Sunday, March 7, 2010

Sad Times

Recently, federal agents raided Dr. Kermit Gosnell's clinic in Pennslyvania and discovered one of my worst nightmares realized: an unsafe clinic, with unsanitary conditions, sketchy staff, and to top it all off, fetus parts in jars. The doctor has killed at least a couple women, injured more, and who knows how many women who went there and just had a bad experience. So why did women go there? It had a terrible reputation. The answer: Gosnell charged very low prices. Women who were going there couldn't afford the extra it cost to go to a safe clinic. So, essentially they had two choices - carry an unwanted pregnancy to term, or go to this super sketchy clinic that was affordable, and hope for the best. Not really very good choices, huh?

Since most of his patients were poor and uneducated, that meant most of his patients would not be filing lawsuits, sending in reports to authorities, going to the press, etc. Other pro-choice organizations had tried to intervene on behalf of patients to no avail as well:

More than a decade ago, CHOICE, a Philadelphia abortion referral service, contacted the state medical board about Gosnell because some of his patients had called CHOICE with appalling stories, said Brenda Green, the organization's executive director.

"We were told that we could not file a complaint. It had to be a patient. It could not be a third party," Green said.

Reproductive health activists and Gilbert Abramson, a lawyer who filed the 2008 case that was later dropped, said they urged Gosnell's patients to file complaints with the state. But when the women learned that they would have to provide medical records and other forms, plus attend a hearing in Harrisburg, they changed their minds.

So, you just had a terrible experience in a medical facility and want to file a complaint -- but in order to do so you must be willing to submit all your medical information including the abortion you just had, and be able to travel two hours to another city to go to a hearing. And people wonder why more reports weren't filed.

I am so glad that this clinic is closed and this doctor is not allowed to perform abortions anymore. But this brings up a sticky topic -- bad clinics. We have all heard stories about this place or that place. I have plenty of experience working with a clinic that drives me insane. (I should pause for a moment and clarify that when I say "bad" I mean that the quality of care isn't amazing -- clinics that have rude staffers, won't be flexible with low-income women, etc. Dr. Gosnell's clinic is definitely AWFUL and the vast vast vast majority of clinics are not even vaguely like that.) What can we do to make clinics that don't provide the best care possible better? And what can we do to make sure a clinic like Dr. Gosnell's never exists ever again?? Can we create some sort of regulatory commission? Since clearly, the health department dropped the ball on this one big time. How we can get this information to low income women?

Unfortunately, many anti-choicers hear stories like Dr. Gosnell's and think that is what abortion care is like and all clinics are like that and they just want to make money and blah blah blah. None of that is true. I think I can say I speak for all the Abortioneers when I say that we all want clinics with qualified, caring doctors, spotless floors, compassionate staff, etc.

I think the saddest part of all of this is best summed up by Susan Schewel, executive director of the Women's Medical Fund, which provides financial help to poor women seeking abortions:

"What happened inside that building is not the real story. The real story is why women sought care there at all," Schewel said. "This prohibition on Medicaid payment leaves desperate women vulnerable to substandard providers."


  1. Oh, how I hate hearing stories such as this. You know it will be seized upon by the news, because scandal is always good copy and because bad news sells. And obviously it will be seized upon by the antis, for obvious reasons. How truly tragic for those poor women. And not surprising in a sense that a greedy, callous doctor decides to set up a true abortion mill to make money. There is obviously a nice niche for a doctor such as that with the state of abortion availability in this country. And how many woman will come forward, with the stigma they would face? He had the perfect racket, and the blame must lay partly with those who have made abortion so difficult to obtain.
    As always, the clinics that do good, caring work are ignored, and only the truly horrible are spoken about.
    We have these tragedies in animal rescue as well. One horrifying misguided rescue gets a lot of press, and the rest of us who quietly work to take proper care of our rescues are ignored.

  2. Dr. Gosnell sounds familiar from my Pennsylvania case-management days. Familiar in that I didn't/couldn't send any patients to his clinic.

    Susan makes an excellent point, which is pretty much the only relevant one.

  3. I would heartily agree with Susan Schewel that desperate women are vulnerable to substandard providers. But I would add more to the ‘real story’ about the shameful legacy we, as a nation, continue to bestow on poor women—ignoring the realities that they have no access to decent health care in general (for themselves or their children), access to medically accurate information about the best birth control for them, and access to affordable birth control.

    The desperation to resort to an unsafe, unsanitary clinic illustrates how motivated and decisive women are when they do not want to be pregnant. It grieves me to think that all those who erected barriers for poor women, think they are helping women. In fact, these misguided misogynists are actually revealing their true selves.

  4. I, too, was saddened reading this horrendous report. But please be aware: just as each of you does not want this awful situation to represent the abortion providers ... so too, the prolifers do not want the very few extremists who murder or cause property damage to be the picture of the prolife side.

  5. this is the consequence of these right wing terrorists running good people out of business. Roe may be intact, but big fucking deal.. .these SOBs might win anyway

  6. What would happen if the FBI or a local health bureau were to visit the wonderful clinics that are blessings to our clients across this nation? What would they find? They would see with their own eyes how wonderful the staff/managers/owners are; how well the patients are cared for; how connected the facility is to the medical and provider community; and how pleased women and their loved ones are with the care and attention they receive.

    Those reports never make the news. Any time we have one of these horrendous stories about an abortion provider there are news stories galore - all focusing on the one problem facility.

    It’s during the foment over one bad provider that we might consider ways to turn this energy into an opportunity to talk about abortion as part of comprehensive reproductive health care for all women, abortion as a normal, safe and legal procedure and, most of all, that every day good women choose abortion for good reasons.

  7. Ooh, you know what I find ridiculous, also? People who claim that guys like Gosnell are the equivalent of antis who bomb clinics. That would be true EXCEPT that the rest of us aren't spending our time sowing the seeds and priming the atmosphere for bad docs to go crazy and harm people. I've seen way too many antis say and do stuff that is just this side of assault (not to mention the outright verbal harassment) to feel any kinship with the ones who say "but I deplore Scott Roeder's actions" (and they often overlap with the harassing ones!) just because here I am deploring Kermit Gosnell. *I* haven't been joining any crowds shit-talking women's dignity and right to quality care lately.

  8. Abortion is like any other speciality--you have good practicioners and bad practicioners and a few of the bad practicioners are able to dodge oversight.

    When right-to-lifers yammer about this guy, the appropriate answer is: That's an anecdote. Anecdotes prove nothing. Anecdote-recital strategy exercise is properly called ARSE.

  9. I blogged on this very encouraging post, and would like to offer the expertise of decades of research.

    I'd say an easy priority would be to push for places that look like clinics to actually be clinics. Because Gosnell's practice was a private physician's office, only the medical board has jurisdiction, and thus only a patient can file a complaint. But were he classified as a clinic, he would be subjected to state oversight and it would be much easier to get the place inspected.

  10. MP, you said "The desperation to resort to an unsafe, unsanitary clinic illustrates how motivated and decisive women are when they do not want to be pregnant."

    Actually, what we're seeing is "fight or flight" response. Given some support, women can and do get past the original panic and settle in to have happy pregnancies. And don't take my word for it. Read the words of then Planned Parenthood medical directory Mary Calderone:

    [1955 Planned Parenthood abortion conference] members agreed, and this was backed up by evidence from the Scandinavians, that when a woman seeking an abortion is given the chance of talking over her problem with a properly trained and oriented person, she will in the process very often resolve many of her qualms and will spontaneously decide to see the pregnancy through, particularly if she is assured that supportive help will continue to be available to her."

    Or Alec Bourne, the doctor who successfully challenged the abortion laws in England:

    "Those who plead for an extensive relaxation of the law [against abortion] have no idea of the very many cases where a woman who, during the first three months, makes a most impassioned appeal for her pregnancy to be 'finished,' later, when the baby is born, is thankful indeed that it was not killed while still an embryo. During my long years in practice I have had many a letter of the deepest gratitude for refusing to accede to an early appeal."

    An opportunity to bond with the embryo/fetus is often all it takes to help a woman resolve her fear and ambivalence. We used to have to wait until quickening. Now there is ultrasound. If we can alleviate her distress in such a non-invasive manner, ought that not to be tried first, before resorting to something as irreversible and invasive as an abortion?

  11. Granny Grump, re: post #1 -- I'm curious, if a place that looks like a clinic must then be a clinic, would you then support crisis pregnancy centers then being shut down or made to offer abortion services? Many of those places attempt to look like clinics and often set up shop right next door or down the street from a "real" clinic. Yet, they do not offer abortion services and intend on convincing a visitor not to have an abortion any way possible -- giving false ultrasound results, calling her incessantly, giving her misinformation, etc.

    Also, regarding your second post, I'm not sure if a conference in 1955 is the best resource regarding how pregnant women feel about their bodies??

    I'm not convinced how showing a woman her US and then saying oh here go have some prenatal care is less intrusive in terms of the bigger picture. (Also, having an abortion is, statistically, much safer than carrying a pregnancy to term) What happens when the child is born? What if the male involved in the pregnancy is not in the woman's life? What if she is living off of food stamps and already has 2 small children? What if she was raped? What if she is 17 and wants to go to college? Why is she pregnant in the first place (ie access to birth control and stuff like that) I think having the OPTION of viewing the ultrasound is great, if a woman wants to see it, then super, if not, then ok.

    Also, regarding the doctor saying he got many letters thanking him for helping them to change their minds, I have received plenty of letters myself on how I have helped them and how much they appreciate my help and support.

    Ok... I think that's it!! :)

  12. BG, why don't we stick with areas of common agreement. Especially since the idea here was that we'd not get into a political discussion.

    1. SOMEBODY needs to be keeping track of which facilities follow accepted standards of care and which don't. Since the state's not doing it, we can pick up the ball.

    2. There needs to be a strategy of closing down, or at least steering women away from, filthy and dangerous places.

    That seems like plenty to have on our plates to start with.

    Prochoicers interested in abortion safety need to have on hand a copy of Hern's "Abortion Practice" -- at least the last edition I saw had a chapter on how to assess an abortion facility.

    I will gladly help people to screen for lawsuits, medical board complaints, etc. It's easy to learn to do.

    But we need to also have an agreement up front that the prochoicers won't try to convince prolifers to refer to the "good" abortion facilities. (Keep in mind that "good" by prochoice standards is "still killing babies" by prolife standards. Would you expect PETA members to make reservations for somebody to have dinner at a steak house?) The prolifers need to agree up front not to try to get the prochoicers to do things they're uncomfortable with (referring to prolife centers, backing a restriction they're not at ease with, etc.)

    That's were the common ground efforts keep falling apart. If each side could just clearly delineate "This is what we are here to do" and each side agree that the common ground effort will stick with that area of COMMON ground, a lot of good can be done.

    As soon as you step outside the common ground, it falls apart. Sigh.

  13. bg, I'm not gonna get into the prolife centers bit unless we can find a common ground area on it. Right now the areas of agreement seem to be:

    1. It ought not to be such a nightmare for women to report quack doctors.

    2. We need to find a way to steer women away from quackery. (Here it gets tricky -- because prolifers will want to steer them toward pregnancy centers, and prochoicers will want to steer them toward abortion facilities that follow safe standards of care. I think we need to agree on "Not THIS place" and let each side, as they encounter the women, then just refer them to where they think real help lies.)

  14. "she will in the process very often resolve many of her qualms and will spontaneously decide to see the pregnancy through"

    This is a great reason to offer ambivalent abortion patients a listening ear, time to consider all information, and referrals to possible resources for pregnancy care and childrearing. Which -- not coincidentally! -- is what all of my clinic's clients are offered.

    And yet, the majority of women who keep their appointments seem quite sure about their decision by the time they are with us. So if you are suggesting we make it harder for women to obtain abortions simply so that they will have to do what humans often do -- accept and rationalize a shitty situation -- I wholeheartedly disagree.

    Warning women away from scary providers must be a priority for all of us, yes. But anti-choicers seem to think that simply saying "don't go there" -- avoiding mention of safe providers, and implying the only remaining option is a crisis pregnancy center -- will save women pain and preserve their fetuses, whereas historically we've seen many women risk their lives trying to induce an illegal abortion when they thought they could not access a safe legal one. In fact, isn't that exactly what was happening when women went to Dr. Gosnell's office?

  15. Hmmmm, mister b.g., just was thinking some more thoughts -- about "harm reduction" work and stuff. Like for example if you think sex work or drug use is dangerous or wrong but still want people to avoid the worst of its effects, so you help them use condoms and clean needles or give them respectful treatment and a safe place to stay, even if your heart is sad about their situation. Obv you can't do this work if you are judgmental or are going to be constantly trying to sell clients on your point of view, or not giving them good care.

    Anyway, I imagine it must be very difficult to work in harm reduction, but I really appreciate those who do it. Yet anti-choicers don't do this --pretty much by definition I guess. Even with sex ed, it's rare to find someone who's "against" premarital sex but will advocate for education in safer sex.

    Don't know if this "means" anything but was just analogizing in my head...would like to discuss with you more! Great post :)

  16. GrannyGrump: Sounds like opening-up abortion clinic complaints to just anyone would clog the gov lines with lame brain wish wash anti bull shit. Also, it's the age wikigooglefacehoo. You can find a quote for anything!

    Dr. Gosnell is a broken man. Though, my deepest sympathies are with the women who sought his services.

  17. It's always amazing to me that the government is so interested in excessive oversight of abortion providers when it is working to their political advantage, and yet they are completely absent when oversight is needed and even requested. It just goes to further demonstrate how unconcerned the government is with women's health and well being. We have a sketchy provider in our community and I struggle constantly with my patients' questions because I know this doctor charges significantly less than we do. And now to add insult to injury, they're trying to eliminate private insurance coverage for abortion services. I fear these actions will just force more women to pursue unsafe abortions because of money.


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