Targeted Regulation of Abortion Providers (TRAP)
Arizona imposes extra restrictions on abortion providers, despite the fact that all health-care providers already must comply with a variety of federal and state regulations governing health, safety, building and fire codes, and zoning requirements.
Restrictions on Where Abortion Services May Be Provided
Arizona places medically unnecessary restrictions on where abortion services may be provided.
Any provider, other than a hospital, who provides five or more first-trimester abortions in any month, or any procedures beyond the first trimester, must be licensed as an "abortion clinic." Ariz. Rev. Stat. Ann. § 36-449.01(2) (Enacted 1999); Ariz. Admin. Code R9-10-1501(2).
An "abortion clinic" in the state must comply with a uniquely imposed licensure scheme that includes dozens of physical-plant, recordkeeping, personnel, and patient-care requirements. Ariz. Admin. Code R9-10-1503 to -1508, -1511, -1512. Additionally, every abortion clinic must maintain ultrasound equipment and perform an ultrasound evaluation for any woman who chooses abortion, regardless of whether there is medical necessity. Ariz. Rev. Stat. Ann. §§ 36-449.03, -2301.02 (Enacted 1999; Last Amended 2012).
Violators are subject to imprisonment for up to 30 days for each offense, and each day of each violation is considered a separate offense. Ariz. Rev. Stat. Ann. § 36-431 (Enacted 1971; Last Amended 1989), 13-707 (Enacted 1977; Last Amended 1987). Civil penalties of up to $500 per violation per day also apply. Ariz. Rev. Stat. Ann. § 36-431.01 (Enacted 1978; Last Amended 2001).
Although a district court initially upheld a number of these regulations, an appellate court later reversed this decision and remanded the case back to the district court to determine whether the regulations as a whole constitute an "undue burden" on a woman's right to choose. Tucson Women's Clinic v. Eden, No. CV 00-141-TUC-RCC, 2002 WL 32595282, (D. Ariz. Oct. 1, 2002), pet. for reh'g denied, pet. for reh'g en banc denied, rev'd in part, aff'd in part, and remanded, 379 F.3d 531 (9th Cir. 2004). The appellate court also affirmed the district court's decision to strike down (1) a regulation giving Department of Health Services unbounded access to unredacted patient records (2) a regulation permitting the Department of Health Services to conduct unannounced, warrantless searches of abortion providers, and (3) a regulation requiring abortion providers to submit copies of fetal ultrasound prints to a private contractor and the Department of Health Services. Upon remand to the district court, the parties stipulated a settlement, agreeing to eliminate some of the more onerous and medically unnecessary requirements and adding a regulation that provided the Department of Health Services only strictly regulated access to patient records. Stipulation of Settlement, Tucson Women's Clinic v. Eden, 2002 WL 32595282, (D. Ariz. Oct. 1, 2002) (No. CV 00-141-TUC-RCC) http://www.azsos.gov/public_services/Register/2009/45/supplemt.pdf
Arizona also allows unannounced inspections of abortion clinics-at the discretion of the state's board of health. NARAL does not automatically oppose provider inspections - even those that are unannounced. But, given Arizona's hostile political climate, there is credible reason to suspect that this law may be misused to serve a political, not public health, agenda. H.B. 2284, 51st Leg., 2d Reg. Sess. (Az. 2014).
Restrictions on Who May Provide Abortion Services
Arizona law makes it illegal for an individual who is not a physician to provide an abortion. Ariz. Rev. Stat. § 36-2153(D) (Enacted 2009, Amended 2012). In August 2011, a state appellate court lifted an injunction that had been issued and reaffirmed by a state superior court blocking this provision. Planned Parenthood Arizona, Inc. v. American Association of Pro-Life Obstetricians and Gynecologists, CV 09-0748 & CV 10-0274 (Consolidated) (Ariz. Ct. of Appeals, Aug. 11, 2011) (order); Planned Parenthood Arizona, Inc. v. Goddard, CV 2009-029110 (Ariz. Super. Ct. Apr. 27, 2010) (order extending injunction). Furthermore, a separate law prohibits a physician's assistant from providing abortion. Ariz. Rev. Stat. §§ 32-2531; 32-2532(A)(4).
Additionally, an individual who is not a physician is not permitted to provide a surgical abortion. Ariz. Rev. Stat. Ann. § 32-2501(11) (Enacted 1984; Last Amended 2004); Ariz. Rev. Stat. Ann. § 32-2531 (A)(12) (Enacted 1984; Last Amended 2000). However, in 2008 the state board of nursing decided the provision of early surgical abortion is within the scope of practice of specially trained nurses. Arizona Board of Nursing, Minutes of Meeting of the Scope of Practice Committee, May 20, 2008, V(E). available at http://www.azbn.gov/documents/meetings/SOP%20Committee/2008/Minutes/SOP%20Minutes%20May%2020%202008.pdf
Arizona law dictates that the state board of nursing does not have the authority to decide the scope of practice for either surgical- or medication-abortion services. Ariz. Rev. Stat. § 32-1606(B)(12). In light of the ruling in Planned Parenthood of Arizona v. American Association of Pro-Life Obstetricians and Gynecologists, parties in a state superior court case, Planned Parenthood of Arizona v. Goddard (2010) allowed this law to go into effect after initially agreeing to delay its enforcement. Planned Parenthood Arizona, Inc. v. Goddard, CV 2010-030230 (Ariz. Super. Ct. July 6, 2011) (stipulation staying enforcement until hearing).
Unenforceable provisions of Arizona's regulations redrafted in 2009 by the state Department of Health Services as part of a stipulated settlement in Tucson v. Eden prohibit anyone other than a doctor from providing various medical procedures before or after an abortion. Ariz. Admin. Code R9-10-1508.
Parties in a case challenging these restrictions agreed to delay their enforcement while the case is underway. Planned Parenthood Arizona, Inc. v. Goddard, CV 2010-030230 (Ariz. Super. Ct. July 6, 2011) (stipulation staying enforcement until hearing). Previously, a state superior court judge rejected a request to block enforcement of this regulatory scheme, ruling that the plaintiffs waited too long to file the claim Planned Parenthood Arizona, Inc. v. Goddard, CV 2009-029110 (Ariz. Super. Ct. Oct. 27, 2010) (order denying plaintiff's motion to amend complaint).
Arizona law also requires a physician providing surgical-abortion care to have admitting privileges at a hospital within 30 miles of the abortion clinic, and requires a physician providing medication-abortion care to have admitting privileges at a hospital within the state. Nothing in the law requires that hospitals grant these privileges. Ariz. Rev. Stat. Ann. §§ 36-449.03(C)(3) (Enacted 1999; Last Amended 2012)