The head of San Francisco's largest abortion clinic testified Tuesday that low-income women "would have nowhere to go'' for late abortions if a federal law banning certain abortion procedures were upheld.

Dr. Elizabeth Drey, medical director of the Women's Options Center at San Francisco General Hospital, also said she was so concerned about the Partial- Birth Abortion Ban Act of 2003 that she had limited outside observers' access to the clinic, even though federal judges have blocked the law from taking effect.

For abortions in the 20th week of pregnancy or later, Drey said, the clinic no longer encourages patients to invite a friend or relative to attend the procedure for moral support and no longer allows medical students to watch the operations.

"I was concerned that they might interpret what (doctors) were doing as violating the act,'' Drey told U.S. District Judge Phyllis Hamilton in the second day of the nonjury trial.

Trials also continued in New York and Lincoln, Neb., where different sets of plaintiffs are challenging the law that President Bush signed last November. It would prohibit any abortion in which the fetus was partially removed intact from the woman's body before being aborted.

Doctors who performed such abortions for any reason except saving a woman's life could be sent to prison for two years. At Tuesday's proceedings in Lincoln, Dr. William Fitzhugh of Richmond, Va., one of four physician plaintiffs, testified he would probably continue his current practices and risk prosecution if the law were upheld.

But Drey, whose San Francisco clinic serves poor women and those who need high-risk or complex abortions, testified that if the law took effect, "it would be very difficult for us to provide second-trimester abortions'' because of the fear of prosecution.

The Women's Options Center performs 2,000 abortions a year, about half of them during the second trimester and about 600 of those during the 20th to 23rd week of pregnancy, when procedures that the federal law would prohibit are most likely to be used, Drey said. If her clinic was unavailable, she said, "poor women would have nowhere to go in Northern California'' for post-19th- week abortions.

Her testimony was directed at one of two central legal issues in the case: whether the federal law would impose an "undue burden'' on access to abortion, the constitutional standard announced by the U.S. Supreme Court in a 1992 case.

The other issue is whether an exemption is required for abortions needed to protect a woman's health. The Supreme Court overturned a similar Nebraska law in 2000, in part because it lacked a health exemption; Congress responded by declaring in the federal law that the abortions it would prohibit were never necessary for a woman's health.

Bush administration lawyers, defending the law, say it was drafted narrowly to prohibit a specific late-term procedure that is never the safest option available.

The procedure "blurs the line between live birth and abortion,'' Assistant U.S. Attorney Sean Lane said in his opening statement Monday at the New York trial. One of the government's scheduled expert witnesses has said studies show that the fetus can feel pain by the 20th week of pregnancy and would suffer intense pain during abortions that the law would prohibit.

The plaintiffs, who include Planned Parenthood and the city of San Francisco in Hamilton's court and the National Abortion Federation in the New York case, contend the law would effectively ban the most common and safest type of abortion in the second trimester.

They argue that the outlawed practice -- partially removing an intact fetus before ending its life -- is sometimes found necessary by doctors to protect patients from injury during dilation-and-evacuation abortions, the predominant procedure after 12 weeks. Because those circumstances can't be foreseen, physicians would risk violating the law any time they performed such an abortion, the plaintiffs maintain.

©2004 San Francisco Chronicle

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