Attorneys for Kentucky's last abortion clinic said as a federal trial opened Wednesday that state regulators are using "onerous" rules to try to shut it down, predicting some women would "take the matter into their own hands" to end pregnancies if the state succeeds.
"There will be no abortions in Kentucky if they win," clinic attorney Donald L. Cox said as proceedings began in a court case that could determine whether Kentucky becomes the nation's first state without an abortion clinic.
The state's attorney, Steve Pitt, said the regulation reflects the state's vested interest in protecting women's health.
"It's about to what extent the commonwealth of Kentucky has the right to regulate abortion practices for the health and safety of women," said Pitt, who is Republican Gov. Matt Bevin's general counsel.
Pitt said that Kentucky women live no more than 200 miles (320 kilometers) from abortion clinics in neighboring states and many live much closer. Some women travel across Kentucky to receive abortions at EMW Women's Surgical Center in Louisville.
Cox said that shutting down the EMW facility and leaving women no choice but to travel out of state would pose a danger to the health of some women.
"The end result will be that some women take the matter into their own hands, and we know where that ends," he said.
The EMW clinic and Planned Parenthood of Indiana and Kentucky are challenging a nearly 20-year-old Kentucky law requiring abortion clinics to have transfer agreements with a hospital and an ambulance service in the event of medical emergencies involving patients.
The trial revolves around a licensing fight that began in March when Bevin's administration claimed the clinic lacked proper transfer agreements and took steps to shut it down. The clinic countered with a federal lawsuit to prevent the state from revoking its license.
U.S. District Judge Greg Stivers blocked the clinic's closure until the dispute could be heard at trial. Stivers is hearing the trial without a jury. Attorneys have said the trial could last at least three days.
In summing up the stakes, ACLU attorney Brigitte Amiri told reporters: "We would be in a situation that's unprecedented. No state in the Union has no abortion clinic. That has not happened, and we intend not to let it happen here."
Planned Parenthood argues that Bevin's administration has used the transfer agreements to block its request for a license to provide abortions in Louisville.
Amid the wrangling, Bevin's administration added new requirements to transfer agreements. Plaintiffs' attorneys said the changes were meant to make it harder to get a license for abortions.
State regulators say the transfer agreements protect women's health. The clinic says there's no medical justification for them and they create an unconstitutional barrier to abortion.
Cox said there's no proof such "onerous regulations improve women's outcomes."
Paula Hillard, a professor of obstetrics and gynecology at Stanford University School of Medicine, testified that abortion-related complications such as excessive bleeding or infections are "very uncommon," and that hospitalizations in such cases are rare.
Dr. Ernest Marshall, who opened the EMW clinic in the early 1980s, testified that his clinic is safe and offers quality care.
Marshall said the transfer agreements at the center of his legal fight weren't much of an issue until the last couple of years. He said his clinic was given days to resolve what regulators viewed as deficiencies in EMW's transfer agreements.
"I felt I had 10 days or it was over," he said.
The state's legal team will call its witnesses later in the week.
EMW has been on the defensive since Bevin's 2015 election.
"What's changed here is not the law," Cox said. "What's changed here is we have a new sheriff in town who's vowed to get rid of abortion."
Asked about the case during an interview with WKYX on Wednesday, Bevin told the station: "If the law allows for certain things to exist, we need to follow that law or change it. That includes having transfer agreements in place. You don't get to change the rules just because they don't fit your desire at that time, which is what some of these abortion providers are trying to do."
The socially conservative governor said he's "not a proponent of killing unborn children. I just think it's a sad commentary on us as a society."
Associated Press writer Adam Beam in Frankfort, Kentucky, contributed to this report.Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.