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Texas Department of State Health Services

Abbott waives fees for birth certificates for individuals from hurricane-affected counties

From Diane Trautman on Facebook, also sent to me in email:

Governor Greg Abbott has approved a request allowing the state to waive fees for mail-in or walk-in birth certificate issuance requests, and local registrars to waive fees for walk-in birth certificate issuance requests, for individuals from hurricane-affected counties. This is important for several reasons, one of which is that a birth certificate is a valid form of supporting documentation for voters without proper ID who need to sign an Affidavit of Reasonable Impediment.

A list of the affected counties is at the announcement. The language used is pretty legalistic, so unless you are familiar with “Section 418.016 of the code”, you may not realize from the announcement just what this means, so thanks to Diane Trautman for the interpretation. You probably know someone, or know someone who knows someone, who needs to know this, so please pass it on.

And then there’s the birth certificate issue

Just another problem that would be exacerbated by a bathroom bill.

In order to modify a birth certificate in Texas, the Department of State Health Services requires transgender individuals to present a certified court order stating the recorded sex on a birth certificate should be changed.

But a transgender person’s ability to obtain that court order is largely determined by where they live and their socioeconomic status, according to transgender individuals, advocates and lawyers who have worked with transgender Texans on the process.

Some county judges — even in more liberal urban areas — are less eager than others to grant the court order that’s required by the state, particularly when it comes to children. That forces some transgender individuals to travel to counties like Travis, Bexar or Dallas, where such court orders can be easier to obtain.

It can also be an expensive process. Court filings fees can reach $300 even before adding on attorneys fees or travel requirements. The process can be even more cost-prohibitive for transgender individuals because they must also obtain letters from both a doctor and a mental health provider certifying they are transgender and under their care to present to the court. For some, that also presents a geographic barrier because Texas faces a shortage of doctors and therapists “who do this kind of work,” said Claire Bow, an Austin-area attorney who helps transgender people obtain updated documents.

But for Bow, there’s a bigger flaw with Republicans’ proposals for bathroom restrictions and the expectation that transgender people could immediately take steps to obtain updated documents.

“The important thing to understand is it’s never the first step in the process,” Bow said of amending birth certificates or IDs. Bathroom bills assume that every transgender person has “gone all the way through the process” or have reached the point in treatment at which their doctors and therapists will sign off on the letter needed for court.

“That’s why this is hard,” she added. “Nobody wakes up one day…and changes their sex.”

The outcome of this complex process is that many transgender Texans live with birth certificates that don’t align with their gender identity for years if not their entire lives.

This is not the first time this issue has been brought up. Getting one’s birth certificate amended can be expensive and time-consuming, and if you happen to have been born in the wrong state, legally impossible. One way Republicans could address this issue would be to make it less cumbersome to amend a birth certificate, with some provision for the folks whose home states have no such mechanism. Of course, if they were inclined to do that, it might lead them to the conclusion that the bathroom bill is ridiculous and harmful and serves no purpose.

This session’s unconstitutional abortion bill passes

Here we go again.

Right there with them

Texas senators voted Friday to send a bill banning the most common second-trimester abortion procedure and changing how health care facilities handle fetal remains to Gov. Greg Abbott’s desk.

Under Senate Bill 8, which passed 22-9, health care facilities including hospitals and abortion clinics would be required to bury or cremate any fetal remains — whether from abortion, miscarriage or stillbirth. The bill would also ban facilities from donating aborted fetal tissue to medical researchers, and aims to outlaw “partial-birth abortions,” which are already illegal under federal law.

Most controversially, the bill now bans dilation and evacuation abortions — a common second-trimester procedure where doctors use surgical instruments to grasp and remove pieces of fetal tissue — unless the fetus is deceased. Medical professionals deem the current method the safest way to perform the procedure on a pregnant woman, and reproductive rights groups have said this change would subject women to an unnecessary medical procedure.

[…]

Amanda Allen, senior state legislative counsel for the Center for Reproductive Rights, said in a news release that Texas legislators are continuing “their crusade against a woman’s right to safe and legal abortion.”

“Texas women deserve access to the health care that is best for them and their personal circumstances — not abortion restrictions pushed by extreme anti-abortion organizations,” Allen said. “The Center for Reproductive Rights vows to battle any unconstitutional measures in the courts until the rights of Texas women are respected and protected.”

The group sued late last year over a Texas Department of State Health Services proposal requiring health providers to bury or cremate fetal remains. Center lawyers won a temporary restraining order and in January a federal judge ruled Texas could not proceed with the rule, citing its vagueness and potential to harm patients.

See here for the background. I don’t know what to say that I haven’t said already, but if I’m going to repeat myself anyway, I’ll say this again: Nothing will change until the people we elect change. We have a chance to do something about this next year. It’s up to us.

Making vaccination information public

I support this.

While most parents in Texas vaccinate their children, the number of parents opting out of immunizations for non-medical reasons is on the rise. Since Texas changed its laws to allow parents to opt out citing a conscientious objection, the number of unvaccinated children has shot up more than 1,700 percent in 13 years, to 45,000 from 2,300. In response, parents and health advocates are backing an effort to increase public reporting on how many students who have skipped vaccines attend each school.

Currently, that data is housed at the state level and available via an open-records request. County and school district-level data also is available online.

House Bill 2249 would require the Texas Department of State Health Services to publish school-by-school data that would indicate the total number of students who forgo vaccinations, including those who opt out by choice, such as a religious objection. No names or identifying information would be listed.

Advocates for publishing the data say the information would offer parents insight into their child’s school and help them weigh whether to switch, particularly for parents of medically fragile children like Riki Graves’ daughter, Juliana. Now 3, she received a new heart at 18 days old, and doctors say she will need to attend a school where least 95 percent of the students are immunized.

“My job as a transplant mom is to protect that organ,” said Graves as she drove from her home in Sugar Land to Austin where she plans to testify before the House Public Health Committee on Tuesday. “We have the data … there’s no reason not to publish it.”

Opponents say there are plenty of reasons, including children’s medical privacy.

“If this is truly about keeping children safe, we have to have that honest conversation about keeping all people safe. It puts a target on the backs of children whose parents have chosen to opt out for various different reasons,” said Jackie Schlegel, a mother of three and executive director of Texans for Vaccine Choice, a grass-roots parent group that has ballooned in recent years as the movement against vaccinating children has gained traction. The group is planning a rally at the Capitol on Thursday, dubbed the “freedom fight.”

“At schools where you do have a high number of opt-out, we are creating a witch hunt against families, and that’s just unacceptable,” Schlegel said.

We clearly have a different definition of “unacceptable”. I think knowing that a given school has a high rate of unvaccinated children is something any parent would want to know. HB 2249 has four co-authors, two of whom )JD Sheffield and John Zerwas) are medical doctors, which ought to tell you something. As the story notes, an identical bill passed the House in 2015 but never got a hearing in the Senate. Let’s hope this year’s version meets a better fate. The Trib has more.

House hears “fetal remains” bill

Seriously?

Rep. Byron Cook

[House Bill 35] would create a registry of organizations that can help pay for burial or cremation of fetal remains. That way, the cost associated with burials would not fall on women, [bill author Rep. Byron] Cook said.

The measure would not apply to miscarriages that happen at home.

“Let me be clear: this bill has nothing to do with abortion procedures whatsoever. It has everything to do with ensuring the dignity of the deceased,” Cook said Wednesday. “We believe Texas can do better than this.”

Cook said he’s opposed to a current method of disposal that allows for grinding up fetuses and disposing of them in sanitary landfills.

“What we’re doing is removing a very objectionable method of disposal. The good news is I haven’t talked to anyone who thinks grinding would be an acceptable method [of disposal],” Cook said. “We’re just really taking off the books something that should be objectionable to everybody.”

However, Cook was challenged during the hearing by state Rep. Jessica Farrar, D-Houston, who said the Republican should revise his bill to outlaw the disposal methods he doesn’t like without mandating burial.

“I think if you want to delete that language, you can delete that language without creating a burial requirement,” Farrar said. “I think we can find a way that is, in some people’s minds, more humane without creating burdens for women.”

[…]

Wednesday’s hearing comes weeks after U.S. District Court Judge Sam Sparks ruled Texas cannot require health providers to bury or cremate fetuses.

Sparks wrote in January that a fetal remains burial rule the Texas Department of State Health Services planned to implement was vague and had the potential for irreparable harm.

Yes, that would be the main sticking point, I presume. I also presume that it would be possible to write a bill to address this never-considered-a-problem-before-HB2-was-struck-down issue in a way that complies with Judge Sparks’ order. I’m not a lawyer, so I can’t say if this bill might do that, but I do know that the lawyers who represent the clinics that would be affected by this law, as they would have been affected by the State Health Services rule that Judge Sparks blocked, will be able to say. And to do, if it comes to that.

“Fetal remains” rule blocked

Good.

U.S. District Court Judge Sam Sparks ruled Texas cannot require health providers to bury or cremate fetuses, delivering another blow to state leaders in the reproductive rights debate.

On Friday afternoon, Sparks wrote in his ruling that Texas Department of State Health Services’ fetal remains burial rule’s vagueness, undue burden and potential for irreparable harm were factors in his decision. He also wrote that the state had proposed the new rule “before the ink on the Supreme Court’s opinion in Whole Woman’s Health was dry.”

“The lack of clarity in the Amendments inviting such interpretation allows DSHS to exercise arbitrary, and potentially discriminatory, enforcement on an issue connected to abortion and therefore sensitive and hotly contested,” Sparks said.

[…]

During two public hearings, department leaders heard stories of abortions, miscarriages, and general grief over losing a baby. While anti-abortion groups argued that the rule was a means to bring human dignity to the fetuses, reproductive rights advocates said the rule was another way for Texas to punish women who chose an abortion, saying the cost of the burials would be passed on to patients, making abortions harder to obtain for low-income Texans.

During multi-day court hearings earlier this month, state attorneys said the rule was designed to provide aborted or miscarried fetuses a better resting place than a landfill. They also argued that there would be no cost for patients to worry about and only miniscule costs for providers. The state also said that there were multiple groups willing to help with costs.

But Center for Reproductive Rights lawyers argued the rule had no public health merits and no clear directions on how it would work for providers. Providers who testified noted it was unclear if they would be on the hook for fines and disciplinary action from Texas if the nonprofit groups mishandled the fetuses. They also said separating fetuses away from other medical waste would likely mean an uptick in costs for transportation and new disposal procedures.

Sparks expressed frustration throughout the court proceedings that neither side could provide a firm estimate of the costs of implementing the rule. He also, one point, agreed with Center for Reproductive Rights attorneys’ argument that there would be no public health benefits.

In his ruling, Sparks wrote that the department’s estimates don’t know “the true impact” of the rule and that their “simple math” is “unsupported by research and relies heavily on assumptions.”

See here, here, and here for the background, and here for a copy of the order; the full order is here. Note that this is just an injunction pending the actual lawsuit to overturn the ruling. The injunction strongly suggests that Judge Sparks thinks the plaintiffs will prevail, but that matter has not been decided yet. Now a trial date will be set and we will proceed from there, while the state will pursue an appeal to rescind the injunction and allow the rule, which had been scheduled to take effect on Friday, to be put in place for the duration of the trial.

Republicans like Ken Paxton are predictably gnashing their teeth about this, but if this rule was so important for the sanctity of life and dignity of the mothers and whatever else, then why wasn’t it proposed earlier than last year in the immediate wake of the HB2 ruling? Rick Perry could have proposed this a decade or more ago. Greg Abbott could have proposed it in 2015. If it was so damn important, why did they wait so long? Who had even heard of such a thing before last year? The timing of the rule gives the show away. It deserves the fate it got from Judge Sparks. A press release from the Center for Reproductive Rights is here, and the Chron, the Statesman, the Current, and the Austin Chronicle have more.

SB6 will hurt people

It will hurt transgender people, who despite what Dan Patrick would have you think, are people like you and me.

Lieutenant Governor Dan Patrick has said his so-called bathroom bill isn’t discriminatory because transgender people can update their birth certificates to reflect their gender identity.

However, statistics obtained by the Observer from the Department of State Health Services (DSHS) suggest that fewer than 1 percent of transgender Texans have updated their birth certificates, meaning the overwhelming majority could be forced to use restrooms that don’t match their gender identity under Senate Bill 6.

LGBT advocates said the DSHS statistics, which have not before been made public, underscore the obstacles transgender Texans face if they seek to correct their gender markers on state identification documents.

[…]

According to DSHS, a total of 497 Texas natives updated their birth certificates “to reflect a medical or surgical sex change” from 2006 to 2016. Last year, the Williams Institute at UCLA estimated that 125,000 transgender adults reside in Texas.

DSHS spokesperson Chris Van Deusen said the department doesn’t specifically track the number of transgender people who’ve corrected their birth certificates. However, in response to a request from the Observer, the state agency compiled the data based on how many people have updated their birth certificates using a court order.

“A court order is required to change the sex due to a medical or surgical sex change but not for a change due to an error,” Van Deusen said. “We’re reasonably confident this captures all changes to sex on birth certificates due to a court order.”

Texas has no standardized procedure for transgender people to update their birth certificates or driver’s licenses, and judges in only three of the state’s 254 counties — Bexar, Dallas and Travis — routinely issue court orders granting gender-marker changes, according to LGBT advocates. Last year, a Texas appeals court in Harris County rejected a trans man’s petition for a gender-marker change on his driver’s license.

There’s no standard procedure for updating one’s birth records. If you were born in another state, which may or may not even allow for this kind of correction, you may be out of luck. If you’re under 18, you are definitely out of luck. Even if all of these procedural issues could be resolved, this would still be discriminatory. Why should trans people have to go through all of this time and expense to be able to use a public restroom?

By the way, this is somewhat parallel to the experience of gays and lesbians before the Obergefell decision, in that in order to mimic the legal rights and protections granted under the law to straight married couples, they had to jump through dozens of legal hoops, often spending hundreds or thousands of dollars in lawyers’ fees to achieve it. Requiring a class of people to expend time and money on things that everyone else gets to have for free no questions asked is the definition of discrimination.

Trans people have been using bathrooms without any fuss for decades. It was never a problem until Dan Patrick decided it was one. His “remedy” to this non-problem will help no one, but it will hurt many people. There are lots of valid business and economic reasons to oppose SB6, and I thank the people in the business community who have helped lead the fight against it. But at the end of the day, this is about treating people as people. Dan Patrick wants to treat some people as something less. I cannot abide that.

“Fetal remains” rule still on hold

Take all the time you need.

As he considers a final ruling on the state’s fetal remains burial rule, U.S. District Court Judge Sam Sparks is delaying the start date of the rule for at least another three weeks.

On Wednesday afternoon, after attorneys for the state of Texas and the Center for Reproductive Rights made their closing remarks, Sparks said he would need more time to review evidence and witness testimony before making a final ruling about the state’s effort to require medical providers to bury or cremate aborted fetuses. The Texas Department of State Health Services had originally scheduled the rule to go into effect Dec. 19.

[…]

For the state, Sparks said he wanted further explanation on the logic behind barring providers from incinerating fetal remains, a medical waste procedure the state has long allowed. He also wanted direction on why the state’s rule should not be viewed as a political statement. He said he did not “think there’s any question” that there isn’t public health benefit to the proposed rule.

“There’s no health benefit, there’s no health problem, there was no problem to be fixed and it’s for the dignity of the fetus or however you want to describe it,” Sparks told state’s attorneys. “I think all life matters and needs dignity but that’s not the point…the point is just as I asked opposing counsel: ‘what is the thought of taking the majority of disposal out?'”

Sparks told attorneys with the Center for Reproductive Rights that he wanted them to identify from their evidence and witness testimony how the rule is unconstitutional and how it would create a burden for women.

Sparks said neither side had made headway on establishing how provider’s costs would be impacted if the rule were implemented.

See here and here for the background. This was a two-day hearing – here’s the Trib story from Day One.

Attorneys for the Center for Reproductive Rights, which sued to stop the rule, called witnesses at Tuesday’s hearing who continuously expressed that the rule is “vague,” doesn’t give enough clarity for medical providers and has no public health benefits.

Amy Hagstrom Miller, founder and CEO of Whole Woman’s Health, the main plaintiff in the case, said on the stand that the rule was “discriminatory” and “offensive.” She said while groups like the Texas Conference of Catholic Bishops have stepped up to take on the cost of cremations and burials, the rule is unclear about who would be responsible for making sure the remains are properly disposed of. She said that vagueness puts providers in a vulnerable position where they could face fines or disciplinary actions by the state if those non-medical groups do something wrong. Also troubling, Miller said, is that it’s difficult for abortion providers to keep a steady roster of medical waste vendors due to alleged harassment from anti-abortion groups.

“It’s confusing for most of us to figure what a clear path would be to compliance,” Miller said. “I find words like ‘interment’ and ‘incineration’ and ‘cremation’ and ‘funeral’ are really confused and used intermittently in a way that is difficult for us to understand and difficult for the public to understand.”

The Statesman notes that the Ag had a bit of a rough time on Tuesday.

U.S. District Judge Sam Sparks abruptly halted a hearing on the constitutionality of the rule and ordered state lawyers to appear in his Austin courtroom, with answers, at 8:30 a.m. Wednesday — a half-hour before the hearing was set to continue for a second and final day.

Visibly frustrated, Sparks said it appeared that the rule, drafted by state health officials and praised by Republican leaders for prohibiting fetal remains from being deposited in sanitary landfills, appeared to improperly countermand a state law allowing cremated ashes to be scattered over any private property with the owner’s consent.

“I want the state to give me answers about how one regulation can overrule another state statute,” the judge said.

[…]

The lead lawyer for the state, John Langley with the attorney general’s office, challenged both abortion providers by repeatedly pointing out that “the rules don’t regulate women at all,” but instead require health care centers to ensure that fetal tissue is properly buried or cremated. Nor does the rule impose funeral requirements on women because it doesn’t require individual burials for each fetus, he said.

Langley also argued that concerns about increased costs were overblown, pointing out that the abortion providers’ own economist estimated that the new rule would add only 54 cents to $1.56 in costs per abortion.

However, economist Anne Layne-Farrar testified that the anticipated cost was based on an estimate provided by the only crematorium that appeared willing and able to handle fetal tissue at a feasible cost. The Dallas-area crematorium, however, is unlikely to be able to handle medical waste from all Texas abortion facilities, let alone from doctor’s offices that provide miscarriage care, she said.

Layne-Farrar also said it was risky to rely on one vendor that, if lost, would force abortion providers to turn to funeral homes that would likely charge $500 to $700 per cremation.

When a lawyer for Texas suggested that clinics could save money by cremating several weeks’ worth of fetal tissue at a time, Layne-Farrar said most of the 11 funeral homes contacted for her study said ethical considerations prohibited them from cremating or burying more than one body at a time.

Does any of that give you confidence that this was something other than a hastily-decreed retaliation for the SCOTUS HB2 ruling from last year? I mean, come on. Judge Sparks had previously been expected to rule on Friday, but clearly we’re going to have to wait a little longer than that. The Chron and the Austin Chronicle have more.

The religious objection to the “fetal remains” rule

It may not be your religion, but who are we to tell people of sincere religious faith what to do?

“The Satanic Temple believes burial rites are a well-established component of religious practice. In addition, members of The Satanic Temple believe in the inviolability of the body and, as such, these rules contradict our fundamental beliefs,” reads a statement posted on the Satanic Temple’s website.

Temple spokesman Lucien Greaves said that health officials’ transparent attempt to give fetal tissue the same rights as a human being (called “personhood” by anti-abortion advocates) directly conflicts with the temple’s beliefs.

“It’s clear these officials deem harassment an acceptable form of pushing their misguided religious agendas,” he said in a [recent] press release.

Citing the Religious Freedom Reform Act, Greaves said members are immune from the new regulation unless the state can present a “compelling reason” for why they should be allowed to violate the Temple’s religious beliefs. So far, church members don’t see one.

“Clearly, the State of Texas has no compelling reason because these rules were not enacted to promote health and safety, but rather to harass and burden women who terminate their pregnancies,” the Temple’s website states, adding that the church will use the legal system to protect their members’ rights.

It’s not an empty threat. “We’ll file an injunction as soon as the state tried to impose this on a member who claims exemption,” the Temple spokesman Greaves told Jezebel.

All righty then. This was from a little while ago, I just hadn’t gotten around to posting it yet. As the story notes, the Satanic Temple has previously sued the state of Missouri over religious objections to that state’s 72-hour waiting period for an abortion. As we know, the “fetal remains” rule is now on hold thanks to the Center for Reproductive Rights, but that doesn’t mean the Temple can’t file its own lawsuit. If nothing else, you have to admire their willingness to throw the language of “religious freedom” back in the state’s face. If you’re going to insist that laws should not apply to religious organizations if those laws conflict with their faith, then you have to accept that this also applies to faiths you don’t care for. The Austin Chronicle and the Press have more.

“Fetal remains” rule put on hold

Good.

A federal judge has delayed Texas’ fetal remains burial rule until Jan. 6.

Judge Sam Sparks ruled Thursday afternoon that the Texas Department of State Health Services would have to push back its start date for requiring health providers to bury or cremate aborted fetuses. The agency had originally slated the rule to go into effect Dec. 19.

Under the rule, Texas health providers are forbidden from disposing of fetal remains in sanitary landfills, regardless of gestation period.

Sparks said each side would get about five hours for a hearing on Jan. 3-4 to make their cases. He said there would likely be a decision on Jan. 6.

See here for the background. The state argued that there is “no increase in costs to health care providers and patients”, which is only true if the funeral homes that had been disposing of remains pro bono in the past do not pass along the significant costs that this rule imposes on them.

The Austin Chronicle adds some details.

Sparks appeared far more confrontational toward state defendants, commenting that Texas must show reasons for implementing the rule other than “political” ones. He also cast ample skepticism on the state’s timing of the rule – filed just four days after their loss in the House Bill 2 case at the U.S. Supreme Court – calling it “curious,” more than once. In a moment of commentary, Sparks said the war against abortion rights is raging “quicker and meaner” than it has in the last 40 years.

State assistant attorney John Langley defended the rule as a “modest step” to protect the unborn, but failed to give evidence of its public health benefit. He argued that the rule in “no way regulates a woman’s right to choose” or places an imposition on clinics. Revealing the intention of the anti-choice regulation, Langley was unable to answer how the rule practically advances a health and safety interest – the very objectives the state health department is tasked with. When asked about how the rule prevents the spread of disease and protects health, the attorney called it a “side issue” to the real goal: Protecting the “dignity” of the unborn. “I acknowledge I don’t have a satisfactory answer, your honor,” said Langley.

Following the hearing, CRR’s Brown called the state’s inability to provide a health rationale “remarkable” and more evidence that the rule is meant to “disrespect” abortion-seeking women. “This rule is really intended to send a message to the Supreme Court that Texas is defying them,” said Brown.

When Langley objected to the temporary restraining order, an agitated Sparks noted that “this is the first time the state of Texas has ever said it was going to go ahead [with a rule] when there’s a suit of substance before the federal court,” and before full trial arguments were heard. “I’m going to remember that.”

Perhaps a contempt charge might be in order, if it comes to that. I mean, look, if this rule is so necessary, then why did it take the state so long to implement it? It didn’t require legislative intervention, just a word from the Governor to State Health Services. Rick Perry could have done this. Greg Abbott could have done it in 2015. Heck, Dubya could have done it. Why did it not happen until shortly after the Whole Women’s Health ruling? The question answers itself. Trail Blazers, the Current, the Press, and the Chron have more.

“Fetal remains” lawsuit filed

As expected.

Today the Center for Reproductive Rights filed new litigation against the state of Texas over unconstitutional new regulations that mandate the burial or cremation of embryonic and fetal tissue that results from abortions, miscarriages, or ectopic pregnancy surgery – regardless of the woman’s personal wishes or beliefs.

The politically-motivated rules are designed to restrict a woman’s right to access safe and legal abortion by increasing both the cost of reproductive health care services and the shame and stigma surrounding abortion and pregnancy loss.

The lawsuit demands that the state halt implementation of regulations finalized late last month by the Texas Department of State Health Services (DSHS). The final rules disregard widespread objection from medical organizations, legal experts and others who argue that these unconstitutional new restrictions offer no public health or safety benefit.

The regulations – first proposed just four days after the U.S. Supreme Court’s historic Whole Woman’s Health v. Hellerstedt decision in June – are in direct defiance of the high court’s ruling, which held that restrictions on legal abortion cannot impose burdens on a woman’s right to access abortion care without providing any legitimate, medical benefit.

Said Nancy Northup, President and CEO of the Center for Reproductive Rights:

“These regulations are an insult to Texas women, the rule of law and the U.S. Supreme Court, which declared less than six months ago that medically unnecessary restrictions on abortion access are unconstitutional.

“These insidious regulations are a new low in Texas’ long history of denying women the respect that they deserve to make their own decision about their lives and their healthcare.  

“The Center for Reproductive Rights will continue to fight for Texas women, and women across the nation, to ensure their rights are protected.”

Said Amy Hagstrom-Miller, president and CEO of Whole Woman’s Health, lead plaintiff in the case:

“Texas’ profound disrespect of women’s health and dignity apparently has no bounds with this new regulation announced just days after our June victory in the Supreme Court. This latest attack is an end run game to add restrictions on abortion care and it ignores thousands of Texan’s testimony and comments.

“We at Whole Woman’s Health have a history of fighting restrictions that are deeply rooted in shaming and stigmatizing Texans and today’s filing is no different. We will not stand for Texas putting more undue burdens on women and families who deserve the safe and compassionate abortion care that we provide at Whole Woman’s Health.”

Today’s lawsuit was filed by David Brown and Molly Duane of the Center for Reproductive Rights, Austin attorneys Jan Soifer and Patrick O’Connell of the law firm O’Connell & Soifer, and J. Alexander Lawrence of the law firm Morrison & Foerster in the U.S. District Court for the Western District of Texas on behalf of Whole Woman’s Health, Brookside Women’s Health Center and Austin Women’s Health Center, Alamo Women’s Reproductive Services, Reproductive Services and Dr. Lendol Davis.

The regulations are part of an ongoing attack across the country to restrict access to legal abortion through unnecessary regulations that endanger women’s health and safety. State legislators have passed more than 330 new restrictions on abortion access in the last five years alone.

The new litigation comes as Texas faces a $4.5 million legal bill over its defense of the sham clinic shutdown laws struck down by the Supreme Court in Whole Woman’s Health v. Hellerstedt.

See here and here for the background. As I said before, I expect the plaintiffs will be able to get an injunction at the district court level, but after that anything can happen. I will of course be keeping an eye on it. The Trib, the Austin Chronicle, the Current, the Chron, and Trail Blazers have more.

“Fetal remains” lawsuit in the works

Get ready.

Health providers and abortion clinics have less than two weeks to figure out how to comply with Texas’ new fetal remains rules — that is, if a lawsuit doesn’t halt the process first.

Amy Hagstrom Miller, founder of abortion provider Whole Woman’s Health, said she is working with the Center for Reproductive Rights on a potential lawsuit opposing the rules. Any lawsuit would need to be filed next week because the rules are set to take effect Dec. 19.

“Here we are, with a situation where Texas is trying to restrict access to safe abortion care by any means necessary,” she said. “It’s really cruel.”

[…]

Health care entities haven’t said how they will comply. Hagstrom Miller, one of the plaintiffs in the Supreme Court abortion case, said that she is still working on a path to compliance but that Whole Woman’s Health is first trying to determine what the rules would entail.

“The regulations as written are very confusing,” she said. “We’re trying to figure out exactly what the law requires.”

See here for the background. I feel reasonably confident that an injunction can be had in district court. What happens after that, with the Fifth Circuit and SCOTUS, is anyone’s guess. But the Center for Reproductive Rights (who you should totally support) won before, and I have faith they can win again. It’s just a damn shame they have to.

The costs of the “fetal remains” rule

This is going to cost a lot of people a lot of money.

State health officials have contended that the “minimum costs in complying with the rules” would total $450 a year per health care facility, arguing that those costs would be offset by the elimination of the cost of landfill disposition.

But Michael Land, a funeral home director and spokesman for the [Texas Funeral Directors Association], said that’s unrealistic and that the costs associated with compliance are likely a “higher dollar amount than what they’re projecting.”

Cremations through a third-party crematorium range from $75 to $100 per specimen. If individuals choose burials, the minimum cost of a small space in a cemetery is $500 and caskets of the appropriate size would likely cost $100, Land said.

If you add labor on the part of the funeral home, the fees could go into the thousands of dollars, he added.

Responding to those concerns, a spokeswoman for the Texas Health and Human Services Commission said the rules don’t require that “these processes” go through funeral homes. Health care providers can work directly with crematoriums or medical waste companies to comply with the rules, said spokeswoman Carrie Williams.

“[Funeral homes] don’t have a mandatory role, and funerals are not required by these rules,” Williams said. “Incineration is still available as an option.”

But the rules indicate that incineration of fetal remains must be followed by interment. State health officials define interment as the “disposition of pathological waste using the process of cremation, entombment, burial, or placement in a niche or by using the process of cremation followed by placement of the ashes in a niche, grave, or scattering of ashes as authorized by law.”

Among the few exceptions to the rule are miscarriages or abortions that occur at home. But fetal remains from miscarriages that occur at health care facilities will still require interment — even if the patient does not desire it.

For those in the funeral business, the increased demand for cremations could mean ending their practice of charitably cremating the tissue from a miscarriage for parents who wished to have a funeral.

“What had always been pretty much a charitable process is now going to become costing quite a bit of money,” Land said. It’s estimated that 10 to 20 percent of pregnancies end in miscarriage.

See here for the background. Someone is going to pay for this little unfunded mandate, and there are a lot more women who have miscarriages than abortions. Remember, this only became a thing after HB2 was thrown out by SCOTUS last year. With any luck, this will meet a similar fate after it takes effect on the 19th.

“Fetal remains” rule goes into effect

Cue up that next lawsuit.

Texas’ proposed rules requiring the cremation or burial of fetal remains will take effect Dec. 19, according to state health officials.

Despite intense outcry from the medical community and reproductive rights advocates, the state will prohibit hospitals, abortion clinics and other health care facilities from disposing of fetal remains in sanitary landfills, instead allowing only cremation or interment of all remains — regardless of the period of gestation.

[…]

Proposed at the direction of Republican Gov. Greg Abbott, the health commission had argued the rules would result in “enhanced protection of the health and safety of the public.” Abbott said in a fundraising email that the rules were proposed because he doesn’t believe fetal remains should be “treated like medical waste and disposed of in landfills.”

But the new requirement prompted outrage from the reproductive rights community, which accused state leaders of pushing unnecessary regulations. Women who experienced miscarriages or lost children in utero questioned why the state would make their situations more difficult by enacting the requirements. And medical providers — including the Texas Medical Association and the Texas Hospital Association — had also raised concerns about who would bear the costs associated with cremation or burial — a figure that can reach several thousand dollars in each case.

In response to those concerns, health officials indicated that health care facilities — and not patients — will be responsible for the disposal of fetal remains and related costs. They also wrote that those costs would be “offset by the elimination of some current methods of disposition.”

See here, here, and here for the background. If you think it’s a coincidence that this was proposed within a few weeks of the SCOTUS ruling striking down HB2, I’ve got a carload of diplomas from Trump University to sell you. Let’s get that next lawsuit going so we can maybe have an injunction in place before this atrocity can take effect. (And if you want to help facilitate that, a donation to the Center for Reproductive Rights would be a fine way to do so.) The Austin Chronicle has more.

We’re going to be fighting about vaccinations for a while

I wish it weren’t so, but it is.

Texas is one of 18 states that allow non-medical exemptions to the vaccines required for school attendance. California had a similar law allowing non-medical exemptions, until last year when it enacted a law that has one of the strictest requirements in the country after a 2014 outbreak of measles traced to the Disneyland theme park infected more than 100 people around the country.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

“Year after year we’ve seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas,” said Christine Mann, a spokeswoman for the Texas Department of State Health Services. “But overall, the numbers are small.”

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 “conscientious exemptions” in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

Some parents are pressing state officials to let them know how many of their children’s peers are unvaccinated. Jinny Suh, who has a 4-year-old son, is helping spearhead a petition drive asking legislators to change state law so that the number of school exemptions is public. Currently, exemption rates are available for individual private and charter schools, but only district-wide for public schools.

State Rep. César Blanco, a Democrat from El Paso, introduced a bill during the last legislative session that would have required schools to notify parents about vaccination rates at the school level, but the bill was stalled in committee.

“As a parent, there are lots of things that people get very passionate about,” Suh said, “but for some reason, in my experience, vaccinations remains an almost taboo topic besides a few passionate people.”

Yes, the anti-vaxxers are a minority, but they are a vocal and organized minority, which is a recipe for political success. Unfortunately, the end result of that political success is a growing public health problem, which is compounded by a lack of leadership in our state government. Honestly, what we need here is for an organized pushback against the anti-vaxxers, a pro-vaccine Moms Demand Action kind of thing. The main difference here isn’t that there is an anti-vaccination legislative faction that needs to be countered. I doubt there are that many legislators who are truly anti-vaccination, though there are a decent number who are in favor of “conscience” objections to some extent. It’s more that there isn’t a vocal and active pro-vaccination legislative force that can advance the cause and/or defend against attempts to weaken vaccination requirements. People who want to see more kids get vaccinated and fewer kids get exempted from vaccinations need to elect a few of their own. Until that happens, we’re going to see more stories like this one.

The next abortion lawsuit should be on its way

We were warned it would need to happen.

Despite intense outcry from the medical community, reproductive rights advocates and funeral directors, Texas isn’t budging on a proposed rule to require the cremation or burial of fetal remains.

Following an initial public comment period that sparked medical concerns and a legal threat, Texas health officials have re-submitted for public consideration a proposed rule change that prohibits hospitals, abortion clinics and other health care facilities from disposing of fetal remains in sanitary landfills, instead allowing only cremation or interment of all remains regardless of the period of gestation — even in instances of miscarriages.

After considering hours of public testimony at an August hearing and more than 12,000 comments submitted in writing, the state made no changes to the rules, which are set to be published in the Texas Register on Sept. 30.

The rules were re-published “after reviewing the feedback and comments we received,” health commission spokeswoman Carrie Williams said on Wednesday. This will require another 30-day public comment period before the rules can go into effect.

[…]

The proposed rule has prompted outrage from the reproductive rights community, which has accused state leaders of enacting unnecessary regulations. Medical providers — including the Texas Medical Association and the Texas Hospital Association — also questioned why the rule change does not allow an exception for miscarriages and ectopic pregnancies.

Despite making no revisions to the rules themselves, the commission has amended its analysis on the financial impact of the rule on health care organizations that must comply, saying the rules won’t increase “total costs” for health care facilities.

Medical professionals and funeral directors had raised concerns about who would bear the costs associated with cremation or burial — a figure that can reach several thousands dollars in each case — and questioned whether the new would trigger a requirement for death certificates so that fetal remains could be cremated or buried. (Under current rules, the state requires funeral directors or a “person acting as such” who take custody of a dead body or fetus to obtain an electronic report of death before transporting the body, according to the Funeral Consumers Alliance of Texas.)

The amended fiscal analysis indicates that the methods allowed in the proposed rules “may have a cost” but “that cost is expected to be offset” by costs currently incurred by facilities. Hospitals and abortion providers currently contract with third-party medical waste disposal services.

See here and here for the background. All this happened by executive order, with no legislative input or public hearings, in the immediate aftermath of the SCOTUS decision striking down the odious HB2. If the words “undue burden” have not formed in your head by now, you need to go back and read that decision again. I guarantee, once this rule is in place, a lawsuit will follow.

Black women face much higher risk of pregnancy-related death in Texas

Any time you’re being compared to a third world country, it’s not a good thing.

Black women bear the greatest risk for pregnancy-related death in Texas by far, according to a much-awaited new report, commissioned because the state rate resembles that of many Third World countries.

The report, which follows the publication of a national study that found Texas’ maternal mortality rate has doubled since 2011, ranked heart conditions, overdose by legal or illegal drugs and high blood pressure of pregnancy as the leading causes of such deaths.

“This confirms what we feared – that many of these deaths could be prevented,” said state Rep. Armando Walle, D-Houston, the House author of the 2013 bill that created a Department of State Health Services maternal mortality task force and charged it with producing biennial reports and recommendations. “It’s a travesty that this is happening.”

[…]

Marian MacDorman, the University of Maryland-based lead author of the Obstetrics & Gynecology study said she applauds the Texas team for “looking into the deaths in greater detail.”

“Although the Texas Department of Health study uses different methods and data sources from mine, I think we both agree that maternal mortality is a serious problem in Texas,” said MacDorman. “I especially appreciate their policy recommendations for how to reduce it.”

The Texas report found most of the state’s maternal deaths – 60 percent – occurred between 42 days and a year after delivery. MacDorman’s study identified 262 Texas deaths in the same two-year period based only on those who died within 42 days.

Walle said he is hopeful the report makes an impression on the 2017 Legislature.

“I’m not naïve to the fact we haven’t expanded Medicaid, but something needs to be done to increase access to pregnant women,” said Walle. “We can’t keeping letting federal dollars go to other states while these women are dying.”

See here for more about the previous study that showed an overall rise in maternal deaths in Texas. The story lists a number of things that could be done to help this situation, all of which involve expanding access to health care, most of which could be accomplished by expanding Medicaid. Since we know that won’t happen under the current leadership, none of whom has been quoted in a story I’ve seen so far, the question is what if anything they would propose to do about it. My guess is it would involve tort reform and high-deductible health plans, because we know those fix everything. Pro Publica has more.

Too many kids are not getting vaccinated

We let this happen, thanks to the fervor of a vocal minority.

The number of Texans who exempt their children from vaccination for non-medical reasons rose nearly 9 percent last school year, continuing a now 12-year-long trend that public health officials worry could eventually leave communities vulnerable to outbreaks of preventable diseases.

The new numbers represent a 19-fold increase since 2003, the first year that Texas law allowed parents to decline state immunization requirements for “reasons of conscience.” The number of such exemptions are still small, a little under 45,000 of the state’s roughly 5.5 million schoolchildren, but they’ve spiked from less than 3,000 that first year, according to the new state data.

“The trend is going in the wrong direction,” said Anna C. Dragsbaek, president and CEO of The Immunization Partnership, a pro-vaccine group. “It’s time for the community to step up and take action on this very troubling trend.”

Concern has picked up in recent years amid the re-emergence of diseases such as measles and whooping cough. A large measles outbreak last year, linked to an initial exposure at Disneyland in California, sparked particular distress.

Texas is one of 18 states that allows waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only two states – Mississippi and West Virginia – don’t grant exemptions from immunization requirements on religious grounds, and all states allow exemptions for medical conditions, such as a compromised immune system.

[…]

Pushed by the Immunization Partnership, the 2015 Legislature considered a bill that would have required the Texas Department of State Health Services to post the exemption numbers of every school on its website.

Under the current law, the department is only required to post aggregate numbers for each school district.

The bill passed the House but died in the Senate. Dragsbaek, impressed at the traction the legislation got, said the partnership will push hard on behalf of any such bill again in 2017.

The bill to require school-specific information called for the inclusion of delinquency numbers, also a big problem. At HISD, for instance, more than 3 percent of children in 2015-2016 – who hadn’t obtained a conscientious exemption – had not received at least one of each vaccine by the district’s age-specified deadline. Enforcement of such deadlines is up to the principal.

“Eleven percent of HISD’s prekindergarten students hadn’t received their first dose of measles vaccine 90 days into the school year,” said Dr. Susan Wootton, a pediatrician at University of Texas Health Science Center at Houston who is leading an HISD task force on immunization delinquency. “That needs to be fixed. Nepal does better than that.”

Harris County’s overall conscientious exemption rate is still relatively low, just 0.62 percent, but it’s doubled in the last five years. So has Montgomery County’s, now 1.73 percent. Brazoria County has gone from 0.30 to 0.80. Gaines County in West Texas has the state’s highest conscientious exemption rate, nearly 5 percent.

That would be a worthwhile bill, but the real goal needs to be to eliminate the “personal belief” exemptions, which are an increasing threat to public health. Unfortunately, the pushback on that last session was ferocious, and that has emboldened the anti-vaxxers. I don’t know how much optimism I have about the school-specific information bill as a result. There are plenty of people who would like to see better vaccination laws, but the energy and organization is on the other side. It would help to get some leadership from, say, the Governor’s office, but he has none to offer, so the rest of us are on our own.

Texas finds a new way to be hostile to women’s health

I feel like it must be someone’s job somewhere to come up with stuff like this.

Right there with them

Right there with them

A group led by an anti-abortion advocate appears to be one of the largest recipients of state funding from the “Healthy Texas Women” program, which lawmakers recently created to help women find health care services paid for by the state.

The Heidi Group, a Round Rock-based center that has promoted alternatives to abortion to low-income women, is set to receive $1.6 million from the women’s health program, according to the comptroller’s office. That makes it the second-highest grant recipient on the current list, behind the Harris County public health department, which will receive $1.7 million.

[…]

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” state agency spokesman Bryan Black said in an email.

Black said the group had already recruited doctors to begin establishing family planning clinics across the state. He also said the women’s health program’s contracts were not final and that there were “more to come.” The program offers $18 million each year.

Abortion-rights supporters lambasted the Heidi Group’s contract.

“It’s very inappropriate that the state would contract with an organization that has never performed the services required by the contract,” said Heather Busby, executive director of NARAL Pro-Choice Texas, in a statement. “The Heidi Group is an anti-abortion organization; it is not a healthcare provider.”

This is a political advocacy group that has been given a contract to provide health care. What could possibly go wrong with that? The Observer gives another reason to be concerned:

[Heidi Group founder Carol] Everett made headlines in early August following her testimony at a Texas Department of State Health Services meeting on new rules about fetal tissue disposal in Texas. There, she asserted that currently allowable means of fetal tissue disposal could result in HIV and other sexually transmitted infections being released into public water supplies, which she later repeated to an Austin Fox affiliate. Her concerns are not echoed by any major medical or public health groups.

So this is like hiring Jenny McCarthy to run your immunization program. This is what the state of Texas under Greg Abbott thinks about women’s healthcare. The Press, which has a more sympathetic portrait of Everett, and the Current, which is harsher, have more.

More on the “fetal remains” rule change

It’s stupid, harmful, unnecessary, expensive, and almost certainly in violation of the SCOTUS ruling in Whole Women’s Health v. Hellerstedt. But other than that, no biggie.

In the aftermath of a car accident in 2014, Denee Booker was told by her doctor that the child she was carrying had died in utero.

To avoid complications, she agreed with her doctor’s suggestion to remove the fetus instead of waiting for it to “naturally pass,” Booker told state health officials during a Thursday hearing on a proposed state rule that would require the cremation or burial of fetal remains.

“That I would have had to take or make either of those decisions is mind-boggling and terrifying,” Booker said of the proposed requirements. “I can’t imagine how much worse that would’ve made my situation.”

Booker was among dozens who testified on a pending rule change that prohibits hospitals, abortion clinics and other health care facilities from disposing of fetal remains in sanitary landfills, instead allowing only cremation or interment of all remains — regardless of the period of gestation — even in instances of miscarriages.

[…]

Medical professionals and others have also questioned whether the new rules would trigger a requirement for death certificates so that fetal remains could be cremated or buried.

Under current rules, the state requires funeral directors or a “person acting as such” who take custody of a dead body or fetus to obtain an electronic report of death before transporting the body, according to the associations’ letter.

The Funeral Consumers Alliance of Texas came out against the measure. Sarah Reeves, a representative for the group, testified that the state’s fiscal analysis of the rule change was incomplete because it found there would be no significant cost to individuals or businesses that must comply.

In a letter submitted to health officials, the group’s director wrote that the average “basic fee” for funeral services is $2,000.

The proposed rule does not indicate who would pay those costs. Hospitals and abortion providers currently contract with third-party medical waste disposal services.

During the hearing, Joe Pojman, executive director of Texas Alliance for Life, suggested that abortion providers should absorb any “nominal increase” in costs associated with the cremation or burial rule as some funeral homes and cemeteries do in cases of miscarriages.

In questioning the health-related justifications for the proposed rules, Planned Parenthood and NARAL Pro-Choice Texas testified that state health officials have not provided any evidence that current methods used by abortion providers to dispose of fetal tissue — which have been approved by the state for 20 years — are less safe or not optimal for public health and safety.

State officials have defended the rule change, saying it was proposed in “the best interests of the public health of Texas.” They also say the proposed rule change reflects the state’s efforts to affirm the “highest standards of human dignity.”

Planned Parenthood has pointed out that the proposed rules treat fetal tissue differently than other medical tissue.

The rule change would not apply to other human tissue that might be removed during surgery, for instance, and the existing disposal methods were not modified for the placenta, gestational sac and other tissue that results from miscarriages and abortions, the organization wrote to health officials.

“While we support reasonable updates to rules that are within the department’s statutory authority and protect and enhance public health and safety, the proposed rules go beyond the limits of this authority, do not further these aims and appear motivated solely by political forces,” said Yvonne Gutierrez, executive director of Planned Parenthood’s political arm in Texas.

The possibility of a legal challenge to the rule change hung over the hearing, with many repeating a warning by reproductive rights lawyers that the proposal “will almost certainly trigger costly litigation.”

See here for some background. The “possibility” of legal action is roughly 100%, I’d say. Lamar Hankins goes into great detail about why this proposed rule change is ridiculous, and it’s clear that this is another example of the state insisting it knows health and medicine better than any dumb ol’ doctors. The rules for this have been the same for 20 years, so the only motive I can think of for changing them now is backlash to Hellerstedt. Maybe the Department of State Health Services will reconsider before they make it official, but if not, we’ll see you in court again. The Observer, the Current, the Austin Chronicle, and Rewire have more.

Get ready for the next abortion lawsuit

Expect it in a couple of months.

Texas’ proposed rules requiring the cremation or burial of fetal remains “will almost certainly trigger costly litigation,” reproductive rights lawyers say.

In a letter to the Texas Department of State Health Services, lawyers with the Center for Reproductive Rights on Monday argued that the new rules — proposed at Gov. Greg Abbott‘s directive — are “plainly in violation” of the legal standard abortion regulations must meet to be deemed constitutional.

In a fundraising email sent to supporters last month, Abbott said he didn’t believe fetal remains should be “treated like medical waste and disposed of in landfills.”

With little notice and no announcement, Texas health officials in July proposed new rules to prohibit abortion providers from disposing of fetal remains in sanitary landfills, instead allowing only cremation or interment of all remains — regardless of the period of gestation. The burial or cremation rule seems to also apply to “spontaneous abortions,” or miscarriages.

A similar measure was signed into law in Indiana but was later blocked by a federal judge.

“Texas politicians are at it again, inserting their personal beliefs into the health care decisions of Texas women,” Stephanie Toti, senior counsel for the Center for Reproductive Rights, in a statement. “The Center for Reproductive Rights is prepared to take further legal action to ensure that Texas women can continue to access abortion and other reproductive health care without interference by politicians.”

[…]

In defending the rule change, state health officials previously said it was proposed in “the best interests of the public health of Texas” and to affirm the “highest standards of human dignity.” In the fundraising letter, Abbott cited the rule change in saying that Texas is working to “turn the tides” against the abortion industry in the state and protect the “rights of the unborn.”

But the reproductive rights lawyers say the disposal requirements are “burdensome for both abortion care and miscarriage management.” And they say the proposed rules are out of line with the legal standard for abortion — that the burdens imposed on women from restrictions on the procedure cannot outweigh the benefits they provide the state, like promoting health.

That legal standard was clarified by the U.S. Supreme Court in its recent decision overturning Texas’ 2013 abortion restrictions. The center represented Texas abortion providers in that lawsuit, formally known as Whole Woman’s Health v. Hellerstedt. 

I had not followed the rules change story – see BOR here and here for further reading on it – but you can see where this is heading. Between this and the BS “medical” pamphlet that gets pushed on abortion patients, there is definitely a case that these are “undue burdens” under the Hellerstedt decision. That’s not a slam dunk – remember as always that the Fifth Circuit will be involved in any litigation, and they upheld HB2 – and it will take some time (and money) to get a suit filed, get a hearing, and hopefully get an injunction for the interim. The anti-abortion zealots will never stop pushing boundaries. It’s what they do. The Current has more.

If we can’t ban it, we’ll BS about it

The “it” in question is of course abortion, with the state of Texas lying to women about its effects and risks.

Death and infertility were just two of the risks a doctor described to Kryston Skinner when she chose to have an abortion last year.

The 23-year-old knew it wasn’t the right time for her to become a mother, though Skinner dreamed of children in the future. The thought of not living to see that day, or becoming infertile, terrified her.

But some of the information she was given was misleading or medically wrong, contained in a long, controversial booklet that state lawmakers require doctors to give women at least 24 hours before an abortion procedure.

Medical experts have long denounced the booklet, saying important sections — such as those connecting abortions to the likelihood of breast cancer and infertility — are wrong.

Now, the Department of State Health Services is planning an update of the booklet, called A Woman’s Right to Know. The new draft doubles down on information highly contested by medical experts and the pro-abortion rights community, stoking the flames of a debate going back more than a decade.

The booklet was mandated by a 2003 anti-abortion law intended to guarantee informed consent from women seeking abortions. It contains information on the developmental stages of a fetus, risks of abortion and other options for pregnant women.

The state is supposed to consult with medical organizations to provide “objective,” “nonjudgmental” and “accurate scientific information” in the booklet. DSHS spokeswoman Carrie Williams said the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

The recent revisions were made “after reviewing medical research and information from experts in the field.” The process included consulting the American Congress of Obstetricians and Gynecologists, she said.

But the group said the state has not incorporated any of its recommendations, which included removing scientifically unsupported language that suggests getting an abortion increases the risk of breast cancer, and that women who have abortions are more likely to become depressed or suicidal.

Here’s the draft of the new booklet, the current booklet, and a letter from the American College of Obstetricians and Gynecologists telling the state that the draft booklet full is of BS. It’s another egregious example of doctors and scientists saying one thing, and a bunch of anti-abortion activists claiming they’re wrong because they want them to be wrong. Remember how much whining there was about Obamacare interfering with the doctor-patient relationship? This is what actual interference with that relationship looks like, since no doctor who isn’t a quack would ever choose to give this booklet to patients. Perhaps this would make a good legal test of the new standard for abortion restrictions. The Austin Chronicle has more.

State settles birth certificate lawsuit

Good.

After undergoing mediation, the state of Texas has reached an agreement with undocumented families in a lawsuit over its denial to issue birth certificates to children born in the U.S. to undocumented immigrants.

The state will clarify and expand the types of secondary forms undocumented immigrants can use to prove their identity, according to attorneys representing the group of undocumented parents and their U.S-born children who filed a lawsuit against the Texas Department of State Health Services.

Previously, immigrants in Texas could request birth certificates for their children if they had two secondary forms of ID, including Mexican voter registration cards and foreign IDs with a photo.

In the agreement, the state said it would accept voter ID cards received by undocumented immigrants in Texas by mail under recent changes to Mexican law, the attorneys said. Until earlier this year, the Mexican voter registration cards could only be obtained in Mexico.

The state also agreed to accept certain documents Central American parents can obtain from their consulates in the U.S. as secondary forms of ID if they are signed and stamped by consular officials. Under the agreement, the list of acceptable secondary documents was also expanded to include other supporting documents, such as copies of utility bills, paycheck stubs and letters relating to public assistance benefits, according to the families’ lawyers.

“We feel confident that undocumented parents with children born here will be able to access their children’s birth certificates,” said Marinda van Dalen, a staff attorney with Texas Rio Grande Legal Aid.

See here and here for the background. The plaintiffs’ argument was that the state had no basis for changing its rules for what ID it would and would not accept, and the state’s defense to that argument didn’t resonate with the judge, so given all that a settlement seems like the best outcome all around. With the exception of the immigration executive order lawsuit, it hasn’t exactly been a great month in the courts for the state of Texas, has it? A statement from the Senate Hispanic Caucus is here, and the NYT and the Observer have more.

First baby affected by Zika born in Texas

Won’t be the last, unfortunately.

A baby boy born with microcephaly in Harris County is the first Zika-affected infant in Texas, the Texas Department of State Health Services announced Wednesday.

The baby’s mother contracted Zika in Colombia, and the baby was infected in the womb, according Umair Shah, executive director of Harris County Public Health. The baby was born a few weeks ago in Harris County outside of Houston, and tests confirmed that he had Zika on Monday, Shah said.

In the state health department news release, State Health Services Commissioner John Hellerstedt called the news “heartbreaking.”

“This underscores the damage Zika can have on unborn babies,” Hellerstedt said. “Our state’s work against Zika has never been more vital.”

[…]

Peter Hotez, dean of the National School of Tropical Medicine at Baylor University, predicted that the baby born with microcephaly in Harris County represents the start of a wave of such births in Texas, as pregnant women who contracted the virus in Latin America deliver children with an elevated risk of birth defects.

If transmission of Zika begins on the Gulf Coast, Hotez said, there could be a second wave of Zika-affected births months from now.

“There’s a good chance that the transmission of Zika has already started in Texas,” Hotez said. “But without federal funds, it’s hard to have the resources to look for it, diagnose it, and do the mosquito control.”

Let’s be clear about why Congress hasn’t acted on Zika funding. A functional Congress would simply appropriate some money for the problem and be done with it. Our Republican-led Congress sees an opportunity to attack Planned Parenthood and promote the Confederate flag. And so here we are. Let’s hope that count of Zika-infected babies doesn’t go up too much while they’re on vacation.

State finally releases abortion data

It’s exactly what you’d expect.

Right there with them

Right there with them

The Texas Department of State Health Services has released the state’s 2014 abortion data after weeks of allegationsthat the agency had been intentionally withholding the numbers.

The 2014 data is significant because it is the first year to reflect the impact of Texas’ anti-abortion law, House Bill 2, on abortion providers and patients across the state.

The U.S. Supreme Court struck downparts of HB 2 as unconstitutional this week, in part because the court could not find evidence for Texas’ justification for the law — that mandatory hospital admitting privileges for abortion providers and hospital-like renovations for abortion clinics would increase patient safety. In their challenge to the law, Texas abortion providers argued that HB 2 would instead reduce access to abortion and would have a disproportionately negative impact on Texas Latinas.

According to the newly released numbers, the providers were right.

One of the most striking revelations is the change in number of medical abortions — a two-pill regimen that, under HB 2, was heavily restricted and required many more clinical visits than a surgical abortion procedure. In 2013, 16,189 Texans got medical abortions; in 2014, that number dropped to almost 5,000. (Medication abortions became easier to access earlier this year, when an FDA label change enabled more providers to issue the drugs under the law.)

The 2014 DSHS data also suggest the law had a disproportionate impact on Texans of color. In 2013, over 24,000 of Texans who got abortions were Hispanic; in 2014, that number decreased by 18 percent to under 20,000. The numbers also show a 7.7 percent decrease among black Texans who got abortions.

Overall, the number of abortions in Texas decreased by 14 percent from almost 64,000 in 2013 to almost 55,000 in 2014. The data also show that the number of abortions performed in clinics dropped by 21 percent from 2013, and the number performed at ambulatory surgical centers increased by 12 percent, reflecting the closure of half the state’s non-surgical center clinics after parts of HB 2 took effect in 2013.

The new numbers also don’t show abortion was any safer post-HB 2. For both 2014 and 2013, complication rates were negligible; the complication rates were 0.04 percent and 0.05 percent, respectively.

See here for the background. On the matter of medical abortions, the Austin Chronicle explains:

While more than 16,000 women took medication to terminate their pregnancies in 2013, less than 5,000 did so in 2014 – a stunning 75% decrease. The number of women going in for surgical abortion, on the other hand, rose about 3,000. The likely reason? HB 2 included a provision that forced women to ingest abortion pills following outdated, more expensive, and potentially more harmful FDA protocol. Some providers responded by discontinuing the service and it was reported that women were less eager to opt for medication abortion, which had forced them to take the pill in the doctor’s office rather than their homes. The FDA has since updated its guidelines. Planned Parenthood Central Texas centers, including the Austin location, saw its medication abortion rates drop to less than 1% from 40% before HB 2.

See here for more on that. Since the FDA updated its guidelines, use of the abortion pill has risen sharply, which is exactly what you’d expect since taking a pill is safer, cheaper, and more convenient than going to a medical facility for an invasive procedure. Of course, women were still seeking medical abortions after HB2’s passage, they just were doing it on their own, without any assistance from a medical professional. Because HB2 was all about their safety, don’t ya know.

More women traveled out of state to obtain abortions as well.

The statistics also show a slight increase in the number of pregnant persons who traveled out of state to obtain abortion care. The number of abortions that took place “out of state” was 754 in 2014, compared to 681 in 2013.

However, data from other states suggest a much larger increase during that time period. As Rewire previously reported, statistics from Arkansas, Kansas, Oklahoma, and Louisiana appear to indicate at least 1,086 patients traveled to those states from Texas to obtain an abortion in 2014.

Basically, everything is as abortion rights activists said it would be under HB2, and whatever the reasons for the delayed release of this data, there’s no question that the timing was convenient for the state. Thanks for not buying the BS, Supreme Court. The Trib and the Chron have more.

Where’s the abortion data?

The ACLU would like to know.

Right there with them

Right there with them

With the U.S. Supreme Court poised to decide the biggest abortion case in nearly a decade, the ACLU of Texas is demanding that the Department of State Health Services “stop concealing” abortion statistics for 2014 and make the information public.

In a letter sent Wednesday to department Commissioner John Hellerstedt, the ACLU accused the state agency of purposely withholding statistics that would show patterns of abortion across the state in 2014, including the number of Texan women who had abortions, the procedures they used and the types of facilities they visited.

The 2014 data is particularly significant, the ACLU said, because it was the first full year during which the state implemented provisions of the controversial abortion law known as House Bill 2. That law, which is the subject of a Supreme Court case, requires doctors performing abortions to have admitting privileges at hospitals within 30 miles of an abortion clinic and also requires clinics to maintain the same standards as hospital-like ambulatory surgical centers.

“It has come to our attention that your agency completed the relevant statistical tables in March 2016,” the ACLU letter said. “Since that time, upper-level supervisors within DSHS have instructed employees to mislead the public about whether these statistical tables are complete, and to refrain from sending email about the statistics in order to avoid creating a paper trail.”

The Department of State Health Services said the data remained incomplete.

“If the data were final, we would release it,” a department spokeswoman said in an email. “The detailed data for 2014 isn’t final yet for Texas. We released the provisional total as soon as it was ready several months ago, but the underlying details are being reviewed for accuracy. For the last several years, Texas abortion data was typically finalized and published between March and June.”

Yeah, I’m afraid the state doesn’t get any benefit of the doubt here. No question, if the data made their legal case look weaker, they’d do whatever they felt like doing to obfuscate for as long as possible. Sure, the DSHS could be telling the truth here, and under normal circumstances I’d counsel patience. But these aren’t normal circumstances, and there’s no basis for trust. Show us the numbers ASAP.

What do you get when you cut off funds for HIV testing?

You get no HIV testing, of course.

Right there with them

Right there with them

When Texas abruptly ended its $600,000 HIV prevention contract with Planned Parenthood’s Houston affiliate in late December, state health officials promisedthat there would be no interruption in services. The Department of State Health Services parceled the money out to three county health departments in the Houston area and insisted at the time that the counties would have the capacity to pick up where Planned Parenthood left off.

But the Observer has learned that as of early June, Harris County’s health department has yet to perform a single HIV test with the money.

So far, the department has received about $250,000 in state funding but is still in the planning stages for its program. The Fort Bend and Galveston County health departments also received smaller portions of the money — Galveston began providing testing in March; Fort Bend hired its staff and began testing in May.

In the five months since losing its contract, Planned Parenthood Gulf Coast (PPGC) estimates that it would have provided 2,900 HIV tests and distributed around 165,000 condoms. Rochelle Tafolla, PPGC’s spokesperson, said most of its testing was conducted in Harris County, the most populous in Texas and home to nearly 23,000 Texans living with HIV. According to state data, Harris County is home to one in four new Texas HIV cases every year and its diagnosis rate is nearly double the state average. Among the state’s five largest urban counties, only Dallas County has a higher new diagnosis rate.

Martha Marquez, spokesperson for the Harris County Public Health and Environmental Services Department, told the Observer that the department plans to hire three staff members and begin testing “in the coming weeks.”

[…]

Testing individuals at risk for HIV as quickly as possible is “key” for reducing new infection rates, said Daniel Williams, policy and regional field coordinator atEquality Texas.

“It’s unfortunate that an organization that had a proven track record in doing exactly what this contract was intended to do was removed from it,” he said. “It’s doubly unfortunate that the contract was then sent to an agency that doesn’t have the resources to pick it right up without the delay.”

Williams pointed to other organizations in the Houston area that provide HIV testing and might have been better prepared than the county health department to pick up where PPGC left off, such as Legacy Community Health or The Montrose Center.

“Harris County has lagged behind the rest of the state in reducing its HIV infection rate, and this six-month gap in performing testing and getting people into treatment is making the situation worse,” he said.

See here for the background. You know who doesn’t care about any of this? Greg Abbott and Dan Patrick, that’s who. I guarantee, we’ll never hear them talk about this in any way that suggests they recognize there was a problem. They really do care about the sanctity of life, don’t they? Slate has more.

Another look at AirBnB

Interesting.

The hotel industry is starting to object. On Wednesday, a report funded by a national trade group claimed some Airbnb hosts function illegally and operate essentially as full-time hotels without the same health and safety oversight. It also says they can reduce the number of affordable options for full-time renters.

The home-rental site has stirred tensions in cities such as New York City, San Francisco, Paris and Barcelona. Austin has created new short-term rental regulations as a result.

In Houston, which does not have similar regulations, the city’s primary tourism agency is working with Airbnb and similar operators about taxes.

A city of Houston spokesman said Wednesday that the state is responsible for health and safety regulations that affect short-term rentals. But a spokesman for the Texas Department of State Health Services, which regulates hotels and bed-and-breakfast operators, said it does not have a role in Airbnb or short-term rentals.

Houston is the state’s second-largest Airbnb market, behind Austin, and officials are preparing for an increase in tourism around the 2017 Super Bowl. It was one of a dozen large U.S. cities included in the American Hotel & Lodging Association study released Wednesday by Pennsylvania State University’s School of Hospitality Management. Researchers tracked Airbnb data from a 13-month period.

“This study shows an explosion in activity among multi-unit hosts and the rise of full-time operators in each of the 12 markets we analyzed. Further, operators renting out three or more units represent a disproportionate share of revenue with only 7 percent driving more than $325 million in the period studied,” said John O’Neill, the Penn State professor who directed the research and is director of the school’s Center for Hospitality Real Estate Strategy.

The study found that nearly 30 percent of the revenue generated from hosts comes from people operating as full-time landlords, or 360 days a year. Individuals or entities renting out two or more residential properties on Airbnb account for 17 percent of hosts and drive nearly 40 percent of the revenue in those markets, according to the study.

The report found that in Houston there are 30 full-time operators who rent out their space for at least 360 days a year, generating $3 million in revenue during the 13-month period studied. In all, 956 hosts generated a total of $11 million in revenue, the report said.

It found 83 hosts operating three or more properties and 82 others with two units.

A copy of that report is here. AirBnB has disputed its findings and released its own report about its potential tax revenue for cities. I have no judgment about who is right or wrong in their facts and figures, I’m more interested in how cities are going to react to AirBnB, which I presume they’re going to have to do sooner or later. So far it has not been on the radar in Houston, but it has been in Austin and may be in San Antonio and elsewhere. I’ll be a little surprised if we see AirBnB regulation on the Council agenda in the near future, but if there’s any indication that it’s negatively affecting hotel tax revenue that could change.

Transgender people can now get correct birth certificates

Excellent news.

Last week, Texas began giving trans people the option of sealing their old birth certificates and issuing new ones, according to Dallas attorney Katie Sprinkle.

Previously, Texas issued amended certificates and those were only issued with a surgeon’s letter. Now, Texas is sealing old records and issuing new birth certificates with a court order. That makes getting accurate documents earlier in the transition process possible.

The change is part of the Texas marriage equality ruling. U.S. District Judge Orlando Garcia ordered Attorney General Ken Paxton and the Texas Bureau of Vital Statistics to issue corrected death certificates for same-sex couples acknowledging their relationship as “spouse” rather than significant other.” That affected inheritance.

As part of that motion filed by a Conroe, Texas gay man, Garcia asked the attorney if Texas was treating LGBT people differently than straight people on other documents. The attorney said birth certificates needed to be addressed.

As part of its update of birth certificates reflecting both adoptive parents or parents who used a surrogate, Texas updated its policy on reissuing birth certificates to trans men and women.

Since a court order can be used to prove a couple are both the parents of a child and should both be on a birth certificate, a court order will suffice for a trans person to use to get a new birth certificate reissued.

And since the original birth certificate in an adoption is sealed, the original birth certificate for a trans person will also be sealed.

See here and here for some background. You may recall that this issue nearly got Ken Paxton held in contempt, but in the end he folded and justice was served. A court order is still needed to get these updated birth certificates, and it may take a couple of weeks to go through. See a lawyer if this is something you might want or need to do.

State cuts off funds to Planned Parenthood for HIV testing

Seriously?

Right there with them

Right there with them

Amid an ongoing battle over Planned Parenthood’s participation in the state Medicaid program, Texas health officials are cutting off funding to a Planned Parenthood affiliate for an HIV prevention program.

In a notice received by Planned Parenthood Gulf Coast late Monday, an official with the Department of State Health Services informed the Houston-based provider that it would not renew its contract for HIV prevention services.

The long-standing grant, which funds HIV testing and prevention services, was set to expire on Dec. 31, according to the notice which was obtained by the Texas Tribune.

“There will be no further renewals of this contract,” a DSHS official wrote in the notice to Planned Parenthood.

The contract is federally funded through the Centers for Disease Control and Prevention but managed by the state. A spokeswoman for the CDC said she was unaware of the state’s notice and did not immediately provide comment.

By ending Planned Parenthood’s contract, the state is cutting off almost $600,000 in annual funding, which the health care provider used for HIV testing and counseling, condom distribution and referral consultations.

Incredible. At least with the cutoff of Women’s Health Program funds, the state made some arrangements for alternate options. It was half-assed and still caused a huge unnecessary upheaval for thousands of women, but there was at least a token gesture towards maintaining the service. That doesn’t appear to be the case here, or at least the flunkies at the HHSC had no comment at the time the story was published. Unless PPGC decides to continue this on its own dime, this service just goes away. Because why would Greg Abbott care about people who might have HIV? And remember, the root of all this is a pack of lies that the state is hoping you’ll all forget.

The Chron story on this is here. I don’t know if this action can be wrapped into the ongoing litigation over the state cutting off Medicaid funds for Planned Parenthood, but regardless perhaps some political pressure can be applied.

Texas Democrats in Congress sent a letter to the Centers for Medicaid and Medicare Services this month asking that they “explore all options available at the federal level” to stop the State of Texas from blocking Planned Parenthood from receiving Medicaid funding for health services.

[…]

“Members of the delegation understand that there is a precedent for intervention, and several options available for the federal government to bring Texas into compliance with federal law,” said Congressman Marc Veasey, D-Fort Worth. “In the past, CMS has decreased or removed federal funding from Texas, which we do not want to happen again as doing so would decrease access to care instead of expanding it.”

Click over to see the letter, which was signed by ten members of the Texas Congressional delegation. The Observer and the Press have more.

Birth certificate denials only started happening recently

Funny how these things work, isn’t it?

Texas has for seven years said it won’t accept Mexican identification cards when issuing birth certificates for children of people in the United States illegally. But it doesn’t appear to have stepped up enforcement until recently, amid mounting political pressure to get tougher on immigration, records obtained by The Associated Press show.

That could validate complaints from immigrant parents suing in federal court, claiming the state is denying “birthright” U.S. citizenship for their Texas-born children guaranteed under the 14th Amendment to the U.S. Constitution.

The AP used open records requests to get annual “self-assessment” surveys completed by local registrars. They show that officials in at least five cities and counties along the U.S.-Mexico border told the Texas Department of State Health Services during the past three years that they were allowing parents to get copies of birth certificates using a Mexican identification known as the matricula consular.

“Most of applicants are here illegally as they claim, and are therefore unable to obtain a valid form of identification from the United States,” Janie Madero, then-registrar in McAllen, wrote in a 2013 survey response. “Therefore our office accepts the matricula consular so they can obtain the birth certificate for their children who were born here.”

[…]

The Department of State Health Services oversees Texas’ Vital Statistics Unit. It reports issuing just one cease and desist letter to a county registrar in Brownsville who was accepting the matricula consular, and that didn’t come until this July.

Two months later, it wrote letters instructing against accepting the Mexican document in response to inquiries from registrars in Dallas and nearby McKinney.

Those three letters were all the state provided when asked for correspondence related to the matricula consular since 2008. Health services spokesman Chris Van Deusen subsequently said his department had “identified some additional communications with local registrars about the matricula” but that the lawsuit made those confidential.

When and how strictly Texas began enforcing its ID rules are important since more than two-dozen parents in the country illegally have sued, saying the state is effectively denying citizenship the U.S. Constitution guarantees to all born on U.S. soil.

Immigration attorneys suggest that the state only got serious about enforcement after women and children from Central America began pouring over Texas’ southern border last summer. Further raising the political stakes was President Barack Obama’s announced executive actions on immigration in November 2014, which sought to temporarily shield from deportation up to 4 million people in the U.S. illegally.

Efren Olivares, one of the lawyers representing immigrant parents suing, said there was a “tightening of the screws” amid Obama’s announcements and Central Americans crossing into Texas at record rates.

“We believe there is an intent behind this,” Olivares said.

See here, here, and here for some background. Basically, the state is trying to rewrite the rules while hoping that no one notices, but their actions belie their words. The only reason this is an issue now is because of politics. The bottom line is that everyone deserves a birth certificate, and last I checked the 14th Amendment was still in effect. It’s time for this charade to end.

Oral arguments in birth certificate lawsuit

Here we go.

U.S. District Judge Robert Pitman heard oral arguments in a lawsuit filed by a group of undocumented parents and their U.S.-citizen children against the state Department of State Health Services, which has effectively blocked the children from obtaining birth certificates.

The families allege that the department has violated the children’s constitutional rights by ordering local county registrars to stop recognizing Mexican consular IDs — known as a matrícula consular — and foreign passports without valid visas, as proof of identification that the parents may use to obtain the vital records. The state argues the documents are susceptible to fraud.

“Is this a solution in search of a problem?” Pitman asked assistant attorney general Thomas Albright, representing the agency, health Commissioner Kirk Cole and State Registrar Geraldine Harris. “What makes this burden necessary?”

Pitman’s remarks came after he told the state’s attorneys he would not allow them to debate the importance of birth certificates, a document he said was “the primary evidence of U.S. citizenship.”

The hearing came after the families asked for an emergency injunction ordering the health department to identify two acceptable forms of identification parents can use to obtain birth certificates.

Attorney Jennifer Harbury, representing the families, reiterated her belief that Texas changed its policies without warning in reaction to the national debate over illegal immigration that reached a fever pitch in 2011. After that, she said, Texas became the only state in the country to prevent undocumented immigrants from getting birth certificates.

But Albright said the families haven’t proven their case enough for Pitman to grant the emergency order, and instead said the issue should play out through a regular trial.

“There is no burden on us to say ‘We’re great. Our rule is perfect,’” he told Pitman. “Today is just one step in what is a longer process. I don’t think they’ve argued the proof that you need.”

Albright also focused on the Mexican matrícula, conceding it has been made more secure and tamper proof but saying it is still susceptible to fraud.

Harbury said the families would be amenable to a ruling that excluded that document from a list of approved items. Her argument, she said, is that nothing else is currently acceptable.

“Forty-nine other states accept another form [of ID],” she said.

Though he seemed to question more than one of the state’s claims, Pitman also appeared hesitant to make a decision without more information. It’s unclear when he will rule.

See here, here, here, and here for the background. If you get the impression that the state didn’t have the strongest argument for its defense, you wouldn’t be alone.

Judge Robert Pittman did not offer many clues about his feelings on the case during the three-hour hearing, but he did grill Albright about the extent of birth certificate fraud, asking several times whether the new state policy was a “solution in search of a problem.”

“If you’re asking if there’s some statistical analysis … I don’t have that,” Albright conceded.

He was quick to add, however: “That’s not my burden.”

Still, the judge did not grant the emergency order, and it is not clear when he will rule. So until then, things will continue to be as they were. The Observer has more.

Counting the number of same sex marriages in Texas

Fewer than I’d have guessed, but still a decent amount percentage-wise.

Statewide, an estimated 2,500 same-sex couples have received marriage licenses in Texas since the [Obergfell] ruling.

There is no exact accounting of how many same-sex marriage licenses have been issued in Texas or Tarrant County because gender is no longer listed on licenses.

But the Star-Telegram’s review of marriage licenses issued in Tarrant County the past two months shows that almost 9 percent of the licenses appear to have been issued to same-sex couples. Statewide, 5.7 percent of marriage licenses appear to have been given to same-sex couples.

“There are many same-sex couples who simply waited until it was legal to seek licenses,” said Jim Riddlesperger, a political science professor at TCU. “As a result, there have been a number of folks who might have gotten married years ago had it been possible to do so who are taking advantage of their opportunity to gain legal recognition for their committed relationship.

“My guess is that the overall percentage will shrink over time from this initial data once the ‘pent-up demand’ has been satisfied.”

[…]

Officials stress that state estimates of same-sex marriage licenses are just that: estimates.

“Since the application no longer has gender identifiers, this ballpark number is based on what we can assume from the applicants’ names,” said Carrie Williams, director of media relations for the Texas Department of State Health Services, which maintains vital records for the state, including marriage applications.

Overall, the state has received 43,522 marriage license applications since June 26, including the estimated 2,500 for same-sex couples, she said.

To get an idea of how many marriage licenses Tarrant County has granted to same-sex couples, the Star-Telegram reviewed a list of 3,427 applications from June 26 to Sept. 8.

The county does not keep a “breakdown of same-sex marriage license applications versus non-same-sex applications,” said Jeff Nicholson, chief deputy for Tarrant County Clerk Mary Louise Garcia. “Since June 26, the forms and our software have been modified so there is no way to discern this. It simply refers to applicants.”

The review shows that at least 296 licenses — or 8.6 percent — appear to have been issued to same-sex couples.

On the one hand, I thought the “pent-up demand” might have been higher. On the other hand, a lot of couples in Texas that really wanted to be married went and got married in other states rather than wait. Either way, I do think the number will decline some as a share of all marriages, then level off. We’ll get a much better handle on the real numbers when the 2020 Census is done. One hopes that by then the whole subject will be considered little more than a statistical curiosity. The Current has more.

State issues new guidelines for birth and death certificates

That was quick.

The state has issued new guidelines for filing and changing vital records to recognize same-sex marriage status, as ordered by a federal judge in San Antonio

In a court advisory filed late Wednesday, the Texas Attorney General’s Office and the Texas Department of State Health Services said they believe the new guidelines comply with the June 26 Supreme Court ruling that found gay marriage legal in all 50 states and a July 7 order by U.S. District Judge Orlando Garcia that prohibits state agencies from enforcing Texas laws that bar same-sex marriage.

Officials also agreed to issue new birth certificates for the two sons of Leigh and Robin Jorgesen of Austin, who helped convince Garcia, of San Antonio, to order the state to act on vital records involving same-sex married couples.

[…]

The state’s advisory also tells the judge that “the processing of software modifications by the third-party vendor that hosts the platform for vital records will take additional time, which will impact the issuance of birth certificates.”

“Until that change is made, those requesting a birth certificate listing parents of the same sex may choose either to (1) obtain the standard birth certificate listing ‘mother’ and ‘father’ as well as an amendment to the birth certificate once the software modification is complete; or (2) obtain an original birth certificate allowing for the parents to be identified as ‘mother,’’father’ or ‘parent’ once the software modification is complete.”

See here for the background. Nothing like a little contempt of court order to focus the mind and make clear what one’s priorities are. It’s almost as if the state had the ability to have gotten this done in a timely fashion without needing to be threatened. I’m sure that couldn’t possibly be the case, though. Trail Blazers has more.