But when the General Assembly passed legislation late last week requiring all offices, clinics and centers like hers that perform first-trimester abortions to be regulated as hospitals — arguably the strictest requirement in the country — Codding turned so red that she went into one of the clinic’s exam rooms and checked her own blood pressure.
Supporters of the vote hailed it as “historic.” Victoria Cobb, president of the antiabortion Family Foundation of Virginia, said the new regulations will be “common-sense safety precautions” that could for the first time allow health inspectors into abortion clinics and potentially make requirements that specific equipment be on hand.
But Codding, 68, sees it as more “shenanigans” in the long-running war over abortion rights. And depending upon how state regulators write the rules later this year, she fears that abortion opponents may succeed in practice what they have failed to achieve in court: an overturn of the landmark Roe v. Wade.
“Let’s be clear,” Codding said late Friday. Women came in throughout the day for abortions, Pap tests, fertility consultations and gynecologic cancer treatments. “This is not about health and safety. This is about targeting abortion providers and making it more difficult if not impossible to provide women affordable access to abortion with respect and dignity.”
“Take a look around,” said a pessimistic Dr. Jan Fruiterman, the clinic’s ob/gyn. He began practicing in the 1970s, when women had to have their husband’s permission before being sterilized and single women weren’t allowed to be given contraceptives. “In a few years, you won’t be able to visit these clinics. They won’t be here. I thought we had come farther that this.”
Codding and other abortion rights activists say the new Virginia law, which Gov. Robert F. McDonnell (R) has said he will sign, is a TRAP law, or a Targeted Regulation of Abortion Providers. Since the Supreme Court gave states the right to restrict abortions in the early 1990s, they say more than 44 states have passed such laws.
And those that require abortion clinics to be regulated as hospitals — which up to now applied only to much rarer second-trimester abortions — have mandated clinics meet the structural and architectural requirements of an ambulatory surgical center.
Unlike Maryland and the District and many other states, Virginia law already requires second-trimester abortions to be performed in hospitals.
A review of these hospital-type regulations by the American Journal of Public Health found that in Texas, for example, the number of abortion providers fell from 20 in 2003 before the regulations to four in 2007. Likewise, in South Carolina, the number of providers dropped from 14 before the hospital regulations, activists said, to three. Some regulations have specific requirements for parking or landscaping.
The Family Foundation’s Cobb said that there are bad actors among abortion providers and the regulations will help root them out. “The pro-life movement has multiple goals. One is to protect unborn life,” Cobb said. “And the other is protecting and caring for women. It’s not the purpose of this legislation to create some ridiculous landscaping requirement.”
Codding watched as clinics around the country closed because they could not meet the hospital standards. So when she decided to build the Falls Church clinic, which opened in 2002, she razed the third-floor office space and built it to meet then-state standards for a Class II hospital, or surgical center.
“If I lived in California, I would reinforce my home against earthquakes. If I lived on the high-water-mark of the ocean, I’d have my house on stilts,” she said. “I live in a state where there’s an earthquake around abortion. So I had to build a center that could withstand whatever came down the road.”
She walks through the center, where the doors and hallways are wide enough to accommodate a gurney. Her exam rooms are big enough and stocked with the equipment required of a surgical center.
“Our ventilation may have to be looked at. And we may need to put in a shower,” she said. “Another regulation for ambulatory surgical centers is to have backup power. So we may have to get a good generator. But we may have city issues with that because the building isn’t ours and we won’t know if our landlord will let us put it on the roof.”
Depending on what the 15-member Virginia Board of Health decides, Codding estimates it could cost at least $100,000 to bring her center up to current ambulatory surgical center standards. “This could still affect us dramatically,” she said.
Likewise, David Nova, planned carefully when he supervised building the new Planned Parenthood clinics in Roanoke and Charlottesville. The facilities, he said, cost about $2 million to build. The hallways there and at two other Planned Parenthood clinics in Virginia Beach and Richmond are wide enough for two gurneys to pass, like in all hospitals. And the exam room is now a “cavernous” 16 by 18 feet.
“You could get a dozen medical personnel in there and do open-heart surgery,” Nova said. “And though our corridors are wide enough for two gurneys to pass by unimpeded, we have one gurney and we’ve never used it. So the wider corridors have nothing to do with safety. It really has to do with politics.”
Cobb and other abortion opponents said no one knows what the Board of Health will do. “They could say, ‘You need a defibrillator.’ It could be that easy,” Cobb said. “Current clinics could be grandfathered and new ones created to meet the standard. This isn’t about putting abortion providers out of business. I just don’t think that’s what our Board of Health would do.”
Just a few blocks up the street from Codding’s Falls Church center, Laura Meyers squeezes through the narrow corridors of the Planned Parenthood clinic she runs. The clinic saw 5,000 patients last year and performed 900 abortions. “We clearly don’t meet the standards here,” she said. And the cost to move walls or retrofit the building would be “prohibitive.” Of the 21 centers that provide most of the first-trimester abortions in the state, this is one, Meyers said, that would most likely close.
“What will happen?” Meyers said, sitting in the empty recovery room. She looked around. “I guess that’s the question.”