For 32 years, Dr. Lester Minto performed abortions at Reproductive Services of Harlingen, a modest, one-story building in Harlingen, Texas right next door to the regional branch of the state Department of Health. Ever since October 31, however, he has been barred from performing abortions. Minto lacks local hospital admitting privileges, which Texas’s new abortion law—H.B. 2—requires all abortion providers to have.

On January 6, Planned Parenthood challenged the admitting-privileges requirement of H.B. 2 before the Fifth Circuit Court of Appeals, and a decision is expected any day. In the meantime, the Rio Grande Valley, a floodplain nearly the size of Connecticut with 1.3 million inhabitants, and some of the lowest per capita incomes in the nation, is without an abortion provider. Women in the Valley must now make a 300-mile round trip to Corpus Christi or a 500-mile round trip to San Antonio for a clinic abortion, a significant obstacle for many poor women due to the costs of travel, lodging, and child care.

On paper, the admitting-privileges requirement sounds like an innocuous bit of quality control. One might assume that any half-decent physician should be able to get admitting privileges. But it doesn’t work that way. Hospitals are not democracies. Some refuse to grant admitting privileges because of religious affiliation, but others simply don't want to go to the trouble and expense of credentialing a doctor who will never work at their institution. Local hospitals “are not going to have anything to do with an abortion provider,” Minto says. In effect, the law gives these hospitals veto power over abortions within a 30-mile radius. Even someone like Minto, who has an excellent, 32-year track record of providing safe and effective abortions, is still barred from practicing.

Undaunted, Minto reinvented himself as a “miscarriage management” consultant. When patients come to his clinic they get an ultrasound to find out how far along they are and counseling. He tells them that he can’t perform abortions anymore, but that there are other options. While Minto can’t perform an abortion, if you show up at his office bleeding from a miscarriage, he can help you out, no questions asked. “Nothing here is back alley,” Minto says. “We do follow-ups with everybody. We still treat them just like we always did."

Between Minto’s patients and women who act on their own, H.B. 2 may not have eliminated abortions in the Valley. It may simply have changed the tools and processes, and made it more dangerous for women to obtain these crucial medical procedures.