Chrissie Thompson

cthompson@usatoday.com

Whether Cincinnati loses its last abortion clinic could now rest with a federal judge.

Planned Parenthood's Southwest Ohio region is challenging an Ohio law that it says has unfairly endangered abortion clinics such as its Elizabeth Campbell Surgical Center in Mount Auburn. The center's closure would make the 2.1-million-person Cincinnati region the largest metro area in the U.S. without an abortion clinic.

The clinic lacks a patient-transfer agreement with a private hospital, a requirement for all Ohio abortion clinics passed into law last year by Statehouse Republicans. Ohio's Department of Health last month cited the Planned Parenthood center for its lack of compliance, saying it could revoke the clinic's license.

None of the private hospitals in Cincinnati will enter into agreements with Planned Parenthood, many for religious reasons, the clinic says. The clinic had an agreement with UC Health to transfer patients in an emergency. Butthe new law bans abortion clinics from forming such agreements with public hospitals, so UC Health backed out last year.

In a suit filed Monday against incoming health department Director Richard Hodges and UC Health, Planned Parenthood asks the U.S. District Court in Cincinnati to rule the law unconstitutional, reinstate the clinic's agreement with UC Health and order the health department not to revoke its license.

If the latter were to occur, "the last provider of surgical abortion services in the Greater Cincinnati area will close, making abortions virtually unavailable in Cincinnati and violating the constitutional rights of and imposing irreparable harm upon (Planned Parenthood) and its patients," the suit says. "Given that the majority of (Planned Parenthood's) patients are low-income, the increased costs, travel, and delays will make it impossible for a significant number of women to obtain an abortion."

The Ohio law and the health department's subsequent treatment of the clinic are denying Planned Parenthood and its patients due process and equal protection under law, the suit says.

A spokesman from the health department declined to comment, since the situation involves pending litigation.

In the past two years, Ohio's abortion clinics have seen their numbers dwindle from 14 to 8, in part due to new abortion restrictions passed last year by the Republican-dominated Legislature.

Abortion opponents say the hospital transfer-agreement rule is fair: They don't want taxpayer-funded hospitals to enable abortions through the agreements. Even though any emergency room would accept an abortion patient, having a plan is safer and more professional, they say.

"Ohio law is clear that our tax dollars cannot support abortion. UC Health is a publicly funded hospital and pro-life taxpayers should not be forced to fund the abortion industry," said Mike Gonidakis, president of Ohio Right to Life, in an email. "What amazes me is that no other hospital in the greater Hamilton County area chooses to do business with Planned Parenthood. If Ohio's health care industry rejects the abortion industry, why can't Ohioans?"

Under the law, the Ohio Department of Health has the authority to grant an exception to clinics unable to ink an agreement with a private hospital. Such clinics must develop formal arrangements with individual doctors, which Planned Parenthood says it has done.

But the health department has yet to respond to Planned Parenthood's request from 2013 for such an exception. It recently declined to do so for a Sharonville abortion provider called Women's Med, which halted abortions in September after a court battle.

Gov. John Kasich, whose administration includes the health department, has said: "I just think we need to follow the law. That's what the health department did."

That sets a worrisome precedent for the remaining Southwest Ohio abortion clinics. Both the Planned Parenthood facility in Mount Auburn and a second Women's Med clinic in Dayton lack hospital transfer agreements and are seeking exceptions from the Ohio Department of Health. The Dayton clinic also has yet to receive a response from the health department.

If the Planned Parenthood clinic and the clinic in limbo in Dayton both eventually close, Southwest Ohio women would have to seek out clinics in Columbus, Indianapolis or Louisville.

That underscores a debate in the legal battle over abortion: If Americans have a right to abortion, how accessible must it be in their community?

A 1992 Supreme Court case set the following standard: States may regulate abortion, but not in a way that creates an "undue burden" for women seeking the procedure.

The 5th Circuit Court of Appeals recently applied that standard in upholding laws that would have slashed the number of abortion clinics in Texas. The Supreme Court failed to opine on that reasoning, but last month stayed the appeals court ruling while the legal battle continues.

"If you listen to the 5th Circuit, they seem to think it's perfectly fine for a woman to drive 175 miles across Texas" for an abortion, said Elizabeth Nash, state issues manager for the pro-abortion Guttmacher Institute. "I think other people would find this as an undue burden because a woman will have to travel very long distance, potentially have to arrange for a hotel room, certainly would be taking time off of work and have to arrange for childcare -- all sorts of issues that would put an abortion out of reach."

Ohio law requires women to have a consultation 24 hours before the abortion with the physician performing the procedure. So if the Planned Parenthood clinic in Cincinnati were to close, women might have to travel for the pre-abortion appointment.

"Roe v. Wade did not guarantee an abortion clinic on every street corner," Gonidakis said.

Planned Parenthood's case has been assigned to Judge Timothy Black, an appointee of President Barack Obama, who this year ruled same-sex marriages performed legally in other states must be recognized in Ohio. He put a stay on the ruling to allow for appeal, and a panel of judges from the 6th Circuit Court of Appeals overturned the ruling last week.