All day, phones rang inside the tiny brick abortion clinic. Women from all over Louisiana, and from as far as Texas, Arkansas and Mississippi, called mostly with the same question: Was the center still taking appointments?
The clinic's embattled administrator, Kathaleen Pittman, eyes red from lack of sleep, reassured them she had yet to cancel any consultations or procedures. Yet she could not promise anyone how long the center would remain open.
"We're now down to two clinics and two physicians serving approximately 10,000 women across the state," she said. "It's just not sustainable."
Late Wednesday, the U.S. 5th Circuit Court of Appeals issued an emergency order allowing a 2014 Louisiana law to take effect, requiring abortion doctors to have admitting privileges at nearby hospitals.
The decision immediately shuttered one of the state's four abortion clinics, the Bossier City Medical Suite in Bossier City. Another, the Delta Clinic in Baton Rouge, remains open, yet without any physicians who can perform abortions. It is referring patients to the Women's Health Care Center in New Orleans.
The future of Shreveport's Hope Medical Group for Women, a small clinic that performs the largest number of abortions in Louisiana, remains uncertain. The physician Pittman relied on most, who conducted two-thirds of its surgeries, does not have hospital admitting privileges. Only one physician, close to retirement age, is left to perform all of the clinic's surgical abortions.
Pittman, a 58-year old Louisiana native who has worked at the center for 23 years, says the clinic faces the most acute crisis in its 36-year history.
She said the center is scrambling to take referrals from the clinic that closed. Its lone physician came into her office Thursday night, sighing after wrapping up surgeries at 9 p.m.
"How long can you keep up with this, Doc?" Pittman asked him. The physician, who runs a private practice in addition to working part time for the clinic, warned her long ago that he would find it impossible to take on an increased workload and harassment from antiabortion campaigners.
"My heart aches," Pittman said, propping her head on her hands in her small office decorated with potted plants, a still life of an orchid, and a sign extolling the virtues of hugs. "All we can do is hope and pray the Supreme Court intervenes."
On March 2, the U.S. Supreme Court will take up a Texas law similar to Louisiana's that requires doctors to have admitting privileges at a hospital within 30 miles of the clinic where they practice.
In the meantime, the Center for Reproductive Rights, which represents four clinics in the Texas legal challenge and three clinics in Louisiana, plans to ask the Supreme Court to block the Louisiana ruling while the justices consider whether such laws are constitutional.
The Supreme Court's ultimate ruling, if it is decisive, would probably have a long-lasting impact on women's access to abortion across Louisiana and a whole swath of the South, where a wave of restrictive laws have forced abortion clinics to shut in the last decade. Already, about half of Texas' 40 abortion clinics have closed since a 2013 law required doctors to have hospital admitting privileges.
"This is a watershed moment in the battle for reproductive rights," said Nancy Northup, president and chief executive of the Center for Reproductive Rights, speaking to reporters Thursday.
Eight states, in addition to Texas and Louisiana, have introduced similar admission-privilege restrictions. In a sign that more could follow, 23 states including Louisiana signed an amicus brief in support of Texas in the Supreme Court case, arguing for states' rights in regulating women's health and safety.
"We are seeing 'undue burden' unfolding in real time in Louisiana, with women struggling to access the care they need and depend on," Dawn Laguens, executive vice president of Planned Parenthood Federation of America, said in a statement. With Texas law requiring that women to wait up to 20 days for an abortion, she noted, many were already traveling to other states such as Louisiana. "Where will they go now?" she asked. "And where will Louisiana women turn?"
Supporters of such laws argue they are common-sense measures intended to protect women, providing them the security of knowing their doctor can admit a patient to a local hospital in the event of complications.
"It's not just about protecting the unborn child, but also the health of the woman," said Benjamin Clapper, executive director of Louisiana Right to Life, a New Orleans-based nonprofit. "These are ways to continue to ensure that the abortion industry is operating under the same standards other surgical centers are operating under."
Opponents counter that the restriction is unnecessary — abortion is safer than childbirth, they note, with fewer than 0.5% of patients experiencing any kind of complication. They argue that the new restrictions represent a calculated attempt to restrict abortions.
At the center of the legal dispute is whether the requirement that doctors have admitting privileges represents an "undue burden." In 1992, the Supreme Court ruled that a law was invalid, and an undue burden exists, if it places "substantial obstacles in the path of a woman seeking an abortion before the fetus attains viability."
In January, the district court blocked the Louisiana law, ruling that it would place an undue burden on "a large fraction of Louisiana women of reproductive age seeking an abortion." On Wednesday, however, the federal appeals court disputed this claim, with U.S. Circuit Judge Jennifer Walker Elrod writing in the panel's opinion that plaintiffs failed to establish that the law creates a "substantial obstacle in the path of a large fraction of women seeking an abortion."
In Louisiana and nearby states, Pittman says, many women already face a heavy burden in securing abortions. After traveling hundreds of miles, some have to stay overnight, as the state requires a 24-hour waiting period between counseling and the procedure. Factor in the cost of a hotel, arranging child care and taking time off work, she said, and "it's just not doable for a lot of patients."
Ever since Hope Medical Clinic opened in 1980 in Shreveport, home to a large Baptist population, it has been a focal point for abortion opponents. A few years after the clinic opened, a mentally ill man attacked the clinic with a 9-pound sledgehammer, smashing windows in the front of the building.
The year Pittman began working at the clinic as a counselor, in 1992, a protester drilled a hole through a clinic door in the middle of the night and inserted butyric acid, the toxic chemical that can cause coughing, sore throat and breathing difficulties. In 2005, protesters attacked the clinic with a petroleum-based bomb.
"We've always felt under siege, but this is worse — this is different," Pittman said. "The possibility of our clinic closing is devastating. This is my life. This is my calling."
Jarvie is a special correspondent.