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Are outpatient surgery physicians in Louisiana required to have admitting privileges to a hospital within 30 miles of the clinic?

Skeptics Asked on November 28, 2021

Recently, I received a Pro-Life mailing regarding the recent June Medical Services, L.L.C. v. Russo Supreme Court case regarding the Louisiana law that required doctors who perform abortions to have admitting privileges to a hospital within 30 miles of the clinic where the abortion is performed, claiming that "Louisiana’s law only sought to extend a requirement to include abortionists that was already required of all other physicians in outpatient surgery settings". Recognizing that the purpose of said law was probably more about suppression than safety, and that not all locations that do abortions do outpatient surgery, is it true that this was already required for all other medical settings in Louisiana that do outpatient surgery?

One Answer

Quick summary:

Some outpatient surgeons in LA require a hospital affiliation, but this does not cover "all other physicians in outpatient surgery settings".

(disclaimer: I'm not a lawyer, just a biomedical research scientist. I'm reading from the plain language of the administrative codes and other sources may also apply in a legal context)

Full answer:

Louisiana law currently does require physicians at Ambulatory Surgery Centers to have admitting privileges, and the text is similar to (but not the same) as the text added for abortion providers:

From the LA administrative codes, Chapter 44 (abortion providers):

Active Admitting Privileges—the physician is a member in good standing of the medical staff of a hospital that is currently licensed by the department, with the ability to admit a patient and to provide diagnostic and surgical services to such patient.

  1. The hospital shall be located not further than 30 miles from the location at which the abortion is performed or induced, and shall provide obstetrical or gynecological health care services.

From the LA administrative codes, Chapter 45 (ambulatory surgery centers):

Each member of the medical staff of the ASC, including physicians who practice under a use agreement, shall be a member in good standing on the medical staff of at least one hospital in the community and that hospital shall be licensed by the department. Members of the ASC medical staff shall be granted surgical privileges compatible with privileges granted by the hospital for that physician.

(note: there are a couple other relevant sections for each; I've just copied a couple of them here, please see the rest of the administrative codes for more)

As far as I can tell, however, the "30 miles" limit was only applied to abortion providers, making the proposed (and currently stricken by the courts) limitation more stringent on abortion providers.

Importantly, however, "Ambulatory Surgery Centers" are not synonymous with "outpatient surgery physicians"; they are buildings, not people, and they are not the only places providing outpatient surgery. Outpatient surgery is common in primary care and urgent care offices, as well as in dental clinics, for example. ASCs tend to provide higher-risk surgical procedures, and are more like a hospital's outpatient surgery department moved outside the building. LA Title 47 covers medical professionals like physicians and dentists, who do procedures of similar levels of risk to abortion providers; they do not require hospital admitting privileges or affiliation:

a. A physician performing office-based surgery shall:

i. possess current staff privileges to perform the same procedure at a hospital located within a reasonable proximity; or

ii. have completed residency training in a specialty that encompasses the procedure performed in an office-based surgery setting;

I believe item (i) there is likely mostly intended to apply to physicians-in-training, such as those currently working on the residency that would qualify them for item (ii); practicing physicians who have completed a residency, therefore, would be exempt from hospital affiliation as long as the procedure is part of their training.

Answered by Bryan Krause on November 28, 2021

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