Abortion in Texas
One year after the Supreme Court decision we survey how hospitals and private citizens are responding to legalized abortion.
There are other options to an unwanted pregnancy, but none is so controversial. How available are abortions today, where are they done, and what has legalizing them meant?
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There are eight abortion clinics in the state—three in Dallas, four in Houston, and one in San Antonio. More may be opening soon in Dallas and Houston, but no reports of new facilities in other towns have been received. Free-standing abortion clinics are operated either because people who believe in abortion start them for humanitarian or philosophical reasons or because the people who run them want to make money. Prices for abortions done in clinics range from an average of $150 for vacuum aspiration up to about $500 for a saline or a uterine induction. The lowest price is around $50 for an endometrial aspiration. Hysterotomy must be done in a hospital and is not offered by any clinics which are presently operating. For these prices, the abortion patient usually receives all lab tests, varying amounts of counseling, the procedure itself, and a supervised recovery period. A few clinics dispense birth control medication and prophylactic antibiotics. Still fewer provide for a follow-up visit to a physician two weeks after the procedure. Most clinics do abortions only until the 12th week of pregnancy. Three—one each in Houston, Dallas, and San Antonio—take patients up to the 20th week of pregnancy.
A free-standing abortion clinic, if operated safely and efficiently, can be the answer for the woman who chooses to have an abortion. Nonetheless, there are disadvantages inherent in the operation of a clinic which does not have access to hospital facilities.
“The problem with commercial clinics is who is in charge,” says an Austin gynecologist who performs abortions for his private patients. “The medical profession is slow to agree, and with justification, to put medical care into the hands of laypersons because the board of a commercial clinic can only be oriented in two directions: profit, or a philosophical position so strong that they forget the nuts and bolts of the operation.”
“Free-standing clinics are not the answer,” he said. “The private physician who does an abortion is always available for consultation. Where is the doctor from a free-standing clinic at night? Where does the woman turn if she needs help? Does she even know the doctor who did the procedure? Clinics now are performing vital functions but they can be faulted on two points: the availability of a doctor at all times and one other which concerns procedure.”
The doctor explained that, in a free-standing clinic where the abortion procedure takes about three or four hours, the cervix is dilated with metal instruments which may at times damage cervical fibers and cause problems with later pregnancies. A private physician with more time, using a sterile seaweed insert, can dilate the cervix gradually, over a period of about six hours, lessening the chance of cervical damage.
A defender of the free-standing clinic is Len Sands, director of Planned Family, Clinic. Inc.. in Dallas. Planned Family is a commercial operation. part of a national organization called Planned Family Center. Other clinics are operated in Detroit and New York. Most of the staff physicians at Dallas Planned Family are flown in from Detroit each week.
While Sands says his operation has been received warmly in Dallas. there are signs that the reception will soon change from warm to hot. Planned Parenthood of Dallas does not recommend the clinic. The Texas State Board of Medical Examiners has the clinic under investigation for not having a pharmacy license, and for employing physicians who are not specifically licensed to practice medicine in Texas. In addition, it is against Texas law for a corporation to employ physicians unless the board of directors is composed of physicians. Only one complaint from a Planned Family patient has been reported to Texas Monthly, however.
Sands is not afraid of a fight. He considers himself a pioneer in the abortion business. “I’ve been campaigning and fighting for abortion since 1965,” he says. “It was my attorney who brought the class action suit in Michigan that legalized abortion in the state.” He says physicians who work at the Planned Family Clinic are all reciprocally licensed to practice medicine in Texas and that his clinic maintains the highest standards of care.
Sands says that Michigan physicians are used to staff the clinic because they have had more experience in doing abortions than Texas physicians. Some Dallas-area doctors do work at Planned Family, but only after they have been trained by the Michigan physicians. The pattern of physicians training other doctor~ to do abortions is a common one, says Sands.
“New York was the only state where abortion was available by consent of the patient and the physician. Reciprocally licensed Michigan physicians went to New York to help New York doctors cope. Michigan physicians opened a clinic in New York. I’m not going to put a patient under a physician who’s unskilled. We get patients in here who’ve been examined by doctors who’ve told them that they’re nine weeks and they’re 17 weeks. Physicians have not had to be that skillful in determining the exact stage of pregnancy until now. Up until this time, they haven’t cared. It’s very disheartening to the patient.”
Not only is it disheartening for a woman to be told she’s further along in her pregnancy than she thinks—it’s expensive as well. A woman who went to Planned Family reports being told when she was on the table ready for the physician to do the abortion that a higher fee would be necessary because she was further along than had been supposed. She had to pay the money immediately, in cash.
“We have 24 rooms here,” explains Sands. “We have our own lab. There are four fulltime counselors who are graduate psychologists. There’s a great deal of apprehension about a procedure that is simpler and safer than a tonsillectomy. We do everything possible to lessen the anxiety. I feel it’s vital, for example, to have a well-decorated facility.” Sands spent from March until August, 1973, looking for an office he felt was presentable for the clinic. When he told landlords what he wanted to use the building for, they lost interest in leasing.
Doctors, too, must meet standards. “I have a trick question I ask before I hire anybody,” says Sands. “I ask, ‘What are the conditions under which abortion is justified?’ If they have any, I don’t hire them. They must believe abortion is a woman’s right.” They also must believe in clinics. “An office is no place to do abortions,” Sands says. “We’re not trying to do anything here but abortions. We’re specialized. We’re not doing anything that a doctor wouldn’t do in his office. We’re not trying to disrupt the medical community; we’re trying to fill the void in it.”
The clinic also has been criticized by people who think Planned Family is responsible for billboards in Dallas which proclaim, “Need an abortion? Call …” Sands says these billboards belong to a service called Abortion Centers of America, which refers women to other agencies besides Planned Family and also does family planning counseling.
Most referral services which advertise on billboards are not free—some charge as much as $50 for referring a pregnant woman to a clinic or counseling service she could find in the phone book.
Whatever the quality of care may be, Planned Family gets patients from all over Texas and adjoining states. Sands says that the clinic is now doing about 80 abortions a week and that “a good one-third of our cases are referred by physicians.” Fees, which range from $150 to $350, include lab work, counseling, pre-operative pelvic examination, the procedure, lie-down and sit-up recovery, a prescription for medication, a post-procedure pelvic exam, and birth control information. Fees must be paid in cash, money orders, or travelers checks (this is the case for most Texas clinics).
Other Dallas facilities include Reproductive Services, a non-profit clinic, and Curtis Boyd and Associates. Dr. Boyd is a private physician who has long been interested in the abortion question and previously worked in New Mexico.
Houston is probably the most “progressive” city in the state as far as availability of abortion is concerned. Including the Jeff Davis clinic, which is for district eligible patients only, Houston has five clinics. Mrs. Billie Broch, director of Planned Parenthood of Houston’s clinic, says that the situation in Houston is changing fairly rapidly. The Planned Parenthood clinic offers vacuum aspirations for women who are not past the 8th week of pregnancy. The cost is $145, and in a limited number of cases financing arrangements can be made.
Besides Planned Parenthood, Houston has Reproductive Services, Cullen Women’s Center, Southwest Women’s Center, and the Jeff Davis clinic. Southwest Women’s Center, which is run by a group of private physicians, has been dubbed “the River Oaks of abortion clinics.” The luxury clinic will perform vacuum aspirations up to 12 weeks for $265—the highest fee for this procedure in the state. “They give beautiful care,” says Mrs. Broch. Cullen Women’s Center is the only Houston clinic where a woman can have an abortion past 12 weeks; here the limit is 20 weeks. Fees are in line with those across the state.
In San Antonio, Reproductive Services does menstrual extractions and abortions up to 10 weeks for a fee of $150. Dr. Foster Moore, the medical director of the clinic, is another Texas physician who has worked for abortion reform. At Bexar County Hospital, abortions are done up to 20 weeks. For late abortions, the hospital is using a new procedure called urea amniocentesis: amniotic fluid is removed from the uterus and replaced with an equal amount of hypertonic urea solution. Fees are higher at Bexar County Hospital since there is a hospital charge. For a vacuum aspiration, for example, the cost is $125 for the doctor and $119.60 for the hospital; for urea induction, the cost is $175 for the doctor and $175 for the hospital. Medicaid and private insurance are accepted.
INSURANCE
Abortion insurance presents a problem. Most clinics demand cash in advance. Medicaid and CHAMPUS (military dependents’ medical insurance) do cover abortion, but not all clinics accept it—some will have the patient pay cash at the time of the procedure and then help her file a claim for compensation later. At the Texas State Board of Insurance, a spokesman said “as a general rule, abortion is not mentioned at all” in insurance policies. If a woman can get coverage, it usually is under the maternity benefits section of the policy—to get these benefits, the woman must sign up nine months in advance of the time when she wishes to use it. This leaves a lot of women out in the cold. Occasionally, sympathetic secretaries in doctors’ offices will write “miscarriage,” or “D&C” instead of “abortion” on the claim form.
WOMEN
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