James Guest, head of Planned Parenthood of Maryland, says it will be business as usual in the agency's eight clinics today. Until the federal government officially tells them to stop, doctors and counselors will continue to counsel patients about abortion.
Yesterday the Supreme Court upheld federal regulations that prohibit abortion counseling at federally subsidized family-planning clinics. In 30 to 60 days, Planned Parenthood lawyers say, the new rules will take effect.
And unless those regulations are blocked, perhaps by Congress, Planned Parenthood and other clinics that accept federal Title X dollars may be forced to limit services to poor women or forgo federal money.
Mr. Guest dislikes both options.
"We are not going to provide discriminatory care, telling one group of patients one thing and another group of patients another thing," he said. "We're not going to provide two levels of care. We're not going to setup a different facility for different women."
He calls the regulations "a gag rule." He says their goal is harassment.
If the new rules stand, Mr. Guest said, they would "deny Title X funds to any facility that even whispers the word 'abortion.' You're dictating to doctors what they can say, even against their best medical judgment."
Under the new rules, Mr. Guest said, poor women would be denied equal health care and their access to birth control would be reduced.
More-affluent women could ask their doctors for abortion information or go to private clinics. "Those who can afford it get one kind of information," Mr. Guest said. "Those who can't get different information."
At Title X clinics, he added, doctors would not be allowed to offer abortion counseling even to paying patients, if the clinic wanted to continue to receive federal funds.
The federal Title X funds come to 90 clinics around Maryland through the state Department of Health and Mental Hygiene, which received about $2.5 million in Title X funds this year.
Planned Parenthood of Maryland has an annual budget of about $4 million, including about $500,000 in Title X dollars. The agency uses that grant to help pay for birth-control services for poor women.
Mr. Guest -- who described himself as "stunned" by the court's ruling -- said he was not certain how Planned Parenthood and similar family-planning organizations would fight the new regulations. "It's unclear what our options are," he said yesterday afternoon as he consulted with lawyers and colleagues about how the court decision would affect their programs.
Planned Parenthood of Maryland serves more than 16,000 patients a year at eight clinics. About 6 percent of its caseload is abortion patients, said Bebe Verdery, Planned Parenthood's legislative lobbyist. The rest of the patients are seeking gynecological exams, birth-control information, testing for sexually transmitted diseases, cancer screening and vasectomies.
"The focus isn't what this does to Planned Parenthood," Ms. Verdery said. "The focus is patients. What will this do to low-income patients?"
In Baltimore, the city health department spends most of its nearly $500,000 appropriation in three family-planning clinics that see nearly 13,000 poor women each year. Those clinics provide only birth-control information, said Dr. Nira Bonner, assistant commissioner in the city health department.
City-run clinics do not perform abortions. A pregnant woman seeking an abortion would be referred to one of the city's maternal- and infant-care centers, which would refer her again to a private clinic for abortion counseling, Dr. Bonner said.
Because the city does not provide abortion counseling, the new regulations apparently would have no direct impact on Baltimore's subsidized clinics, Dr. Bonner said. "But I think if this ruling goes into effect, it's a retrogressive step. It's limitation in terms of options to women, particularly poor women who do not have a wealth of options.
"And secondly, I think it's a serious violation of medical ethics to withhold information from patients," Dr. Bonner said.