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Northwest Florida's sole abortion clinic has closed permanently after reaching a settlement with state regulators.

In May, the Florida Agency for Healthcare Administration (ACHA) issued an emergency order to suspend American Family Planning's license after the agency said three women were hospitalized after receiving abortions at the clinic.

The clinic disputed ACHA's account of the incidents and appealed the closure to an administrative law judge who had set a hearing for this month to determine if the clinic could reopen.

However, a little more than a week before the hearing was set to begin, American Family Planning's attorney Julie Gallagher notified the judge that a settlement had been reached between the clinic and ACHA, and the case was dismissed on Jan. 6.

No details of the settlement were available in the public docket of the case, but Gallagher told the News Journal in an email that American Family Planning has given up its license as an abortion clinic and will not reopen in Pensacola.

The news is another blow for Florida abortion rights advocates after the U.S. Supreme Court overturned the right to an abortion with the release of the Dobbs v. Jackson Women's Health Organization opinion in June and Florida's new 15-week abortion ban going into effect in July.

"It has felt like a regression for us, for women, for people who need access to abortions," Amy Weintraub, reproductive rights program director at Progress Florida.

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Abortions on decline since temporary closure

Florida collects data on abortions performed in the state based on the residency of the patient. Escambia and Santa Rosa counties saw a combined 29% decrease in the number of abortions in 2022 compared to the previous year and a 22% decrease from the level of abortions in 2020, according to ACHA data.

With the closure of the Pensacola clinic, the only abortion provider in the Florida Panhandle region is in Tallahassee.

A group of local abortion rights activists responded last year to the Dobbs decision and the closure of the Pensacola abortion clinic by organizing a new abortion rights group called the Pensacola Abortion Rights Taskforce.

Robin Blyn with Pensacola Abortion Rights Taskforce said her group trying to contact other providers to see if they have an interest in providing service to Northwest Florida.

"Our efforts to get another clinic are underway," Blyn said. "We are looking at another provider providing a clinic or a mobile clinic if nothing else. So we are definitely focused on that because right now, people are in an untenable position."

Weintraub said 60% of Florida counties have no abortion providers.

Weinraub said that those especially impacted by the lack of providers are those who can't afford a long-distance trip.

"It's especially problematic for people who face having low incomes already, who are already marginalized by our healthcare system, and most commonly, that's going to mean that people of color, people who have emigrated, people with disabilities are going to be the ones who are most severely impacted," Weintraub said.

Allegations against Pensacola clinic

The 97-page complaint filed by AHCA alleged that the clinic violated Florida law when three women nearly died during abortion procedures and had to be rushed to the hospital, and the clinic failed to report the incidents to the state within 10 days.

In one procedure in August 2021, the patient had to be hospitalized and have parts of her colon removed, according to the emergency order.

In March, another woman started bleeding following an abortion and the clinic's staff determined the woman needed to go to the hospital. When EMS personnel arrived to transfer her to a local hospital, they documented "pools of blood on the floor," the order said.

The woman was cool to the touch, did not have a pulse detectable in her wrist and had extremely low blood pressure.

At the hospital, she had emergency surgery, during which a doctor found a "big hole on the left wall of the uterus and another on the right side," along with lacerations to her cervix, according to the emergency order. After an emergency surgery failed to try to save her uterus, the woman had to undergo a complete hysterectomy and received 10 pints of blood to stabilize her.

In May, another woman arrived for an abortion, and after she was administered drugs beforehand was told to wait in her car, despite regulations requiring her vital signs be monitored in an exam room, the order said. Her procedure was halted before it was complete after she received lacerations to her cervix and a possible rupture of her uterus.

The clinic staff told her and her spouse to go to a hospital in Mobile, Alabama, rather than a local one in Pensacola as the woman's spouse wanted and as required under the clinic's license, according to ACHA's emergency order.

The clinic didn't document the woman's discharge, though her spouse was given discharge paperwork.

The woman's spouse told ACHA that the staff of the clinic was unable to get a blood pressure reading from the woman. She was driven by her spouse to the hospital in Mobile, and when she arrived, the hospital recorded she had no blood pressure and her blood oxygen level was at 80%.

She was resuscitated at the hospital and had to have a blood transfusion to "replace egregious blood loss," according to the ACHA's emergency order.

The complaint also alleges other violations of Florida law, including failing to document the consent of seven patients being administered ketamine and failing to keep ultrasound photographs in patient records.

One of the issues the Pensacola clinic faced in its legal battle with ACHA was the allegation that in 309 cases the clinic failed to observe Florida's 24-hour waiting period. The 309 cases increased the potential fine the clinic was facing from the other incidents from $43,000 to $343,000.

The law requires a doctor to go over the procedure a full 24 hours in advance, even if the doctor is prescribing pills for a medicated abortion.

Last year also saw courts allowing Florida's 24-hour waiting period on abortion procedures to go into effect.

"Even if it's pills, you have to meet with them at least 24 hours before," Blyn said. "So that means we're talking about multiple days, time off from work, childcare because 60% of women who get abortions already have children and the costs of all of that."

Hope for new clinic

Weintraub said despite repeated polls showing the majority of Americans support abortion rights, she's not optimistic 2023 will be any better in Florida as the Republicans dominate the Legislature.

As of Wednesday, no abortion-related bill had been filed for the upcoming legislative session, but Weintraub said she is hearing everything is on the table, including a full ban.

"We will do all we can to defend against that, but with the makeup of the legislature being what it is due to gerrymandering, it is what we were facing," Weintraub said.

The Pensacola Abortion Rights Taskforce is joining the Women's March in holding a "Bigger than Roe rally" on the steps of Pensacola's federal courthouse Sunday to mark the 50th anniversary of the Roe v. Wade decision that made abortion legal in the United States.

Blyn said their group is looking to end the stigma surrounding abortion in Northwest Florida.

"People actually support abortion, but in our particular area, there are fears of saying it," Blyn said. "And one thing we have to do is just say the word abortion and not treat it as a bad word."