Demonstrators on both sides of the abortion-clinic debate gathered in the meeting room, a nearby room and outside the building. (Steve Helber/AP)

Virginia’s Board of Health did an about-face on abortion regulations Friday, voting to impose strict, hospital-style building standards even on existing clinics and reversing its June decision.

The reversal came two days after the office of Attorney General Ken Cuccinelli II (R) sent a letter to board members advising them against grandfathering clinics — and warning that they could be personally liable for legal fees if they were sued after ignoring his legal advice.

Coming just weeks before Election Day, and on the heels of a General Assembly session dominated by contentious anti-abortion bills, the decision promises to further inflame the issue in Virginia’s neck-and-neck presidential and U.S. Senate races.

“There’s lot of people who are really fired up,” said Connie Boyer, 59, a retired computer programmer who was one of hundreds demonstrating outside the meeting and who held a sign reading “Stop the War on Virginia Women.” She added: “You talk about the Arab Spring. Well, we’ve got the same thing going on here.”

The board’s 13 to 2 decision also could have implications for next year’s race for governor — endearing Cuccinelli even more to the conservative activists expected to dominate the 2013 nominating convention but perhaps hurting him with swing voters if he gets to the general election.

Some of the state’s 20 abortion clinics have said they will go out of business if forced to make the costly renovations required to meet the new architectural standards.

The board’s decision is not the final word on the matter: The architectural rules face more hurdles in a review process that is expected to stretch into next year.

Even so, hundreds of activists on both sides of the abortion issue flocked to a Henrico County office park for the meeting, expressing either delight or outrage at the outcome.

“Shame! Shame! Shame!” abortion rights advocates chanted once the vote was tallied. “Women are going to die!” Some yelled obscenities as security officers, who had used metal-detecting wands on everyone entering the meeting room, ushered them out.

Within seconds of the vote, Victoria Cobb of the Family Foundation of Virginia issued a news release praising the decision and calling claims that clinics would close “hysterical.”

“We are pleased that the Board wasn’t fooled by the abortion industry’s distractions from the real issue of abortion centers in Virginia found with bloody patient tables, unsanitized conditions and untrained staffs,” Cobb said in the statement, referring to clinic inspection reports she had publicized in the days leading up to the meeting.

Some abortion rights advocates accused the attorney general of “bullying” the board with the letter, which was first brought to light by the Virginian-Pilot.

But some board members said they’d had a genuine change of heart after the board voted 7 to 4 in June to give clinics a reprieve.

“I regretfully admit I was operating under a lot of confusion” in June, said M. Catherine Slusher, a physician appointed by Gov. Robert F. McDonnell (R). “It’s not a matter of personal preferences. It’s a matter of the General Assembly has passed a law, and it’s up to us to create the regulations that abide with that law.”

Rather than capitulation to Cuccinelli and McDonnell, antiabortion activist Leslie Davis Blackwell saw the about-face as a “Saint Paul moment” — an epiphany like the one she had a few years ago after 30 years of abortion-rights activism. She addressed the gathering to say she’d had two abortions as a young woman and now deeply regrets them.

About 80 activists from both sides jammed the board’s meeting room, and 100 more were seated in overflow space next door. Hundreds more demonstrated for hours outside.

The two board members who voted to keep the exemption in place were H. Anna Jeng of Norfolk, who was appointed by then-governor Timothy M. Kaine (D), and James Edmondson of McLean, who was appointed by then-governor Mark R. Warner (D) and reappointed by Kaine.

Both urged their colleagues to resist Cuccinelli’s advice, saying that his office could not refuse to provide legal representation to them if they bucked his advice. Edmondson offered three amendments aimed at exempting current clinics or allowing the state health commissioner to grant variances. All three died in 13 to 2 votes.

Jeng left the meeting in tears. Edmondson, who risked missing his daughter’s wedding rehearsal in the District to attend the meeting, became emotional while talking with reporters afterward.

“Access matters,” he said, his voice cracking.

After one of the most contentious debates of the 2011 General Assembly session, legislators voted to regulate abortion clinics like outpatient surgical centers. State officials quickly wrote emergency regulations dictating such things as the size of exam rooms and the storage of patient records.

In June, the Board of Health had been expected to pass permanent regulations that were substantially the same as the emergency rules. It did so, but with a surprise amendment partially grandfathering in existing clinics.

Only 11 members were present for the June vote. In the interim, McDonnell filled a vacancy on the board with John W. Seeds, an obstetrician-gynecologist who performed abortions in the past but is now a vocal critic of the procedure.