Florida Abortion Clinics Are Struggling To Stay Open

FORT LAUDERDALE, Fla. — Eileen Diamond was going over patient intake forms in her small office next to the waiting room at the abortion clinic she oversees in South Florida.

“This patient said not to discuss the cost of the procedure when her boyfriend is in the room,” she told a fellow staff member. Diamond is the director of Benjamin Surgical Services International, whose doors have been open for nearly 50 years in the Fort Lauderdale area.

“This one has no money, but she’s getting close to six weeks,” the staff member read off another sheet.

“This one already has three kids and is on probation, she needs to get in front of a judge ASAP.” “This one texted me from the waiting room, she can’t afford the ultrasound.” “This one has a fetal abnormality but just called ― it’s too overwhelming to travel with her kids, she’s continuing the pregnancy.” “This one’s 16 years old.”

Diamond and the staffer went back and forth for several minutes, discussing which of their patients they’d be able to provide care for under the state’s six-week abortion ban. So many patients call the clinic in a panic that Diamond and the staffer have dubbed themselves the “C.R.O. Queens” ― “come right over,” they tell any patient who calls. “Every minute counts,” Diamond said.

It’s a dreaded but common part of their daily routine since Florida enacted the extreme six-week restriction on May 1. Since then, Diamond estimates they’ve turned away 200 patients who were too far along in their pregnancies to get care. And that’s just the ones who made it to the clinic: One staffer who answers the phones told HuffPost she turns away between 30 and 40 callers a week. A six-week abortion ban is essentially a total ban; most people with regular menstrual cycles won’t take a pregnancy test until about the four-week mark, once they’ve missed their period. This leaves a week or two to access an abortion. For those with irregular cycles, it could take longer.

The past two years have been hellish for people like Diamond who work within the shrinking ecosystem of abortion care in Florida. Many abortion clinics are hanging on by a thread. Restricting care to six weeks has meant fewer patients, which means less income for the clinic. That necessitates sweeping budget and staff cuts that can eventually lead to a clinic shuttering for good. Many clinic staffers told HuffPost it feels as though the walls are closing in on them.

Florida was once a safe haven for abortion care, even in the immediate aftermath of the Supreme Court’s Dobbs decision that overturned Roe v. Wade. But nearly half of the country has criminalized abortion in the two years since, and Florida has enacted its six-week ban. In the two months after Florida’s ban went into effect, the state saw a 575% increase in people looking to travel out of state for care, according to new data from the National Abortion Federation.

Some people are optimistic about a November ballot measure that seeks to restore access until the point of fetal viability. It would be a monumental win for advocates if the measure passes, re-establishing the state as a critical safe haven in the Southeast, where most states have near-total abortion bans.

But even if the pro-choice measure succeeds, some abortion clinics might not be around to see it enacted. The amendment, if passed, wouldn’t restore access until early next year ― effectively an eternity for many small clinics already struggling to pay the bills just four months after the six-week abortion ban went into effect.

Abortion clinics in Florida are also contending with the formidable Republican machine that is the state government. Gov. Ron DeSantis and his GOP supermajority have created one of the most conservative bastions in the country: the nexus of culture wars waged against so-called woke-ism, transgender kids and abortion rights.

The hostility from politicians and anti-choice advocates “has always existed around abortion, but it has reached a fever pitch since the Dobbs decision,” said Dr. Chelsea Daniels, an abortion provider with Planned Parenthood South, East and North Florida. Under DeSantis’ leadership, the state passed a 15-week abortion ban with no rape and incest exceptions, and later the six-week ban that included a $25 million annual allotment of taxpayer money to anti-abortion, faith-based pregnancy centers that are unregulated. Even some state agencies are combative toward the very clinics they are responsible for licensing. Florida abortion clinics are flooded with a kind of fear and anxiety many of them have never known.

Sitting in her office, Diamond recounted some of the violence she has experienced in her 30 years working at different abortion clinics in Florida. She survived a butyric acid attack in one of her clinics. At another, she discovered a fake bomb planted underneath her car. There was recently an arson attempt at the BSSI clinic, but the attacker got the suite number wrong and set fire to their neighbor’s office. (“The hurricane doors we had ordered for this very reason hadn’t arrived yet,” she said. “Now our neighbors have them too.”)

Diamond has experienced some truly frightening violence, but she said she’s more terrified now than she has ever been.

Independent clinics, like Diamond’s, are abortion facilities that don’t belong to a national federation or don’t have an affiliation outside of their community, like Planned Parenthood. They’re independently owned, community-based clinics whose main service is abortion care.

They’re like your local bookstore or hardware store. When business is slow, the local hardware store is much more vulnerable to closing its doors than Home Depot or Lowe’s. Despite how small they are, indie clinics provide 55% of all abortion care in the U.S., according to 2023 research.

Abortion clinics are also competing with deceptive faith-based pregnancy centers, which are funded by the state government and often lie to women about how far along they are in order to prevent them from accessing abortion care. There are three times more fake abortion centers than actual abortion clinics in the state of Florida.

“We can’t take for granted that independent clinics can just hang on for months and remain open under the six-week ban … Once they close, they’re typically gone for good,” said Jay Thibodeau, communications director at Abortion Care Network, the national association for independent abortion clinics.

Florida state agencies tasked with enforcement of abortion bans have become increasingly hostile toward clinics ― especially small, independent clinics that don’t have the resources to fight back. To some, it feels as though the state knows just how vulnerable they are.

“If they can make independent clinics seem like they’re not safe or not following laws, or burden them with fines they can’t pay ― then they win. And they don’t have to necessarily ban abortion if clinics are shutting down,” one volunteer with the Orlando group Stand With Abortion Now told HuffPost. SWAN is best known for racking up millions of views on TikTok when its volunteer escorts talk back to clinic protesters.

Sources in abortion care told HuffPost it feels as though they are forced to report to and rely on institutions that are opposed to their very existence. Florida’s Agency for Health Care Administration, tasked with the licensing and inspection of clinics, changed its own regulatory rules under the 15-week abortion ban and didn’t notify clinics, according to multiple sources. AHCA quietly moved the regulatory line from allowing clinics to provide care up to 15 weeks and six days to 15 weeks and zero days.

Republicans wrote the abortion ban vaguely ― never clarifying if clinics could provide care up to 15 weeks, or through 15 weeks ― which led to certain facilities being penalized by AHCA for reasonable interpretations of the law.

Instead of announcing the change, AHCA carried out surprise inspections and handed down fines to any clinic not complying with this new, unannounced rule. This change happened a month or two before the six-week ban took effect, according to multiple sources. People working in abortion in Florida were so terrified of retaliation that many only agreed to speak with HuffPost if they remained anonymous.

Some speculated that AHCA is tasked with shutting down abortion clinics on orders from the anti-choice Republican powers that be, describing the state agency as “not good-faith actors” and “politically motivated.”

“They’re trying to force an error,” one source who works at an abortion clinic said. “They’re trying to dismantle the clinic structure.”

When DeSantis signed the 15-week abortion ban into law at a central Florida megachurch, Simone Marstiller, the head of AHCA at the time, spoke at the rally in support of the restriction. Marstiller’s presence was a “shocking conflict of interest,” Florida state Rep. Anna Eskamani (D) told HuffPost.

Alecia Collins, a spokesperson for AHCA, told HuffPost via email that “there is nothing political about the agency following its duties to protect the health, safety, and welfare of patients and residents.”

“The top priority for the agency is to protect the safety of the mother and her child, and the state’s laws reflect this commitment,” Collins continued. “The agency’s position has always reflected the plain language of the statute. Prior to May 1, 2024, Florida law clearly provided that apart from saving the life of a pregnant woman or preventing serious injury to them, the last day to legally perform an abortion was 15 weeks; it did not say 15 weeks and six days.”

Enforcement of abortion regulations ultimately comes down to the inspector assigned to oversee a certain clinic. If that inspector is friendly, there are usually no major issues, but if the inspector is combative or personally anti-abortion, it can spell doom for a clinic. Some sources believe that this is likely what happened with the move from 15 weeks and six days to 15 weeks flat — that one hard-line inspector decided the agency should only allow abortion up to 15 weeks, and the rest of the agency had to play along. If that’s the case, the subjectivity of the licensing and regulation process is nearly as terrifying as the idea of a politically motivated state agency.

Multiple sources told HuffPost that the scrutiny from AHCA and the general fear of working in abortion care is at an all-time high for Florida clinics.

“At one time, inspections were once a year,” said Mona Reis, founder of the Presidential Women’s Center, a group of independent abortion clinics in South Florida. Then the inspections started coming twice a year, and now “it’s the highest it’s ever been,” she said. Reis, dubbed Florida’s “godmother” of independent abortion clinics, recently retired but still stays in contact with clinic staff.

A month or two after an abortion law goes into effect, AHCA normally conducts surprise inspections to ensure clinics are in compliance with the new law. Like clockwork, inspectors visited every abortion clinic in the state a month or so after the six-week ban went into effect in May.

Some clinic workers said that AHCA inspectors openly intimidated clinic staff, attempting to isolate them and ask questions about recent patients. Some inspectors asked for a list of patients who were turned away because they were too far along, seemingly trying to surveil pregnant folks who may have left Florida to get care in another state, or sought out abortion pills by mail. Hearing this from neighboring clinics, one staffer blacked out the names on all intake forms of patients who were past six weeks, in anticipation of an inspection. All of the sources who spoke with HuffPost were found to be in compliance with the new law and did not receive any citations.

“You change the goalposts in the middle of providing services, you’re gonna catch people that you can fine later,” Eskamani told HuffPost.

“Republicans weaponize almost every state agency for all parts of their agenda,” she said. “Using fines as a tool of punishment is not new to government, especially in the fight for abortion.”

In 2022, a new abortion restriction went into effect: Patients had to wait 24 hours between their first consultation with a physician and a second appointment when they got an abortion. A month after the 24-hour waiting period went into effect, AHCA carried out spot inspections at clinics throughout the state.

Julie Murano, who works at an independent abortion clinic in Orlando, said she had been calling AHCA every day for two weeks during this time asking whether the new restriction was in effect. The law was passed in 2015, but there were various legal battles that stretched on for years, making the actual date of enforcement somewhat confusing. It was also a chaotic time: The 24-hour waiting period went into effect shortly before the 15-week ban, and right around the same time that Roe fell. Every time Murano called, AHCA declined to offer any information.

“I asked them if the law had gone into effect yet, if they had any information as to when it was going to go into effect. All they could tell me was: ‘We know the law has passed, but we don’t have any other further information at this time,’” Murano, the human resources director at the Center of Orlando for Women, told HuffPost.

When AHCA conducted an inspection at Murano’s clinic, the agency found that the facility had provided 193 abortions without enforcing the 24-hour waiting period. An administrative judge recommended in January 2023 that the clinic pay a $67,550 fine ― much less than the maximum penalty ― and acknowledged the clinic’s efforts to get information from AHCA during this time. But AHCA, which has final say on penalties, ordered the clinic to pay $193,000, the maximum fine permitted.

The fine was so large that it “would likely force the clinic into bankruptcy or closure,” an attorney for the clinic said at the time. The only way the clinic was able to keep its doors open was by crowdfunding from the public. “This is a transparent attempt to bankrupt the clinic in order to further limit access to abortion in a state that desperately needs it,” the group wrote on the fundraising page. With the help of SWAN, the Orlando clinic raised $221,000 to pay the fine and keep their doors open.

At one point during my conversation with Diamond at the BSSI clinic, a staffer ran into the room and announced: “Inspection!” The color drained from Diamond’s face. She exchanged an uneasy look with the physician I was also speaking to, and they followed the staffer out.

When Diamond returned, she let out a low sigh of relief and said it was just a fire inspection. The physician in the room laughed and said, “You can’t just say ‘inspection’ around here.”

Murano is deeply worried about the future of the Orlando clinic and its sister clinic in Tampa. Both clinics are barely bringing in enough income to keep their doors open. They’ve crowdfunded only $10,000 of the $500,000 needed for the Orlando clinic to stay afloat, and the Tampa clinic has barely raised any money. They’ve had to lay off staff and cut other expenses, too. The Orlando clinic used to have an off-duty police officer at the facility three times a week because of the anti-choice protesters who harass and surveil patients and staff outside the clinic. Since the six-week ban, they can no longer pay for the officer.

Violence is another everyday challenge that many Florida abortion clinics face. Multiple staffers said they believe the Dobbs decision emboldened anti-choice advocates and intensified the harassment and surveillance at clinics.

At Murano’s Orlando clinic, patients are harassed walking into the facility, and anti-abortion pregnancy centers set up mobile sonogram buses to try to confuse patients. Some protesters follow providers and staff to their cars, taking photos of their license plates. The clinic escort with SWAN said it’s standard practice for the group to wear face masks while working so protesters can’t identify them and find out where they live. Last month, a protester spat on a SWAN escort; police found a gun strapped to his ankle after he was detained.

The threat of violence is even worse at the Tampa abortion facility. There are more protesters in Tampa, but the real issue is that law enforcement is not helpful, Murano said. “I’ve personally called 911 three or four times in one day and an officer never even showed up,” she told HuffPost, referring to an incident that happened in December 2023. “The protesters were coming on the property, telling us that they were going to blow up the building, that they were going to kill us all, and not one police officer came out after repeated calls. Even our patients were calling them.” (The Tampa Police Department did not respond to HuffPost’s request for comment.)

There may be a light at the end of the tunnel for abortion rights advocates in Florida. Amendment 4, which Floridians will vote on in November, seeks to create a constitutional right to abortion before fetal viability (somewhere around 22 to 24 weeks). The measure also creates an exception beyond viability for when an abortion is “necessary to protect the patient’s health.” If the amendment passes, it would likely take effect in early 2025 and be a huge lifeline of care for the entire Southeast.

Floridians Protecting Freedom, the coalition behind the pro-choice ballot measure, has raised around $40 million, a spokesperson for the group told HuffPost. They’ve hosted dozens of door-knocking and phone banking events around the state.

“The future of abortion rights and clinics in Florida depends on voters passing Amendment 4 this November,” Diamond said.

Lauren Brenzel, Floridians Protecting Freedom campaign director, is optimistic, but acknowledges that there are still many battles ahead. After getting the ballot language approved in April by one of the most conservative state supreme courts in the country, anti-choice Republicans are still trying to mislead voters by approving a deceptive financial impact statement that will appear alongside Amendment 4. The measure must get at least 60% of the vote rather than a simple majority, and even if it’s successful, pro-choice advocates are steeling themselves for continued legal battles from Republicans.

State Senate Minority Leader Lauren Book (D), an outspoken abortion rights advocate, has promised to fundraise an additional $60 million with her heavyweight Palm Beach donors, many of whom are Republican women, to pass the pro-choice measure. “They all, on principle, are behind Amendment 4, even if they vote Republican on everything else,” Book said.

It’s an odd dynamic in a state where registered Republicans outnumber Democrats by more than 950,000. Former President Donald Trump, who is running for a second term on a right-wing manifesto that seeks to ban abortion nationwide, currently leads Vice President Kamala Harris, the Democratic nominee, by 7 points in Florida. But in the same poll, nearly 70% of respondents said they support Amendment 4. Even Trump said in a recent press conference that he thinks “probably the vote [on the amendment] will go in a little more liberal way than people thought.”

If the amendment passes, some voters believe that access in Florida will be restored and the Sunshine State will go back to being a safe haven for care in the Southeast. But the damage may already be done for some of Florida’s independent abortion clinics.

“What is the point of having a ballot initiative if you don’t have any clinics to go to? That’s our biggest fear,” said Jessica Hatem, executive director of Emergency Medical Assistance Abortion Fund, a Florida-based abortion fund that works primarily with independent clinics.

One abortion clinic in the state has already shut down and two others have stopped providing abortion care since the ban went into effect four months ago, according to AHCA’s public website and INeedAnA.com, which tracks clinic closures. At least two other clinics are at risk of closing in the coming weeks, and a total of eight clinics have shut down or stopped providing abortion care since the Dobbs decision.

One staffer at the BSSI clinic had just started at the Fort Lauderdale facility a few weeks before my visit. The clinic she’d worked at before ― a women-owned center that had been open for over 40 years ― closed after the six-week ban went into effect.

Ellen Kimmel, a counselor at the Presidential Women’s Center in West Palm Beach, recently had a patient come in who had made an appointment at another clinic, but by the time she arrived at the facility no one was there. “She said they don’t answer the phone, nobody’s there ― they’re just gone,” Kimmel said. She assumes the clinic has shut down.

A Woman’s Choice, in Jacksonville, used to be busier than any of its four sister clinics in other states. They were open six days a week and provided care to hundreds of patients every month when the 15-week ban was in effect. They were so busy, staff often had to ask patients’ companions to wait in their cars to make space for other patients in the waiting room. Since May, the clinic is down to a third of the patients they once saw, forcing them to cut staff and reduce hours.

“It’s something that we absolutely think about,” Amber Gavin said when asked if she worries about having to shut down the clinic. Gavin, the vice president of advocacy and operations at A Woman’s Choice, oversees the Jacksonville center as well as four other clinics in North Carolina and Virginia.

“People have to remember that it’s like any other medical office: We’re paying our staff, we’re paying for the electricity, we’re paying for medical supplies, we’re paying for our physicians,” she said. “Like any other business, you need to see patients in order to continue to keep the lights on. It is a really vulnerable time.”

Once a clinic closes, it’s nearly impossible to reopen. It’s extremely difficult to get a license for a new clinic, or to find providers and staff. Just finding a property that will lease to a clinic is nearly impossible, said Eskamani, the state representative.

Eskamani, who worked at Planned Parenthood for six years before being elected to the Florida House, recalled when the city of Orlando did a lottery revitalization, which encouraged redevelopment and private-sector investment. They wanted to buy one of Planned Parenthood’s Orlando properties to build a new community center. Planned Parenthood agreed to sell, believing this would be good for them too; they could find a bigger space with better security options. But they never found anything.

“We never, ever found a new footprint in this part of Orlando because nobody would rent to us. And this is Orlando!” Eskamani said, referring to Orlando’s status as a liberal city.

Diamond, in Fort Lauderdale, is looking to offer other services at her clinic to create another avenue of income and avoid shutting down. Many clinics across the country have stayed open despite extreme abortion bans because they diversified their services, offering STI testing, contraception and obstetric care to keep themselves afloat.

Sitting at her desk, Diamond took a deep breath. The workday was nearly over and she looked exhausted. “I bring so many of these patients home with me, mentally,” she said.

That day it was the 16-year-old whose mother died from an overdose and who now needs to get a judicial bypass to get an abortion. Diamond recalled telling the teenager, “You don’t have anyone, but you have me ― whether you get this abortion or not. Even after all of this, I’ll be here.”

Diamond isn’t about to go back on her promise. “An important way to show up for our community is to stay open, no matter what happens,” she said. “So that’s what we’re gonna do.”