our clinic, they show their care and concern by taking videos of the patient and posting them on YouTube. Our legislators in Madison have opted for similar grandstanding without regard for the realities of medical care or the needs of the women of Wisconsin.

Muriel Hogan and Wendie Ashlock work at Affiliated Medical Services, one of the abortion clinics affected by 2013 Wisconsin Act 37. Hogan is an office worker. Ashlock is the clinic director, with 18 years of ultrasound experience.