Groveling for Choice: What Good Doctors Will Do

Carole Joffe

The negotiations that physicians have to undertake with hospital administrators, insurance executives, and other doctors give us window into the chaotic and Kafkaesque world that is contemporary abortion provision, even as Roe remains technically legal.

"I actually went down on my knees begging him-but I think he felt he had been doing too many lately, and his hospital had been breathing down his neck. I walked out of there shaking…."

"I groveled and flattered him as much as I could. I sweet talked him. Finally he caved."

These are two stories of women physicians imploring male colleagues on behalf of patients who need abortions. The two events took place more than forty years apart, but the dynamics are eerily similar. The first speaker, Dr. Ethel Bloom (not her real name), now a retired general practitioner, is recounting for me her memories of what it meant to be an abortion-sympathetic doctor before Roe v Wade.

The daughter of her best friend, about to leave for college, had become pregnant. Dr. Bloom tried to obtain an abortion for her from an ob/gyn colleague who occasionally took risks and did abortions in his hospital, violating the rules of that time by claiming "medical necessity." (Bloom's gutsy, and ultimately successful, strategy for obtaining an authorized abortion in this case was to lie to another doctor that the young woman had tested positive for rubella, also known as German measles. The hospitals in the area had just begun to approve abortions for women with rubella, as evidence accumulated of the severe birth defects associated with the disease. As the first generation of tests were expensive, Bloom gambled — correctly — that the hospital would not retest her.

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The second speaker, Dr. Margaret Riley (not her real name), is a vibrant and witty ob/gyn in her forties. In a just world, a woman like this would not have to "grovel," as she put it, before colleagues to get needed care for her patients. She currently is the medical director of a freestanding abortion clinic in an East Coast state and I recently heard her speak at a conference. A small portion of the patients who come to her clinic are too sick to have their abortions performed there safely and require having the procedure done in a hospital. This is when the groveling starts, as Riley has to deal with individuals and institutions beyond the clinic.

The case she discussed at the conference concerned a 17-year-old teenager with a history of recurrent pulmonary embolism (blood clots in the lungs). When the teen became pregnant, her hematologist suggested termination as the safest course, as pregnancy could dangerously exacerbate her condition, possibly leading to death. With the hematologist's backing, Dr. Riley arranged to perform the abortion in a local hospital. The young woman was admitted to the hospital, and prepared for surgery.

Literally as she prepared to leave for the hospital to do the procedure, Dr. Riley was informed by a clinic staff member that someone from the patient's insurance company had just called to announce that the company refused to authorize payment for the abortion. An in-hospital procedure would cost thousands of dollars, money which the family of the teenager did not have. Riley called the medical director of the company. "He said they would only pay if the ‘condition is life-threatening.' Of course, I wanted to shout, ‘You moron! Don't you know pregnancy in a patient with pulmonary embolism is life threatening?!' But I restrained myself. I calmly kept telling him how sick she was. I told him that the she had been on the pill but had to go off because of her condition….Finally, the breakthrough came when I got the hematologist to call him, and confirm how sick she was. Then he agreed. Of course, he thought that I, the abortion doctor, was doing this just for the money — but a hematologist, well that was a a different story."

This case of the 17-year-old with pulmonary embolism was just one of several that Dr. Riley discussed which described the challenges she faces when advocating with gatekeepers for women too sick for clinic abortions. The negotiations that Riley has to undertake routinely with hospital administrators, insurance executives, and physicians in other specialities in such instances gives us yet another window into the chaotic and Kafkaesque world that is contemporary abortion provision, even as Roe remains technically legal. Some of those with whom Riley must plead are quite upfront with her on their anti-abortion views, others have different motivations. When I asked her, in a follow-up interview, whether she thought the insurance director was motivated primarily by anti-abortion sentiments or by a desire to cut costs, she gave an answer that seemed to encompass both: "I think it was sexism actually."

Margaret Riley's situation, in fact, is in some respects better than that of her fellow clinic directors in other areas. She operates in a fairly liberal state, and over the years, has worked out an "understanding" with a local hospital that usually lets her perform abortions for very ill patients in its facilities. But in other places, hospitals' refusals to deal with seriously ill women seeking abortions is so egregious that a new term has entered the vocabulary of abortion advocates — "ambulance cases." Mainly, but hardly exclusively, occurring in Catholic hospitals or hospitals which have merged with Catholic institutions, the phrase refers to situations in which very ill women are sent from one hospital to another in an ambulance because the first hospital refuses to treat them. Here the pleading done by abortion providing ob/gyns with members of hospital ethics committees or heads of departments often falls on deaf ears.

Two particularly notorious cases occurred a few years ago in a Chicago suburbs, in a community hospital that merged with a Catholic institution. In the first case, a woman with an ectopic pregnancy — a potentially life threatening situation — was discharged from the hospital and sent by ambulance to another hospital. Because a fetal heartbeat was detected, the first hospital refused to perform an abortion (though they did offer to remove her fallopian tube, which would have compromised future fertility).

In the second case, a patient's water membrane burst prematurely at 18 weeks, putting her at risk of chorioamnionitis, an infection of the uterus that can cause high fever and is associated with sterility. Though the typical course in such situations is to induce labor before the infection develops, the hospital refused to do so until the patient developed a fever. The frustrated admitting physician sent the patient to another hospital for immediate treatment.

As Leo Tolstoy famously said at the beginning of Anna Karenina — "all unhappy families are unhappy in their own way" — we can say of the contemporary abortion scene, that all sites of provision are deeply challenged in their own way. The clinics, of course, have no shortage of problems, facing onerous restrictions and constant harassment. But hospital-based abortion care, especially when very ill patients are involved, pits the abortion provider against a host of more powerful forces, some truly astonishing in their disregard for women's health and wellbeing. And proud physicians like Margaret Riley are resigned to the fact that they will be doing a a lot of begging.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

News Law and Policy

Anti-Choice Group: End Clinic ‘Bubble Zones’ for Chicago Abortion Patients

Michelle D. Anderson

Chicago officials in October 2009 passed the "bubble zone" ordinance with nearly two-thirds of the city aldermen in support.

An anti-choice group has announced plans to file a lawsuit and launch a public protest over Chicago’s nearly seven-year-old “bubble zone” ordinance for patients seeking care at local abortion clinics.

The Pro-Life Action League, an anti-choice group based in Chicago, announced on its website that its lawyers at the Thomas More Society would file the lawsuit this week.

City officials in October 2009 passed the ordinance with nearly two-thirds of the city aldermen in support. The law makes it illegal to come within eight feet of someone walking toward an abortion clinic once that person is within 50 feet of the entrance, if the person did not give their consent.

Those found violating the ordinance could be fined up to $500.

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Harassment of people seeking abortion care has been well documented. A 2013 survey from the National Abortion Federation found that 92 percent of providers had a patient entering their facility express personal safety concerns.

The ordinance targets people seeking to pass a leaflet or handbill or engaging in “oral protest, education, or counseling with such other person in the public way.” The regulation bans the use of force, threat of force and physical obstruction to intentionally injure, intimidate or interfere any person entering or leaving any hospital, medical clinic or health-care facility.

The Pro-Life Action League lamented on its website that the law makes it difficult for anti-choice sidewalk counselors “to reach abortion-bound mothers.” The group suggested that lawmakers created the ordinance to create confusion and that police have repeatedly violated counselors’ First Amendment rights.

“Chicago police have been misapplying it from Day One, and it’s caused endless problems for our faithful sidewalk counselors,” the group said.

The League said it would protest and hold a press conference outside of the Planned Parenthood clinic in the city’s Old Town neighborhood.

Julie Lynn, a Planned Parenthood of Illinois spokesperson, told Rewire in an email that the health-care provider is preparing for the protest.

“We plan to have volunteer escorts at the health center to make sure all patients have safe access to the entrance,” Lynn said.

The anti-choice group has suggested that its lawsuit would be successful because of a 2014 U.S. Supreme Court decision that ruled a similar law in Massachusetts unconstitutional.

Pam Sutherland, vice president of public policy and education for Planned Parenthood of Illinois, told the Chicago Tribune back then that the health-care provider expected the city’s bubble zone to be challenged following the 2014 decision.

But in an effort to avoid legal challenges, Chicago city officials had based its bubble zone law on a Colorado law that created an eight-foot no-approach zone within 100 feet of all health-care facilities, according to the Tribune. Sidewalk counselor Leila Hill and others challenged that Colorado law, but the U.S. Supreme Court upheld it in 2000.

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