The vast majority of Unregulated Pregnancy Clinics (UPCs) advertise medical or quasi-medical services. Nearly all UPCs offer pregnancy tests and more than 75 percent offer a free ultrasound examination. About 35 percent also offer STD/STI tests.
In other words, they (at the very least, UPCs with ultrasound) are engaged in the practice of medicine—they must be supervised by a doctor or equivalent medical practitioner. And their medical practices are unquestionably subject to the authority of the state.
And yet, in nearly all states, UPCs are unregulated. While advertising and presenting their facilities as conventional medical clinics, and even though they often look like medical offices, with waiting rooms, exam rooms outfitted with medical equipment, and staff wearing lab coats and scrubs, the law does not treat them like medical clinics.
This lack of medical oversight and standards exposes their clients to risk. The state doesn’t even know if their medical services are supervised by any doctor, much less a qualified one who is acting within their scope of practice and actively ensuring that professional standards are followed.
Just focusing on one element—the ultrasound. The state doesn’t know:
1. Whether there is a legitimate standing order from a qualified doctor which directs how ultrasound exams are to be performed.
2. Whether a qualified doctor reviews the scans from ultrasound examinations, and whether those reviews are done in a timely manner.
3. Since the doctor, if there is one, doesn’t see the client either before or after the ultrasound examination, whether there a reasonable way for the doctor to contact the client or the client to contact the doctor.
4. Whether the ultrasound client even knows who the supervising doctor is.
5. Whether the ultrasound technician is qualified to perform the examination.
6. The client hears the ultrasound technician talking, but that technician has no ability or authority to evaluate the scan. That’s the job of the doctor. So the question is whether the client ever hears or reads conclusions from the doctor because that’s the only source for a valid reading of an ultrasound scan.
7. Whether the ultrasound technician is performing transvaginal examinations and whether those clients are given a reasonable, informed choice.
8. Whether there is a guarantee of client privacy, that is: for information in the hands of the doctor, is that “protected health information” under HIPAA, and for information in the hands of the UPC, is there any law protecting the client’s privacy.
9. Whether the UPC discloses to outsiders information that would be protected under HIPAA.
10. Whether an ultrasound procedure is covered by requirements that routinely apply to legitimate clinics, such as glove wearing, hand washing, sanitation, pull dates for products used, and medical waste.
UPCs target clients who are young, have lower incomes, and may not be familiar with medical standards. These clients are vulnerable and often already scared. So it’s unreasonable to adopt a “buyer beware” attitude. The American Medical Association “urges the development of effective oversight for entities offering pregnancy-related health services and counseling.”
Unregulated pregnancy clinics need to be regulated and, to do that well, the state needs to direct a study and get to know a lot more about their operations.