Given the challenging professional and political conditions for abortion providers, there is a tendency for pro-choice activists and organizations to speak of abortion providers at times as if they are infallible. They are not. Within their group, abortion providers experience the occasional normal risk-related patient complications. Like their colleagues in other areas of medicine, honest mistakes occur at times and the infrequent bad doctor does surface once in awhile.
Most who work at abortion clinics, or for the pro-choice cause, are so accustomed to misinformation and intentional deceit about abortion that many initially thought the news about Kermit Gosnell was too ghastly to be true. How quickly should any of us judge the merits of any indictment? Pro-choice organizations eventually did publicly condemn the man for the criminal he was. It wasn’t enough condemnation for some and, I hate to say it but some of the criticism of the pro-choice leadership “silence” was fair.
Throughout the trial of Gosnell, abortion opponents supplied a steady stream of commentary indicating that pro-choice people protect bad doctors who provide abortions. It may seem off topic but how many adoption lawyers do anti-abortion people “protect” after an adoption has been mishandled? When a “crisis pregnancy center” misrepresents itself as an abortion clinic, how many of their supporters ignore the harm in the deception? More on those issues in a later post.
There should be no reluctance at all to discuss the facets of the Gosnell case that draw attention to a doctor who included abortion in his practice and did so recklessly and criminally. Holding pro-choice views or working in an abortion practice does not make one tolerant of malpractice or criminal conduct! When a bad doctor is exposed in other medical fields people may respond with outrage but they don’t paint all doctors in the same field as bad. Nor do they label all workers in that field as protective. Once the doctor is censured or his/her license revoked, people are grateful for the systems in place to deal with such transgressions.
Unlike other doctors, abortion providers are under constant regulatory and political scrutiny. Like other doctors, they are conscientious and consider their patients’ well-being their chief priority. To hear what is disseminated by anti-choice groups, you’d never know any professionalism existed among abortion providers. Anti-choice leaders continuously strategize about how best to sully the reputations of abortion providers. One of the more destructive forms of anti-choice harassment is videotaping patients for whom an ambulance is called. They film it for two reasons: 1) to intimidate, and 2) to accumulate “data” to bolster their misleading claims about what is “normal” for abortion patients. In their world, risks are acceptable in other medical procedures but not abortion. It doesn’t seem to occur to them that when a clinic calls an ambulance, the doctor is being responsible and following professional medical standards and protocols.
Regardless of the unfairness in how doctors who provide abortions are treated, there are some bad guys. Brian Finkel, an Arizona abortion provider, was convicted in 2004 of sexually abusing 13 of his patients. He was sentenced to 35 years in prison. Whatever his medical skills, only bad doctors abuse patients. Tom Tucker provided abortions in Mississippi and Alabama. In addition to being the subject of medical board complaints in both states, he was the subject of several death or injury malpractice cases. New York convicted an abortion provider for murder in 1995 after he botched a second trimester abortion he wasn’t qualified to perform; the patient bled to death. With the exception of a few, the pro-choice community did not rally around these doctors and in fact expressed relief that they were no longer providing abortions.
What does it take to get pro-choice people to respond to negative events involving abortion providers? A little over 20 years ago I directed an abortion clinic. When I assumed the position, I hired appropriate staff so that it could also provide comprehensive reproductive health services. The doctor was responsible for regulatory compliance. There were some things that seemed amiss. For example, during one period I had to sign a monthly check to an RN who was never there but whose name was on all medical charts as the attending nurse.
The people who actually assisted with the abortions were not medically trained or licensed. After a patient had a seizure I was able to convince the doctor to have a trained person present at all times. After hiring a part-time RN, her signature was put on all charts regardless if she was there. In other words, medical records were routinely falsified. The doctor simply did not believe that abortions necessitated full-time, expensive, and trained medical staff required by law.
When the doctor decided to offer second trimester abortions, he also decided to offer sedation to patients. After purchasing the drugs and some equipment, he did not seek additional training nor did he want to hire a nurse or technician trained in anesthesia. Second trimester abortions are more complicated and there were several occasions in which patients experienced problems in their hotel rooms. Support staff, not medically trained, answered the phone after hours. The patient calls were not always handled as professionally as they should have been. Word about patient experiences reached two other abortion providers who had the decency to call me personally. I began to question whether the clinic I took such pride in was delivering what I thought.
A nurse practitioner (RNP) I had hired primarily for the reproductive health services component of the clinic came to my office one day to let me know that she was resigning and why. The violations the doctor was regularly committing was the only reason, some not illegal but all potentially dangerous to patients. She cited the frequency in which she had been pulled away from her work to assist the doctor with crises that occurred during abortions, most related to sedation. Aside from the risk to patients, she also believed that her professional license was at risk. Regardless of his sound medical skills, with sedation in particular, training, legal compliance, and protocols are imperative. It is noteworthy that the involuntary manslaughter conviction Gosnell received was due to sedation complications.
After the RNP resigned, I started a conversation with the doctor about the violations. I also let him know that I had heard from other providers and that they were concerned. In addition to my job directing the clinic, I was also a public figure leading a pro-choice constitutional amendment initiative. How could I be advocating safe and legal abortion if I was working at a clinic that was not entirely operating to maximize the “safe” aspect of abortion? The doctor informed me that since I was not medically trained, I did not know what I was talking about.
This doctor, now deceased, had been incredibly good to me. Nonetheless, my moral compass was stronger than my personal affections. It was a hyper political era for the abortion issue, with a highly involved media. A lawyer explained to me that by virtue of having knowledge of unsafe and illegal practices, I would be legally liable in the event there was ever a lawsuit. That was his legal speak. He then spoke in ethical terms and advised me that in life it is incumbent on all of us to do what is right when we know there is real or potential harm involved. The lawyer prepared a letter to the medical board, assuring me the complaint would be private. Nothing would be public unless there were violations that did not get corrected and disciplinary action was taken. I then met with the doctor and informed him that I was resigning from the clinic due to the continuing violations. I also informed him of the letter to the medical board.
After resigning from the clinic, I was able to receive a salary for my work with the constitutional initiative and explained to the pro-choice organizations that I was leaving the clinic in order to devote all of my time to the political dimensions of the issue. Shortly afterward, the doctor had received notice that my claims were going to be investigated. Amazingly, the doctor responded to the matter by writing a scathing letter about me, suggesting that I was actually anti-abortion, and mailing it to hundreds of pro-choice people, including politicians. Since I was a public figure, he could say anything he wanted about me. Since he was a private figure and the medical board complaint was private, I could not respond to his words without liability.
The letter made its way to the press. My resignation from the clinic, and then the amendment campaign, became front page news. Several judges, politicians, and, yes, abortion providers called me to let me know that they believed I did the right thing.
Who spoke out against me? The local chapters of Planned Parenthood and National Organization for Women! The NOW president even issued a press statement that the doctor was the best there was and that I was a “former disgruntled employee…” Those organizations had long believed that someone from “their own” should have had the position leading the pro-choice cause. Ego and politics trumped concern for patient safety or even the plausibility that I had acted appropriately. The medical board was not able to verify or reach individuals who could verify my claims. No matter, I did my part and was at least confident that the doctor would change or at the very least avoid putting patients at risk.
The vitriolic response from the most vocal in the pro-choice movement was personally hurtful but truly a shame for the cause of preserving the right to safe and legal abortion. It was a lesson about the confluence of politics and a cause as well as the power of ignorance in our own thinking at times as our convictions blind us. It was arguably “evidence” of the pro-choice community “protecting” a doctor; after the news hit, I received countless letters and calls from anti-abortion folks. Since I did generally have respectful and collegial relationships with most of them, there was not much exploitation of the situation. I really appreciated that. In truth, there were very few in the pro-choice community who did not support my actions. Their voices were publicly silent because it was the appropriate response to a privately conducted medical board investigation.
Yes, some abortion providers are bad and some make mistakes. The resistance to acknowledge it does no favors for the pro-choice cause. The failure to do so can imply that this area of medical practice will accept any standard provided abortion remains legal. That simply is not true and yet when the Gosnell case hit the news, pro-choice leaders were reluctant to respond. It was acceptable to take a wait and see attitude about the facts. It was not acceptable to avoid responding. It was bad public relations to miss the opportunity to proactively address exactly what the standards are concerning late term abortions, clinic personnel, and so on. Those issues eventually got addressed but as reactions and not as educational responses to a situation no pro-choice person would want to see for patients.
Gosnell’s pathetic legacy will continue to fuel mostly unproductive discourse. The anti-abortion forces will be sure to invoke his name as synonymous with all abortion providers. They will continue to do all they can to malign all abortion providers through lies or implication. Just as the anti-choice protesters have routinely displayed photos of full-term fetuses to imply that all abortions are late term, they will now display photos of Gosnell. He does not represent any competent doctor. He certainly is not representative of the late Drs. George Tiller, Slepian, Gunn, and Britton – all of them responsible, dedicated doctors murdered by extremists who opposed them for providing abortions in their medical practices. Gosnell was and is a dishonorable and incompetent man at best. Let’s work harder to ensure that the good guys are supported and the bad guys are thwarted.