Even sadder times: Bad doctors, system failures, lost lives

Terrible news. Kermit Gosnell has made the news again. You might remember, we wrote about him in March when his medical office was discovered to be practicing abortion in improper ways and under unsafe conditions.

Now he has been charged with multiple counts of murder. I'm warning you, the story is long, sad and gross; also, both the article and the grand jury report have some unsourced descriptions and apparent speculation. But ignore those and the allegations are still clear. Investigators say that some of the wrongdoings are too old to press charges or too many files have been destroyed to amass sufficient evidence; nevertheless, from the evidence they did gather, they're charging Gosnell and several other people with the deaths of seven prematurely-delivered infants and one woman who sought his services. In fact, because of how much the piece (and all the headlines and abbreviated news pieces going around) lingers on the dead newborns, it's easy to miss the few lines mentioning that he and his staff caused the deaths of at least two women and injuries for many others.

Gosnell's lawyer, while maintaining that everyone's innocent until proven guilty and the case must have its day in court etc, also apparently attempted to mitigate Gosnell's actions by saying he "served patients in a low-income city neighborhood for decades." Would he really have us believe this is what serving the underserved looks like? It's not even like this happened in the middle of nowhere, Wyoming. It's west Philly. It's devastating that society, our insurance system and Medicaid laws, state regulators and medical services have abandoned some women to a situation where they can't obtain the safe, legal and ethical care available a few miles from them. The other side of the tracks may as well be the other side of the world.

Another stupid thing to say:

State regulators ignored complaints about Gosnell and the 46 lawsuits filed against him, and made just five annual inspections, most satisfactory, since the clinic opened in 1979. The inspections stopped completely in 1993 because of what prosecutors said was the pro-abortion rights attitude that set in after Democratic Gov. Robert Casey, an abortion foe, left office.

It strikes me as fucked up and crazy that someone would blame this disaster on a "pro-abortion rights attitude." No pro-choice person wants women to be injured and killed because they sought abortions! In fact, many people are pro-choice because they're aware that women risking injury and death is part of the status quo for most times and places in which abortion is illegal. If there were actually a pro-abortion-rights attitude in Pennsylvania government, they'd have been collaborating with experts who actually care about improving the quality of abortion care.

In fact, if more states did exactly that, then we wouldn't have situations like this in Pennsylvania on the one hand, and state agencies like Louisiana's shutting down clinics for no cause simply to prevent abortions on the other hand. (As Robin Rothrock -- RIP -- said at that time, "No one in their right mind would think the state of Louisiana is interested in quality abortion care. It is interesting that the state sees itself as an expert on these issues when it does not provide any such care, and when it prohibits use of any public dollars for abortion care, including training.")

The most frustrating, haunting thing in all of this is summed up by an excerpt from the March article:

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.

As Rob wrote at Abortion Gang yesterday, states keep getting the oversight wrong. Many states harass providers baselessly. Yet Gosnell was a concern of pro-choice advocates and case managers for years, but the medical board said only an actual patient could file a complaint. Apparently, the state can pursue an abortion clinic relentlessly and routinely without a particular basis, but review of a doctor in private practice (any doctor, not just an abortion provider) must be prompted by a patient. If this is true (confirm, anyone?), I just don't understand it.

We Will Keep Our Clinics Open!

In the last year (+) several abortion clinics around the country have closed for a myriad of reasons. We often mention that a vast majority of abortion doctors are "aging out" and fewer medical students currently coming out of school are motivated to provide abortions. Several clinics have also closed after inspections by the Department of Health and Human Services or similar state agencies (DHH, DHS). Abortion provision is challenging and comes up against many blockades on many levels. 

In Fayetteville, Arkansas, the Fayetteville Women's Center closed its doors because the doctor is facing health problems. Several other doctors have become ill, died, or simply reached the age, or well beyond the age, of retirement. Dr. Eugene Glick and Dr. Tiller are two doctors who come to mind who have passed away. Of course, Dr. Tiller did not die of old age or a disease, he was murdered by anti-abortion radicals.

Several clinics have closed after DHH inspections. This is challenging because when a clinic is shut down or its license is suspended, the fairness of DHH is always in question. A few months in Montgomery, Alabama, the Beacon Women's Center had its licence suspended after a DHH inspection. More recently in Shreveport, Louisiana, the Hope Medical Group for Women was shut down after a DHH inspection. Based on a recent law signed by the Louisiana governor, any abortion clinic with any defiency at all must suspend operation immediately and the appeals process to reopen can take months -- here is an article from RH Reality Check to help give a little perspective. According to that article, the owner of Hope Medical Group is going to challenge this law in court. In the northeast, at least two doctors have had to close their doors because of problems found by DHH.

When clinics are closed because DHH finds problems, it is challenging. If DHH came into abortion clinics and advised staff on how to run better medical facilities, that would be great. For example, at my clinic we are constantly striving to improve our patient care and services. The problem is that in reality, very often  DHH inspectors walk into abortion clinics with the intent of finding something wrong. When I read a news story about a clinic being ordered to close, there is no way to know if the problems cited are problems that actually warranted (medically or otherwise) shutting the clinic down. In states like Alabama or Louisiana where the social environment is conservative, it's very possible that both the DHH inspector and the person who wrote the news article are anti-choice. Really, I guess that is possible in Anywhere, USA.

Where I work we spend day after day stressing over what DHH might try to make into an issue. We know we run a clinic that offers safe medical care. Yet instead of focusing on improving our overall patient care and services, we must worry over which piece of our policies and procedures DHH might decide to pick apart if an anti-choice inspector shows up one day.

Abortion care is under seige in this country. Roe v. Wade may never even be overturned, but folks who are in power and against abortion continue to attempt everything they can to make it as difficult as possible to seek abortion care. My boss, who has worked in abortion provision since Roe v. Wade, often mentions that liberals are not as organized as we once were. Women who are of reproductive age today were not alive or not of reproductive age during pre-Roe years. Sometimes I wonder how many hoops women will have to jump through to get a simple medical procedure before folks are ready to get back out and yell, "We will keep our clinics open, enough is enough!"