Opinion ID: 441672
Heading Depth: 3
Heading Rank: 2

Heading: Legislation affecting second trimester abortions

Text: 86 (a) Rule 51: No post first trimester abortions may be performed in Freestanding Outpatient Surgical Facilities 87 Rule 51 requires that if a FSOF performs abortions there must be a written policy governing the abortion procedures performed there. Included in the policy must be a provision requiring that only uncomplicated pregnancies of not over 14 weeks duration may be performed in a facility unattached to or physically remote from a parent hospital. R. 325.3851 (Rule 51). In effect, Michigan's Rule 51 requires that all second trimester abortions be performed in a facility owned and operated by a parent hospital. By statutory definition, freestanding surgical outpatient facilities do not include surgical facilities owned and operated by a hospital. Sec. 20104(5). Thus, the effect of Rule 51 is to prohibit any abortion clinic, whether or not it is licensed as a FSOF, from performing second trimester abortions unless the clinic is owned and operated by its parent hospital and is attached to or not remote from that hospital. 88 Rule 51 primarily bears on second trimester abortions, and, as reviewed above, the Supreme Court held in Roe v. Wade that during the second trimester the State has a compelling interest in maternal health that justifies the reasonable regulation of second trimester abortions. But, because of the Supreme Court's recent decision in Akron, this analysis now involves an intermediate step. Now, in order to ascertain the reasonableness of second trimester regulation, it must be determined whether the regulation depart[s] from accepted medical practice. Akron, 103 S.Ct. at 2493. 89 In Akron the Supreme Court struck down a city ordinance requiring that after the first trimester an abortion had to be performed in an acute care, full-service hospital. Id. 103 S.Ct. at 2497. The Supreme Court agreed that during the second trimester a State has a compelling interest in maternal health, but the Court reiterated that the existence of this compelling State interest in health is only the first step of the analysis. Before a restrictive regulation can be upheld, the State must also demonstrate that the regulation is reasonably designed to further this State interest. 90 In that case, the city of Akron did argue that the in-hospital requirement was reasonably related to the State's interest in maternal health. However, this was countered by evidence of recent medical developments that show a dramatic increase in the safety of abortions performed early in the second trimester. This present medical knowledge negated Akron's contention that the in-hospital requirement reasonably furthered the State's interest in maternal health. Id. 103 S.Ct. at 2496. Based on the increased safety of second trimester abortions, the Supreme Court concluded that the in-hospital requirement for all post first trimester abortions depart[ed] from accepted medical practice. Id. 103 S.Ct. at 2493. Although it recognized that a State must necessarily have latitude in adopting regulations of general applicability in this sensitive area [of second trimester abortions], the Supreme Court nevertheless invalidated the regulation and warned that if it appears that during a substantial portion of the second trimester the State's regulation 'depart[s] from accepted medical practice,' [then] the regulation may not be upheld simply because it may be reasonable for the remaining portion of the trimester. Id. 103 S.Ct. at 2495 (citation omitted). 91 In light of the Supreme Court's holding in Akron it appears we must reverse the trial court and find invalid Michigan's requirement that only uncomplicated pregnancies of not over 14 weeks duration may be performed in a facility unattached to or physically remote from a parent hospital. It is true that, unlike the legislation in Akron and Ashcroft, the Michigan statute does not require all second trimester abortions be performed in an acute care, general service hospital. The wording of Rule 51, however, leads one to conclude that only facilities owned and operated by a hospital may perform second trimester abortions, since only these facilities would have a parent hospital. Also, to perform a second trimester abortion, such a hospital-owned facility would have to be adjacent to (or at least not physically remote from) the parent hospital. Assuming the existence of a compelling state interest in maternal health that justifies Michigan's regulation of second trimester abortions, Michigan has not advanced any reasonable justification for Rule 51's distinguishing FSOFs from outpatient facilities owned and operated by a parent hospital and not physically remote from that parent hospital. Indeed, Rule 51 ignores the impressive evidence that--at least during the early weeks of the second trimester--D & E [dilatation-and-evacuation] abortions may be performed as safely in an outpatient clinic as in a full-service hospital. Id. 103 S.Ct. at 2496 (footnote omitted). 92 Because it fails to reasonably limit its effect to the period in the [second] trimester during which [the state's] health interest will be furthered, id. 103 S.Ct. at 2495, we conclude Rule 51's requirement that only pregnancies of less than fourteen weeks duration may be performed in a FSOF is invalid.