Tammi Kromenaker directs the Red River Women's Clinic, the only abortion clinic in North Dakota. With three full-time staffers, it serves women in North Dakota, South Dakota and parts of Minnesota. The clinic, in Fargo, N.D., has been open for 15 years now, since 1998.
It's Kromenaker's clinic that would be directly affected by North Dakota's new ban on abortions after six weeks, the most restrictive in the nation. We spoke Monday afternoon about that law, other restrictions she finds even more threatening and why she has no plans to close anytime soon.
Sarah Kliff: It's been about a week since North Dakota passed the country's most restrictive abortion ban. Is this something you expected from the legislature in 2013? Or was it a surprise?
Tammi Kromenaker: Going into this legislative session we fully expected the personhood issue to come up. That's been bouncing around North Dakota for the past several sessions.
We weren't sure what to expect with other bills. North Dakota already has some of the most restrictive laws in the country and we're already engaged with the state on a restriction on medication abortion that passed in 2011. I don't know if everyday lawmakers know that, that we're in litigation with the state right now.
Honestly, the bills that they came up with have blown me away as far as how restrictive they are. Because North Dakota already has some of the most restrictive laws, I couldn't imagine it would go this far. It took a lot of us by surprise, the sheer number of bills. It might have even surprised them how far they got. There's still one left pending that's a 20-week ban. Who cares about a 20-week ban now?
SK: What does all of this mean for your clinic?
TK: First of all, I don't think they're going to go into effect. The heart beat ban [which bars abortions after six weeks] is so blatantly unconstitutional. I'm fully confident we'll get an injunction. There are constitutional questions that are involved with the heart beat bill. Even the governor said in his veto statement that they're open to constitutional questions.
The next one, the more concerning bill, is the TRAP bill, which requires our doctors to have admitting privileges at a hospital. Our doctors will actively work to apply for those privileges.
SK: I'm curious though, if the heart beat law did stand, would it be possible to perform abortions? Or would it be too restrictive?
TK: There’d be such a minute that would be able to get an abortion. Unless we were to diversify services, which other clinics have done as abortion rates have gone down, than it would be hard.
We are primarily an abortion provider. There is a very good Title X family planning clinic. We’ve not attempted to duplicate the services. Unless we try to compete with them, we operate as primarily an abortion provider.
SK: What about the other law you mentioned, that requires your doctors to have admitting privileges at a hospital? You mentioned that one was more worrisome.
TK: I think that first of all, you can look to Mississippi to see how this has already played out [after it passed a similar law in 2011]. There are very well-qualified doctors there who have been unable to gain privileges because the hospital doesn't want to engage in the debate.
My fantasy would be a local physician would step up and say, I'm willing to be your provider.. Our physician are not local and that’s part of why I believe we were targeted. They knew, the sponsors of the bill, that it would be difficult to gain privileges.
SK: Who are your doctors?
TK: We have three, all under the age of 45, which is sort of unusual. I know friends who run clinics and their median age is like 62. We've worked hard to get these young, very-skilled physicians. Their complication rate is below national averages, and we've had that called into question, how is it so low.
It's almost like, we know we're a target. We're under extreme scrutiny. We're very careful about who we employ and almost like we have to be sorry about having such competent physicians.
SK: How long have you been the only abortion clinic in North Dakota?
TK: Since February 2001. Just to be clear, we’re not like Mississippi where other clinics have been legislated out of existence. This population is small, and it can only support one clinic. There was one that opened in 1991 and closed in 2001. There were two clinics for about two and a half years, but Fargo can't support more than one clinic.
SK: How have your patients reacted to this?
TK: In the first couple of days we had calls like "My appointment is already scheduled, is that still valid" right alongside others calling to make an appointment. The women who were actually in the clinic, the day it was signed, were just outraged. They were just like, this is ridiculous. They have no idea what my life is like.
Anytime abortion laws are in the news, women do become concerned. But it doesn't stop them. They still come in.
SK: How much of your time is devoted to handling legislation and litigation? I know you mentioned earlier that you're already engaged in a lawsuit with North Dakota.
TK: Until this last week, it was very manageable. We do work with the Center for Reproductive Rights [on litigation] which is obviously a huge help. There was some stuff as we got closer to the vote, updating information and pulling some numbers that took some of my time.
In the last week, its just this media firestorm that has taken up my time. Luckily I have a staff in place that is able to just run the day to day operations of the clinic. Tuesday [when the law passed] we were seeing patients.
It takes a huge amount of time and energy handling the e-mails that come in. I handle the main e-mail address. We’re a small clinic, we’re not this large corporation or organization.There are three full-time staff including myself. We're teeny tiny. We wouldn't be here if it wasn't for CRR's ability to handle a lot of these legal cases.
SK: When you think out a year or two from now, will your clinic still be open?
TK: Definitely I expect to be here in a year or two. The thing is these laws are so unconstitutional. The sad part about all this attention on these extreme bills is all the other places where there other attacks. I know people who run in Texas, where they're trying to require them to become ambulatory surgical centers. That's a huge threat. We're diverting attention away from some very real threats.
The upside though—not that there’s actually an upside—is I really am hopeful we have awakened a silent majority. That they will finally step up at the polls and say this is too much. You have gone too far.