VIDEO: PBS Examines “Abortion Providers Under Siege”

Emily Douglas

PBS has produced an exceptional segment about violence and harassment targeting abortion providers, asking whether Dr. George Tiller's killing was an act of domestic terrorism and what the effect of decades of violence has on women's access to the procedure.

PBS has produced an exceptional segment about violence and harassment targeting abortion providers, asking whether Dr. George Tiller’s killing was an act of domestic terrorism and what the effect of decades of violence has on women’s access to the procedure.  Senior correspondent Maria Hinojosa went to provider Dr. Warren Hern’s Boulder, Colorado, clinic, met with Dr. Leroy Carhart, a Nebraska provider, and attended Dr. Tiller’s funeral in Wichita.

Dr. Hern describes the security precautions he takes — traveling with federal marshals, in a secured car separate from his family — as "a step away from prison."

Hinojosa says to Carhart, "Some people listening to this are going to say…Dr. Tiller was shot, it was a lone crazy gunman, this is not a whole movement to take down American society and doctors." Carhart thoughtfully responds,

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"This is a whole movement to make abortion unavailable to women."

"That’s what this is about."

"Yes."

"The murder of Dr. Tiller was — "

"One step," Carhart responds.

"Being a target is not my fault," Hern states unequivocally, when Hinojosa asks him whether, if he provided abortions more "quietly," he’d avoid attention.  "I’m providing a service to women who need it."

PBS has received a high volume of mail from anti-choice viewers, so the Women’s Media Center has launched a campaign to let PBS know that viewers support the frank, accurate portrayal of violence against providers.  You can send an letter to PBS through the Women’s Media Center here.

News Abortion

GOP Fact-Check: Hospital Transfers Don’t Signal Abortion Dangers

Christine Grimaldi

Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire.

Rep. Marsha Blackburn (R-TN) justified her recent subpoenas of a prominent later abortion provider and first responders in the community where he works by pointing to “public reports” that people who sought abortion care from the doctor required hospital transfers.

Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire. In fact, the rare instances signal a continued commitment to appropriate patient care that begins in an abortion clinic. A patient may not require further treatment upon arrival at the hospital, indicating a proactive clinic rather than a dangerous one. Regardless of the circumstances, anti-choice activists often hijack so-called emergencies to fuel their coverage of the alleged dangers of abortion care.

Freestanding clinics manage most immediate abortion-related complications, including those that occur during later abortions, said Dr. Daniel Grossman, a provider and professor in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.

Abortion-related complications are rare throughout all stages of pregnancy. The even rarer event that such complications necessitate a hospital transfer doesn’t indicate the work of a bad abortion provider, Grossman explained in an interview with Rewire.

“There are sometimes things that happen that are unforeseeable,” he said.

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Evidence Contradicts Blackburn Subpoena Claims

Grossman, his University of California, San Francisco colleague Dr. Ushma Upadhyay, and other reproductive health care practitioners and policy experts studied just how often those unforeseeable instances occur in a review of nearly 55,000 abortions covered under the fee-for-service California Medicaid program from 2009-2010. The state data allowed researchers to track subsequent follow-up care sought after an abortion.

Among all abortions, about one of 5,491, or 0.03 percent, involved ambulance transfers to emergency departments on the day of the procedure, the researchers found.

For procedures in the second trimester or later, major complications that required hospital admissions, blood transfusions, or surgery amounted to 34 cases, or 0.41 percent.

Many hospitals don’t provide abortions, which essentially forces providers to perform the procedure at a freestanding clinic or turn away patients, Grossman said. Providers would not do something unsafe, he stressed, “but that puts a lot of pressure on them because they don’t have that option of deciding to do the procedure of a higher-risk patient in a hospital.”

States that have enacted targeted regulations of abortion providers, known as TRAP laws, may force providers to gain hospital admitting privileges, even though hospitals can’t refuse to care for transfers and emergency arrivals. Many hospitals don’t want to issue admitting privileges to abortion providers, Grossman said, in part because their patient admissions are so infrequent—putting the onus back on clinics to provide abortion care.

Data supports Grossman’s assessment about abortion and clinic safety. Abortion care is one of the safest medical procedures performed in the United States, according to Planned Parenthood and the American Congress of Obstetricians and Gynecologists. “The rate of complications increases as a woman’s pregnancy continues, but these complications remain very unlikely,” the groups said in a joint fact sheet.

Blackburn, the chair of the U.S. House of Representatives’ Select Investigative Panel on Infant Lives, framed such instances differently when she shifted the panel’s focus from fetal tissue research practices to later abortion care, issuing subpoenas in mid-May to Dr. LeRoy Carhart and various local and state entities in Maryland.

“Public reports indicate at least five women have been sent to the hospital since December while seeking an abortion in this clinic,” Blackburn said in a press release. Blackburn expressed concern for “the sake of the women who have been rushed from that clinic to the hospital with increasing frequency.”

Blackburn Allegations Rooted in Dubious Sources

Blackburn’s press release cited the five hospital transfers since December 2015, but her subpoenas demand documentation dating back to 2010—signaling a deeper scope to her investigation.

The National Abortion Federation (NAF), the professional association of abortion providers, countered Blackburn’s basis for the subpoenas.

“Abortion opponents have been targeting Dr. Carhart for years because he is a very vocal and visible abortion provider,” NAF spokesperson Melissa Fowler told Rewire in an email. Following the 2009 murder of Dr. George Tiller, Carhart arguably became the country’s most prominent provider of later abortion care.

The Maryland Board of Physicians, one of the targets of Blackburn’s subpoenas, indicates that Carhart is in good standing. The board’s online practitioner profile system lists no Maryland disciplinary actions, no pending charges, and no reported malpractice judgments and arbitration awards within the past ten years. Malpractice settlements are another measure of provider competence, and Carhart hasn’t had three or more malpractice settlements of at least $150,000 in the past five years, according to the system. Additionally, the courts have not reported “convictions for any crime involving moral turpitude,” which the board defines as “conduct evidencing moral baseness” and determines on an individual basis under common law.  

Absent allegations on the board’s website, the “public reports” smearing Carhart appear to come from anti-choice news outlets. In March, LifeSiteNews.com cited eyewitness accounts from anti-choice activists in reporting that Carhart sent a fourth woman to the hospital in four months. A leader of the radical anti-choice group Operation Rescue covered the same allegations for LifeNews.com.

The same website in 2013 alleged that the Washington Post downplayed the death of a young woman who sought a later abortion at the clinic. However, the Maryland medical examiner’s office found that the woman died of natural causes from a rare complication that can also occur in conjunction with childbirth, and state health officials found “no deficiencies” in the care she received at the clinic. Blackburn’s subpoenas include Adventist HealthCare Shady Grove Medical Center, formerly Shady Grove Adventist Hospital, where the woman died.

Anti-choice organizations and their reports have played a prominent role in the current congressional inquiry. Troy Newman, Operation Rescue’s president, and David Daleiden founded the Center for Medical Progress (CMP), the anti-choice front group that triggered the select panel’s investigation into allegations that Planned Parenthood profited from fetal tissue donations obtained from abortions.

Blackburn referenced CMP’s heavily edited videos in her threat “to pursue all means necessary” to obtain documents from StemExpress, the tissue procurement company that worked with Planned Parenthood. The GOP’s exhibits at the panel’s April hearing on fetal tissue “pricing” reportedly duplicated or nearly duplicated the “evidence” in the CMP attack videos.

Blackburn’s select panel spokesperson denied that the subpoenas are based on information from anti-choice sources.

“The subpoenas we issued are not based on the sources you have cited,” the spokesperson told Rewire in an email. “However, due to confidentiality agreements, we are not at liberty to disclose the identities of our sources.”

Anti-Choice Activists Hijack Emergencies

Although Blackburn’s evidence may come from different sources, the fact remains that Operation Rescue and other radical anti-choice activists are known for surveilling abortion clinics and making repeated records requests, all to report similar claims about botched abortions necessitating hospital transfers.

duVergne Gaines, director of the Feminist Majority Foundation’s National Clinic Access Project, said surveillance tactics enable anti-choice activists not only to photograph and video emergency responders, but also follow up with Freedom of Information Act and equivalent state-level requests for records, including 9-1-1 tapes, if state laws permit their release.

“They collect data,” Gaines said in an interview. “They put that up on the websites themselves, on their own Facebook pages, and have no real knowledge about what or why an ambulance may have been contacted.”

Hospital transfers in some instances have nothing to do with the procedure. Contrary to initial anti-choice accounts, the Lincoln, Nebraska Journal Star reported that a woman transferred in 2015 from a local Planned Parenthood to a hospital “wasn’t suffering complications from an abortion, but had instead sought help at the clinic after being assaulted at her home nearby.”

At times, anti-choice activists may manufacture emergency scenarios, Gaines said. “The most obvious example is alleging that a minor is inside being forced to undergo a procedure against her will, and that can happen if they see a minor go in [to a clinic],” she said.

Rewire reported in March that police appeared at a Mississippi clinic and threatened to charge a single mother with fetal homicide after her daughter, a minor seeking a legal abortion, signed a bogus Life Dynamics document stating that she was being coerced into the procedure.

The prominent anti-choice group uses the document to deceive and intimidate patients and providers by threatening legal action should they go through with obtaining or providing abortion care.

NAF President Vicki Saporta said that many of her group’s members have experienced anti-choice tactics such as staking out clinics for emergency vehicles, placing calls to summon emergency responders, and trailing ambulances to hospitals with the aim of gathering confidential patient information. Preferred tactics depend on the local anti-choice community, she said.

Saporta pointed to a crisis pregnancy center that opened in the same complex as the Germantown, Maryland, clinic where Carhart practices. A Germantown Pregnancy Choices, which comes up as the Maryland Coalition for Life when entered into Google Maps, operates within less than 200 feet of the clinic. The Maryland Coalition for Life cited eyewitness accounts and a video in March to support allegations that an underage girl required a hospital transfer “due to medical emergencies related to a late term abortion.”

Anti-choice activists targeting clinics over safety share a common denominator. “Once their bogus claims are investigated, for the most part, no action is taken because nothing is actionable,” Saporta said.

Analysis Violence

Spiritual Salvation: The New Excuse for Violence and Threats Against Abortion Providers

Jessica Mason Pieklo

"Anything I can do to help protect people who are trying to provide services to women I was willing to do,” said Dr. Mila Means in an interview with Rewire, after the close of Angel Dillard's trial for writing her a threatening letter in 2011. “And I just had no idea it would turn into this.”

In 2009, Scott Roeder murdered Dr. George Tiller, leaving Wichita, Kansas, without an abortion provider. A full year would pass before local physician Dr. Mila Means considered stepping in to start offering abortions. She began training to offer the procedure as part of her Wichita practice—largely because nobody else was doing so.

“That was a big issue. Patients in need of services and not able to get them,” said Means in an interview with Rewire last week.

“I had someone who sought me out, who I only met once …. She had two children and was early on [in her pregnancy] and wanted a medical abortion,” said Means. “And I said ‘Well, I can’t do that here,’ and tried to refer her to Kansas City. But there was no way she could get away from her husband or anything to be able to get care,” Means continued.

“And that was really a big part of my thought: ‘Well, somebody’s got to do something in this city.'”

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Means has been tied up in litigation for the last five years because of a letter she received in January 2011 from a woman named Angel Dillard, who warned Means that should she go through with her plans, thousands of people across the country would be looking into her background to learn her habits and routines, and that Means would be checking under her car every day for explosives. That letter attracted the attention of the Department of Justice (DOJ), which sued Dillard under the Freedom of Access to Clinic Entrances (FACE) Act. Last Friday, Wichita jurors sent a very dangerous message to the anti-choice movement where Dillard’s case was concerned: Present your threat to abortion providers as an attempt at spiritual salvation, and the law will look the other way.

The eight-person Sedgwick County jury concluded that Dillard’s January 15, 2011 letter, which also referenced Tiller speaking to Means from hell, constituted a “true threat.” In other words, that letter was a threat and not automatically protected free speech, as Dillard and her attorneys had argued.

But the jury also found that while it was reasonable for Means to feel threatened given the reference to Tiller’s murder, the car bomb mention, and so on, those threats were not enough to warrant any of the civil damages the DOJ had asked for on Means’ behalf, or the protective order the agency had asked for keeping Dillard away from Means.

See, Dillard’s evangelical Christianity included an angry God, a vengeful God, explained her attorney Craig Shultz to jurors in his closing argument. Dillard is a strong woman with strong beliefs who uses strong words to persuade others like Means, to change their ways, he said—in other words, her letter was just an example of those strong words.

“The letter was intimidating, but it was a more spiritual threat, a more emotional threat,” presiding juror and Wichita native Adam Cox, 37, told Rewire in an interview following the verdict. “It was not a threat of physical violence … and therefore it did not violate the law.”

This distinction—between spiritual violence and physical violence—is exactly the cover the radical anti-choice movement has sought from the law for decades. And that’s exactly what the Dillard jury gave them when they found Dillard not liable for threatening Means out of providing abortions in Wichita. Although the circumstances of the cases are obviously different, the idea that being spiritually compelled toward the threat of violence should be enough to excuse that threat in the court of law echoes the reasoning used by other anti-choice extremists.

It’s a mutation of the legal theory of justifiable homicide, the idea that an act like murder is legally excusable in some circumstances because it’s preventing a greater evil—in this case, legal abortion. That’s what Paul Hill used to try to justify his murder of abortion provider Dr. John Britton and Britton’s bodyguard in 1994.

Like Dillard, Paul Hill considered himself a minister.

It’s the same argument Roeder used during his trial for killing Dr. Tiller. It’s the same position advocated by Roeder associate and self-proclaimed minister Michael Bray, convicted in 1985 for possessing explosives and conspiring to blow up abortion clinics.

While Roeder, Hill, and Bray were convicted for their crimes, each, like Dillard, attempted to cloak their conduct in the guise of being called by God to act.

And this is the same line of thinking self-proclaimed Colorado Springs Planned Parenthood shooter Robert Lewis Dear Jr. has said he will use to defend himself should he be determined competent to stand trial.

When Dear was initially detained by law enforcement following the shooting, and throughout his legal proceedings so far, he has consistently made anti-choice statements. He’s repeated the idea that Planned Parenthood is “selling baby parts,” the same argument made by the anti-choice Center for Medical Progress and its founders David Daleiden and Operation Rescue’s Troy Newman, spread by heavily edited videos, and repeated ad nauseam by conservative lawmakers looking to stir up their base in a particularly ugly election cycle.

Dear faces a total of 179 counts, including murder and attempted murder, from the five-hour standoff. The hearing to determine his competency to stand trial continues May 10. In the first phase of that hearing last month, prosecutors portrayed Dear as a man with deeply held religious and political convictions, which they said motivated Dear to hold siege at the reproductive health-care facility and eventually kill three. It is those very same sincerely held religious beliefs and a paranoia that the federal government is persecuting Christians that, Dear’s defense team argues, rise to the level of a diagnosable delusional disorder, rendering him incompetent to stand trial. According to the detective on Dear’s case, Dear wants to raise a “defense of others” argument—in other words, again, the legal argument that a crime is justified to prevent a greater evil.

Dillard’s attorneys argued she was simply preaching the path to redemption for Means, and not sending out a larger call to action against her.

But the truth of the matter is that Dillard’s statements were enough to give seasoned domestic terrorism law enforcement officers a reason to visit Dillard—twice, as one investigator testified at Dillard’s trial. They looked Dillard up in their internal network to find they already had a flag on her for links to abortion extremist Roeder.

In other words, in 2011 and at the moment the FBI was sent in to investigate, as best as the evidence showed, Means was to be the next big target of anti-choice violence. And the only reason she wasn’t was because the portion of FACE that is designed to prevent acts of violence from happening actually worked. The DOJ responded, potentially preventing an act of abortion terrorism that would have caused physical harm. It really doesn’t matter that they declined to pursue a criminal case against Dillard, a point her attorneys tried to emphasize during trial. The DOJ still brought a civil case. And civil cases are expensive to bring, which means lawyers must also consider how much money the case is worth. It sounds crass, but it’s true; it’s not profit, it’s penalties and damages. In Dr. Mila Means’ case, those were valued at approximately $20,000. For civil cases, that’s rarely, if ever, enough for an agency to justify spending five years of resources. And still, the DOJ went in hard. That alone suggests this case means more than any $20,000 verdict for Means. This case, in terms of anti-choice violence, was and remains significant.

Means never ended up developing an abortion practice, a fact she ascribes to the impossibly anti-choice political and cultural climate of Kansas. “What happened was two-pronged,” explained Means in an interview after the close of the trial but before the verdict. One issue, she said, stemmed from when the Kansas legislature “passed the TRAP laws.”

In 2011, Gov. Sam Brownback (R) signed a series of anti-choice restrictions, including ones similar to those passed in Texas that are currently under review by the U.S. Supreme Court. Those regulations, like hospital admitting privileges requirements and strict architectural requirements, have since been blocked by a federal court.

“I felt like, as an individual trying to fund getting started … there was no way I could have an ambulatory surgical center, and there’s still no guarantee that the doctors in this town will get [admitting] privileges,” Means said.

And then there was the other “prong”: Word had gotten out to the local anti-choice community that Means was training to expand her practice to provide abortions for patients who needed them. In addition to the added anticipated costs related to Kansas’ TRAP laws, Means had to consider security costs.

“As things progressed, I became much more aware of how expensive security was going to be,” said Means. For example, early in the process of attempting to expand her practice to include abortion services, Means attended a meeting with area providers. According to Means, security for that approximately two-hour meeting cost about $800.

Kansas needs abortion doctors. But Means is hesitant to recommend people come in and try and take up the work. “Only if they are prepared for it to be their whole life,” she said.

“The person that I trained with, he was in his 70s,” said Means. “I’m thinking that potentially our future providers are going to be physicians who have raised their kids, done their other kind of work, that still want to give, and are willing to crawl into a hole.”

That’s because, Means noted, violence against abortion providers is increasingly normalized. “The threats work,” said Means.

Means was pessimistic about the outcome of her case and concerned about the ripple effect such a decision could have for inspiring other threats of violence against abortion providers. “If we can’t even get people to look at [Dillard’s communication to Means] and say there’s something different here, how can we get proactive legislation [to protect providers]?” she wondered.

“Anything I can do to help protect people who are trying to provide services to women I was willing to do,” said Means. “And I just had no idea it would turn into this.”

The next day, the jury decision came down.

The jury found Dillard to be a threat. They just weren’t convinced she was enough of threat. That’s because the letter was sold as part of Dillard’s fire-and-brimstone spiritual redemption, the kind she could have been learning from Scott Roeder and Michael Bray.

Thankfully, Dillard’s case doesn’t hold much broad legal precedent, because it’s limited to the battle between Dillard, Means, and the DOJ. The DOJ could try and appeal the verdict, but it is a steep hill to climb. There are limited legal grounds to appeal in any case. Even with the problematic evidentiary rulings regarding Dillard’s purported prison ministry to Roeder and the inherent conflict between the jury finding Dillard’s letter to be a true threat but not enough of one, the DOJ has a lot of cases. The agency has to evaluate if, after five years of effort dedicated to pursing the case against Dillard, it is worth continuing. It’s a sobering reality for abortion rights advocates.

In the meantime, what that verdict shows is not just how ingrained radical Christian anti-choice sentiment is in places like Wichita, but how it is metastasizing into the law: Dillard wasn’t threatening Means’ physical well-being. She was just preaching. This was not about death to Means. It was about salvation.

The jury bought it.

The First Amendment protects the ugliest of speech. But it also demands accountability from speakers. That accountability is never about manners, or as Dillard’s attorneys claimed during her trial, shutting down abortion-related speech with which the government disagrees. It is always about whether that speech puts the safety of others in jeopardy.

Except when it’s not. When it’s speech outside abortion clinics directed at patients, abortion doctors, and clinic staff. Or when it’s women facing online death threats by former partners. Or when they are “spiritual threats” to car bomb abortion providers. Then that accountability and safety balance gets all out of whack. Inevitably, women’s lives are put in the cross-hairs.

“All of these people continue to embolden each other,” Means said.

She is exactly right. It is no coincidence that Dear shouted about “no more baby parts” at his arrest in Colorado, months after Daleiden and Newman began releasing videos purporting to show Planned Parenthood was selling fetal tissue. Make no mistake about it: Abortion doctors are and will continue to be the main targets of the violent anti-choice right. But as the attack on Colorado Springs Planned Parenthood proved, if you go to a reproductive health-care facility, you are a potential target.

All of these people embolden each other. And a jury in Wichita just gave them another push.