Full opinion text
OPINION HUYETT, District Judge. INTRODUCTION This court is required to address again the difficult and controversial issue of the permissible degree of governmental regulation of a woman’s abortion decision. In this action for declaratory and injunctive relief, plaintiffs challenge the 1988 and 1989 amendments to Pennsylvania’s Abortion Control Act of 1982 (“the Act”), Act of March 25, 1988, 1988 Pa.Laws 262, No. 31, §§ 3-10 (“Act 31”) and Act of November 17, 1989, 1989 Pa.Laws 592, No. 64, §§ 1-9 (“Act 64”), amending 18 Pa.Cons.Stat.Ann. §§ 3201-20 (Purdon 1983 and 1990 Supp.). Plaintiffs assert that Act 31 and Act 64 violate the United States Constitution and 42 U.S.C. § 1983 (1981). I have subject matter jurisdiction over this controversy pursuant to 28 U.S.C. § 1331 (1966 and 1990 Supp.), 28 U.S.C. § 1343(a)(3), (4) (1976 and 1990 Supp.), and the fourteenth amendment to the United States Constitution. Just three days prior to the scheduled effective date of Act 31, following a hearing, I granted plaintiffs’ motion for a temporary restraining order and enjoined defendants from: (1) enforcing the provisions of section 3206 and (2) publicly disclosing or otherwise making available for public inspection and copying any report filed pursuant to sections 3207(b) or 3214(f). An evidentiary hearing and oral argument on plaintiffs’ motion for a preliminary injunction was held on May 9, 1988. With the consent of the parties, I ordered that the earlier temporary restraining order would remain in effect until such time as I ruled on the motion for a preliminary injunction following the hearing. See Order (May 9, 1988). Two weeks later, on May 23, 1988,1 preliminarily enjoined various portions of the Act. Planned Parenthood of Southeastern Pennsylvania v. Casey, 686 F.Supp. 1089 (E.D.Pa.1988) {“Casey 7”). Defendants did not appeal this decision. Thereafter, I stayed all proceedings pending issuance of the decision of the United States Supreme Court in Webster v. Reproductive Health Services. At about the time of the Supreme Court’s decision in Webster, the Pennsylvania legislature began debating various amendments to the Act. Several months later, on November 17, 1989, Act 64 was adopted to become effective in sixty days. With the consent of the defendants and leave of the court, plaintiffs filed an amended complaint to extend the scope of their challenge against the Act to include the 1989 amendments. After a conference held in chambers, I extended, over the objection of defendants, the preliminary injunction order to encompass the 1989 amendments to the Act. See Planned Parenthood of Southeastern Pennsylvania v. Casey, 736 F.Supp. 633 (E.D.Pa.1990) (“Casey 77”). The trial of this action on the merits was held during the week of July 30,1990. The parties have entered into a comprehensive stipulation of uncontested facts and a supplemental stipulation of uncontested facts for the purposes of trial. Based upon the stipulation of uncontested facts and the supplemental stipulation of uncontested facts, the evidence presented at trial, and the evidence presented at the hearing on plaintiffs’ motion for a preliminary injunction which the parties have agreed would be admissible at the trial on the merits, I make the following findings of fact and conclusions of law. However, because in many ways the Pennsylvania legislature has come full circle by re-enacting many provisions of the Act which were deemed unconstitutional at various stages during the 1982 action involving the 1982 Act, I shall first summarize the lengthy history of abortion legislation in Pennsylvania. I. HISTORY OF ABORTION REGULATION IN PENNSYLVANIA In its landmark decision in Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973), the Supreme Court invalidated statutes, like Pennsylvania’s, containing general prohibitions against abortions, because such statutes unconstitutionally violated a woman’s fundamental right to privacy. See also Doe v. Bolton, 410 U.S. 179, 93 S.Ct. 739, 35 L.Ed.2d 201 (1973). In the year following Roe v. Wade, over the Governor’s veto, the state legislature enacted Pennsylvania’s first comprehensive “Abortion Control Act.” See Abortion Control Act of 1974, 1974 Pa.Laws 639, No. 209 (amended 1978, repealed 1982). After extensive and substantial litigation, various provisions of the 1974 Act, including sections relating to spousal and parental consent to abortion procedures, to the proscription of advertising for abortion procedures, to the choice of post-viability abortion procedures, and to the criminal standard governing the performance of abortions at viability, were struck down. See Planned Parenthood Ass’n v. Fitzpatrick, 401 F.Supp. 554 (E.D.Pa.1975) (three judge panel), affd mem. in part sub nom., Franklin v. Fitzpatrick, 428 U.S. 901, 96 S.Ct. 3202, 49 L.Ed.2d 1205 and vacated and remanded mem. in part sub nom., Beal v. Franklin, 428 U.S. 901, 96 S.Ct. 3201, 49 L.Ed.2d 1204 (1976), modified on remand, Civil Action No. 74-2440 (E.D.Pa. Sept. 16, 1977) (unreported), aff'd sub nom., Colautti v. Franklin, 439 U.S. 379, 99 S.Ct. 675, 58 L.Ed.2d 596 (1979). See also Doe v. Zimmerman, 405 F.Supp. 534 (M.D.Pa.1975) (three judge panel). In 1978, the legislature attempted to restrict a woman’s access to abortions by limiting medical assistance funding for the procedure. See Act of September 26, 1978, 1978 Pa.Laws 773, No. 148, §§ 1-2. A successful challenge was mounted against this effort. Roe v. Casey, 464 F.Supp. 487 (E.D.Pa.1978), aff’d, 623 F.2d 829 (3d Cir.1980). Thereafter, a bill based on a model developed by Americans United For Life, a nonprofit organization, was introduced by the House as an amendment to a Senate bill regulating “tough guy” competitions. See Note, Toward Constitutional Abortion Control Legislation: The Pennsylvania Approach, 87 Dick.L.Rev. 373, 382 n. 84 (1983). Despite being rejected by the relevant legislative committee, the bill was passed overwhelmingly. The Senate, after brief discussion, concurred with the House amendment. While acknowledging his personal opposition to abortion, Dick Thorn-burgh, then Governor of Pennsylvania, vetoed the bill and explained his action as follows: I am concerned that [some] provisions, and to some extent, the overall tone and tenor of the bill, would have the effect of imposing an undue, and, in some cases, unconstitutional burden upon even informed, mature adults intent upon obtaining an abortion under circumstances in which the U.S. Supreme Court has determined they are entitled to do so.... Likewise, I am concerned that some of the detailed, complex and burdensome requirements of the bill, accompanied as they are by severe criminal penalties, could well foster an atmosphere in which many physicians would be deterred from providing the kind of abortion-related medical services to which the U.S. Supreme Court has held their patients are constitutionally entitled. This could well disrupt the traditional doctor-patient relationship and impinge upon the right of physicians to practice. Of even greater concern is the potential for more experienced and conscientious physicians to refrain from involvement in even medically necessary abortions, and to abandon the field to marginal practitioners. It could even lead to a resurgence of “back alley” abortions, which no thoughtful person would wish to happen.... I am also concerned that in its entirety the bill in its current form goes further than is necessary in protecting the state interests in this area.... In so doing, it threatens to create additional regulation and bureaucracy and to unduly involve government in the private lives of its citizens. See Veto Message to the Senate at 7 (December 23, 1981) [Plaintiffs’ Exhibit 60], After revision and introduction on the floor of the House as an amendment to a bill relating to paramilitary training, the Abortion Control Act of 1982 was passed by both the House and Senate. Signed by Governor Thornburgh on June 11,1982, the Act was to take effect within 180 days, on December 8, 1982, from its enactment. The Abortion Control Act of 1982 imposed detailed regulations on abortions which required that: (1) a pregnant woman wait a mandatory 24 hours prior to undergoing an abortion procedure after giving her consent to the procedure; (2) a physician personally provide certain specified information to a woman seeking an abortion as a part of the informed consent process; (3) unemancipated minors obtain parental or judicial consent for an abortion procedure; and (4) all second trimester abortions be performed in a hospital. The 1982 Act also strictly limited post-viability abortions; dictated the use of specific procedures and, in some cases, the presence of a second physician to save the aborted fetus; imposed detailed reporting regulations; required fetal pathology reports; restricted the availability of public funds for the performance of abortions; and regulated private insurance coverage for the performance of abortions. Further, the 1982 Act subjected physicians and clinics violating the Act to criminal prosecution, as well as civil tort liability and revocation or suspension of licensure. Before the Act took effect, the American College of Obstetricians and Gynecologists (“ACOG”), Pennsylvania Section, various abortion clinics and physicians, among others, filed suit in this court alleging that the 1982 Act was unconstitutional in its entirety and immediately filed a motion for a preliminary injunction. See American College of Obstetricians and Gynecologists, Pennsylvania Section, et al. v. Thornburgh, et al., Civil Action No. 82-4336. Based upon what the Third Circuit later described as “an unusually complete factual and legal presentation from which to address the important constitutional issues at stake,” see American College II, 737 F.2d at 290, J concluded that the 1982 Act as a whole was constitutional with the exception of the 24-hour waiting period contained in section 3205. American College of Obstetricians and Gynecologists, Pennsylvania Section v. Thornburgh, 552 F.Supp. 791 (E.D.Pa.1982) (“American College I”). Plaintiffs immediately filed a notice of appeal, and the Commonwealth filed a cross-appeal challenging my ruling on the 24-hour waiting period provision. The Third Circuit, on December 9, 1982, granted the plaintiffs’ motion for stay of enforcement of the entire Act pending appeal. After expedited briefing and argument, the Third Circuit withheld opinion pending three decisions of the Supreme Court which were under submission. After consideration of supplemental briefs and reargument, the Third Circuit ruled that various sections of the 1982 Act were unconstitutional, including the detailed reporting provisions imposed upon physicians, the requirement of discriminatory insurance, the compulsory “informed consent” information which must be given to a pregnant woman seeking an abortion, and the sections attempting to control the method of abortion and mandate the attendance of a second physician under certain circumstances. American College II, 737 F.2d at 283. Further, in light of the decisions in Akron and Ashcroft, the Commonwealth conceded, and the Third Circuit agreed, that the 24-hour waiting period, the physician-only disclosure requirements, and the proscription against second trimester abortions unless performed in a hospital were unconstitutional. Id. at 293. The Supreme Court subsequently affirmed by a five to four vote. Thornburgh, 476 U.S. at 747, 106 S.Ct. at 2169. Thereafter, Pennsylvania’s legislature adopted the 1988 and 1989 amendments to the Act. These amendments include many provisions similar, if not identical, to the provisions of the 1982 version of the Act struck down by this court, the Third Circuit, and the United States Supreme Court, as well as other provisions to which plaintiffs object. These include a mandatory 24-hour waiting period for all women seeking to have an abortion; a parental informed consent/judicial by-pass procedure for minor women seeking to terminate their pregnancy; spousal notification provisions; physician-only disclosure requirements; and various reporting and disclosure requirements. II. FINDINGS OF FACT A. The Parties and Witnesses. 1. Plaintiff Thomas Allen testified as an expert at trial in the field of obstetrics and gynecology. He is qualified to testify as an expert in this field, and I found his testimony to be credible in all respects. Dr. Allen is a physician licensed to practice medicine in Pennsylvania and is an Associate Clinical Professor in the Department of Obstetrics and Gynecology at the University of Pittsburgh. He graduated from the University of Pittsburgh School of Medicine in 1943. He is an emeritus staff member of Magee Women’s Hospital, and is Medical Director of Women’s Health Services, Inc. He has been a Diplómate of the American College of Obstetrics and Gynecology since 1954, has been a Fellow of the American College of Obstetrics and Gynecology since 1955, and a Fellow of the Pittsburgh Obstetrical and Gynecological Society since 1974. From 1972 to the present, Dr. Allen has been active in planning, establishing and administering Women’s Health Services, Pittsburgh’s first free standing abortion clinic. From 1970 to 1979, he was active in establishing and contributing services to the Pittsburgh Free Clinic. Dr. Allen has a private obstetrical and gynecological practice with one other specialist. [Court’s Exhibit 1 at ¶ 1; Plaintiffs’ Exhibit 81; Trial Testimony of Dr. Allen, Vol. I at 35-39]. 2. Plaintiff Planned Parenthood of Southeastern Pennsylvania (“PPSP”) is a non-profit corporation providing comprehensive family planning, medical and counseling services (including birth control education), pregnancy testing and counseling, gynecological care, first trimester abortions, and vasectomies at medical clinics in Philadelphia, Montgomery and Delaware Counties. The Center City Philadelphia clinic offers these services Monday through Friday. Abortions are performed on Wednesdays, Thursdays, Fridays and Saturdays at PPSP’s Center City Philadelphia Clinic. [Court’s Exhibit 1 at 11 2]. 3. Plaintiff Reproductive Health and Counseling Center (“RHCC”) is a for-profit corporation in Chester, Pennsylvania, which operates a clinic that performs first and early second trimester abortions. [Court's Exhibit 1 at II 12]. 4. Plaintiff Women’s Health Services, Inc. (“WHS”) in Pittsburgh, Pennsylvania, is a non-profit health center providing fertility control education, pregnancy counseling, general counseling for individuals and couples, PMS counseling and treatment, contraceptive and gynecological care, public education, and first and early second trimester abortions. [Court’s Exhibit I at 1125], 5. Plaintiff Women’s Suburban Clinic (“WSC”) is a non-profit corporation in Pao-li, Pennsylvania which operates a health care facility providing abortions, ongoing gynecological services, mini-laparoscopies, pregnancy testing, community education, and other counseling services. [Court’s Exhibit 1 at 1142], 6. Plaintiff Allentown Women’s Center (“AWC”) is a for-profit corporation in Allentown, Pennsylvania which operates a clinic providing pregnancy testing and counseling, contraceptive and gynecological care, and first trimester abortions. [Court’s Exhibit 1 at 1155]. 7. Defendant Robert P. Casey is the Governor of the Commonwealth of Pennsylvania. [Plaintiffs’ Amended Complaint and Defendants’ Answer to Amended Complaint at ¶ 13]. 8. Defendant N. Mark Richards, M.D., is the Secretary of Health of the Commonwealth of Pennsylvania. [Plaintiffs’ Amended Complaint and Defendants’ Answer to Amended Complaint at ¶ 14]. 9. Defendant Ernest Preate, Jr., is the Attorney General of the Commonwealth of Pennsylvania. [Plaintiffs’ Amended Complaint and Defendants’ Answer to Amended Complaint at 1115]. 10. Defendant Michael D. Marino is the District Attorney for Montgomery County, Pennsylvania. [Plaintiffs’ Amended Complaint and Defendants’ Answer to Amended Complaint at 1116]. 11. Sue Roselle testified at the hearing on plaintiffs’ motion for a preliminary injunction and at trial. I found her testimony on both occasions to be credible in all respects. Ms. Roselle is the Executive Director of WHS. As Executive Director, she is responsible for the ongoing operation of the clinic and for staff selection, and she reports to the Board of Directors of WHS. She holds a master’s degree in social work from the University of Illinois at Urbana, and a M.S.B.A. in management from Robert Morris College. She is Treasurer of the Pennsylvania Chapter of the National Association of Social Workers, a member of the Academy of Certified Social Workers, President of Pennsylvanians for a Right to a Private Life, and serves on the Health Services Committee of the American Red Cross, Pittsburgh-Allegheny Chapter. She has over ten years’ experience in health care administration, including medical services and home health care. She is a former director for emergency medical service systems for the 12 counties of southwestern Pennsylvania. [See Casey I, 686 F.Supp. at 1093 (1111) ]. 12. Sylvia Stengle testified at the. hearing on plaintiffs’ motion for a preliminary injunction. I found her testimony to be credible in all respects. Ms. Stengle is the founder and Director of AWC. She is responsible for the ongoing operation of the clinic and hiring. She holds a bachelor’s degree from the University of Wisconsin, and has taken graduate courses in sociology and psychology. Prior to founding AWC in 1978, she was the Education Director for Planned Parenthood of Northampton County, Pennsylvania. She has been personally involved in counseling since 1973, and now supervises the AWC counseling staff. She serves on the Board of Directors of the National Abortion Rights Action League. [See Casey I, 686 F.Supp. at 1093-94 (1112) ]. 13. Dr. Cathy Dratman testified at the hearing on plaintiffs’ motion for a preliminary injunction. I found her testimony to be credible in all respects. Dr. Dratman is licensed to practice medicine in Pennsylvania and New Jersey. She is a graduate of Hahnemann Medical College, and completed her internship and residency at Pennsylvania Hospital in Philadelphia. She is board certified by the American Board of Obstetrics and Gynecology. She has been Medical Director of PPSP since 1986, and has a private obstetrical and gynecological practice in New Jersey. She does not presently perform abortions, but in the past has performed and referred patients for first and second trimester abortions up to 20 weeks gestation. As Medical Director of PPSP, she maintains close contact with, and generally oversees, all abortion procedures performed at the clinic. [Casey I, 868 F.Supp. at 1094 (H 13) ]. 14. Dr. Steven J. Davidson testified at trial as an expert in the field of emergency medicine. He is qualified to testify as an expert in emergency medicine, and I found his testimony credible in all respects. Dr. Davidson is a physician licensed to practice medicine in Pennsylvania and California. He is a Division Head of Pre-Hospital Care and Professor of Emergency Medicine at the Medical College of Pennsylvania where he teaches, both clinically and didactically, medical students, interns, residents and house staff. He received his bachelor’s degree in chemistry with honors from Temple University in 1971 and graduated from Temple University Medical School in 1975. Dr. Davidson’s internship and residency, in emergency medicine, took place in the Medical College of Pennsylvania. Subsequently, he was awarded a master’s degree in business administration from the Wharton School of the University of Pennsylvania in 1989. Dr. Davidson’s hospital appointments include attending physician at the hospital at the Medical College of Pennsylvania, associate in the Department of Emergency Medicine at the Mercy Catholic Medical Center, and he serves on the intensive care unit, attending staff and affiliate staff, at Jefferson Hospital. He presently sees patients in emergency rooms approximately 600 hours annually. He has been a Fellow of the American College of Emergency Physicians since 1982, and has been a Dip-lómate of the American Board of Emergency Medicine since 1980. Finally, he is the author or co-author of numerous publications and has given numerous presentations on topics in the field of emergency medicine. [Trial Testimony of Dr. Davidson, Vol. I at 10-14; Plaintiffs’ Exhibit 77]. 15. Dr. Michael Alan Grodin testified at trial as an expert in the field of medical ethics. He is qualified to testify as an expert in medical ethics, and I found his testimony credible in all respects. Dr. Gro-din is a physician licensed to practice medicine in Massachusetts and New York. He received his bachelor’s degree from Massachusetts Institute of Technology in 1973 and graduated from Albert Einstein College of Medicine in 1976. Dr. Grodin was an intern and junior resident in pediatrics at Harbor General Hospital in Torrance, California (UCLA), and completed his residency in pediatrics at Massachusetts General Hospital and Boston City Hospital (Harvard University). While at Boston City Hospital, he was Chief Resident in Pediatrics. Subsequently, he completed a clinical fellowship in pediatric cardiology at Children’s Hospital Medical Center in Boston. Dr. Grodin is a pediatrician and a professor with over eleven years of experience in the field of medical ethics. He has taught courses and lectured within the Boston University Schools of Liberal Arts, Medicine, Law, Public Health, Social Work, and Theology over the past eleven years. He is presently Associate Director of the Law, Medicine and Ethics Program and Director of Medical Ethics at Boston University Schools of Medicine and Public Health, where he is also Associate Professor of Health Law, Pediatrics, and Socio-Medical Sciences and Community Medicine. In addition, he is Adjunct Associate Professor of Philosophy in the College of Liberal Arts at Boston University. Dr. Grodin is a Medical Ethicist and Human Studies Chairman for the Department of Health and Hospitals of the City of Boston, and serves on the Institutional Review Board and Ethics Advisory Group-Institutional Ethics Committee of Boston City Hospital. He is a staff pediatrician at Associated Pediatricians of Boston, an associate visiting pediatrician at Boston City Hospital, and a senior associate in pediatrics at Beth Israel Hospital in Boston. In addition, he serves on the boards of directors of the American Society of Law and Medicine, and Public Responsibility in Medicine and Research. He is a member of the National Committee on Bioethics of ACOG. Finally, he served as medical ethics reviewer for The New England Journal of Medicine and Oxford University Press, authored or coauthored numerous publications in the areas of moral dilemmas in medicine and problematic decision-making in clinical medicine, and has delivered numerous presentations on various topics in the field of medical ethics. [Trial Testimony of Dr. Grodin at 91-96; Plaintiffs’ Exhibit 78]. 16. Dr. Ronald J. Bolognese testified at trial as an expert in the fields of obstetrics, gynecology and perinatal medicine. He is qualified to testify as an expert in these areas, and I found his testimony credible in all respects. Dr. Bolognese is a physician licensed to practice medicine in Pennsylvania and New Jersey. He received his bachelor’s degree from Princeton University in 1959 and graduated from the University of Pennsylvania School of Medicine in 1967. Dr. Bolognese completed his internship at Bryn Mawr Hospital and his residency in obstetrics and gynecology at Pennsylvania Hospital in Philadelphia. Dr. Bolognese was the Chief of Obstetrics and Gynecology at Williams Air Force Base Hospital in Arizona from 1967 to 1969. He has specialty certifications from ACOG and the Maternal-Fetal Medicine Board, a division of ACOG. He is the Director of the Section on Perinatology of the Department of Obstetrics and Gynecology at Pennsylvania Hospital. Since 1985, he has been the Chairman of the Department of Obstetrics and Gynecology at Pennsylvania Hospital. He has been a Professor of Obstetrics and Gynecology at the University of Pennsylvania School of Medicine since 1982, after serving as a clinical assistant professor and associate professor of obstetrics and gynecology. Finally, he is the author or co-author of numerous publications and has delivered several presentations on topics in his fields of expertise. [Trial Testimony of Dr. Bolognese, Vol. I at 137-141; Plaintiffs’ Exhibit 79]. 17. Dr. Lenore E.A. Walker testified at trial as an expert in the field of family violence. She is qualified to testify as an expert in the area of family violence and the effects of battering on women, children and other members of their families, and I found her testimony credible in all respects. Dr. Walker is licensed to practice psychology in Colorado and New Jersey. She received her bachelor’s degree in psychology from Hunter College of the City University of New York in 1962, her master’s degree in clinical school psychology from City College of the City University of New York in 1967, and her doctorate degree from Rutgers University’s School of Psychology in 1972. Dr. Walker has more than twenty years of experience as a licensed clinical, forensic, and school psychologist. She is currently the president of Walker and Associates in Denver and the founder and Executive Director of the Domestic Violence Institute, a non-profit organization which conducts research in the area of family violence. Dr. Walker is a Fellow of and has served on the Council of Representatives of the American Psychological Association and as chair of its Women’s Caucus. In 1987, she was the recipient of the Board of Professional Affairs Distinguished Professional Contributions to Psychology in the Public Interest Award, one of the American Psychological Associations highest honors. Dr. Walker is also an adjunct professor of psychology at the University of Denver. During her career she has been Chairperson of the Department of Psychology and Associate Professor of Psychology at Colorado’s Women’s College, an Assistant Professor of Psychiatry at Rutgers University's Medical School, and an Assistant Professor at Rutgers University’s Graduate School of Applied and Professional Psychology- Dr. Walker was one of the first scientists in the country to conduct clinical research on intra-family violence and is one of the foremost experts on the psychology of battered women and families. From 1978 to 1981, she acted as the principal investigator for a National Institute for Mental Health funded study on the "battered women syndrome.” She is the author or co-author of numerous publications, including The Battered Woman, her first book published in 1979 for which she received a Distinguished Media Award from the Association for Women in Psychology. She serves as an assistant editor for a number of major “referee” journals in her field, has delivered several presentations on topics in her field, and consulted with governmental agencies and testified, in criminal and civil cases in thirty states and federal courts, as an expert on domestic violence and the battered women syndrome. [Trial Testimony of Dr. Walker, Vol. II at 3-9; Plaintiffs’ Exhibit 80]. 18. Jean A. Dillon testified at trial, and I found her testimony credible in all respects. She is a counselor for Women’s Resource Center of Monroe County, Inc., a non-profit organization that provides counseling services to battered women, victims of sexual abuse, and children in domestic violence situations. Women’s Resource Center of Monroe County is a member organization of the Pennsylvania Coalition Against Domestic Violence which provides similar services to battered women and children. Ms. Dillon provides protection from abuse accompaniment for battered women and children to courthouses, shelters women in need of a safe house, and spends many hours working on a crisis intervention hotline annually. Also, she is a former victim of spousal abuse. [Trial Testimony of Ms. Dillon, Vol. Ill at 143-165]. 19. Dr. Vincent M. Rue testified at trial as an expert in the areas of problem pregnancy decision-making, marital family relationships, and psychological effects following an abortion. Dr. Rue received a bachelor’s degree in sociology from St. John’s University, a master’s degree in clinical social work from St. Louis University, and doctorate degree in family relations from the University of North Carolina, School of Home Economics at Greensboro. He is co-founder and co-director of the Institute for Abortion Recovery and Research in New Hampshire, and Executive Director of Sir Thomas Moore Clinic in California. In addition, from 1975 to 1980, he was an Associate Professor of Family Relations at the School of Fine and Applied Arts of California State University at Los Angeles, and was an Adjunct Associate Professor at the School of Professional Psychology at United States International University in San Diego. Dr. Rue is a licensed marriage and family counselor in California, and a trained psychotherapist. He is not a psychologist and has never conducted a controlled research study. While Dr. Rue has produced various published works in his field, he has never had any of his work published in a referee journal. Because he is not a physician, Dr. Rue has never provided informed consent for an abortion or any other medical procedure. In addition, he has not conducted any research on the informed consent procedures utilized in abortion clinics in Pennsylvania. [Trial Testimony of Dr. Rue, Vol. II at 143-155; Defendants’ Exhibit 62]. Dr. Rue submitted a study he co-authored with others, The Psychological Aftermath of Abortion, to Surgeon General C. Everett Koop and the House of Representatives Committee on Government Operations as a part of a federal investigation of the medical and psychological effects of abortion which purports to establish the existence of a psychological disorder denominated “post abortion syndrome.” After submission for peer review by scientists with the Center for Disease Control, the National Center for Health Statistics and other scientific institutions, his study was found to have “no value” and to be “based upon a priori beliefs rather than an objective review of the evidence.” See The Federal Role in Determining the Medical and Psychological Impact of Abortion on Women, Committee on Government Operations, H.R. 101-392, 101st Cong. 1st Sess. (Dec. 11, 1989) at 12 [Plaintiffs’ Exhibit 67 at 12]. The Board of Directors of the American Psychological Association, after review of all of the scientific literature, has determined that there are no scientific studies which support the existence of a “post abortion syndrome” as suggested by Dr. Rue. [Trial Testimony of Dr. Rue, Vol. II at 51]. Because Dr. Rue lacks the academic qualifications and scientific credentials possessed by plaintiffs’ witnesses, I conclude that his testimony, which is based primarily, if not solely, upon his limited clinical experience, is not credible. His testimony is devoid of the analytical force and scien-tifie rigor which typified the testimony of plaintiffs’ expert psychologist, Dr. Walker. Moreover, his admitted personal opposition to abortion, even in cases of rape and incest, suggests a possible personal bias. Finally, his testimony concerning informed consent is suspect in light of his lack of direct involvement in obtaining informed consent for any medical treatment or procedure. 20.Dr. Watson Allen Bowes, Jr., testified at trial as an expert in the fields of high risk obstetrics and maternal fetal medicine. He is qualified to testify as an expert in these fields, and I found his testimony credible in certain respects but subject to certain limitations caused by his admitted philosophical opposition to abortion. In addition, because Dr. Bowes is not a certified specialist in emergency medicine, like Dr. Davidson, his testimony on issues pertaining to this area is not entitled to the same weight as the testimony of Dr. Davidson. Dr. Bowes is a physician licensed to practice medicine in North Carolina and Colorado. He received his bachelor’s degree from Washington and Lee University in 1955 and graduated from the University of Colorado School of Medicine in 1959. Dr. Bowes completed his internship at Mary Hitchcock Memorial Hospital, his residency (general practice) at the University of Colorado, and his residency (obstetrics and gynecology) at the University of Colorado School of Medicine. In addition, he was a Fellow in Obstetrics and Gynecology, Reproductive Physiology Laboratory at the University of Colorado School of Medicine. Dr. Bowes is certified by ACOG, as well as ACOG’s Division of Maternal-Fetal Medicine. He is presently a Professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine at Chapel Hill. Previously, he taught obstetrics and gynecology at the University of Colorado as an assistant professor, associate professor and full professor. Finally, he is the author of various publications in his field. [Trial Testimony of Dr. Bowes, Vol. Ill at 25-32; Defendants’ Exhibit 61]. 21. Patricia Potrzebowski, Ph.D., testified at trial, and I found her testimony credible in all respects. She is the Director of the Division of Health Statistics and Research, State Health Data Center, Department of Health. She has a bachelor’s degree in biology from Schimer College, Mount Carroll, Illinois. In 1974, she obtained a doctorate degree in human genetics from the Graduate School of Public Health from the University of Pittsburgh. She has been the Director of the Division of Health Statistics since late 1976 or early 1977. [Trial Testimony of Dr. Potrzebow-ski, Vol. Ill at 88-90; see also Casey I, 686 F.Supp. at 1094 (¶14)]. B. Procedures and Practices of Plaintiffs. (1) Planned Parenthood of Southeastern Pennsylvania 22. PPSP performs approximately 2,800 first trimester abortions a year. The abortion procedure presently costs full payment patients $240, if the woman is 12 weeks or less from her last menstrual period. All fees cover only the direct costs of the procedure, including personal counseling, medical testing and examination, the abortion procedure, medical supervision during the post-surgical recovery, and a post-abortion examination. [Court’s Exhibit 1 at 113]. 23. PPSP charges $180 for abortions for women who are on medical assistance but whose abortions are not reimbursable by the state. [Court’s Exhibit 1 at 114]. 24. PPSP accepts state medical assistance reimbursement in lieu of direct payment for abortions for victims of rape and incest, and for women with life-threatening conditions. In 1987, approximately 53 of the abortions performed at PPSP were reimbursed by the Commonwealth. [Court’s Exhibit 1 at II 5]. 25. When a woman believing she is pregnant presents herself at a PPSP clinic, she is given a pregnancy test and examined by a nurse practitioner or physician. Women who believe they have just recently become pregnant are offered early detection by means of a blood test or special urine test. Once it is determined that she is pregnant, the woman is encouraged to participate in an individual options counseling session with a PPSP counselor. [Court’s Exhibit 1 at ¶ 7]. 26. Options counselors are volunteers or staff counselors who have completed a special training program under the supervision of PPSP counselors and other senior staff members. This training program consists of 43 hours of group sessions that focus on factual information regarding adoption, abortion, contraception and referral resources. The course also gives participants the opportunity to evaluate, explore and share their attitudes and feelings. The course is certified by Temple University, and participants receive four CEU credits for completion of the training. [Court’s Exhibit 1 at II8]. 27. Abortion counselors are members of PPSP’s counseling staff or college student interns working under the supervision of a staff counselor. These counselors have college backgrounds and experience in a health or social services related field. All abortion counselors have had on-site training in pregnancy counseling and abortion care and are required to participate in ongoing in-service training. [Court’s Exhibit 1 at II 9]. 28. Each PPSP client participates in an individual abortion counseling session on the day her procedure is scheduled. In this session, the counselor and the woman discuss the woman’s medical history, personal situation and feelings about abortion. The counselor explains the abortion procedure and its risks. Post-abortion care and contraceptive plans are also explored. If the client has been accompanied to the clinic by a person she wishes to involve in the counseling, that person will be included in part of this session. In some cases the abortion counselor will serve as the support person and accompany the woman through the procedure. [Court’s Exhibit 1 at 1110]. 29. To assure that minors are informed of all options and are making a free and informed choice, PPSP counseling sessions for minors are more extensive. In the course of the counseling session, minors are given detailed information on the procedure and its risks. Minor women are also counseled on future contraceptive care. When a minor does elect to involve a parent or other supportive adult such as an aunt, guardian or older sibling, the counsel- or will first meet privately with the minor. Then, at the counselor's discretion and with the minor’s consent, the parent or adult will be brought in for joint counseling. [Court’s Exhibit 1 at ¶ 11]. 30. Many of PPSP’s abortion patients come from referrals from other clinics where they previously have received options counseling. [Court’s Exhibit 1-A at 11115]. 31. During options counseling at PPSP, the counselors discuss with the woman the option of keeping her baby or giving it up for adoption. [Court’s Exhibit 1-A at 11116]. 32. It is typical for a woman to receive counseling about her options once she has her pregnancy diagnosed at one of PPSP’s centers, and to receive counseling again at the surgical center in Center City. [Court’s Exhibit 1-A at H 123]. 33. In 1987, PPSP performed 359 abortions for women under the age of 18. [Court’s Exhibit 1 at ¶ 6]. 34. PPSP encourages minors to bring a parent with them. [Court’s Exhibit 1-A at 11114]. 35. Approximately 65% of the minors bring a parent with them to the counseling session in PPSP’s experience. [Court's Exhibit 1-A at ¶ 117]. 36. PPSP refers women with medical problems that make them high-risk patients to hospitals. [Court’s Exhibit 1-A at II113]. 37. PPSP advises minors (and others) that if anything unusual or any sort of complications occur to let PPSP know and come back for treatment or to go to an emergency room for treatment. [Court’s Exhibit 1-A at If 124]. 38. PPSP collects information for its internal use concerning medical complications following an abortion. [Court’s Exhibit 1-A at 11122]. (2) Reproductive Health and Counselling Center 39. RHCC performs approximately 2,900 first and early second trimester abortions annually. [Court’s Exhibit 1 at 1112]. 40. RHCC employs a staff of approximately four physicians, one nurse practitioner, and two full-time and two part-time counselors. Abortions are performed on Tuesday, Wednesday and Friday afternoons. Additional counseling sessions are available by appointment. [Court’s Exhibit 1 at ¶ 13]. 41. At RHCC, one physician works at a time during those hours of operation when abortions are performed. [Court’s Exhibit 1-A at ¶ 141]. 42. First trimester abortions (up to 12 weeks from the last menstrual period) with local anesthesia cost RHCC clients $220. For abortions from 12 to 16 weeks from the last menstrual period the cost is $375, plus an additional $70 for a required ultrasound. [Court’s Exhibit 1 at H 14]. 43. If RHCC’s clients are eligible for medical assistance reimbursement, RHCC seeks reimbursement from the Commonwealth. In 1987, RHCC was reimbursed for no more than 20 such abortions. The reimbursement rate was $59.50 to the clinic and $81.50 to the physician. [Court’s Exhibit 1 at ¶ 15]. 44. Where a client receives medical assistance from the state but is not eligible for medical assistance for an abortion, RHCC provides a $50 cost reduction for first trimester abortions with local anesthesia. [Court’s Exhibit 1 at II16]. 45. While RHCC’s clients come primarily from Delaware, Philadelphia, Chester and Bucks Counties, approximately 3-4% of its clients come from areas in excess of three hours travelling time. [Court’s Exhibit 1 at II17]. 46. A woman’s first contact with RHCC is usually by telephone. Women who call RHCC may or may not have had a pregnancy test prior to calling. Telephone counselors refer the women to RHCC or to the agency closest to her home or place of work for the test. [Court's Exhibit 1 at H 19]. 47. If a woman has a positive pregnancy test and wants to terminate the pregnancy, RHCC will schedule an abortion appointment, usually within one week’s time. If the woman indicates uncertainty about her decision, the telephone counselor will recommend her making an appointment to talk further with an options counselor about her decision. [Court’s Exhibit 1 at 1120]. 48. At an options counseling session, an RHCC counselor talks with the woman about her feelings about her pregnancy. The purpose of the session is to let the woman know about each of the three options available to her: carrying to term and keeping the child, carrying to term and giving the child up for adoption, and abortion. Where appropriate, the woman is urged to talk about these options with supporting family members and friends. The role of the counselor in these sessions is to support the decision of the woman and to provide information that would be necessary as she acts on her decision. [Court’s Exhibit 1 at U 22], 49. Pre-abortion counseling at RHCC, which each woman must participate in on the day of her abortion and which is different from options counseling, involves a discussion of the woman’s decision, a review of her medical history and a description of the risks and complications of the abortion procedure. The informed consent part of the session is done with groups of four women. The counselor describes the medical procedure, reviews the risks and complications, and answers questions or addresses concerns. RHCC also provides counseling to the person or persons who accompany women for abortions. [Court’s Exhibit 1 at 11 23]. 50. Pre-abortion and options counselors are trained and supervised by RHCC’s head counselor who has nine years counseling experience. [Court’s Exhibit 1 at II24]. 51. Telephone counselors’ salaries at RHCC are between $6 and $6.30 an hour. For options counselors, salaries begin at $6.30 an hour. [Court’s Exhibit 1-A at 11134]. 52. RHCC counselors are not required to have a bachelor’s degree. [Court’s Exhibit 1-A at 11135]. 53. If a woman receives options counseling and pre-abortion counseling at RHCC, such counseling occurs on different days, with options counseling being available on Tuesdays and Thursdays. [Court’s Exhibit 1-A at ¶ 136]. 54. In 1987, RHCC performed abortions on 349 minors. Approximately 60% of these minors were accompanied by a parent. That percentage has decreased to approximately 50%. All minors who choose not to be accompanied by a parent are required to bring a responsible adult with them to RHCC who will stay in the building as long as the minor is there and will accompany the minor home. [Court’s Exhibit 1 at II18; Court’s Exhibit 1-A at 145]. 55. RHCC strongly urges options counseling for all minors who have not involved their parents in the decision. [Court’s Exhibit 1 at ¶ 21]. 56. In general, RHCC supports and encourages parental involvement in the abortion decision where possible. [Court’s Exhibit 1-A at 11137]. 57. If a parent accompanies a minor to RHCC for the abortion procedure, the minor reviews the risks and informed consent provision in the group session while the waiting room counselor goes over that information, including possible complications, with the parent. [Court’s Exhibit 1-A at ¶ 138]. 58. RHCC keeps statistics on complications. [Court’s Exhibit 1-A at ¶ 139]. 59. The Medical History Form used by RHCC was being used prior to the 1988 amendments to the Act. [Court’s Exhibit 1-A at 11142], 60. RHCC submits quarterly reports of complications to the National Abortion Federation. [Court’s Exhibit 1-A at ¶ 143]. 61. Doctors at RHCC sign the individual reporting forms (Report of Induced Termination of Pregnancy) submitted to the Pennsylvania Department of Health (“Pa-DOH”) immediately following the abortion procedure. [Court’s Exhibit 1-A at 11144]. 62. No physician at RHCC has ceased performing abortions because their identity is listed on PaDOH pregnancy termination forms. [Court’s Exhibit 1-A at 11140], (3) Women’s Health Services and Dr. Allen 63. WHS has a staff of approximately 75 people (including 8 physicians, 14 nurses and 33 counselors) and offers ongoing programs which are inclusive of approximately 2,700 client contacts a month. [Court’s Exhibit 1 at 11 25]. 64. Free pregnancy testing and counseling are available at WHS daily, Monday through Saturday. Abortions are performed Tuesdays, Fridays and Saturdays. Gynecology clinics are held on Wednesdays, Thursdays, and any other day a patient’s condition dictates. Once their pregnancy is diagnosed, clients usually schedule their abortions by telephone. [Court’s Exhibit 1 at 1126]. 65. WHS provides approximately 12,900 free pregnancy tests and 7,000 first trimester and early second trimester abortions each year. The abortion procedure at WHS costs as follows: $330 if twelve weeks or less from the last menstrual period; and $430 if thirteen to fourteen weeks from the last menstrual period; and $650 if fifteen to sixteen weeks from the last menstrual period. The fee includes the abortion procedure, laboratory testing, personal counseling, contraceptive care, pathological examination and medical supervision during the post-surgical recovery period. [Court Exhibit 1 at 11 27]. 66. WHS does not perform abortions after 17 weeks gestation. [Court’s Exhibit 1-A at II 85], 67. If clients are eligible for medical assistance, WHS takes the necessary information and seeks reimbursement from the Commonwealth. Medical assistance is available only where the abortion is necessary because of the life-threatening condition, or because the patient was a victim of rape or incest. In 1989, WHS was reimbursed for 46 such abortions. [Court’s Exhibit 1 at ¶ 28]. 68. Where a client receives medical assistance from the state, but is not eligible for medical assistance for an abortion, WHS nevertheless will discount the cost of the abortion. Last year, WHS accommodated 1,170 clients who were unable to pay the full amount. WHS has never turned away any client seeking an abortion merely because of inability to pay. [Court’s Exhibit 1 at II 29]. 69. WHS’s clients come primarily from Allegheny County. In 1989, however, 909 of their abortion patients came from areas in excess of two hours travelling time (100 miles) from the clinic. [Court’s Exhibit 1 at 1130], 70. When a patient presents herself at the WHS clinic, she receives a pregnancy test and blood tests. [Court’s Exhibit 1 at 1132]. 71. As to WHS, free pregnancy tests and counseling are available Monday through Saturday, but 95% of counseling services are provided on the same day of the abortion. [Court’s Exhibit 1-A at 11110]. 72. Both Magee and WHS take a patient’s history prior to performing the abortion. [Court’s Exhibit 1-A at 1190], 73. In Dr. Allen’s private practice, a patient completes a history form, which is a sort of health questionnaire, which is then amplified by a nurse’s questions and further amplified by the physician when he sees her. [Court’s Exhibit 1-A at 11 91]. 74. At WHS, the patient completes the history form, which is gone over by a counselor, and then the physician reviews it prior to performing the abortion. [Court’s Exhibit 1-A at 1192], 75. All women are required to have an individual interview with a counselor on the day of their abortion. During this interview, a woman is counseled with respect to her options and her decision to have an abortion. Information regarding the risks and benefits of the abortion procedure and the patient’s medical history is provided to her. In that connection, the counselor seeks to ensure that the woman is not unduly ambivalent about her decision and that she is not being coerced. In addition, the counselor discusses future contraceptive use with the patient. [Court’s Exhibit 1 at II 33]. 76. If the client appears ambivalent about her decision, the counselor will refer her to one of the.staff therapists and the abortion will be rescheduled to give the patient more time to consider her options. On rare occasions, the clinic will refuse to perform the abortion, if convinced of the patient’s continued ambivalence. [Court’s Exhibit 1 at 11 34]. 77. Options counseling is provided on the day of the procedure by WHS professional counselors who are selected on the basis of personal qualifications and maturity. [Court’s Exhibit 1 at 1136]. 78. Extensive and intensive problem pregnancy counseling is available at WHS at no charge to clients either before or after a decision with respect to an abortion has been made, regardless of what that decision may be. Personal counseling is also available after the abortion procedure and clients are encouraged to take advantage of that service. [Court’s Exhibit 1 at II37], 79. At WHS, the average counseling takes 20 minutes. [Court’s Exhibit 1-A at 11102], 80. In 1989, 703 of WHS’s abortion patients were under the age of 18. WHS presently encourages minors to bring a parent or other adult with them. Because WHS believes that parental involvement should be encouraged, clinic counselors are instructed to offer to speak with the minor’s parents, if the minor would prefer that to making direct contact herself. When minors refuse to inform their parents under any circumstances, their wishes are currently respected. [Court’s Exhibit 1 at 1131]. 81. Fifty percent of the minors who go to WHS are accompanied by a parent. When a parent accompanies a minor seeking an abortion, WHS first counsels the minor with respect to her options and her decision to have an abortion, and also provides her with information on future contraceptive use. The parent is then asked to join the minor, at which time the abortion procedure and possible complications are described. The counselor also answers any questions they might have. An informed consent form is then read out loud to the parent and minor while they follow along with their own copies. Each then signs the form in the medical record. [Court’s Exhibit 1 at 1135; Court’s Exhibit 1-A at HU 97, 101], 82. No abortion can be performed on a minor at Magee without a parent’s written consent. [Court’s Exhibit 1-A at If 94]. 83. Approximately 30% of Dr. Allen’s patients seeking abortions are minors. [Court’s Exhibit 1-A at †[ 95]. 84. If a parent comes with a minor for an abortion procedure at Magee, Dr. Allen will speak to the parent too. If a parent comes with a minor for an abortion procedure at WHS, a counselor speaks to the parent. [Court’s Exhibit 1-A at H 96], 85. At present, WHS’s director of personal counseling holds a Ph.D. [Court’s Exhibit 1 at If 38]. 86. Personal counselors at WHS are professional therapists who have at least five years of clinically supervised experience at the master’s degree level or above. [Court’s Exhibit 1 at If 39]. 87. Both paraprofessional and professional counselors at WHS are required to begin their employment with a week of classroom preparation, consisting of approximately 35 hours of medical and counseling orientation*to the abortion clinic. This instruction is provided by the associate medical director, director of counseling, and director of clinical services. [Court’s Exhibit 1 at 1140]. 88. The medical information to be presented by counselors at WHS is .developed under the supervision of a physician, the WHS associate medical director. The counseling protocols are developed and presented under the supervision of the director of counseling who holds a Ph.D. from the University of Pittsburgh. WHS also has an ongoing training module comprised of monthly inservices and quarterly individual supervision. [Court's Exhibit 1 at 1141], 89. Dr. Allen always does some counseling with his patient prior to the procedure and goes over the informed consent form with them. [Court's Exhibit 1-A at 1f 89]. 90. Dr. Allen signs PaDOH reporting forms for Magee but WHS uses his signature stamp for such forms. [Court’s Exhibit 1-A at ¶ 93]. 91. WHS has a hot-line for women to call if they have any unusual symptoms or problems after an abortion to make sure there is immediate treatment. [Court’s Exhibit 1-A at ¶ 103]. 92. WHS provides information to the National Abortion Federation and the Alan Guttmacher Institute, including information concerning complications and the frequency that WHS’s patients report to them or WHS observes them. [Court’s Exhibit 1-A at If 105]. 93. If a medical emergency resulting from an abortion performed at WHS occurs, an ambulance is called to take the person to the hospital. [Court’s Exhibit 1-A at 11 111], (4) Women’s Suburban Clinic 94. WSC performs approximately 3,350 first trimester abortions a year. Abortions are performed Tuesdays, Wednesdays and Thursdays. [Court’s Exhibit 1 at 1143]. 95. The fee for an abortion at WSC is $275. At present, WSC accepts state medical assistance reimbursement for abortions for cases of rape, incest and life endangerment. Approximately 40 such claims are reimbursed by the Commonwealth annually. [Court's Exhibit 1 at 1145]. 96. Appointments for counseling and abortions are made through WSC telephone counselors. A positive pregnancy test is required before an abortion is scheduled. [Court’s Exhibit 1 at ¶ 46]. 97. The telephone counselors at WSC make appointments and receive clients but they do not counsel about pregnancy options. [Court’s Exhibit 1-A at ¶ 125]. 98. Depending on the patient interest and availability, appointments are made at WSC in one of the following ways: a. If a woman requests counseling and the abortion on the same day, the first available appointment is given. There is often a one to two week wait in obtaining an appointment. Approximately 70% of the abortion appointments are scheduled this way. b. If a woman wants to see a counselor prior to the day of her abortion, a pre-abortion session is scheduled. Approximately 30% of the abortion appointments are scheduled this way. [Court’s Exhibit 1 at 1147], 99. A woman who calls WSC and expresses concern and confusion over an unwanted pregnancy is offered an opportunity to see a counselor to discuss her options. Resource information is available for options including keeping the child, foster care and adoption. Information concerning maternity homes is also available for those women who wish to carry their pregnancy to term. [Court’s Exhibit 1 at ¶ 49]. 100. All counseling at WSC is provided on an individual basis by a trained counsel- or. All but one member of WSC’s counseling staff have master’s degrees. The other has a bachelor’s degree with several years experience in counseling and family planning. All have backgrounds in various fields of human services. [Court’s Exhibit 1 at II 50]. 101. It is WSC’s policy that in order to counsel effectively, without becoming overstressed by the emotional demands of the job, counselors are not permitted to provide counseling for more than 20 hours a week. [Court’s Exhibit 1 at II 51]. 102. WSC encourages that partners and/or parents be seen by the counselor during or after the counseling session. However, all clients are first seen alone by a WSC counselor. [Court’s Exhibit 1 at ¶ 52], 103. Counseling at WSC is provided in an objective, nonjudgmental manner. The client’s decision is reviewed and explored. The counselor also reviews the client’s medical history, describes the abortion procedure, reviews birth control methods and goes over the informed consent form. Disclosure of medical risks and benefits is made as well. Also, post-abortion information, including what to do in the event of an emergency, is reviewed. [Court’s Exhibit 1 at ¶ 53]. 104. For women who express ambivalence over their abortion decision, the WSC counselor will further explore the issues. If the counselor feels that the woman is not sure of her decision, it is suggested that she take some time to reevaluate her choice. Additional counseling is available to assist the woman to come to a decision with which she feels comfortable. [Court’s Exhibit 1 at H 54], 105. Counselors at WSC start at $8.50 per hour and are all part-time employees. [Court’s Exhibit 1-A at ¶ 126]. 106. Of the approximately 3,350 abortions WSC performed in 1987, 410 (12.25%) were performed on minors. [Court's Exhibit 1 at 1144], 107. WSC encourages minors to attend with a parent. [Court’s Exhibit 1-A at ¶ 127]. 108. All minors who have not informed a parent about their decision to have an abortion are asked to come to WSC for precounseling before the abortion appointment. This is done to give adolescents the opportunity to explore with a counselor their reasons for not involving their parents and affords them the time and opportunity to reevaluate that decision prior to the abortion. [Court’s Exhibit 1 at ¶ 48]. 109. If a parent comes in with a minor to WSC, the minor is first seen alone by the counselor and then the parent joins the counseling session. [Court’s Exhibit 1-A at 11130]. 110. WSC does not perform abortions due to medical emergencies defined by the Act or otherwise. [Court’s Exhibit 1-A at n 128]. 111. If an emergency occurs when performing an abortion at WSC, a crash cart is used to stabilize the woman and then, in all probability, the woman would be transferred to a hospital based upon the physician’s or medical director’s decision. [Court’s Exhibit 1-A at 11129], 112. WSC maintains or collects internal data regarding complications that occur during the performance of abortions. [Court’s Exhibit 1-A at 11133]. (5) Allentown Women’s Center 113. AWC provides approximately 5,300 pregnancy tests and 4,000 first trimester abortions each year. [Court’s Exhibit 1 at 1156]. 114. Abortions are performed at AWC three to five days a week, depending on patient need. [Court’s Exhibit 1 at ¶ 57]. 115. The abortion procedure at AWC costs $280, with additional charges for services such as RhoGam shots for women more than twelve weeks pregnant, and general anesthesia. The fee includes personal counseling both before and after the abortion, the abortion procedure, laboratory testing, and medical supervision during the post-surgical period. [Court’s Exhibit 1 at ¶ 58]. 116. For patients who receive medical assistance from the Commonwealth, AWC’s fee for abortion is $225. [Court’s Exhibit 1 at 11 59], 117. In the case of those medical assistance patients who require an abortion because of a life-threatening disease or because they were victims of rape or incest, AWC has received reimbursement from the state, so that no fee was charged directly to the patient. In 1987, AWC received less than $4,000 in medical assistance funds. [Court’s Exhibit 1 at ¶[ 60]. 118. AWC’s patients come primarily from an 18-county area in northern Pennsylvania encompassing the counties of Le-high, Northampton, Carbon, Schuylkill, Lu-zerne, Lackawanna, Lebanon, Berks, Bucks, Pike, Chester, Lancaster, Susqueha