LETTER: Clinic 554 doctor demands New Brunswick government fund abortions outside hospitals

Editor’s note: On Oct. 26, 2022, New Brunswick’s Progressive Conservative government under Blaine Higgs proposed legislation that would allow Medicare payments for surgeries outside of hospitals. The government argues that the move will alleviate wait lists for procedures such as cataracts, vasectomies and colonoscopies. Health Minister Bruce Fitch, in a CBC interview, stated that there were no wait lists for abortions and thus, the province would continue to uphold Schedule 2, of Regulation 84-20 of the Medical Services Payment Act that restricts Medicare funding for abortions to hospital settings.

According to Reproductive Justice New Brunswick, the province of New Brunswick is not complying with the Canada Health Act and a 15-year-old Supreme Court ruling found such restrictions were unconstitutional. In 2014, after the closure of the Morgentaler Clinic in Fredericton, Clinic 554 opened its doors to replace it in providing abortions in the province. Like its previous iteration, the staff at Clinic 554 regularly waived fees for patients unable to pay and were committed to barrier-free reproductive health.

Unfortunately, Clinic 554 – primarily a family practice – was forced to stop most of its services in 2020, despite constant advocacy to repeal the regulation, leaving many of the family practice’s 3,000 patients without a family doctor. The Canadian Civil Liberties Association is taking the New Brunswick government to court for refusing to fund non-hospital abortions. The association argues that New Brunswick’s regulation restricting Medicare-funded abortions to hospital settings is unconstitutional, is contrary to the Canada Health Act, and violates the Canadian Charter of Rights and Freedoms. Dr. Adrian Edgar, the medical director of Clinic 554, wrote the following letter to Health Minister Bruce Fitch.

Dear Minister Fitch,

Abortions provided outside of hospitals require immediate funding in New Brunswick.

The need is dire.

Patients see me every week for these procedures – as a result of barriers to abortion access in hospitals across the province. The burden on these marginalized patients is unduly harmful and cannot be allowed to continue.

I have copied the Canadian Civil Liberties Association above, because your announced plan to exclude abortion provision from expanded public funding for surgeries outside hospital settings is a persistent violation of the Canada Health Act and a de facto act of discrimination against gender minorities and women in New Brunswick – the only groups who this policy limits the healthcare of. Their rights are enshrined in our Canadian Charter of Rights and Freedoms. To continue to knowingly pursue this sex-based discrimination is an unacceptable policy choice when it clearly disenfranchises these protected classes.

Abortion procedures provided outside hospitals are safer than, more cost-effective than, and preferred by patients to, those provided in hospitals. These are long and well-established medical facts.

Abortions provided outside hospital settings cause fewer infections, require fewer repeat surgeries, necessitate fewer ER visits, and lead to fewer admissions to hospital than abortions provided in hospital settings. This information is widely available to you and your department, as well as letters attesting to these facts from myself and the Head of the Department of Obstetricians and Gynaecologists at the Fredericton Dr. Everett Chalmers Hospital.

Your department is also in receipt of letters affirming the urgent need for publicly funded abortions to be insured and provided outside hospitals, from the New Brunswick Medical Society and the Board of Directors of Horizon health.

To continue to ignore the plight of these patients and force them to travel across and out of province, for care I provide locally is inconsistent with the standard of care for abortion provision in Canada, and again, the Canada Health Act. 

To insist patients travel and enter hospitals unnecessarily during a pandemic is a dereliction of your department’s duty to promote and protect best public health practices.

To state an intention of acting in all manners to relieve the untenable burden on our Emergency Departments and hospitals, while continuing to ignore such an obvious and easy policy correction, is inexplicable to everyone.

Unless the explanation is that your department is intent on punishing pregnant patients for having abortions. In which case, let me assure you, that type of rotten bigotry and abuse of authority will not be tolerated, nor forgotten, by New Brunswickers.

Please explain the comments you made to the media today and why, in detail, your government continues to limit abortion provision to hospitals at all – despite every piece of evidence and data point distinctly undermining the safety and fiscal rationale for doing so.

Adrian Eoin Edgar is the medical director of Clinic 554 and is a reproductive justice activist.