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Coulee Medical Center, along with a couple dozen other public hospitals in Washington state, has been ordered by the state attorney general to provide surgical abortions.

The hospital has offered abortion by medicine, but not surgery.

That violates the Reproductive Privacy Act, according to Attorney General Bob Ferguson who wrote to CMC in November, stating it was in violation of the law because it fails to offer “substantially equivalent” care to those seeking an abortion, a standard it must meet under the law.

Any hospital that can offer to perform a Caesarian section to remove a baby from a mother must be able to offer a surgical abortion, a substantial equivalent.

CMC does offer complete obstetrics services, including C-sections.

CEO Ramona Hicks told Hospital District 6 commissioners Monday, that she had responded to Ferguson’s letter, saying that the hospital is looking for ways to come into compliance.

But she also explained to him about some obstacles to doing so.

CMC loses money by offering complete obstetrics services, with its elected commissioners choosing to subsidize the practice for the health of the community. Many small hospitals do not.

Offering C-sections requires finding ways to provide extra training for health care professionals who could not get enough continuing experience just doing them in this community; the small population doesn’t need that many of the surgeries but doctors have to meet requirements to be sure their skills are maintained. Adding abortions to the burden will present another challenge in order to offer a procedure that is rarely sought, according to Hicks.

Nevertheless, CMC must find a way to comply with the law.

But employees don’t have to, another possible challenge.

The Reproductive Privacy Act, created by a vote of the people on Initiative 120 in 1991, specifically states, “No person or private medical facility may be required by law or contract in any circumstances to participate in the performance of an abortion if such person or private medical facility objects to so doing. No person may be discriminated against in employment or professional privileges because of the person’s participation or refusal to participate in the termination of a pregnancy.”

CMC is a public hospital, not private, so it must comply, Hicks said.

“It’s a matter of finding people … that are willing to participate,” she said. “Then it’s training, competency, ongoing competency.”

Because it’s not currently offered, safely offering abortions will require finding providers to do it, going through the process of giving them privileges to practice in CMC, credentialing them, making sure they’re trained and competent, continually, “aspects of safely performing what [Ferguson] says is required by law,” Hicks said.

She’s been looking for outside resources for help. Hicks told commissioners that the University of Washington has “really stepped up to the plate” and wants to help in training, observing that “this is a medical problem, not a law problem.”

“So, we’re just in those beginning stages, and we’ll let you know how it goes,” Hicks told commissioners. “I know that it’s a subject that’s very difficult for folks and it’s going to be very difficult to have the conversation with the staff. But we have to, and we’re up to it, and we’ll … keep marching forward.”