|Action||Amend the Regulation after Assessment and Receipt of Public Comment|
|Comment Period||Ends 10/31/2018|
NOIRA TRAP Comment
The Mission Statement of the Virginia Board of Health is as follows: “The State Board of Health exists to provide leadership in planning and policy development for the Commonwealth and the Virginia Department of Health to implement a coordinated, prevention-oriented program that promotes and protects the health of all Virginians. In addition, the Board serves as the primary advocate and representative of the citizens of the Commonwealth in achieving optimal health.” As a Maternal-Fetal Medicine physician, my job is to use an evidence-based approach to provide my patients with the best possible care. Similarly, the Board of Health is tasked to use an evidence-based approach to protect the health of Virginians. In 2011, Virginia passed Targeted Restrictions of Abortion Providers (TRAP) laws, under the guise of protection of Virginia woman, however, they held abortion providers to stricter building standards than facilities performing outpatient procedures with much higher complication rates than surgical abortions. First-trimester surgical abortion is already an extremely safe procedure, with serious complications occurring in approximately 0.25% of procedures. In October 2016, in response to the June 2016 US Supreme Court decision Whole Woman’s Health v. Hellerstedt, which ruled virtually identical TRAP laws in Texas to be unconstitutional, some of the most onerous of the TRAP regulations in Virginia were repealed by the State Board of Health, however many such regulations remain, without any benefit to the health of Virginia women. Many medical associations have spoken out against TRAP Laws. The American Congress of Obstetricians and Gynecologists (ACOG) spoke out against these laws in their November 2014 Committee Opinion, writing “Facility and staffing requirements enacted in some states, under the guise of promoting patient safety, single out abortion from other outpatient procedures and impose medically unnecessary requirements designed to reduce access to abortion.” ACOG formally opposes these medically unnecessary laws, “because they improperly regulate medical care and do not improve patient safety or quality of care.” ACOG issued a statement following Whole Woman’s Health v. Hellerstedt, applauding the decision. A large majority of Virginians (58%) polled in 2013 also opposed these laws. Soon, the Virginia State Board of Health will again consider repeal of TRAP regulations in Virginia. I urge the Board to do so. The current regulations are politically motivated and do not serve to further the health of Virginia women. Facilities that provide five or more first trimester abortions per month are still required to be licensed as a category of the hospital with unique and restrictive requirements, some of which are more restrictive than for inpatient hospitals. These requirements are medically unnecessary, and due to costs of compliance, have forced the closure of many clinics offering abortion in the Commonwealth. TRAP regulations in Virginia do not differentiate between providers of medical and surgical abortions, and hold them to the same standard, despite the fact that medical abortions only require the administration of a pill to the patient. Virginia also requires that only licensed physicians to provide patients with medical abortion, despite the fact that the appropriate medical evaluation is well within the skill set of midlevel providers. TRAP regulations in Virginia also require licensed facilities to be subject to unannounced inspections, and allows for any employee of the Virginia Department of Health to enter the premises of a licensed abortion facility and to be granted access to patient names and medical records. This is an invasion of the privacy of Virginia women and serves no medical purpose. The purpose of the Virginia Board of Health is to protect the health of all Virginia citizens. Decisions made by the Board should be based on medical evidence, not politics, religious beliefs, or ideology. Abortion is a safe and Constitutionally-protected legal procedure, and any restrictions on abortion providers should
be based on the evidence. The evidence does not support TRAP laws, and the United States Supreme Court has ruled that they are unconstitutional and do not enhance patient safety. I urge the Virginia legislature to consider a complete repeal of these restrictive laws which do nothing to protect the health of citizens of Virginia.
Jessica M. DeMay, MD, FACOG, Fellow, Society for Maternal Fetal Medicine