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PLANNED PARENTHOOD OF SOUTHEASTERN PENNSYLVANIA V.

May 23, 1988

Planned Parenthood Of Southeastern Pennsylvania, et al
v.
Robert P. Casey, et al.



The opinion of the court was delivered by: HUYETT, 3RD

 Daniel H. Huyett, 3rd, United States District Judge

 INTRODUCTION

 In this action for declaratory and injunctive relief, plaintiffs challenge the 1988 amendments to the Pennsylvania Abortion Control Act of 1982, Act of March 25, 1988, No. 31 §§ 3-10, 1988 Pa. Legis. Serv. 173 (Purdon) ("Act 31"), amending 18 Pa. C.S.A. §§ 3201-20 (the "Act"). *fn1" Plaintiffs assert that Act 31 violates the United States Constitution and 42 U.S.C. § 1983. I have subject matter jurisdiction under 28 U.S.C. §§ 1331, 1343(a)(3), and 1343(a)(4), and the Fourteenth Amendment to the United States Constitution.

 Act 31 was scheduled to take effect on April 24, 1988. *fn2" On April 21, 1988, following a hearing, I granted plaintiffs' application for a temporary restraining order and enjoined defendants from enforcing the provisions of section 3206 of the Act and from publicly disclosing or otherwise making available for public inspection and copying any report filed pursuant to sections 3207(b) or 3214(f) of the Act until further order of the court.

 An evidentiary hearing and oral argument on plaintiffs' motion for a preliminary injunction was held on May 9, 1988. Following that hearing, and by agreement of the parties, I ordered that the temporary restraining order issued on April 21, 1988 would remain in effect until such time as I ruled on the motion for a preliminary injunction. I further suspended the requirement that certain reports be filed with the Commonwealth on May 15, 1988.

 The parties have entered into a comprehensive stipulation of facts for the purposes of the motion for a preliminary injunction only. Based on that stipulation and the evidence of record, and in the context of this motion for a preliminary injunction, I make the following findings of fact and conclusions of law.

 FINDINGS OF FACT

 1. Plaintiff Thomas E. Allen is a physician licensed to practice medicine in Pennsylvania and is an Associate Clinical Professor in the Department of Obstetrics and Gynecology at the University of Pittsburgh. He graduated from the University of Pittsburgh School of Medicine. He is an active staff member of Magee Women's Hospital, is on the Consulting Staff of Presbyterian University Hospital, and is Medical Director of Women's Health Services Incorporated. He has been a Diplomate of the American Board of Obstetrics and Gynecology since 1954, has been a Fellow of the American College of Obstetrics and Gynecology since 1955, and a Fellow of the Pittsburgh Obstetrical and Gynecological Society since 1974. From 1972 to the present, Dr. Allen has been active in planning, establishing and administering Women's Health Services, Pittsburgh's first free standing abortion clinic. From 1970 to 1979, he was active in establishing and contributing services to the Pittsburgh Free Clinic. Dr. Allen has a private obstetrical and gynecological practice with four other specialists. [Stipulation of Uncontested Facts para. 1]

 3. Plaintiff Reproductive Health and Counseling Center (RHCC) is a for-profit corporation in Chester, Pennsylvania which operates a clinic providing first and second trimester abortions. [Stipulation of Uncontested Facts para. 12]

 4. Plaintiff Women's Health Services, Inc. (WHS) is a non-profit health center in Pittsburgh, Pennsylvania providing fertility control education, pregnancy counseling, contraceptive and gynecological care, public education, and first and early second trimester abortions. [Stipulation of Uncontested Facts para. 25]

 5. Plaintiff Women's Suburban Clinic (WSC) is a non-profit corporation in Paoli, Pennsylvania which operates a health care facility providing abortions, ongoing gynecological services, mini-laparotimies, pregnancy testing, community education, and counseling. [Stipulation of Uncontested Facts para. 39]

 6. Plaintiff Allentown Women's Center (AWC) is a for-profit corporation in Allentown, Pennsylvania which operates a clinic providing pregnancy testing and counseling, contraceptive and gynecological care and first trimester abortions. [Stipulation of Uncontested Facts para. 53]

 7. Defendant Robert P. Casey is the Governor of the Commonwealth of Pennsylvania. [Stipulation of Uncontested Facts para. 83]

 8. Defendant N. Mark Richards, M.D., is the Secretary of Health for the Commonwealth of Pennsylvania. [Stipulation of Uncontested Facts para. 84]

 9. Defendant LeRoy S. Zimmerman is the Attorney General of the Commonwealth of Pennsylvania. [Stipulation of Uncontested Facts para. 85]

 10. Defendant Michael D. Marino is the District Attorney for Montgomery County, Pennsylvania. [Stipulation of Uncontested Facts para. 86]

 11. Sue Roselle testified at the hearing on May 9, 1988. I found her testimony to be credible in all respects. Ms. Roselle is the Executive Director of Women's Health Services, Inc. As Executive Director, she is responsible for the ongoing operation of the clinic and for staff selection, and reports to the Board of Directors of WHS. She holds a Master of Social Work degree from the University of Illinois at Urbana, and an M.S.B.A. in management from Robert Morris College. She is Treasurer of the Pennsylvania Chapter of the National Association of Social Workers, a member of the Academy of Certified Social Workers, President of Pennsylvanians for a Right to a Private Life, and serves on the Health Services Committee of the American Red Cross, Pittsburgh-Allegheny Chapter. She has over ten years' experience in health care administration, including emergency medical services and home health care. She is a former director for emergency medical service systems for the 12 counties of southwestern Pennsylvania. [Testimony of S. Roselle; Verification of S. Roselle]

 12. Sylvia Stengle testified at the hearing on May 9, 1988. I found her testimony to be credible in all respects. Ms. Stengle is the founder and Director of the Allentown Women's Center. She is responsible for the ongoing operation of the clinic and hiring. She holds a Bachelor of Arts degree from the University of Wisconsin, and has taken graduate courses in sociology and psychology. Prior to founding AWC in 1978, she was the Education Director for Planned Parenthood of Northampton County, Pennsylvania. She has been personally involved in counseling since 1973, and now supervises the AWC counseling staff. She serves on the Board of Directors of the National Abortion Rights Action League. [Testimony of S. Stengle; Verification of S. Stengle]

 13. Cathy Dratman, M.D., testified at the hearing on May 9, 1988. I found her testimony to be credible in all respects. Dr. Dratman is licensed to practice medicine in Pennsylvania and New Jersey. She is a graduate of Hahnemann Medical College and served an internship and residency at Pennsylvania Hospital in Philadelphia. She is board certified by the American Board of Obstetrics and Gynecology, and is a Fellow of the American College of Obstetrics and Gynecology. She has been Medical Director of Planned Parenthood of Southeastern Pennsylvania since 1986, and has had a private obstetrical and gynecological practice in New Jersey. She does not presently perform abortions, but in the past has performed and referred patients for first trimester and second trimester abortions up to 20 weeks gestation. As Medical Director of PPSP, she maintains close contact with, and generally oversees, all abortion procedures performed at the clinic. [Testimony of Dr. Dratman; Verification of Dr. Dratman]

 14. Patricia Potrzebowski, Ph.D., has submitted a declaration and supplementary declaration in this matter. She is the Director of the Division of Health Statistics and Research, State Health Data Center, Department of Health (hereinafter Health Statistics Division). [Stipulation of Uncontested Facts para. 235] She has been the Division Director since late 1976 or early 1977. [Stipulation of Uncontested Facts para. 236] She has a Bachelor of Science in Biology from Schimer College, Mount Carroll, Illinois. In 1974, she obtained a doctorate degree in human genetics from the Graduate School of Public Health from the University of Pittsburgh. [Stipulation of Uncontested Facts para. 237]

 15. Plaintiff Planned Parenthood of Southeastern Pennsylvania performs approximately 2,800 first trimester abortions a year. The abortion procedure presently costs full-payment patients $ 225 if the woman is 12 weeks or less from her last menstrual period. All fees cover only the direct costs of the procedure, including personal counseling, medical testing and examination, the abortion procedure, medical supervision during the post-surgical recovery, and a post-abortion examination. [Stipulation of Uncontested Facts para. 3]

 16. PPSP charges $ 180 for abortions for women who are on medical assistance but whose abortions are not reimbursable by the state. [Stipulation of Uncontested Facts para. 4]

 17. PPSP accepts state medical assistance reimbursement in lieu of direct payment for abortions for victims of rape and incest, and for women with life-threatening conditions. [Stipulation of Uncontested Facts para. 5]

 18. In 1987, PPSP performed 359 abortions for women under the age of 18. [Stipulation of Uncontested Facts para. 6]

 19. When a woman believing she is pregnant presents herself at a PPSP clinic, she is given a pregnancy test and examined by a nurse practitioner or physician. Women who believe they have just recently become pregnant are offered early detection by means of a blood test or special urine test. Once it is determined that she is pregnant, the woman is encouraged to participate in an individual options counseling session with a PPSP counselor. [Stipulation of Uncontested Facts para. 7]

 20. Options counselors are volunteers or staff counselors who have completed a special training program under the supervision of PPSP counselors and other senior staff. This training program consists of 43 hours of group sessions that focus on factual information regarding adoption, abortion, contraception and referral resources. The course also gives participants the opportunity to evaluate, explore and share their attitudes and feelings. The course is certified by Temple University. Participants receive four CEU credits for completion of the training. [Stipulation of Uncontested Facts para. 8]

 21. Abortion counselors are members of PPSP's counseling staff or college student interns working under the supervision of a staff counselor. These counselors have college backgrounds and experience in a health or social services related field. All have had on-site training in pregnancy counseling and abortion care and are required to participate in ongoing in-service training. [Stipulation of Uncontested Facts para. 9]

 22. Each PPSP client participates in an individual abortion counseling session on the day her procedure is scheduled. In this session, the counselor and the woman discuss the woman's medical history, personal situation and feelings about abortion. The counselor explains the abortion procedure and its risks. Post-abortion care and contraceptive plans are also explored. In the course of this session the information necessary for informed consent is presented to the client. These sessions routinely last 30-40 minutes. If the client has been accompanied to the clinic by a person she wishes to involve in the counseling, that person will be included in part of this session. In some cases, the abortion counselor will serve as the support person and accompany the woman through the procedure. [Stipulation of Uncontested Facts para. 10]

 23. PPSP counseling sessions for minors are more extensive, to assure that minors are fully informed of all options, are relatively clear-minded, and are making a free and informed choice. They are given detailed information on the procedure and its risks. They are also counseled on future contraceptive care. When a minor does choose to involve a parent or other supportive adult such as an aunt, guardian or older sibling, the counselor will first meet privately with the minor. Then, at the counselor's discretion and with the minor's consent, the parent or adult will be brought in for joint counseling. [Stipulation of Uncontested Facts para. 11]

 24. PPSP advertises that it provides abortion services in the telephone directories serving the greater Philadelphia and Delaware County areas. [Stipulation of Uncontested Facts para. 81]

 25. Plaintiff Reproductive Health and Counseling Center operates a clinic that performs approximately 2,900 first and early second trimester abortions annually. [ See Stipulation of Uncontested Facts para. 12]

 26. RHCC employs a staff of approximately six physicians, one nurse practitioner, and two full-time and three part-time counselors. Abortions are performed on Wednesday and Friday afternoons and on Saturday mornings. Additional counseling services are available by appointment. [Stipulation of Uncontested Facts para. 13]

 27. First trimester abortions (up to 12 weeks from the last menstrual period) with local anesthesia costs RHCC clients $ 210. For abortions from 12 to 16 weeks from the last menstrual period, the cost is $ 365, plus an additional $ 70 for a required ultrasound. [Stipulation of Uncontested Facts para. 14]

 28. If RHCC's clients are eligible for medical assistance reimbursement, RHCC seeks reimbursement from the Commonwealth. [Stipulation of Uncontested Facts para. 15]

 29. Where a client receives medical assistance from the state but is not eligible for medical assistance for an abortion, RHCC provides a $ 50 cost reduction for first trimester abortions with local anesthesia. [Stipulation of Uncontested Facts para. 16]

 30. While RHCC's clients come primarily from Delaware, Philadelphia, Chester and Bucks counties, approximately 3-4% of its clients come from areas in excess of three hours traveling time [Stipulation of Uncontested Facts para. 17]

 31. In 1987, RHCC performed abortions on 349 minors. Approximately 60% of these minors were accompanied by a parent. All minors who choose not to be accompanied by a parent must be accompanied by a responsible adult who will stay in the building as long as the minor is there and will accompany the minor home. [Stipulation of Uncontested Facts para. 18]

 32. A woman's first contact with RHCC is usually by telephone. Women who call RHCC may or may not have had a pregnancy test prior to calling. Before any appointment is made, she must have had a positive pregnancy test. Telephone counselors refer the woman to RHCC or to the agency closest to her home or place of work for the test. [Stipulation of Uncontested Facts para. 19]

 33. If a woman has had a positive pregnancy test and wants to terminate the pregnancy, RHCC will schedule an abortion appointment, usually within one week's time. If the woman indicates uncertainty about her decision, the telephone counselor will recommend that she make an appointment to talk further with an options counselor about her decision. [Stipulation of Uncontested Facts para. 20]

 34. RHCC strongly urges options counseling for all minors who have not involved their parents in the decision. [Stipulation of Uncontested Facts para. 21]

 35. In an options counseling session, an RHCC counselor talks with the woman about her feelings about her pregnancy. The purpose of the session is to let the woman know about each of the three options available to her: carrying to term and keeping the child, carrying to term and giving the child up for adoption, and pregnancy termination. The woman is urged to talk about these options with supporting family members and friends. The role of the counselor in these sessions is to support the decision of the woman and to provide information that would be necessary as she acts on her decision. [Stipulation of Uncontested Facts para. 22]

 36. Pre-abortion counseling at RHCC, in which each woman must participate on the day of her abortion and which is different from options counseling, involves a discussion of the woman's decision, a review of her medical history and a description of the risks and complications of the abortion procedure. The informed consent part of the session is conducted in groups of four women. The counselor describes the medical procedure, reviews the risks and complications, and answers questions or addresses concerns. RHCC also provides counseling to the person or persons who accompany the woman for an abortion. [Stipulation of Uncontested Facts para. 23]

 37. Pre-abortion and options counselors are trained and supervised by RHCC's head counselor, who has nine years' counseling experience. [Stipulation of Uncontested Facts para. 24]

 38. RHCC advertises that it provides abortion services in the telephone directory serving the Delaware County - Main Line areas. [Stipulation of Uncontested Facts para. 82]

 39. Plaintiff Women's Health Services, Inc. has a staff of approximately 85 people (including 13 physicians, 14 nurses and 30 counselors) and offers ongoing programs which are inclusive of approximately 3,000 client contacts a month. [Stipulation of Uncontested Facts para. 25]

 40. Free pregnancy testing and counseling are available at WHS daily, Monday through Saturday. Abortions are performed Tuesdays, Fridays and Saturdays. Gynecology clinics are held on Wednesdays and Thursdays and any other day a patient's condition dictates. Once their pregnancies are diagnosed, clients usually schedule their abortions by telephone. [Stipulation of Uncontested Facts para. 26]

 41. WHS provides approximately 11,800 free pregnancy tests and 7,600 first and early second trimester abortions each year. The cost of an abortion procedure at WHS is as follows: $ 275 if twelve weeks or less from the last menstrual period; $ 375 if thirteen to fourteen weeks from the last menstrual period; and $ 500 if fifteen to sixteen weeks from the last menstrual period. The fee includes the abortion procedure, laboratory testing, personal counseling (including contraceptive care), pathological examination, and medical supervision during the post-surgical recovery period. [Stipulation of Uncontested Facts para. 27]

 42. WHS accepts state medical assistance reimbursement in lieu of direct payment for abortions for victims of rape and incest, and for women with life-threatening conditions. [Stipulation of Uncontested Facts para. 28]

 43. Where a client receives medical assistance from the state, but is not eligible for medical assistance for an abortion, WHS nevertheless will discount the cost of the abortion. Last year, WHS accommodated 1,470 clients who were unable to pay the full amount. WHS has never turned away any client seeking an abortion merely because of inability to pay. [Stipulation of Uncontested Facts para. 29]

 44. WHS's clients come primarily from Allegheny County. In 1987, however, 761 of their abortion clients came from areas in excess of two hours traveling time (100 miles) from the clinic. [Stipulation of Uncontested Facts para. 30]

 45. In 1987, 907 of WHS's abortion clients were under the age of 18. WHS presently encourages minors to bring a parent or other adult with them. Because WHS believes that parental involvement should be encouraged, clinic counselors are instructed to offer to speak with a minor's parents. When a minor refuses to inform her parents of her pregnancy under any circumstances, her wishes are presently respected. [Stipulation of Uncontested Facts para. 31]

 46. When women present themselves at the WHS clinic, if indicated, they are examined by a nurse practitioner or physician's assistant. All women receive a pregnancy test and blood tests. In addition, every woman is required to have an individual interview with a counselor on the day her abortion is to be performed. These interviews routinely last twenty minutes to one hour. During this interview, a woman is counseled with respect to her options and her decision to have an abortion. In that connection, the counselor seeks to ensure that the woman is not unduly ambivalent about her decision and that she is not being coerced. In addition, the counselor discusses future contraceptive use with the patient. If the client appears ambivalent about her decision, the counselor will refer her to one of the WHS staff therapists and the abortion will be rescheduled to give the patient more time to consider her options. The clinic will refuse to perform the abortion if convinced of a patient's continued ambivalence. This is rare, however, because the great majority of WHS's patients have absolutely decided to have an abortion before seeking medical care. [Stipulation of Uncontested Facts para. 32]

 47. When a parent accompanies a minor seeking an abortion, WHS first counsels the minor with respect to her options and her decision to have an abortion, and also provides her with information on future contraceptive use. The parent is then asked to join the minor, at which time the abortion procedure and possible complications are described. The counselor also answers any questions they might have. An informed consent form is then read out loud to the parent and minor while they follow along with their own copies. Each then signs the form in the medical record. [Stipulation of Uncontested Facts para. 33]

 48. Options counseling is provided on the day of the procedure by WHS paraprofessional counselors, who are selected on the basis of personal qualifications and maturity. [Stipulation of Uncontested Facts para. 34]

 49. Extensive and intensive problem pregnancy counseling is available to all WHS clients at no charge, either before or after a decision with respect to an abortion has been made, regardless of what that decision may be. [Stipulation of Uncontested Facts para. 35]

 50. Personal counseling is also available after the abortion procedure; clients are encouraged to take advantage of the service. [Stipulation of Uncontested Facts para. 35]

 51. Personal counselors at WHS are professional therapists who have at least five years of clinically supervised experience at the master's degree level or above. At present, both of WHS's personal counselors hold Ph.D. degrees. [Stipulation of Uncontested Facts para. 36]

 52. Both paraprofessional and professional counselors at WHS are required to begin their employment with a week of classroom preparation, consisting of approximately 35 hours of medical and counseling orientation to the abortion clinic. This instruction is provided by the Associate Medical Director, Director of Counseling and Training, and Director of Clinic Services. [Stipulation of Uncontested Facts para. 37]

 54. WHS advertises that it provides abortion services in the telephone directories serving the greater Pittsburgh and Aliquippa areas. [Stipulation of Uncontested Facts para. 80]

 55. Plaintiff Women's Suburban Clinic performs approximately 3,350 first trimester abortions a year. Abortions are performed Tuesdays, Wednesdays and Thursdays. [Stipulation of Uncontested Facts para. 40]

 56. Of the approximately 3,350 abortions WSC performed in 1987, 410 (12.25%) were performed on minors. [Stipulation of Uncontested Facts para. 41]

 57. The fee for an abortion at WSC is $ 225. At present, WSC accepts state medical assistance reimbursement in lieu of direct payment for abortion for victims of rape and incest, and for women with life-threatening conditions. [Stipulation of Uncontested Facts para. 42]

 58. Appointments for counseling and abortions are made through WSC telephone counselors. A positive pregnancy test is required before an abortion is scheduled. [Stipulation of Uncontested Facts para. 43]

 59. Depending upon patient interest and availability, appointments are made at WSC in one of the following ways:

 a. If a woman requests counseling and the abortion on the same day, the first available appointment is given. There is often a one to two week wait in obtaining such an abortion. Approximately 70% of the abortion appointments are scheduled this way.

 b. If a woman wants to see a counselor prior to the day of her abortion, a pre-abortion counseling session is made. Approximately 30% of the abortion appointments are scheduled this way.

 [Stipulation of Uncontested Facts para. 44]

 60. All minors who have not informed a parent about their decision to have an abortion are asked to come to WSC for pre-counseling before the abortion appointment. This is done to give adolescents the opportunity to explore with a professional counselor their reasons for not involving their parents, and affords them the time and opportunity to reevaluate that decision prior to the abortion. [Stipulation of Uncontested Facts para. 45]

 61. A woman who calls WSC and expresses concern and confusion over an unwanted pregnancy is offered an opportunity to see a counselor to discuss her options. Resource information is available for options including keeping the child, foster care and adoption. Information concerning maternity homes is also available for those women who wish to carry their pregnancies to term. [Stipulation of Uncontested Facts para. 46]

 62. All counseling at WSC is provided on an individual basis by a trained counselor. All but one member of WSC's counseling staff have master's degrees; the other has a bachelor's degree with several years' experience in counseling and family planning. All have backgrounds in various fields of human services. [Stipulation of Uncontested Facts para. 47]

 63. Counseling sessions at WSC average between thirty minutes to an hour. [Stipulation of Uncontested Facts para. 48]

 64. WSC believes that part-time employment is necessary in order to counsel effectively without becoming overstressed by the emotional demands of the job. Therefore, no counselor is scheduled to see clients more than 20 hours a week. [Stipulation of Uncontested Facts para. 49]

 65. WSC suggests that partners and/or parents be seen by a counselor during or after the counseling session. However, all clients are first seen alone by a WSC counselor. [ See Stipulation of Uncontested Facts para. 50]

 66. Counseling at WSC is provided in an objective, nonjudgmental manner. The client's decision is reviewed and explored. The counselor also reviews the client's medical history, describes the abortion procedure, reviews birth control methods and goes over the informed consent form. Disclosure of medical risks and benefits tailored to the needs of individual clients is made as well. Also, post-abortion information, including what to do in the event of an emergency, is reviewed. [Stipulation of Uncontested Facts para. 51]

 67. For women who express ambivalence over their abortion decision, the WSC counselor will explore further. If the counselor feels that the woman is not sure of her decision, it is suggested that she take some time to reevaluate her choice. Additional counseling is available to help the woman to come to a decision with which she feels comfortable. [Stipulation of Uncontested Facts para. 52]

 68. Plaintiff Allentown Women's Center provides approximately 5,300 pregnancy tests and 4,000 first trimester abortions each year. [Stipulation of Uncontested Facts para. 54]

 69. Abortions are performed at AWC three to five days a week, depending on patient need. [Stipulation of Uncontested Facts para. 55]

 70. The abortion procedure at AWC costs $ 250, with additional charges for services such as RhoGam shots for women more than 12 weeks pregnant and general anesthesia. The fee includes personal counseling both before and after the abortion, the abortion procedure, laboratory testing, and medical supervision during the post-surgical period. [Stipulation of Uncontested Facts para. 56]

 71. For patients who receive medical assistance from the Commonwealth, AWC's fee for an abortion is $ 195. [Stipulation of Uncontested Facts para. 57]

 72. AWC has received state medical assistance reimbursement in lieu of direct payment for abortions for victims of rape and incest, and for women with life-threatening conditions. [Stipulation of Uncontested Facts para. 58]

 73. AWC's patients come primarily from an 18-county area in northeastern Pennsylvania encompassing the counties of Lehigh, Northampton, Carbon, Schuylkill, Luzerne, Lackawanna, Lebanon, Berks, Bucks, Pike, Chester, Lancaster, Susquehanna, Wayne, Monroe, Montgomery, Columbia and Wyoming. Many of these counties have no local services available to women seeking abortions, AWC being the closest facility to which the women can come. [Stipulation of Uncontested Facts para. 59]

 74. In 1987, 946 (22%) of AWC's abortion patients were 18 or under. Of these, 3 were age 13; 32 were age 14; 64 were age 15; 178 were age 16; 286 were age 17; and 383 were age 18. An additional 366 were 19 year-olds. Most of those minors between ages 13 and 15 involved a parent in their decision to have an abortion. Approximately one-half of the 16 year-old minors involved a parent; while less than half of the 17 year-olds involved a parent. [Stipulation of Uncontested Facts para. 60]

 75. AWC encourages its minor patients to involve their parents in the abortion decision and to bring a parent or other supporting adult with them at the time of counseling and the procedure. Clinic counselors are routinely available to speak with a minor's parents. When a minor refuses to inform her parents under any circumstances, AWC respects those wishes. [Stipulation of Uncontested Facts para. 61]

 76. Approximately 54% of AWC's minor patients have parental consent for abortions. [Testimony of S. Stengle]

 77. In all cases, AWC requires that some adult is available to care for a minor patient. [Testimony of S. Stengle]

 78. In most cases, appointments for counseling and abortions at AWC are made through telephone counselors. A positive pregnancy test is required before an abortion will be scheduled. When a woman calls requesting an abortion, the telephone counselor collects personal data, menstrual history and medical history. If the caller is a minor, the telephone interview is more extended to assure that the minor fully understands what she must do and what the procedure will involve. [Stipulation of Uncontested Facts para. 62]

 79. When a telephone counselor makes an appointment, pre-abortion instructions are given to the woman. These instructions include what the woman must do and what she must bring with her on the day of the appointment. [Stipulation of Uncontested Facts para. 63]

 80. Any woman who calls AWC and expresses concern and confusion over an unwanted pregnancy is offered an opportunity to see a counselor to discuss her options. Resource information is available for options, including keeping the child, foster care, and adoption. Information concerning prenatal care, welfare and support services is also available for those women who wish to carry their pregnancies to term. [Stipulation of Uncontested Facts para. 64]

  81. When they present themselves at AWC's clinic, all women are examined by a nurse practitioner or physician's assistant and, where necessary, are given a pregnancy test and blood workup. In addition, all women are required to have an individual interview with a counselor on the day their abortion is scheduled. These interviews routinely last from 20 minutes to an hour. In this interview, the abortion procedure and other alternatives are explained to the woman. [Stipulation of Uncontested Facts para. 65]

  82. If the patient appears ambivalent about her decision to have an abortion, the AWC counselor will review options and suggest that the patient take more time to consider her decision before terminating the pregnancy. On occasion, the clinic has refused to permit an abortion if, after consultation, the counselor and the clinic supervisor are convinced of the woman's extreme ambivalence, coercion, or that she is otherwise overly distraught. They will sometimes refer these women to outside counselors. Such instances are infrequent, however, because the great majority of AWC's patients have absolutely decided to have an abortion before making an appointment at the AWC clinic. [Stipulation of Uncontested Facts para. 66]

  83. When a parent does accompany a minor to the AWC clinic, a counselor will first meet privately with the minor. After assuring that the minor has reached her decision to have an abortion freely and without coercion, the counselor will give the minor the option to continue the counseling session jointly with her parent, or to be counseled separately. In either case, the counselor will describe the procedure and possible complications, as well as answer any questions they may have. The minor is then asked to sign an informed consent form. [Stipulation of Uncontested Facts para. 67]

  84. When a minor chooses not to have a parent involved, AWC counselors explore and encourage the involvement of a supporting adult. Counseling of minors who have not informed their parents is more extensive and includes a discussion of why the minor has chosen not to involve her parents. [Stipulation of Uncontested Facts para. 68]

  85. The options counseling provided on the day of the procedure at AWC is conducted by paraprofessional staff counselors, who are selected on the basis of personal qualifications. Most of the counseling staff have bachelor's degrees. Two are presently working on master's degrees. All have backgrounds in various fields of human services. [Stipulation of Uncontested Facts para. 69]

  86. All of AWC's counselors are required to begin their employment with at least one week of orientation. Instruction is provided by the Director, the nurse practitioner, the Patient Services Coordinator and other counseling staff. During the first months of work, the new staff has frequent meetings either on an individual basis or as a group with administrative staff to reinforce correct integration of medical information and continued development of interviewing skills. [Stipulation of Uncontested Facts para. 70]

  88. AWC advertises that it provides abortion services in the telephone directories of several communities including but not limited to Allentown, Pottsville, Carbondale, and Hazelton. [Stipulation of Uncontested Facts para. 79]

  89. At all plaintiff clinics, a counselor talks with the woman about her feelings about her pregnancy. [Stipulation of Uncontested Facts para. 75]

  90. If at any time during the pre-abortion counseling session the woman expresses ambivalence or dissatisfaction with her decision to terminate her pregnancy, the counselor may recommend additional counseling to explore her options. [Stipulation of Uncontested Facts para. 76]

  91. All plaintiff clinics recommend that a woman who is uncertain about her decision to obtain an abortion make an appointment to talk further with a counselor about her decision. [ See Stipulation of Uncontested Facts para. 72] If the counselor feels that the woman is not sure of her decision, the counselor suggests that she take some time to reevaluate her choice. [Stipulation of Uncontested Facts para. 77]

  92. Additional counseling by the medical providers is available to assist the woman in coming to a decision with which she feels comfortable. [Stipulation of Uncontested Facts para. 78]

  93. These counseling practices inevitably cause some delay in the performance of abortions.

  94. As of December 31, 1987, there were 147 facilities in the Commonwealth approved by the Department of Health to perform abortions. [Stipulation of Uncontested Facts para. 93]

  95. In 1987, there were 51,630 abortions performed in Pennsylvania and reported to the Pennsylvania Department of Health. [Stipulation of Uncontested Facts para. 88] There were 51,666 abortions performed in 1986; 53,465 in 1985; 59,258 in 1984; 59,288 in 1983; 60,772 in 1982; 62,701 in 1981; and 65,777 in 1980. [Stipulation of Uncontested Facts para. 89]

  96. Of the 51,630 abortions performed in Pennsylvania in 1987, 48,923 (94.8%) were performed within the first three months of pregnancy. [Stipulation of Uncontested Facts para. 90] Conversely, 2,707 (5.2%) were performed after the first three months of pregnancy.

  97. Of the 51,666 abortions performed in Pennsylvania and reported to the Pennsylvania Department of Health in 1986, 49,278 (95.4%) were performed within the first three months of pregnancy. [Stipulation of Uncontested Facts para. 98] Conversely, 2,388 (4.6%) were performed after the first three months of pregnancy.

  98. Second trimester abortions in Pennsylvania increased from 2,335 in 1986 to 2,540 in 1987. [Stipulation of Uncontested Facts para. 91]

  99. I deduce that 145 abortions were performed in the third trimester in Pennsylvania in 1987.

  100. Patients aged 19 and under accounted for 26.9% of abortions performed in 1987. [Stipulation of Uncontested Facts para. 92] However, I note that minors aged 18 and under accounted for only 10,025 (19.4%) of the abortions performed in 1987. [ See Stipulation of Uncontested Facts para. 94]

  101. Patients aged 19 and under accounted for 26.3%, or 13,569 of the abortions reported in Pennsylvania in 1986. [Stipulation of Uncontested Facts para. 99] However, I note that minors aged 18 and under accounted for only 9,695 (18.8%) of the abortions performed in 1987. [ See Stipulation of Uncontested Facts para. 101] 102. The following table represents the numbers of induced abortions performed in Pennsylvania in 1987 by age of woman, as reported to the Pennsylvania Department of Health: AGE (YEARS) NUMBER 10 0 11 1 12 16 13 84 14 377 15 955 16 1,896 17 2,768 18 3,928 19 3,883 20-24 17,004 25-29 11,005 30-34 6,026 35-39 2,915 40-44 721 45 or older 40 Unknown 11 TOTAL 51,630

  [ See Stipulation of Uncontested Facts para. 101] 104. The following table represents the number of induced abortions performed in Pennsylvania in 1987 by weeks since last menstrual period, as reported to the Pennsylvania Department of Health: WEEKS FROM LAST NUMBER MENSTRUAL PERIOD 10 or less 36,279 11-12 9,111 13-14 3,533 15-17 2,394 18-22 132 23-26 14 27 or more 2 unknown 165 TOTAL 51,630

  [Stipulation of Uncontested Facts para. 95] 105. The following table represents the numbers of induced abortions performed in Pennsylvania in 1987 by primary type of procedure, as reported to the Pennsylvania Department of Health: PRIMARY ABORTION NUMBER PROCEDURE Suction Curettage 37,666 Sharp Curettage 48 Dilation and Evacuation 13,342 Intra-Uterine Saline Installation 453 Intra-Uterine Prostaglandin Instillation 78 Hysterotomy 2 Hysterectomy 6 Other 20 Unknown 15 TOTAL 51,630

  [Stipulation of Uncontested Facts para. 96] 106. The following table represents the number of abortions performed in Pennsylvania in 1986 by type of procedure, as reported to the Pennsylvania Department of Health: PRIMARY ABORTION NUMBER PROCEDURE Dilation, Evacuation, and Curettage 51,031 Intra-uterine Saline Installation 450 Intra-uterine Prostaglandin Installation 152 Hysterotomy 3 Hysterectomy 3 Other 27 TOTAL 51,666

  [ See Stipulation of Uncontested Facts para. 102]

  107. Of the 51,666 abortions performed in Pennsylvania and reported to the Pennsylvania Department of Health in 1986, 49,537 were performed on Pennsylvania residents. Residents of other states and territories accounted for 2,124 abortions, and residents of other countries accounted for 5. Of the 1986 abortion patients residing in Pennsylvania, 15,471 (31.2%) resided in Philadelphia; 7,919 resided in Allegheny County; 2,966 resided in Montgomery County; 2,794 resided in Delaware County; and 2,235 resided in Bucks County. [Stipulation of Uncontested Facts para. 100]

  108. Section 3206(a), as amended by Act 31, provides:

  
Except in the case of a medical emergency, or except as provided in this section, if a pregnant woman is less than 18 years of age and not emancipated, or if she has been adjudged an incompetent . . ., a physician shall not perform an abortion upon her unless, in the case of a woman who is less than 18 years of age, he first obtains the informed consent both of the pregnant woman and one of her parents; or, in the case of a woman who is incompetent, he first obtains the informed consent of her guardian. In deciding whether to grant such consent, a pregnant woman's parent or guardian shall consider only their child's or ward's best interest.

  109. Section 3205(a), as amended by Act 31, provides:

  
No abortion shall be performed or induced except with the voluntary and informed consent of the woman upon whom the abortion is to be performed or induced. Except in the case of a medical emergency, consent to an abortion is voluntary and informed if and only if, prior to the consent having been given, the physician who is to perform the abortion, or the referring physician, or [another qualified person to whom the responsibility has been delegated by either physician], has orally informed the woman of the nature of the proposed procedure or treatment and of those risks and alternatives to the procedure or treatment that a reasonable patient would consider material to the decision whether or not to undergo the abortion, and the woman certifies in writing prior to the abortion that she has been provided such information.

  110. The Act does not separately define "informed parental consent." The Act does not explicitly state that the parent must visit the clinic personally in order to give his or her informed consent.

  111. Minors who become pregnant usually believe that they are mature enough to make the decision to consult a physician and to terminate the pregnancy. [Stipulation of Uncontested Facts para. 74]

  112. Clinics in Pennsylvania that offer abortion counseling services and abortions support and encourage parental involvement in a minor's decision to have an abortion, where possible. [Stipulation of Uncontested Facts paras. 73, 105]

  113. The unrebutted testimony of Sue Roselle was that, in her experience as a health care administrator, the concept of "informed consent" (as opposed to "consent") implies an in-person consultation with the patient or, in this case, parent. [Testimony of S. Roselle]

  114. Under Act 31, and in the absence of further guidance from the Commonwealth or the courts concerning the procedure necessary to obtain legally valid parental consent, the plaintiff clinics will require an in-person consultation with the parent to assure the parent's consent is informed. [Testimony of S. Roselle and S. Stengle; Verifications of J. Green, S. Miller, and C. Wall. See Stipulation of Uncontested Fact paras. 106, 130]

  115. Even if the concept of "informed consent" does not, in and of itself, require an in-person consultation, plaintiff clinics believe that an in-person visit by the parent to the clinic is necessary in order to avoid the risk of criminal or civil penalties for failure to establish proper identification of the parent. [Testimony of S. Roselle and S. Stengle; Verifications of J. Green, S. Miller and C. Wall; Stipulation of Uncontested Fact paras. 130-131]

  116. Indeed, some clinics, such as plaintiff RHC, intend to require that all certifications of parenthood and the minor's age be notarized. [Stipulation of Uncontested Facts P 132] WHS probably will require all women who state their age as 24 years or less to present proof of identity, and parents to present a birth certificate to certify parenthood. [Testimony of S. Roselle]

  118. Some parents may find it difficult to come to a clinic for the necessary counseling because of work schedules, illness, family and other commitments. [Stipulation of Uncontested Facts para. 109]

  119. Some parents may be unable to come to the clinic for many days, or possibly even weeks, after their minor daughters have decided to seek an abortion. [Stipulation of Uncontested Facts para. 110]

  120. Some, but not all, minors must travel long distances to reach a clinic. A parent who cannot accompany the minor on her initial trip would have to make a separate trip to the clinic to give consent if the clinics insist on an in-person meeting. Following that, the minor, whether or not accompanied by the parent, would have to make another trip to the clinic for the abortion procedure. [Stipulation of Uncontested Facts para. 113]

  121. Plaintiff AWC, for example, services a large 18-county area. In 1987, of its approximately 4,000 abortion patients, 138 (3.26%) came from areas in excess of two hours travelling time (100 miles) from the clinic. 1,220 (29%) came from areas in excess of 1 1/2 hours traveling time; while 2,276 (54%) came from areas in excess of 1 hour traveling time. [Stipulation of Uncontested Facts para. 114]

  122. If a parent does not have the proper documentation upon his or her visit to a clinic, it may be necessary to reschedule counseling and abortion until a later time. [ See Stipulation of Uncontested Facts para. 133]

  123. An in-person visit by a parent for informed consent may cause delays of several days or possibly weeks, even in cases where the parent is prepared to consent. [ See Stipulation of Uncontested Facts paras. 108, 110]

  124. Delays in obtaining parental consent could be both dangerous and prohibitive since most minors decide to have an abortion much later in their pregnancies than do adults. [ See Stipulation of Uncontested Facts para. 116]

  125. Adolescents as a group are reluctant to establish contact with unfamiliar organizations. Many delay the initial step of calling a clinic until well into their pregnancies. [Stipulation of Uncontested Facts para. 117]

  126. Adolescents as a group tend to deny their pregnancies out of guilt and to put off making any decision as to what to do. [Stipulation of Uncontested Facts para. 118]

  127. Many adolescents are not aware that they are pregnant for many weeks or months because of ignorance about contraception, their own menstrual cycles, and pregnancy. [Stipulation of Uncontested Facts para. 119]

  128. Delays can arise from a minor's fear and hesitation in divulging to her parents that: first, she has been sexually active; second, that she is pregnant, and third, that she wishes to have an abortion. Because of the disruption and trauma caused by such disclosures, a minor will tend to delay telling her parents that she is pregnant for days or even weeks. [Stipulation of Uncontested Facts para. 120]

  129. The plaintiff clinics often find themselves having to expedite a minor's testing, counseling and procedure because the minor has delayed going to a clinic until she is near or into the second trimester of pregnancy. [Stipulation of Uncontested Facts para. 121]

  130. The fact that many minors delay seeking an abortion until they are near or into the second trimester of pregnancy is in no way related to any action of the Commonwealth.

  132. Publicly available statistics suggest that a delay of one week in the performance of an abortion can increase the risks to the patient from both a mortality and morbidity standpoint. [Stipulation of Uncontested Facts para. 125]

  133. Late abortions, particularly second trimester abortions, are more dangerous than early abortions. Risk of hemorrhage or infection increases with each week of delay. [Stipulation of Uncontested Facts para. 123]

  134. Later abortions pose greater risks of injury to the uterus and retention of products of contraception. [Stipulation of Uncontested Facts para. 124]

  135. Scientific studies have demonstrated that the risk of death caused by abortion increases approximately 40% for each week of delay. C. Tietze, Induced Abortion: 1979, A Population Council Fact Book 83 (3d ed., N.Y. Population Council (1979)). [Stipulation of Uncontested Fact para. 126]

  136. Because teenagers are more likely to have had no previous dilations of the cervix, later abortions can be an especially dangerous procedure for them. ...


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