On November 28, 2018, three members of the Reproductive Rights and Justice Project (RRJP) clinic at Yale Law School testified at a hearing held by the Connecticut Department of Public Health, Office of Health Strategy about the dangers to reproductive health care access posed by a proposal by Yale New Haven Hospital (YNHH) to shift primary care patients to a new center at Long Wharf co-managed by two federally-run clinics (FQHCs).
Rachel Kogan ’19, Sarah Jane Bever-Chritton ’20, and Ahmad Maaz ’20 provided the testimony, assisted by Erica Turret ’20 as part of a clinic project supervised by Katie Kraschel, Lecturer in Law and co-teacher of the RRJP clinic.
Prior to the hearing, the Hartford Courant published an op-ed by Kogan discussing the potential impact on abortion access if YNHH’s proposed closure of its current primary care clinics proceeds. The students expanded on the arguments made in the op-ed in the public hearing.
Kogan stated that the location at Long Wharf poses transportation difficulties to patients and also imposes additional hurdles, particularly to low-income New Haven women, to accessing medically necessary and constitutionally protected care. There are also federal restrictions on FQHCs like the Cornell Scott-Hill Health Center, one of the clinics that will co-manage the proposed new center. These federal abortion and speech restrictions do not apply to YNHH, and YNHH’s proposed fix — maintaining abortion services separately at its downtown location — does not fully address the issue, according to the clinic.
According to Maaz, separating abortion services from other reproductive care stigmatizes abortion and results in a fragmentation of reproductive health care with negative consequences for the health of patients.
Currently, patients at YNHH with positive pregnancy tests routinely receive same-day referrals to abortion counseling services at Yale Family Planning. This ease of access to care will be lost if the termination of primary care services at YNHH proceeds as proposed. With their pregnancy underway, patients who will have already gone to the proposed Long Wharf location will have no choice but to make another appointment, on a later date, at a different location for other services. Having to schedule another appointment at a different location will impose additional costs on already cash-strapped patients.
Bever-Chritton testified that under proposed Title X federal regulations popularly known as the “domestic gag rule,” which are almost certain to take effect as proposed, providers at the new clinic locations will be prevented from making effective referrals to abortion providers to patients, including providers at YNHH. Even if a patient is adamant in her choice to terminate her pregnancy, the most a provider could do is provide a list of “comprehensive health care providers” — without identifying which facilities on the list provide abortion services, according to the clinic. Worse, while doctors will be forbidden from directly referring patients seeking an abortion to an abortion provider, they will be required to provide referrals to prenatal services — even if the patient does not want these services.
Because of these implications, Kogan urged the state to require YNHH to condition its block payment to Cornell Scott-Hill on the complete physical and financial separation of Title X funds such that no Title X funds will be spent at the new Long Wharf location. Ensuring that the new facility does not use Title X funding would satisfy the domestic gag rule’s new requirement that Title X funds be physically and financially separated from any facility that provides abortion or unencumbered abortion referrals.
“In order to fulfill its pledge to ensure that patients in the community continue to receive comprehensive reproductive health care, YNHH must commit to a similar model,” said Kogan.
Under Connecticut’s Certificate of Need law, the Office of Health Strategy is required to consider whether an applicant has “satisfactorily demonstrated that any consolidation resulting from the proposal will not adversely affect health care costs or accessibility to care.” If the State decides to approve the proposed termination, it must ensure that access to all medically necessary care is protected, including abortion and abortion referrals, the clinic said. Public comment closes on December 5, 2018, after which the state must provide a decision within 60 days.
“Our clinic hopes that if the application is approved, the state will require YNHH take affirmative steps to protect access to the full spectrum of reproductive health care, including vital and constitutionally protected abortion services and referrals,” said Kraschel.
The Reproductive Rights and Justice Project at Yale Law School gives students firsthand experience in fast-paced litigation and timely and strategic advocacy in a highly contested area of the law. Students advocate for reproductive health care providers and their patients, and have an opportunity to develop non-litigation skills by undertaking non-litigation matters involving legislative and regulatory work, public education, and strategic planning, at the federal, state, and local level.