I generally support the Board of Health’s proposed amendments to the regulations for the licensure of abortion facilities in the Commonwealth. I strongly support the governor’s recommendations for the regulations for the licensure of abortion facilities in the Commonwealth.

As an emergency physician, I frequently care for pregnant patients, manage emergency complications of pregnancy, perform procedures with sedation.  As a hospital administrator I oversee quality and safety for my department and the hospital in which I work, I am very familiar with the federal guidelines for that govern preparedness of emergency departments across the commonwealth of Virginia.

I SUPPORT the Board’s recommended amendments to Section 12VAC5-412-250, regarding documentation of anesthesia services in the patient record. I routinely perform procedural sedation and the recommendation is consistent with current standards.  "Emergency Cardiovascular Care" has replaced "Advanced Cardiovascular Life Support" as defined by the American Heart Association.  Capacity to perform "Emergency Cardiovacsular Care" is adequate to provide sedation in the outpatient clinic setting.

I OPPOSE the Board’s recommended amendment to Section 12VAC5-412-10 that “first trimester” of pregnancy be defined as “the first 12 weeks from conception as determined in compliance with § 18.2-76 of the Code of Virginia.” Similarly, I OPPOSE the Board’s recommended amendment to Section 12VAC5-412-230(A) that “Abortions performed in abortion facilities shall be performed only on patients who are within the first trimester of pregnancy based on an appropriate clinical estimate by a licensed physician as determined in compliance with § 18.2-76 of the Code of Virginia.”  

In addition, I SUPPORT Governor Terry McAuliffe’s recommendation for Section 12VAC5-412-230 that “first trimester” of pregnancy be defined as “13 weeks and 6 days after last menstrual period or based on an appropriate clinical estimate by a licensed health care provider.”

In the healthcare environment, it is universally accepted that the pregnancy length be determined by the first date of the last menstrual period, and that along with physical exam are sufficient to determine gestational age.  Likewise, the first trimester of pregnacy is defined as a gestational age through 13 weeks and 6 days.  The second trimester begins at 14 weeks.

I SUPPORT the Board’s recommended amendment to Section 12VAC5-412-10 to separately define “medication induced abortion” and “surgical abortion” and SUPPORT the substance of those definitions.  Although both methods are reasonable and safe alternatives for women seeking termination of pregnancy, they should be defined separately as they are different procedures.

I SUPPORT the Board’s recommended amendments to Section 12VAC5-412-370, regarding design and construction standards for abortion facilities, and SUPPORT Governor McAuliffe’s additional recommended amendments to this section.  There is abundant evidence that pregnancy termnations can be performed safely in freestanding clinics and in the office setting with proper equipment for performing in office surgical procedures.  In fact, when compared with hospitals, the complication rate for the procedure is greater for those performed in hospitals, and at best equal when adjusted for pre-existing medical conditions.  Surgical procedures are routinely performed in the office setting, and there is no medical evidence supporting the need to replicate the physical environment of the hospital to improve safety.

I SUPPORT the Board’s recommended amendments to Section 12VAC5-412-290, regarding emergency services.  In order to be compliant with EMTALA, Emergency Departments and Hospitals throughout the Commonwealth must be prepared to manage patients needing emergency care after office surgical procedures.  There are no other circumsances in which an outpatient facility must have a pre-determined contract for emergency services.  Furthermore, upcoming national Emergency Department Quality Standards include preparedness for managing pregnancy and complications, including those related to termination.