Florida abortion clinics struggling to stay open despite being monitored and fined

PLANNED PARENTHOOD: Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, visits the West Palm Beach, Florida, center in June 2022. Carline Jean/South Florida Sun Sentinel

FORT LAUDERDALE, Fla. — As pregnant women flood into Florida abortion clinics, trying to get a procedure before they reach 15 weeks, the clinics are struggling with new regulations, increased state inspections, and in some cases hefty fines that threaten their businesses.

After Florida’s 24-hour waiting period requirement for abortions went into effect last spring, it took only two weeks for state inspectors to descend on abortion clinics and dole out penalties for improper paperwork or lack of documentation.

Second and third surprise visits followed after July 1 when Florida’s 15-week abortion ban became law and state administrators scrutinized the clinics’ documentation yet again

Now, with a proposed six-week abortion ban sailing through the state Legislature, busy clinics already are buried in paperwork, filing reports that ask detailed questions and undergoing more vigilant monitoring.

“A lot of clinics have had to go through the hoops we went through,” said Kertch Conze, an attorney for A Gyn Diagnostic Center in Hialeah, which settled allegations from the state that the clinic did not provide required information to women at least 24 hours before abortions. The February settlement shows the clinic agreed to pay $7,000 out of $41,000 in fines.

Complying with mandates

Clinic administrators say it has been a difficult year complying with new state mandates, consent documentation, time stamps, increased scrutiny and lack of communication from the state’s Agency for Health Care Administration, which regulates abortion clinics.

Every abortion clinic in Florida received an almost immediate visit from a state inspector in May 2022 on the heels of a ruling by a Leon County circuit judge on April 25 that upheld the 24-hour waiting period law. The law had passed in 2015 but had been on hold during a seven-year constitutional fight.

While Planned Parenthood has an advocacy and policy arm that helped prepare its 18 Florida clinics for the “24-hour” law, the 34 smaller independent clinics were less ready.

“Not all clinics have representation or resources,” said one clinic administrator, who asked not to be named for fear of becoming a target of anti-abortion activists. “It’s not like ACHA had a form and said fill it out. We had to create our own way of proving we waited 24 hours.”

Bailey Smith of Florida’s Agency for Health Care Administration didn’t respond directly to the Sun Sentinel’s request for comment on the numerous fines on clinics, but said via email: “The Agency will respond timely and appropriately to any legislation passed regarding providers we regulate.” She said her agency has not mandated a particular form for documentation related to the 24-hour waiting period and that its authority to fine up up to $1,000 is outlined in a Florida Statute.

When clinics lacked documentation, state inspectors gave the maximum allowable penalty – a $1,000 fine – for each patient file that failed to show compliance.

The agency, which regulates abortion clinics, has issued close to $500,000 in fines to 14 of Florida’s 52 abortion clinics. Some of the businesses settled; some still are fighting the fines. Broward County’s East Cypress Women’s Center has challenged a $56,000 fine stemming from allegations that it did not properly comply with the 24-hour waiting period. Today’s Women Medical Center in Miami challenged a potential $3,000 fine for allegedly violating the same law and settled for $500.

'They want to close as many clinics as possible'

Conze believes the flurry of inspections and fines are about more than documentation.

“My personal opinion is that they want to close as many clinics as possible,” he said “When they flag as many as 200 files and fine a clinic $1,000 per file, that’s enough to put a small business out of commission.”

The largest fine, $193,000, was levied against an Orlando abortion clinic that inspectors allege violated the 24-hour law for 193 patients who mostly had medication abortions.

The clinic, Center of Orlando for Women, challenged the large sum and asked for a $100-per-patient fine instead. Julie Gallagher, an attorney representing the clinic, argued that imposing the maximum fine for each violation was arbitrary and unfair. “If they had to pay $193,000, they likely would have to close,” Gallagher said. “They just couldn’t pay it.”

On Friday, an administrative law judge recommended that the clinic pay $67,550, saying the center violated the law but lowered the fine. His recommendation will go back to the state agency for final action.

Gallagher said the clinic was not told the law was in effect when they broke it.

“My client was trying to get information from AHCA about the effective date of the law that put the 24-hour period into play, and AHCA wouldn’t tell them. Then the agency surveyed all the clinics in the state for compliance. It’s an example of 'gotcha' ... we will not tell you what you should be doing, but we are going to fine you when you aren’t doing it.”

In written documents defending the fine, lawyers for AHCA wrote that the agency is under no legal obligation to promptly alert clinics about changes in law.

Targeting providers

Gallagher said state inspectors also are making unannounced visit to abortion clinics, claiming they are following up on complaints. “They just come out for the sake of coming out. There are no complaints, and if there is, they won’t tell you what it is and I suspect they have no proof. They likely are getting tips from the anti-choice community who just want to stir things up.”

At least a half-dozen clinics in the state have been inspected in the last year because of complaints, state records show.

“What we are seeing is more visits from AHCA, and they want to look at every patient file. They used to do a random sampling but now they want every single record,” Gallagher said.

“This is called administrative burden,” said Rep. Anna Eskamani, D-Orlando, an abortion rights proponent. “Targeting providers through fees and fines and regulations ... it’s designed to push providers out of existence.”

Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, said it is not just the documentation that has made abortion care in Florida more onerous. The 24-hour waiting period means two office visits with a physician. “That’s double the workload of patients because the visit must be in person and by a physician. The staffing and workflow and scheduling has become extremely complicated to manage,” Goodhue said.

If a six-week abortion ban becomes a reality, Florida would be the only state with that restriction that also requires a 24-hour waiting period.

“We will be able to survive, but the reality is less people in Florida are going to be able to get abortions,” Goodhue said.

A South Florida abortion clinic owner said most women don’t know they are pregnant that soon. With the amount of documentation required, more administrative burden, and fewer women qualifying for abortions, after 30 years, she likely will not be able to stay open.

“I think you will see a majority of clinics close,” she said, asking the Sun Sentinel not to identify her clinic so it doesn’t become a target for state inspectors. “It’s just not sustainable.”