The Bush Administration’s long-heralded gag order–a regulation that prevents federally funded family planning centers from providing abortion counseling–went into effect Thursday, leaving a bureaucratic ball of confusion for California clinics leading a nationwide fight to thwart the rule.
The state’s 220 clinics, which receive $12 million a year in federal family planning funds, have implemented an elaborate bookkeeping plan that takes advantage of state law, which contradicts the federal regulation by mandating that clinics suggest abortion as an option for pregnant women.
Under the plan, staff members whose salaries are paid with state or private money will continue to offer the counseling while those who are paid by the federal government will not.
Barbara Jackson, director of public affairs for Planned Parenthood of Orange and San Bernardino counties, said her organization simply made adjustments to use state money for pregnancy testing and options counseling and to redirect federal money for approved services. “We’re not changing our service one iota,” Jackson said Thursday. “We’re providing the same level of care for our patients that we always have and always will.
“We had made the decision that we could not deny our patients information, and we’ve not renegged on that commitment to our patients. We’ve simply been practical and decided that if we can’t use federal money for that service, we’ll use other money for that service.”
At Planned Parenthood’s five Orange County clinics Thursday, patients found signs explaining that federal money was not sudisidizing pregnancy counseling or testing. Those patients who received those services signed release forms stating that they understood that their care was funded by the state, not the federal government.
“The only thing different is simply making it clear to our patients, to anyone that is concerned about this issue, that these particular services are not funded by federal dollars,” Jackson said.
Last year, Planned Parenthood of Orange and San Bernardino counties received $122,000 in Title 10 federal funds–those that cannot now be used for pregnancy testing and counseling. That is only about 3.7% of the program’s $3.3-million budget, which made it somewhat simple to divert the funds from the prohibited activities, Jackson said. Because California has a state family planning office that funds clinics, the ruling “has a much greater impact in other parts of the country.”
But even in Southern California, some clinic’s found Thursday that while the fund-diversion plan sounded good in theory, it was not easy in practice–and could put the clinics on shaky legal ground.
At the T.H.E. Clinic for Women in Los Angeles’ Crenshaw district–where 2,500 largely poor, mostly minority women come each year for family planning services–nurse practitioners must account for every hour of their time and who is paying for it.
If a woman tests positive for pregnancy in the morning, when the nurses are being paid with state funds, she will receive counseling and pamphlets outlining her options–carrying the baby to term and raising it, placing the child up for adoption or in a foster home, or terminating the pregnancy.
But if a patient visits in the afternoon, when the nurses’ salaries are drawn from federal money, any discussion of abortion will be taboo and the woman will be told euphemistically to come back another time if she wants to talk about further options.
Across the nation, many family planning centers are following California’s lead, said Judith DeSarno, executive director of the National Family Planning and Reproductive Health Assn., which represents 90% of the nation’s 4,000 federally funded family planning clinics. “Everyone is trying a variation of the California theme,” she said.
The new system was put to the test Thursday morning at T.H.E. Clinic for Women, when nursing director Marilyn Norwood received a visit from a 21-year-old college student who is 10 weeks pregnant and wanted information about abortion. During the session, Norwood told the young woman–who had not heard of the gag order–that she would have been out of luck if she had arrived an hour later. Norwood found the encounter frustrating–and infuriating.
“I am angry,” said the bespectacled, 61-year-old nurse practitioner who has worked at the clinic for 18 years. “Now, (in the afternoons) all of a sudden I have to sit there like I have tape across my mouth?”
To Sylvia Drew Ivie, the clinic’s executive director, the plan is “a real bureaucratic nightmare. . . . We have never before had to account for time spent on what you are permitted to say and what you are not permitted to say.”
But the real hardship, Ivie said, will be on patients, many of whom have to take public transportation to the clinic and have difficulty coming for visits–let alone coming back a second time at a precise hour for counseling that was once available any time.
In rural Tulare County, Family Planning Program Inc. serves 7,000 patients each year in its three clinics. Executive Director Kay Truesdale said the program’s one full-time bookkeeper must design a system for keeping track of which money is spent on what. Truesdale is worried that the clinics will be forced to spend more on administration, which could mean a cutback in other services.
“It’s going to be difficult. We are a very small agency and it’s going to add a burden to our clinic. . . . Each layer of (bureaucracy) adds to the cost of doing business and that takes away from the money that we can use to see patients, no matter how you slice it.”
The gag order, initiated by President Ronald Reagan in 1988, goes into effect amid a flurry of activity in Washington that has opponents hoping the regulation will not remain in effect for long. The Senate on Thursday overrode President Bush’s veto of a bill that would have nullified the regulation, although the House is expected to sustain the veto.
Meanwhile, two legal challenges are pending. A federal judge in Washington may rule today on a request brought by the National Family Planning and Reproductive Health Assn. for an injunction to delay implementation of the rule. And an appeals court hearing is scheduled Oct. 14 in another lawsuit, also brought by that group.
In the interim, DeSarno said, her organization is concerned that the government could crack down on California and other states that are using creative maneuvers to get around the rule, particularly because the U.S. Department of Health and Human Services has not given explicit approval to their methods. Health and Human Services officials have only said that the California plan is under review.
“There are severe federal penalties if you say you are going to comply with regulations and then you don’t,” DeSarno said. “It’s considered fraud. We now don’t know–are we complying or are we not complying? People are being put at great risk. The California clinics may be put at great risk.”
California clinic administrators have been outspoken opponents of the abortion gag rules. Officials of the California Family Planning Council said more than a year ago that the clinics would forfeit federal assistance rather than deny women full discussion of their options. Instead, the clinics decided to try the new plan–a decision that was encouraged by a favorable court ruling in one of the lawsuits and wavering by the federal government on the precise scope of the regulations.
Sima Michaels, associate director of the council, said the organization has instructed its member clinics to post signs informing clients that federal funds are not being used for pregnancy counseling. In addition, she said, patients are being asked to sign consent forms stating that they understand that federal money is not being used for the services.
“So far,” she said, “we have not heard that our plan is not acceptable. We are complying with the gag rule. We’re just being creative about it.”
Times staff writer Jodi Wilgoren contributed to this story.
DIVISIVE ISSUE: Senate votes to override Bush abortion counseling veto. A27
