The comedian Joan Rivers died on September 4. She had undergone a “routine procedure,” an endoscopy, for an examination of her vocal chords, on August 28 at what is termed “an ambulatory surgical center” for outpatient surgery. She experienced cardiac arrest, was taken by ambulance to a hospital, put into a medically-induced coma, and then on life support. Her death has prompted public discussion of ambulatory surgical centers. For example, PBS’ NewsHour broadcast such a story on September 12.

There are now 5,000 such surgical centers in the United States, a 28 percent increase in the past decade, and they now perform 23 million surgeries yearly. The surgeries include endoscopies, colonoscopies, shoulder rotator cuffs, cataract removals, plastic surgeries, and more. These facilities differ from hospitals in that they do not have emergency rooms or intensive care units. When asked what questions patients considering undergoing a surgery at such facilities should ask, Shannon Pettypiece of Bloomberg News responded, that a patient should ask about the facility’s accreditation and certification, and “What’s the backup plan if something does go wrong? How close am I to a hospital if I do need to get to the emergency room?”

In fact, the safety of patients undergoing surgeries in these facilities is the current subject of public discussion, of legislation, and of litigation, in the context of abortion clinics. Legislatures in a number of states have passed laws requiring that the doctors in abortion clinics have “admitting privileges” to a hospital within a certain number of miles of the clinic. While the media portrays such legislation as part of a “war on women,” as an effort to close abortion clinics (like the July 30 headline in the Washington Post: “Mississippi—Bid to Shut Abortion Clinic Is Struck Down”), the states have argued in court that these requirements:

• foster a woman’s ability to seek consultation and treatment for complications directly from her physician, not from an emergency room provider;
• assist in preventing patient abandonment where a physician who performs the abortion leaves the patient to her own devices to obtain care if complications develop; and
• help ensure that the credentialing of physicians beyond initial licensing and periodic license renewal occurs, a matter of importance where there is likely underreported morbidity and mortality.

The legislation and litigation has occurred in the context of:

• the conviction of Dr. Kermit Gosnell of involuntary manslaughter in the death of Karnamaya Mongar, who died in 2009 after an anesthesia overdose during an abortion,
• growing awareness of the nature and degree of complications from surgical abortions; and
• the adoption by the American Association for the Accreditation of Ambulatory Surgical Facilities of standards on the subject of complications and continuing care.

Wherever the particulars of this requirement are imposed on outpatient surgical facilities that do not perform abortions, there is no litigation arguing that it imposes an undue burden on patients’ ability to obtain outpatient surgeries. Moreover, wherever doctors who perform surgical abortions have, or could obtain, “admitting privileges,” there is no litigation arguing that it imposes an undue burden on patients’ ability to obtain abortions.

Here is what I suggest be done until this litigation has run its course. The states should require that all outpatient surgery facilities, including abortion clinics, post the following notice, or a similarly worded notice, outside their entrances and on their webpages, and include it among the papers presented to patients for their written consent:

In order to protect your health in the case of a complication from a surgery you undergo at this facility, state law requires that each of the doctors of this facility possess admitting privileges to a nearby hospital. The doctors of this facility do possess these privileges. The names of the physicians and the names and locations of the hospitals to which they have admitting privileges are identified below.

Abortions clinics that have been excused by a court from the state law requiring admitting privileges would be required to post a differently worded notice, as follows:

In order to protect your health in the case of a complication from an abortion you undergo at this facility, state law requires that each of the doctors of this facility possess admitting privileges to a nearby hospital. The names of the doctors of this facility who do possess these privileges, and the names and locations of the hospitals to which they have admitting privileges are identified below. If there are doctors who do not possess these privileges, they are identified below. They have been excused from the state law protecting your health by a court ruling that such a requirement restricts your constitutional right to obtain an abortion. In such instances, state law requires that we identify other facilities that provide abortions whose doctors DO have admitting privileges. Those facilities are identified below.