Houston doctor Theodore Herring Jr. had his license temporarily suspended last week, after he was found to have violated a new state law requiring abortion doctors to have admitting privileges at a nearby hospital.
That provision is among the ones under review by the Fifth U.S. Circuit Court of Appeals. While the law is tied up in that court, abortion doctors in Texas are still required to follow it – meaning they need admitting privileges at a hospital within 30 miles of their clinic.
The procedure to apply for those privileges can be complex.
"The most challenging part for meeting those medical staff standards involves determining whether or not a practitioner is competent to practice, and in what areas," says Kay Mitchel, director of medical staff services at Houston Methodist Hospital and Texas Medical Center.
That’s called the credentialing process, and it involves three steps.
"The first would be verifying that the information provided is true," Mitchel says. "The second would be reviewing all of the information that we’ve gathered from the applicant. And then the third would be assessing the complete application to ensure that the applicant meets all the qualifications for the medical staff membership and clinical privileges that he or she has applied."
Some of that process is standardized by the federal Center for Medicare and Medicaid Services. The second major step in the application is called privileging, and it establishes what the doctor would be permitted to do in the hospital.
"So although the process can seem a little bit daunting and quite lengthy, it’s a very important element in patient safety," Mitchel says. "The medical staff and board of directors at Houston Methodist Hospital require practitioners to document extensive qualifications. For example, we require verification of education, training, board certification, valid licensure, explanation of any malpractice claim history and we must do that with sufficient adequacy to assure that any patient will receive the highest level of care."
But even after doctors get that 'in,' it doesn’t last forever.
At Houston Methodist, it’s good for 24 months. When it’s time to renew, the doctor submits a log of his or her clinical activity at the hospital and at the primary clinic and provides references.
"We’ve worked with at least 25 hospitals around the state in the last six months trying to get privileges on behalf of our physicians," says Amy Hagstrom Miller, president and CEO of Whole Woman’s Health. "Some hospitals require an application in order to even get an application."
The company has five abortion facilities and one ambulatory surgical center in Texas. Hagstrom Miller says some hospitals require their doctors bring in a minimum number of patients to the hospital each year.
"Some hospitals have a minimum requirement, some of them as stringent as 10 or 12 surgeries you need to do annually in order to maintain your privileges," she says. "And so that’s a second phase of challenges we’ll probably face over the next couple of years … once we've secured those privileges, how do we be sure we maintain them in a practice where it's pretty rare for our patients to need hospital care?"
Abortions are not typically performed at a hospital, and complications requiring hospital admissions are rare. Other procedures those doctors might perform could include delivering a baby or tying a woman’s tubes.
Right now, Tennessee and Utah are the only other states [PDF] that require abortion doctors have admitting privileges. A number of other states, including Alabama, North Dakota and Wisconsin, enacted similar laws – but those laws have been blocked pending final court decisions. Here in Texas, an appeals court decision on whether this provision is constitutional is expected later this year.
