The Philadelphia abortion clinic disaster:
Is more regulation the answer?

cover of Grand Jury report on Women's Medical Center in PhiladelphiaOn one thing, both sides of the abortion divide agree: the now-closed Philadelphia clinic of Dr. Kermit Gosnell, Women’s Medical Society, was a true “chamber of horror,” as a Grand Jury report stated. The report details unspeakably filthy conditions, unlicensed and unqualified personnel performing complex medical procedures involving anesthesia, a doctor who repeatedly flouted both the law and the prevailing standards of medical care regarding later abortions, and inevitably, at least two patients dead and numerous others injured.

Predictably, reactions to this tragic situation have resembled a Rorschach test of sorts for both the antiabortion and abortion rights movements. The former has responded with gleeful “we told you so” messages, stating that Gosnell is not all that different from other abortion providers, while the latter camp—in which I include myself—has placed the blame squarely on the relentless war opponents have waged on legal abortion in the 38 years since Roe v Wade.

Long before news of the conditions at Gosnell’s practice came to light, I had been aware of what I have termed “rogue clinics,” facilities that prey disproportionately on the poorest and most vulnerable women in our society, often immigrants with little English-speaking ability (as was the case with the Nepalese women, Karnamaya Mongyar, who was the second woman known to have died at Women’s Medical Society). But even if the marginality and stigma associated with abortion drove such women to an outlier such as Gosnell (whose prices were lower than other providers in the area and who did not have as many protesters outside his clinic), why was he allowed to remain in practice so long?

Patients, their relatives, and other physicians in Philadelphia—who often had to clean up after Gosnell’s mistakes—made frequent complaints to the authorities. Gosnell was the subject of numerous malpractice suits. It remains baffling, and enraging, that neither the city or state departments of health performed the oversight that the situation demanded. The failure is even more puzzling in that Pennsylvania recently received a ranking from Americans United for Life, an anti-abortion group, as the “third most prolife state” in the country.

In the wake of this disaster, abortion opponents have called for more regulation of abortion. But it is important to understand that Gosnell’s practice was not only an outlier with respect to the egregious care offered there, but also in terms of the inexplicable lack of oversight. The reality that I have seen far more often, as a longtime observer of abortion provision, is excessive regulation—regulation that serves no purpose other than to make care more cumbersome and expensive, and has virtually nothing to do with patient safety. Abortion clinics, there is ample evidence to suggest, suffer both from too many ideologically driven restrictions and inspections that are often biased.

Consider, for example, the case of Hope Medical Group in Shreveport, Louisiana, a clinic that for over 30 years has offered exemplary abortion care to women in a large area of the Deep South. Late in the afternoon of the Friday before Labor Day weekend, the state without warning shut down Hope Medical Group, notifying the media first, and only then faxing the clinic of its decision. (The clinic had recently been inspected and the inspector informed staff of minor violations, none of which had directly to do with patient safety.) Hope Medical was the first clinic to feel the brunt of a recently passed state law, which permitted the Louisiana Secretary of Health to close an abortion facility without prior warning. Through the tireless efforts of Robin Rothrock, the clinic’s founder and director, and the equally tireless work of her lawyers from the Center for Reproductive Rights, a judge overturned the closure order and the clinic soon re-opened. Rothrock, who passed away recently, had sued the state of Louisiana some 30 times (most of the time winning) over its capricious abortion regulations, and it is hard not to conclude that the state’s action in closing her down was retaliatory.

Or consider the case of Dr. George Tiller, the Wichita abortion provider who was assassinated in his church in May 2009. For years, his practice had been the target not only of violent protestors, but also of anti-abortion officials in state government who tried numerous times to shut him down, claiming his practice violated Kansas law governing the performance of later abortions. Tiller repeatedly was vindicated in court: in his last trial, which ended several months before his murder, the jury acquitted him in less than 45 minutes.

Finally, consider the “TRAP laws” (targeted regulations of abortion providers) and “informed consent” scripts that are imposed on clinics in numerous states. The TRAP laws are burdensome requirements on facilities and staffing which, in the words of the Center for Reproductive Rights, are “different and more stringent than the legal requirements imposed on other practices.” A thorough review by the Guttmacher Institute of informed consent mandates found that twenty three states required abortion providers to tell patients information that was blatantly untrue or misleading, such as the alleged links between abortion and breast cancer, suicide and future infertility.

Speaking as one who has interviewed the former staff of Dr. Tiller’s clinic in great detail about both the state of the art of medical and emotional support services that were offered to patients who came for later abortions because of fetal anomalies, as well as the staff’s scrupulous attention to conforming with Kansas law, it is surreal to me that this facility was subjected to near-constant attack by authorities, while the barbaric practices of Dr. Gosnell in the performance of late abortions were officially ignored for so long. Dr. Tiller and Robin Rothrock were both ultimately vindicated by the courts, but the toll on providers, financial and emotional, of such clear political persecution is deeply unfair.

Rogue clinics notwithstanding, legal abortion has achieved a remarkable safety record since Roe. The way to prevent future disasters such as occurred in Philadelphia is to end the marginalization of abortion from mainstream medicine, restore Medicaid funding for poor women’s abortions, and ensure that states follow the same standards and practices of oversight of abortion facilities as occur elsewhere in our health system.

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