FARGO (AP) - Nearly two dozen women get abortions on an average Wednesday at the lone North Dakota clinic that performs them, often spending scarce resources to travel long distances to the Fargo building, where volunteers escort them through a crowd of protesters lining the street outside.
The Red River Valley Women's Clinic, which opened under another name in 1981, is the only place within 230 miles where abortions are performed legally - an estimated 1,200 a year. Now clinic officials fear they may need to go to court just to stay in business.
North Dakota appears ready to follow Mississippi's lead in requiring that doctors who perform abortions have hospital-admitting privileges. Clinic director Tammi Kromenaker said the bill could cut services for the women it serves, about half of whom are estimated to be living below the poverty line.
"It's not over until the governor signs the bill, and then we take the next steps and see where that leads us," Kromenaker said. "If our doctors are not able to get privileges, you can just look to Mississippi what happened there. We would have to litigate this."
Outside of Fargo, the nearest abortion clinics are four hours to the south in Sioux Falls, S.D., and four hours to the southeast in Minneapolis.
The crowd of protesters this Wednesday was smaller than usual, largely because of the subzero temperatures. But Ken Koehler was among those at 8 a.m., bundled up in a parka and carrying a sign urging women to ask him for help or call an 800 number.
If Mississippi's continuing fight is any indication, the Fargo clinic will likely be embroiled in legal challenges for some time if Senate Bill 2305, which is expected to pass the House, becomes law. The bill's sponsor, Republican Rep. Spencer Berry, a Fargo doctor, stopped short of saying the proposal is meant to shut down the clinic.
"The goal of the legislation is to try and provide good public policy, for now and going forward as it relates to the state's ability to assure that this is about the health and safety of the women who are presenting for abortion services," Berry said.
Kromenaker said the bill - along with a number of other abortion measures proposed by the Republican-dominated Legislature - is meant to make it impossible for the facility to operate.
"Sen. Berry must know if you look at other states like Mississippi that have done similar measures, it is close to shutting down one clinic," she said. "My concern with him saying that is that he is not looking at our safety record or he is questioning our safety record."
Mississippi passed a law last year that requires anyone doing abortions to be an OB-GYN with privileges to admit patients to the hospital. The state's lone abortion clinic announced last month it had received notice that the state health department intends to revoke its operating license, though it is not expected to close anytime soon.
In a lawsuit filed by the Jackson, Miss., clinic, the facility's attorneys argued that the admitting privileges requirement "effectively gives local hospitals veto power" over the clinic's ability to keep its license and stay in business.
Officials with Sanford Health, the largest hospital in the Dakotas, declined to talk about the North Dakota bill.
"At Sanford, we choose not to discuss abortion topics," clinic spokesman Darren Huber said in an email.
Kromenaker said she's not surprised that Sanford has opted to stay out of the discussion, especially since the bill has yet to become law.
"You are asking the hospitals to get involved in a very contentious matter," Kromenaker said. "People are leery to do that because they see what is happening at our clinic ... the protests, the attention."
Sanford officials said any doctor can apply for hospital credentials. Once an application has been submitted, several items are reviewed, including a background checks on previous employment or medical school references, and malpractice information. The information then travels up the chain to three committees, ending with the hospital's board of directors.
Asked if the hospital would make a decision to deny privileges to avoid the abortion controversy, Berry said, "I'm not aware of that, no. As far I know."
Berry, who had one time had hospital privileges to deliver babies, said obtaining the credentials is not a hardship. He said he has never been turned down when applying for them.
However, Kromenaker said some hospital require that doctors admit a certain amount of patients to the facility each year to maintain their privileges. She said it's rare when a patient of hers needs hospitalization, and it would be impossible for abortion doctors to meet that threshold.
None of the hospitals testified about the bill in committee. Christopher Dodson, a spokesman for the North Dakota Catholic Conference who discussed the issue with officials at St. Alexius Medical Center, a Catholic hospital in Bismarck, spoke briefly in support of the proposal.
"Women should never be abandoned," Dodson said when asked what he told lawmakers. "So as long as (abortion) is legal, we have to protect the women as well. It ensures that women's health care interests are best protected."
Sister Susan Lardy, a St. Alexius vice president, did not speak directly about the bill but issued a statement.
"As a Catholic health care provider, St. Alexius Medical Center follows the ethical and religious directives set forth by the Catholic church," she said. "These principles provide our organization with a clear picture of how to deliver compassionate care under the auspices of the ethical standards of behavior in health care that flow from the church's teaching about the dignity of the human person."
Democratic Sen. Carolyn Nelson, of Fargo, argued against the bill on the Senate floor.
"The sole purpose of that bill is to close down the clinic as far as I'm concerned," she said. "I don't see Sanford changing their protocols on how they allow people to get privileges. They require that a doctor have 10 visits a year and the clinic doesn't need that many."