Full opinion text
OPINION ROBERT F. COLLINS, District Judge. This is an individual and class action brought by two representatives-of the class of pregnant women desiring abortions, three physicians who perform abortions, and five clinics offering facilities for the performance of abortions. The action seeks declaratory and permanent injunctive relief against the operation of La.Rev.Stat.Ann. §§ 40:1299.35.2(B); 1299.35.3; 1299.35.5; 1299.35.6(B)(3), (4), (5) and (7); 1299.35.10(A)(18); 1299.35.12; 1299.35.13 and 1299.35.14 (West Supp.1981) (hereinafter referred to as “the challenged sections”), and against state officials who will be required to execute and enforce the statute challenged herein. La.Rev.Stat.Ann. § 40:1299.35.12 was enacted September 11, 1980 and was not repealed by subsequent legislative action. La.Rev.Stat.Ann. §§ 40:1299.35.2(B); 1299.35.3; 1299.35.5; 1299.35.6(B)(3), (4), (5) and (7); 1299.35.10(A)(18); 1299.35.13 and 1299.35.14 were amended and reenacted by the 1981 session of the Louisiana legislature and became law on July 23, 1981. The plaintiffs contend that the challenged sections are intended to and will have the effect of deterring women from exercising the fundamental right to abortion which was recognized by the Supreme Court in Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973). The plaintiffs also contend that the challenged sections subject physicians who perform abortions and facilities which provide abortion services to regulation and criminal prosecution if they fail to comply with the provisions. The plaintiffs challenge these sections on various grounds, contending that they are violative of the due process and equal protection clauses of the Fourteenth Amendment; that they are unconstitutionally vague; and that they violate the free exercise clause of the First Amendment. Plaintiff Margaret S. is a citizen of the United States residing in New Orleans, Louisiana. At the time of filing of the original complaint, Margaret S. was eight weeks pregnant and desired an abortion. Margaret S. was certified by this Court as a class representative for the class described in paragraph 16 of the original complaint and paragraph 19 of this second amended and supplemental complaint. She brings this action on behalf of herself and all others similarly situated. Plaintiff Linda S. is a citizen of the United States residing in Louisiana. At the time of the filing of this complaint, Linda S. was ten weeks pregnant and desired that an abortion be performed in Louisiana. Linda S. is 17'years old, unmarried and unemancipated. She claims that both of her parents are vehemently opposed to abortion, and she would be afraid to ask their consent. She has no knowledge of how she could obtain a court order for an abortion. She contends that she is a mature minor, and it would not be in her best interests for her parents to know of her decision to get an abortion. She wishes to sue under a pseudonym to- protect her privacy rights. She seeks to represent herself and all other minors similarly situated. Plaintiff Dr. Roy C. Wood is a citizen of the United States residing in Baton Rouge, and is a physician licensed to practice medicine in the State of Louisiana. Dr. Wood is actively engaged in the practice of medicine, including the performance of abortions, in Baton Rouge. Dr. Wood brings this action on his own behalf and on behalf of all those similarly situated, and on behalf of his pregnant women patients who desire abortions, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Calvin Jackson is a citizen of the United States residing in New Orleans and is a physician licensed to practice medicine in the State of Louisiana. Dr. Jackson is actively engaged in the practice of gynecology, including the performance of abortions, in New Orleans. Dr. Jackson brings this action on his own behalf and on behalf of all those similarly situated, and on behalf of his pregnant women patients who desire abortions, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Dr. Duncan McKellar is a citizen of the United States residing in New Orleans, Louisiana, and Dallas, Texas, and is a 'physician licensed to practice medicine in the States of Louisiana and Texas. Dr. McKellar is actively engaged in the practice of medicine, including abortions, in New Orleans. Dr. McKellar brings this action on his own behalf and on behalf of all those similarly situated, and on behalf of his pregnant women patients who desire abortions, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Clinical Leasing Services, Inc. is a Delaware corporation doing business in Louisiana as Delta Women’s Clinic (hereinafter Delta Women’s Clinic). Plaintiff Delta Women’s Clinic provides facilities and support staff for the performance of services to women in the area of family planning, counseling, pregnancy tests, abortions, sterilizations, birth control, and other gynecological services. Plaintiff Delta Women’s Clinic raises its own claims and the claims of its women patients, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Orleans Women’s Clinic is a corporation doing business in New Orleans, Louisiana. Orleans Women’s Clinic offers facilities and support staff for the performance of services to women in the area of family planning, pregnancy tests, abortions, sterilizations, birth control, and other gynecological services. Plaintiff Orleans Women’s Clinic raises its own claims and the claims of its women patients, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Causeway Medical Suite is a corporation doing business in New Orleans, Louisiana. Causeway Medical Suite offers facilities and support staff for the performance of services to women in the area of family planning, pregnancy tests, first trimester abortions, birth control, and related gynecological services. Plaintiff Causeway Medical Suite raises its own claims and the claims of its women patients, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Metairie Women’s Medical Center is a corporation doing business in Metairie, Louisiana. Metairie Women’s Medical Center offers facilities and support staff for the .performance of services to women in the area of family planning, pregnancy tests, abortions, sterilization, birth control and gynecological services. Plaintiff Metairie Women’s Medical Clinic raises its own claims and the claims of its women patients, among whom are minors who are not emancipated judicially or by marriage. Plaintiff Bossier City Medical Suite is a corporation doing business in Bossier City, Louisiana. Bossier City Medical Suite offers facilities and support staff for the performance of services to women in the area of family planning, pregnancy tests, abortions, birth control and other gynecological services. Plaintiff Bossier City Medical Suite raises its own claims and the claims of its women patients, among whom are minors who are not emancipated judicially or by marriage. Defendant David C. Treen, a resident of Louisiana and citizen of the United States, is Governor of the State of Louisiana. He is the successor in office to Edwin W. Edwards, named as defendant in the original complaint. As Governor he is responsible for the execution of the laws of the State including the challenged sections. Defendant William J. Guste, Jr., a resident of Louisiana and citizen of the United States, is Attorney General of the State of Louisiana. As such, he is responsible for the enforcement of laws of the State, including the challenged sections. Defendant George A. Fischer, a resident of Louisiana and citizen of the United States, is Secretary of Louisiana’s Health and Human Resources Administration (hereinafter HHRA) and successor in office to William A. Cherry, M.D., who was named as defendant in the original complaint. As Secretary of HHRA, he is responsible for the administration, control, and operations of the functions, programs, and affairs of HHRA and the policies with respect hereto, including the challenged sections. Margaret S. and Linda S. bring this action pursuant to Fed.R.Civ.P. 23 on behalf of all women similarly situated. Dr. Roy Wood, Dr. Calvin Jackson and Dr. Duncan McKellar also bring this action pursuant to Rule 23, on behalf of all physicians similarly situated. Margaret S. and Linda S. bring this action on behalf of all women and minors who are now or may become pregnant and who desire or may desire an abortion to be performed in Louisiana by the physician of their choice. Dr. Roy Wood, Dr. Calvin Jackson, and Dr. Duncan McKellar bring this action on behalf of all present and future physicians who desire to give full, safe, and adequate medical advice and treatment to their patients, including the performance of abortions, but who have been or will be restricted in their medical practice by operation of the challenged sections and by defendants’ actions thereunder, and who are threatened with criminal prosecution if they perform an abortion in violation of any of the terms of the statute challenged herein. In approaching this inquiry into the constitutionality of the Louisiana abortion statute, the Court is of the opinion that it is appropriate to preface its discussion of the challenged sections with a statement of the legislative intent motivating the enactment of the provisions regulating abortion: [i]t is the intention of the Legislature of the State of Louisiana to regulate abortion to the extent permitted by the decisions of the United States Supreme Court. The Legislature does solemnly declare and find in reaffirmation of the longstanding policy of this State, that the unborn child is a human being from the time of conception and is, therefore, a legal person for purposes of the unborn child’s right to life and is entitled to the right to life from conception under the laws and Constitution of this State. Further, the Legislature finds and declares that the longstanding policy of this State is to protect the right to life of the unborn child from conception by prohibiting abortion impermissible only because of the decisions of the United States Supreme Court and that, therefore, if those decisions of the United States Supreme Court are ever reversed or modified or the United States Constitution is amended to allow protection of the unborn then the former policy of-this State to prohibit abortions shall be enforced. La.Rev.Stat.Ann. § 40:1299.35.0 (West Supp.1981). The Court finds this expression of legislative intent particularly significant in view of the Supreme Court’s specific holding in Roe v. Wade, 410 U.S. 113, 158, 93. S.Ct. 705, 729, 35 L.Ed.2d 147 (1973), that “the word ‘person,’ as used in the Fourteenth Amendment, does not include the unborn,” and the Court’s refusal to decide “the difficult question of when life begins.” 410 U.S., at 159, 93 S.Ct., at 730. The Court stated “[w]hen those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer. Id. Finally, before embarking upon this journey into the constitutionality of the challenged sections of the Louisiana abortion law, the Court notes that this is not the first time it has been faced with the formidable task of deciding the constitutionality of Louisiana laws regulating abortion. In Margaret S. v. Edwards, 488 F.Supp. 181 (E.D.La.1980), (hereinafter referred to as “Margaret S (I) ”), this Court declared certain sections of the Louisiana abortion statute unconstitutional. La.Rev.Stat.Ann. §§ 40:1299.35.1 et seq. (West Supp.1979). The challenged sections in this matter raise issues identical as well as similar to those decided in Margaret S (I). In addition, the present Louisiana abortion statute imposes additional restrictions on the fundamental right to obtain an abortion. The Ultra-Sound Testing Requirement La.Rev.Stat.Ann. § 40:1299.35.2(B) (West Supp.1981) requires the attending physician in an abortion procedure to perform an ultra-sound test upon the pregnant woman before carrying out the abortion procedure. The ultra-sound procedure, which involves the use of sound waves to produce fetal pictures, enables the physician to estimate fetal age. The constitutionality of this section is an issue of first impression since it is the first law of this nature to be enacted by a state legislature. The plaintiffs contend that the ultrasound requirement violates the due process and equal protection clauses of the Fourteenth Amendment in that it impedes women’s access to abortions. Specifically, the plaintiffs charge that the ultra-sound requirement directly interferes with the abortion right because it increases the cost of abortions and lessens the availability of the procedure in Louisiana. The plaintiffs also contend that this provision creates an illegal classification by imposing the ultrasound testing requirement only upon pregnant women seeking abortions, while it is not required in comparable medical procedures. In analyzing the plaintiffs’ claim that the ultra-sound testing requirement is repugnant to the due process clause of the Fourteenth Amendment, it is necessary to set forth the applicable standard of review. In the seminal case involving the constitutionality of. legislation concerning abortion, Roe v. Wade, 410 U.S. 113, 153, 93 S.Ct. 705, 727, the Supreme Court held that the right of privacy encompasses a woman’s decision whether to terminate her pregnancy. The Court stated that “[w]here certain ‘fundamental rights’ are involved ... regulation limiting these rights may be justified only by a ‘compelling state interest,’ (citations omitted) and that legislative enactments must be narrowly drawn to express only the legitimate state interests at stake.” Roe, 410 U.S., at 155, 93 S.Ct., at 728. Applying this standard, the plaintiffs must initially demonstrate “that the state regulation in question interferes directly with a woman’s abortion decision.” Scheinberg v. Smith, 659 F.2d 476, 482 (5th Cir.1981), reh. den. 667 F.2d 93 (5th Cir.1981), on remand 550 F.Supp. 1112 (S.D.Fla.1982). If the plaintiffs sustain this burden of proof, then the onus shifts to the State to show “ ‘the compelling basis for the law, that is, that the burden [imposed on the abortion decision] is not “undue” or unjustifiable.’” Id. (quoting Charles v. Carey, 627 F.2d 772, 777 (7th Cir.1980)). The task before the Court, then, is to determine whether the plaintiffs have demonstrated that the ultra-sound testing requirement interferes directly with a woman’s fundamental right to obtain an abortion. The plaintiffs contend that this requirement interferes directly with the abortion right since it would raise the cost of abortions by imposing an unnecessary test. The plaintiffs further maintain that the ultra-sound testing requirement would lessen the availability of abortion services in Louisiana because physicians would be able to perform fewer abortions if the test were required. The Court finds credible evidence in the record to support the plaintiffs’ claim that the ultra-sound testing requirement would impose additional costs on women seeking abortions in Louisiana. The evidence reveals that the ultra-sound testing requirement would increase the cost of each abortion in Louisiana by at least $100.00, given current rates. This significant increase in the cost of an abortion would be likely to occur for several reasons. First, the current cost of an ultra-sound test administered on an outpatient basis in Louisiana ranges from $60.00 to $195.00. Additionally, the testimony adduced at trial indicates that relatively few obstetricians and gynecologists in private practice own ultrasound machines. If required to perform an ultra-sound test on each abortion patient, these physicians would incur substantial costs in purchasing and maintaining such machines, and in hiring or training technicians to assist with the administration of the test. Further, since the ultra-sound test is a relatively new technique which most physicians are not familiar with, they would be required to secure additional training in order to properly administer the test and interpret the results. The requirement that the attending physician in the abortion procedure also administer the ultra-sound test is an additional factor which would raise the cost of abortion. Currently, a first trimester abortion can be performed in approximately five minutes, and a second trimester procedure in approximately ten minutes. The performance of an ultra-sound test requires approximately twenty minutes. Thus, the statutorily imposed requirement that the attending physician perform the ultrasound test would require the physician to spend an additional twenty minutes with each patient. Two physicians, as well as the administrator of an abortion clinic in Louisiana, stated at trial that this additional expenditure of time occasioned by the ultra-sound testing requirement would result in higher costs for abortion services. The State contends that this testimony was speculative, especially since there was no testimony by cost accountants establishing such an increase. It is the opinion of the Court, however, that the plaintiffs’ failure to prove the precise amount of such an increase does not refute their claim that the ultra-sound testing requirement would result in higher prices for abortion services, especially in view of the testimony to this effect given by physicians who perform abortions on a regular basis. With respect to their individual practices, these physicians are in the best position to know whether such a testing requirement would affect prices for abortion services. This is true, even if they are not capable at this time to state with specificity the amount of such an increase. Moreover, in an era of rising medical costs, and a trend toward passing these expenses on to consumers, it does not strain the imagination to conclude that at least some of the additional costs imposed by the ultra-sound testing requirement will be borne by the consumers of abortion services. The State argues that even if the ultra-sound testing requirement would increase the cost of abortions in Louisiana, this result has no constitutional significance under the established jurisprudence. In support of its stance on this issue, Louisiana cites Harris v. McRae, 448 U.S. 297, 100 S.Ct. 2671, 65 L.Ed.2d 784 (1980) and Maher v. Roe, 432 U.S. 464, 97 S.Ct. 2376, 53 L.Ed.2d 484 (1977), which dealt with refusals by states or the federal government to make funds available for abortions. In these cases, the Court held that such refusals did not constitute a direct interference with the abortion right. In Harris, the Court stated: it simply does not follow that a woman’s freedom of choice carries with it a constitutional entitlement to the financial- resources to avail herself of the full range of protected choices. The reason why was explained in Maher: although government may not place obstacles in the path of a woman’s exercise of her freedom of choice, it need not remove those not of its own creation. Indigency falls in the latter category. The financial constraints that restrict an indigent woman’s ability to enjoy the full range of constitutionally protected freedom of choice are the product not of governmental restrictions on access to abortions, but rather of her indigency. 448 U.S., at 316, 100 S.Ct., at 2688. The State argues that in light of the Maher and Harris holdings, the additional costs imposed upon the abortion procedure by the ultra-sound testing requirement do not constitute a direct burden on the abortion right. The Court does not agree, however, that these cases support the defendants’ argument, since Maher and Harris focus on the “basic difference between direct state interference with a protected activity and state encouragement of an alternative activity consonant with legislative policy.” Maher v. Roe, 432 U.S., at 475, 97 S.Ct., at 2383. In contrast, the Court is confronted here with “a government-imposed regulation that -adds to the cost of abortion,” and as such, it “is a government-created obstacle and is subject to strict scrutiny.” Planned Parenthood Association of Kansas City, Missouri v. Ashcroft, 655 F.2d 848, 864 (8th Cir.1981), op. supp. 664 F.2d 687 (8th Cir.1981), cert. granted 456 U.S. 988, 102 S.Ct. 2267, 76 L.Ed.2d 733 (1982). In Ashcroft, the Court held that a Missouri law which raised the cost of abortion by requiring the presence of a second physician during the abortion of a “viable unborn child” constituted a direct burden to the abortion right and was therefore subject to strict scrutiny. Mo.Rev.Stat. § 188.030,3. The Court’s sentiments there are appropriate here, for if the rule were as the State claims, “the state would be free to add on any costly requirements under the guise of regulation, and would not be required to justify these requirements by a compelling state interest.” Id. The plaintiffs also demonstrated at trial that because of the increased amount of time the ultra-sound testing provision would require of physicians performing abortions, the law would decrease the availability of abortion services in Louisiana. Testimony revealed that currently, in a typical Louisiana abortion clinic, approximately 24 abortions can be performed in four hours. If the ultra-sound testing requirement were operative, only eight abortions could be performed in a comparable period of time. This is particularly significant in a state that is already under-served in terms of the availability of abortion services. See Plaintiffs’ Exhibits #4A-G. Approximately 17,680 abortions were performed in Louisiana in 1980. The projected number of abortions which would have been performed in 1978 had there been good availability is 48,680. Thus, only 35.4 percent of the. need for abortion services in Louisiana was met. Further, in 1978, 64 percent of the women in Louisiana lived in a parish which had no abortion provider; whereas, the comparable nationwide figures for counties was 27 percent. The Court has concluded that Louisiana’s ultra-sound testing requirement constitutes a direct burden on the abortion right. Accordingly, the State must demonstrate a compelling state interest which justifies this requirement. Roe, 410 U.S., at 155, 93 S.Ct., at 728; Scheinberg, 659 F.2d at 482. Louisiana offers in support of the requirement that such testing is necessary in order to accurately determine gestational age and the correct method of abortion, and to determine life-threatening conditions such as atopic pregnancies. The Court will analyze each of these contentions. As to the first claim, that ultrasound testing is necessary in order to accurately determine gestational age, the state has failed to demonstrate that such testing is medically necessary. Louisiana does not argue that the most common method of determining gestational age, a pelvic examination coupled with the patient’s menstrual history, is inaccurate or otherwise unreliable. The range of error in estimating gestational age by this method is approximately plus or minus one week during the first trimester, and plus or minus 10 days to two weeks during the second trimester. By contrast, ultra-sound testing does not' measure gestational age with any reliability until the eighth week of pregnancy. By the eighth week of pregnancy, approximately 60 percent of all abortions in Louisiana have already been performed. Ultrasound testing achieves its greatest accuracy in approximately the twelfth week of pregnancy, when it is possible to determine gestational age to within plus or minus three to four days, that is, assuming skilled personnel and high quality equipment. Starting with the eighteenth week of pregnancy, however, the accuracy of ultrasound testing declines to plus or minus one week by the 20th week of pregnancy, and, by the 24th week, to plus or minus 10 days. The testimony of several physicians indicated that overall, that is, throughout the course of a pregnancy, the clinical examination method and ultra-sound testing are comparable in their levels of accuracy and reliability as to gestational age. The overwhelming weight of the evidence further indicates that ultra-sound testing is not medically indicated for all pre-abortion cases; rather, the evidence indicated that ultra-sound testing is medically indicated in a selected number of cases where a discrepancy exists between a patient’s menstrual history and the size of her uterus, .where an unidentified mass is present, or where the patient has other abnormalities which impede the accuracy of clinical examination. In such cases, ultra-sound testing can increase the accuracy and confidence level of the treating physician. In the vast majority of cases, however, ultra-sound testing is not necessary in order to enable the physician to exercise his or her best medical judgment. It is apparent then, that ultrasound testing is medically indicated or helpful in only a selected number of cases in determining gestational age. Thus, the State has failed to demonstrate, by advancing this rationale for the ultra-sound testing requirement, a compelling basis for the requirement. The Court remains unconvinced by the additional reasons offered in support of the requirement. While the State argues that the ultra-sound testing would enable a physician to determine the correct method of abortion for each patient, expert testimony established that the use of ultra-sound testing prior to the abortion procedure would not affect the treating physician’s decision as to the proper method of abortion. Louisiana also argues that ultra-sound testing is necessary in order to determine life-threatening conditions such as atopic pregnancies. However, there was no suggestion at trial that this condition occurs with such frequency so as to justify the imposition of such a sweeping requirement. It is significant to note too, that because the ultra-sound test is a relatively new device, the long-term biological and genetic effects of sonography are unknown at this time. This factor also militates against the imposition of so sweeping a requirement in the absence of a clear and pressing need. In reaching the conclusion that thé State of Louisiana has not demonstrated a compelling basis for the ultra-sound testing requirement, the Court deems it appropriate to reiterate the “important and legitimate” state interests identified in Roe. 410 U.S., at 163, 93 S.Ct., at 731. There it was stated: [T]he State does have an important and legitimate interest in preserving and protecting the health of the pregnant woman, ... and treatment ... it has still another important and legitimate interest in protecting the potentiality of human life. These interests are separate and distinct. Each grows in substantiality as the woman approaches term and, at a point during pregnancy, each becomes “compelling.” With respect to the State’s important and legitimate interest in the health of the mother, the “compelling” point, in the light of present medical knowledge, is at approximately the end of the first trimester. This is so because of the now-established medical fact ... that until the end of the first trimester mortality in abortion may be less than mortality in normal childbirth. It follows that, from and after this point, a State may regulate the abortion procedure to the extent that the regulation reasonably relates to the preservation and protection of maternal health. Examples of permissible state regulation in this area are requirements as to the qualifications of the person who is to perform the abortion; as to the licensure of that person; as to the facility in which the procedure is to be performed, that is, whether it must be a hospital or may be a clinic or some other place of less-than-hospital status; as to the licensing of the facility; and the like. This means, on the other hand, that, for the period of pregnancy prior to this “compelling” point, the attending physician, in consultation with his patient, is free to determine, without regulation by the State, that, in his medical judgment, the patient’s pregnancy should be terminated. If that decision is reached, the judgment may be effectuated by an abortion free of interference by the State (emphasis added). With respect to the State’s important and legitimate interest in potential life, the “compelling” point is at viability. This is so because the fetus then presumably has the capability of meaningful life outside the mother’s womb. State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother. Id., at 410 U.S. 163-64, 93 S.Ct. 731-32. The Supreme Court emphasized in Roe that the State’s interest in maternal health is not “compelling” until the end of the first trimester. In Margaret S (I), 488 F.Supp. at 195, this Court observed that “[sjinee the Roe decision, major advances have occurred in medical knowledge,” and that the post-first trimester abortion technique employed by nearly all physicians who perform abortions in Louisiana, dilation and evacuation, is safer than childbirth until the eighteenth week of pregnancy. Reasoning from the Supreme Court’s holding in Roe that the State’s compelling interest in maternal health does not commence until abortion threatens maternal health in the same degree as does childbirth, this Court held that the State may not regulate abortion until the eighteenth week of pregnancy. Margaret S (I), supra, at 195-196. The Court has observed that approximately 93.3 percent of all abortions performed in Louisiana have been performed by the end of the first trimester of pregnancy. The Court emphasizes again, as the Supreme Court explicitly stated in Roe, that until the compelling point is reached, a physician may, in consultation with his patient, decide to terminate her pregnancy, and if this determination is reached, the abortion may be effectuated without interference by the State according to the physician's medical judgment. Id. It is significant to note that in enumerating examples of permissible regulations which reasonably relate to the preservation and protection of maternal health subsequent to the point where the State’s interest becomes compelling, the Supreme Court failed to specify diagnostic procedures which a physician must employ in the abortion procedure. Indeed, the Court recognized that its decision vindicated “the right of a physician to administer medical treatment according to his professional judgment up to the points where important state interests provide compelling justifications for intervention.” Roe, 410 U.S. at 166-67, 93 S.Ct. at 733. This Court is of the opinion that La.Rev.Stat.Ann. § 40:1299.35.2(B) (West 1981), which requires the attending physician to perform an ultra-sound examination on abortion patients, must fall. This result is dictated by the jurisprudence since the statute commands a physician to perform a specific diagnostic procedure which imposes significant costs upon the exercise of a woman’s constitutionally protected right to obtain an abortion, and it is apparent that there is no legitimate, compelling state interest justifying the requirement of such a test. Indeed the evidence indicates that this test would be useless in the vast majority of abortions performed in Louisiana. Accordingly, this section of the statute cannot survive the constitutional attack launched by the plaintiffs in this matter. In view of the Court’s disposition of this issue, it is unnecessary to consider the plaintiffs’ challenge to this section on equal protection grounds. Parental Consent for Minors La.Rev.Stat.Ann. § 40:1299.35.5 (West Supp.1981) prohibits a physician from performing an abortion on an unemancipated pregnant woman under eighteen years of age without parental consent or a court order. Before trial, the State, contending that this provision was clearly constitutional, presented this issue to the Court in a Motion for Summary Judgment. After a careful consideration of the arguments of counsel, the submitted memoranda, and the applicable law, the Court granted the Motion for Summary Judgment and stated that it would issue reasons for its ruling in a final opinion on the merits. See Minute Entry, Collins, J., November 18, 1981. In opposing the motion for summary judgment, the plaintiffs contended that the issue of the constitutionality of the minor consent provisions was not ripe for summary judgment because of the presence of disputed issues of material fact. Fed.R.Civ.P. 56. The plaintiffs stated their intention to demonstrate, inter alia, at the trial of this matter that the requirement of parental- consent in every instance of a minor seeking an abortion often does not promote maternal health or further the goal of protecting minors; that the statute is facially defective in that the Court procedures provide insufficient guidance to judges who must determine whether a pregnant minor is competent to make a decision concerning abortion, or whether an abortion is in her best interests; and that, as a practical matter, the Court procedure is unworkable and unduly burdensome on minors seeking abortions. After a careful consideration of each of these contentions, the Court concluded and remains of the opinion that, assuming the truth of these allegations, they are nevertheless insufficient to defeat the State’s Motion for Summary Judgment on the issue of the constitutionality of the minor consent provisions. In Bellotti v. Baird, 443 U.S. 622, 643, 99 S.Ct. 3035, 3048, 61 L.Ed.2d 797 (1979) (hereinafter Bellotti II), the Supreme Court held that where a state “decides to require a pregnant minor to obtain one or both parents’ consent to an abortion, it also must provide an alternative procedure (footnote omitted) whereby authorization for the abortion can be obtained.” The Court elaborated on the substantive and procedural aspects of such. proceedings: A pregnant minor is entitled in such a proceeding to show either: (1) that she is mature enough and well enough informed to make her abortion decision; in consultation with her' physician, independently of her parents’ wishes; or (2) that even if she is not able to make this decision independently, the desired abortion would be in her best interests. The proceeding in which this showing is made must assure that a resolution of the issue, and any appeals that may follow, will be completed with anonymity and sufficient expedition to provide an effective opportunity for an abortion to be obtained.” Bellotti II, 443 U.S. at 643, 644, 99 S.Ct. at 3048. The Court finds that Louisiana’s minor consent provisions, La.Rev.Stat.Ann. § 40:1299.35.5, fulfill the requirements governing abortions for unemancipated minors set forth in Bellotti II. This statute does not permit an absolute parental veto, a fatal constitutional defect which led to the downfall of other state statutes. See, e.g., H.L. v. Matheson, 450 U.S. 398, 101 S.Ct. 1164, 67 L.Ed.2d 388 (1981); Bellotti v. Baird, 428 U.S. 132, 96 S.Ct. 2857, 49 L.Ed.2d 844 (1976) (Bellotti I); Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976). Rather, the statute provides for parental consent and, alternatively, a judicial procedure wherein the pregnant minor can demonstrate that she is sufficiently mature to make the decision that an abortion is in her best interests. In addition to requiring a confidential and expeditious hearing of the matter, the statute provides safeguards to ensure that the minor is able to exercise her constitutional right to an abortion, including dual jurisdiction. This enables the minor to obtain a Court order in an area in which she resides or in another area if she fears that her presence in court will alert the public that she is seeking an abortion. She may also obtain a trial de novo in the event that she appeals a decision denying her an abortion. This allows her a second opportunity to convince an independent decision maker that she is sufficiently mature to make the abortion decision. The statute also permits a minor who cannot afford court costs to proceed in forma pauperis. Most importantly, this statute establishes a standardized procedure for pregnant minors seeking judicial approval for abortions. In this regard, the parental consent statute does not suffer from the infirmities which rendered its predecessor unconstitutional in Margaret S (I), 488 F.Supp. at 203. La.Rev.Stat.Ann. § 40:1299.35.5 (West Supp.1979). While it is true that the statute does not establish criteria by which a judge must determine whether a minor may obtain an abortion, the failure to establish such criteria is not sufficient to defeat the statute. The establishment of such criteria may unnecessarily restrict a decision maker in his deliberations, particularly where each case will undoubtedly involve the consideration of many different factors and circumstances pertaining only to the individual seeking an abortion. Moreover, the statute provides that “[j]urisdiction to hear [such] applications shall be in the court having juvenile jurisdiction in the parish where the abortion is to be performed or the parish in which the minor is domiciled.” La.Rev.Stat.Ann. § 40:1299.35.5(B)(2) (West Supp.1981). Juvenile courts decide difficult issues involving the health, welfare and best interests of minors on a regular basis. Thus, they are particularly well suited to decide abortion-related issues as they can bring to bear a wealth of experience on each case. The Court disagrees with the contention that the statute is unworkable as a practical matter or is unduly burdensome on minors seeking abortions. The statute outlines a precise procedure that is to be carried out expeditiously and with a minimum of inconvenience to the minor. While a minor who must endure this process may experience some mental or emotional discomfort, the statute nevertheless provides an appropriate resolution of the conflicting rights involved, that is, the right of a minor to secure an abortion and the right of the state to further “ ‘a constitutionally permissible end by encouraging an unmarried pregnant minor to seek the help and advice of her parents in making a very important decision whether or not to bear a child.’ ” Bellotti II, supra, 443 U.S., at 640-41, 99 S.Ct., at 3047 (quoting Planned Parenthood of Central Missouri v. Danforth, supra, 428 U.S. at 91, 96 S.Ct. at 2851 (concurring opinion). Further, the court procedure established by the statute gives a minor a workable alternative to parental consent and complies with the requirements set forth in Bellotti II, supra. Accordingly, the Court has concluded that La.Rev.Stat.Ann. § 40:1299.35.5 (West Supp.1981) is constitutional. Post-First Trimester Hospitalization Requirement La.Rev.Stat.Ann. § 40:1299.35.3 (West Supp.1981) requires an abortion performed subsequent to the first trimester of pregnancy to be performed in a hospital. In Margaret S. v. Edwards, 488 F.Supp. 181, 191-196, this Court declared unconstitutional the predecessor to this statute. La.Rev.Stat.Ann. § 40:1299.35.3 (West Supp.1979). Reaching this conclusion after an extensive analysis of the statutory provision, the applicable jurisprudence, and the practical impact that the post-first trimester hospitalization requirement would have on women in Louisiana seeking abortions, the Court determined that the requirement limited access to abortion while it had no rational relationship to the preservation of maternal health, and that it regulated abortions prior to the time when the State’s interest becomes compelling. Margaret S (I), supra, at 196. Subsequent to this Court’s decision in Margaret S (I), supra, in Gary-Northwest Indiana Women’s Services, Inc. v. Bowen, 496 F.Supp. 894 (N.D.Ind.1980), aff'd sub nom. Gary-Northwest Indiana Women’s Services, Inc. v. Orr, 451 U.S. 934, 101 S.Ct. 2012, 68 L.Ed.2d 321 (1981), a three-judge panel considered the constitutionality of an Indiana law requiring second trimester abortions to be performed in hospitals and concluded that the statute was constitutional. The Supreme Court summarily affirmed. In light of the Supreme Court’s summary affirmance of Gary-Northwest, supra, the Louisiana legislature re-enacted a mandatory post-first trimester hospitalization requirement. La.Rev.Stat.Ann. 40:1299.35.3 (West Supp.1981). On November 18, 1981, the plaintiffs brought on for hearing a motion for summary judgment on the issue of the constitutionality of this provision. The plaintiffs contended that the Supreme Court’s summary affirmance of Gary-Northwest, supra, was not binding on this Court since the constitutionality of a post-first trimester hospitalization requirement was not an issue on appeal in that case. After a careful consideration of the arguments of counsel, the submitted memoranda, and the applicable law, the Court agreed with the plaintiffs and granted their motion for summary judgment. At that time, the Court indicated that it would issue reasons for this decision in its final opinion on the merits. See Minute Entry, Collins, J., November 18, 1981. The issue confronting the Court concerns the significance of the Supreme Court’s summary affirmance of Gary-Northwest Indiana Women’s Services, Inc. v. Bowen, 496 F.Supp. 894 (N.D.Ind.1980), and the weight that decision should be accorded. The plaintiffs argue that the Supreme Court’s Gary-Northwest, supra, decision is not binding on this Court since the issues presented on appeal in that matter did not include the constitutionality of the post-first trimester hospitalization requirement. To the contrary, the State argued that the Gary-Northwest, supra, decision was indeed binding on the Court since a “ ‘[s]ummary disposition of an appeal ... is a disposition on the merits.’ ” Hicks v. Miranda, 422 U.S. 332, 344, 95 S.Ct. 2281, 2289 (1975) (quoting C. Wright, Law of Federal Courts 495 (2d Ed. 1970)). While the jurisprudence is replete with authority to the effect that a summary affirmance is a decision on the merits, it is also true that “summary affirmances have considerably less precedential value than an opinion on the merits.” Illinois State Board of Elections v. Socialist Workers Party, 440 U.S. 173, 180-181, 99 S.Ct. 983, 988, 59 L.Ed.2d 230 (1979). Moreover, it is also settled doctrine that “the precedential effect of a summary affirmance can extend no further than ‘the precise issues presented and necessarily decided by those actions.’ ” Id. 99 S.Ct. at 989 (quoting Fusari v. Steinberg, 419 U.S. 379, 391-392, 95 S.Ct. 533, 540-541, 42 L.Ed.2d 521 (1975). “Questions which ‘merely lurk in the record,’ (citations omitted) are not resolved, and no resolution of them may be inferred.” Illinois State Board of Elections, 440 U.S. at 183, 99 S.Ct. at 989 (quoting Webster v. Fall, 266 U.S. 507, 511, 45 S.Ct. 148, 149, 69 L.Ed. 411 (1925). Further, “[s]ummary actions ... should not be understood as breaking new ground but as applying principles established by prior decisions to the particular facts involved.” Mandel v. Bradley, 432 U.S. 173, 176, 97 S.Ct. 2238, 2240-2241, 53 L.Ed.2d 199 (1977). While lower courts are bound by summary actions on the merits by the Supreme Court, Hicks v. Miranda, 422 U.S. 332, 343-345, 95 S.Ct. 2281, 2289, the Court has noted that “[a]scertaining the reach and content of summary actions may itself present issues of real substance.” Id. at 422 U.S. 345 n. 14, 95 S.Ct. at 2290 n. 14. Accord, Mandel v. Bradley, supra, 432 U.S. at 176, 97 S.Ct. at 2240. Further, “[b]ecause a summary affirmance is an affirmance of the judgment only, the rationale of the affirmance may not be gleaned solely from the opinion below.” Id. The Court may examine the jurisdictional statement to determine what issues were necessarily decided on appeal to the Supreme Court. Illinois State Board of Elections v. Socialist Workers, 440 U.S. at 182, 99 S.Ct. at 989; Mandel v. Bradley, 432 U.S. at 176, 97 S.Ct. at 2240; Gibson v. Berryhill, 411 U.S. 564, 576, 93 S.Ct. 1689, 1697, 36 L.Ed.2d 488 (1973). The jurisdictional statement in Gary-Northwest indicates that three questions were presented to the Supreme Court: I. Whether the Three-Judge District Court Erroneously Treated the Supplemental Petition for Injunctive Relief as a Rule 60 Motion for Relief from Judgment, When It had Never Entered a Final Judgment On the Merits of the Second Trimester Hospital Restriction in any Previous Proceeding? II. Whether this Court Should Vacate the Judgment Below and Remand for a Full Hearing before the Entire Three-Judge Court oh the Merits of the Second Trimester Hospital Restriction? III. Whether the District Court Abused Its Discretion in Preliminarily Upholding the Second Trimester Hospital Restriction, When the Overwhelming Majority of Indiana Hospitals Ban all Abortion Services, and there is no Compelling Health Reason for Mandatory Hospitalization? Jurisdictional Statement in Gary-Northwest Indiana Women’s Services, Inc. v. Bowen, No. 80-1275, p. i; Exhibit A, Memorandum of Law in Support of Plaintiffs’ Motion for Summary Judgment. It is apparent from the jurisdictional statement in Gary-Northwest that the Supreme Court was not confronted with the precise issue presented here, that is, whether a mandatory hospitalization requirement for post-first trimester abortions is constitutional. The issues on appeal in Gary-Northwest are properly characterized as procedural. The first issue concerned the characterization of a motion as a 60(b) motion. The second contended that a full hearing on the merits was mandated. The third issue considered whether the district court abused its discretion in refusing to issue a preliminary injunction. This Court is of the opinion that the Supreme Court’s summary affirmance signified the Court’s satisfaction that these questions were adequately resolved by the lower court. However, none of the issues on appeal in Gary-Northwest addresses the full merits of the constitutionality of a mandatory post-first trimester hospitalization requirement. Only the third question presented to the Supreme Court in Gary-Northwest could possibly be characterized as substantive, rather than procedural. Yet, even assuming this to be so, it does not mean that the Supreme Court considered the factual issues raised in the same context as this Court faced them in Margaret S (I). The third issue raised in Gary-Northwest concerned the applicable standard in granting motions for preliminary injunctive relief. The district court denied the plaintiffs’ motion for preliminary injunctive relief against Indiana’s second trimester hospitalization requirement after concluding' that the plaintiffs had failed to demonstrate a likelihood of succéss on the merits. The plaintiffs appealed the district court’s ruling on this issue. The Supreme Court’s summary affirmance indicates, as is apparent from the jurisdictional statement in Gary-Northwest, that the Court was of the opinion that the district court did not abuse its discretion in refusing to grant preliminary injunctive relief. This summary affirmance, however, was not tantamount to a decision on the merits on the constitutionality of a post-first trimester hospitalization requirement since it is clear that different standards apply in the granting of preliminary and permanent injunctions. Univ. of Texas v. Camenish, 451 U.S. 390, 101 S.Ct. 1830, 68 L.Ed.2d 175 (1981). In Camenish, supra, the Court rejected the suggestion that a determination of the likelihood of success on the merits constitutes a decision on the merits. The Court stated that “[T]his reasoning fails, however, because it improperly equates ‘likelihood of success’ with ‘success’, and what is more important, because it ignores the significant procedural differences between preliminary and permanent injunctions.” Id. 101 S.Ct. at 1833. The Court remanded Univ. of Texas v. Camenish, 451 U.S. 390, 100 S.Ct. 1830, 68 L.Ed.2d 175 (1981), for a full hearing on the merits after emphasizing the settled rule of law concerning preliminary injunctions: “A party thus is not required to prove his case in full at a preliminary injunction hearing, ... and the findings of fact and conclusions of law made by a court granting a preliminary injunction are not binding at trial on the merits.” Id. (citations omitted). The Court further stated that it is “generally inappropriate for a federal court at the preliminary injunction stage to give a final judgment on the merits”. Id. The Court refused to speculate on the merits of the challenge until the completion of the trial on the matter. The procedural framework of Gary-Northwest Indiana Women’s Services, Inc. v. Bowen, 496 F.Supp. 894 (N.D.Ind.1980), is similar to that in Camenish, supra, in that both courts decided motions for preliminary injunctive relief. In neither case were full hearings on the merits held before Supreme Court review. In contrast, this Court granted permanent injunctive relief against Louisiana’s post-first trimester hospitalization requirement after a full trial on the merits where evidence establishing the burdensomeness of this requirement, without regard to the preservation of maternal health, led the Court to declare it unconstitutional. The Court’s conclusion on this issue is further buttressed by the presence of an important factual distinction between Gary-Northwest, supra, and this matter. Incorporated into the Indiana statute was a statutory definition of hospitals that included ambulatory out-patient surgical centers. Ind.Code Ann. § 35-1-58.5-1(0(2). By contrast, the Louisiana statute does not define the term “hospital” to include outpatient facilities. See La.Rev.Stat.Ann. §§ 2100 et seq. This definitional distinction means, of course, that the Indiana statute permits post-first trimester abortions to be performed in a wider variety of institutions. It would also mean that post-first trimester abortions are more readily accessible in Indiana. The Court has noted, in Margaret S (I), supra, at 488 F.Supp. 192, and in this matter, supra, n. 12, “that severe limitations ... [exist] oh the availability of post-first trimester abortions in Louisiana.” Since the “precedential significance of ... [a] summary action ... is to be assessed in the light of all the facts in that case,” Mandel v. Bradley, supra, 432 U.S. at 177, 97 S.Ct. at 2241, this important factual difference between the statute in Gary-Northwest, supra, and the Louisiana statute under consideration here also lessens the precedential value of Gary-Northwest Indiana Women’s Services, Inc. v. Bowen, 496 F.Supp. 894 (N.D.Ind.1980). In Margaret S (I), supra, this Court considered in great detail the issue of the constitutionality of Louisiana’s mandatory hospitalization requirement for post-first trimester abortions. After carefully considering all the evidence adduced at trial, including a considerable amount of expert testimony and many documents and other exhibits in the voluminous record amassed in Margaret S (I), as well as an extended analysis of the pertinent jurisprudence, the Court concluded that the statute was unconstitutional because it limited “access to abortion without regard to preservation of maternal health, and because it ... attempted to regulate abortions prior to the time when the State’s interest in maternal health becomes compelling.” Margaret S (I), supra, 488 F.Supp. at 196. No evidence has been offered to the Court in this matter to suggest that this conclusion should be altered. Other courts, when faced with ample evidence of the burdensomeness of second trimester hospitalization requirements, have also declared them unconstitutional. See, e.g., Wolfe v. Stumbo, 519 F.Supp. 22 (W.D.Ky.1980); Planned Parenthood Association of Kansas City, Missouri v. Aschroft, 483 F.Supp. 679, 686-687 (W.D.Mo.1980), aff'd in part, rev’d in part, 655 F.2d 848 (8th Cir.1981), opinion after remand, 664 F.2d 687 (8th Cir.1981) cert. granted, 456 U.S. 988, 102 S.Ct. 2267, 73 L.Ed.2d 733 (1982). The Court finds the reasoning in Ashcroft, supra, particularly instructive. On appeal, the Eighth Circuit remanded the second trimester hospitalization requirement to the district court for further findings of fact. This occurred after the Supreme Court’s summary affirmance of Gary-Northwest, supra, and suggests that the Court concluded that the summary affirmance was not dispositive of the issue of the constitutionality of Missouri’s second trimester hospitalization requirement. On remand, the district court again declared the requirement unconstitutional after hearing additional evidence on the availability and safety of second trimester abortions in Missouri. This Court notes that the Supreme Court has recently determined that a second trimester hospitalization requirement is unconstitutional. See, e.g., City of Akron v. Akron Center for Reproductive Health, Inc., 462 U.S. 416, 103 S.Ct. 2481, 76 L.Ed.2d 687 (1983). In light of the Supreme Court’s decision in Akron, supra, the Court is of the opinion that its previous ruling in this matter should not be disturbed despite the Supreme Court’s summary affirmance of Gary-Northwest, supra. The jurisprudence establishes that summary affirmances are dispositive of issues that are necessarily decided. Thus, such affirmances must be carefully scrutinized in order to determine the precise reach of the decision. The jurisdictional statement in Gary-Northwest, supra, indicates that the only issue on appeal which concerned the constitutionality of the second trimester hospitalization requirement addressed the issue of the appropriateness of preliminary injunctive relief in the matter. Further, important legal and factual differences exist between Gary-Northwest Indiana Women’s Services, Inc. v. Bowen, 496 F.Supp. 894 (N.D.Ind.1980), and the matter before this Court. . Accordingly, since La.Rev.Stat.Ann. § 40:1299.35.3 (West Supp.1981) is a re-enactment of the mandatory second trimester hospitalization requirement which this Court declared unconstitutional in Margaret S. (I), supra, the Court has concluded that this provision, too, must fall. Accordingly, the plaintiff’s Motion for Summary Judgment on this issue will be and hereby is GRANTED. Informed Consent La.Rev.Stat.Ann. 40:1299.35.6(B) (West Supp.1981) requires a physician, prior to performing an abortion, to orally inform the pregnant woman of certain facts, including: that in his or her opinion, the woman is in fact pregnant; the number of weeks that have elapsed since conception; the anatomical and physical development of the fetus; whether the child is viable, according to the best medical judgment of the attending physician; the type of technique which will be utilized in the abortion procedure and the medical risks and possible consequences associated with it; and that public and private agencies are available to assist her if she wishes to continue her pregnancy. The plaintiffs maintain that the informed consent provisions are unconstitutional. First, they object to the requirement that the attending physician personally perform the counseling duties required under the statute. The plaintiffs contend that this requirement significantly burdens women’s exercise of the abortion right by preventing clinics from utilizing physicians’ services efficiently and economically, thereby increasing the cost of abortions. The crux of the plaintiffs’ argument in this regard is that the requirement that the attending physician personally perform counseling duties would force the physician to spend a significantly greater amount of time at the clinic and, since the physician’s fees are the single largest component of costs in the abortion procedure, would result in an increase in the cost of abortions. The plaintiffs also argue that the physician counseling requirement represents a substantial intrusion into the physician-patient relationship and that the State’s interest in maternal health does not justify such a requirement. In contrast, the State argues that the physician counseling requirement comports with the community standard for informed consent for obstetric and gynecological surgical procedures. The State contends that by failing to personally perform counseling duties in the abortion procedure, the attending physician fails to provide the quality of care that is the standard within the medical community. A review of. the applicable legal standard is appropriate at this juncture. The Court has previously stated that Roe v. Wade, 410 U.S. 113, 155, 93 S.Ct. 705, 728, 35 L.Ed.2d 147 (1973), establishes that the right of privacy, which is implicit in the concept of liberty guaranteed by the Fourteenth Amendment, encompasses a woman’s decision to terminate her pregnancy. Thus, “only compelling state interests can justify any state limitations.” Women’s Medical Center of Providence, Inc. v. Roberts, 530 F.Supp. 1136, 1143 (D.R.I.1982). Accord, Roe v. Wade, 410 U.S. at 155, 93 S.Ct. at 728; City of Akron v. Akron Center for Reproductive Health, Inc., 462 U.S. 416, 103 S.Ct. 2481, 76 L.Ed.2d 687 (1983); Planned Parenthood League of Massachusetts v. Bellotti, 641 F.2d 1006, 1016 (1st Cir.1981). “When any state regulations implicate directly a woman’s abortion decision, it is incumbent on a court to determine whether the regulations in question are justified by a compelling state interest and whether they have been drafted narrowly to further that compelling state interest.” Scheinberg v. Smith, 659 F.2d 476, 482 (5th Cir.1981). Accord, Carey v. Population Services International, 431 U.S. 678, 686, 97 S.Ct. 2010, 2016, 52 L.Ed.2d 675 (1977); Poe v. Gerstein, 517 F.2d 787, 791 (5th Cir.1975), aff'd sub nom. mem., Gerstein v. Coe, 428 U.S. 901, 96 S.Ct. 3202, 49 L.Ed.2d 1205 (1976). Initially, the plaintiffs must demonstrate that “the state regulation in question interferes directly with a woman’s abortion decision,” Scheinberg, supra, 659 F.2d at 482, since if the regulation constitutes only a de minimis burden on the abortion right, it is permitted under the jurisprudence. See Charles v. Carey, 627 F.2d 772, 777 (7th Cir.1980); Women’s Medical Association v. Roberts, 530 F.Supp. 1136, 1143 (D.R.I.1982). The evidence adduced at trial established that the physician counseling requirement would affect the cost of abortion services in Louisiana. In a typical Louisiana abortion clinic, only one physician is on duty at any given time. While the attending physician is available to consult with patients should they so request, his duties are normally confined to the actual performance of the abortion procedure. Other aspects of a woman’s care while at the clinic, including counseling, preparing the woman for the procedure, and post-operative care, are provided by other clinic personnel such as nurses, laboratory technicians, counselors, and clerical workers, whose services are not as costly as those of a physician. The testimony at trial established that physicians’ fees account for approximately 50 percent of the total cost of providing abortion services. If physicians performed counseling duties as well as the abortion procedure, they would spend more time at clinics and would charge additional fees. These increased costs would undoubtedly be reflected in higher fees to patients. Thus, by limiting the attending physician’s involvement to the actual perf