Analysis Abortion

Anti-Choice Advocates Disingenuously Claim Ohio Clinic Represents ‘Other Gosnell’

Sharona Coutts

Anti-choice campaigners have attempted to tar all abortion providers with the crimes of Dr. Kermit Gosnell. But a close reading of a state inspection report on a Cuyahoga Falls clinic shows that the problems identified there—while serious—were of a different order of magnitude to anything found at Gosnell’s clinic.

When the Ohio Department of Health shuttered the Capital Care Network abortion clinic in Cuyahoga Falls this April, anti-choice campaigners claimed state inspectors had discovered “Gosnell-like violations” of state health laws at the facility.

“These deplorable conditions should cause all Ohioans to pause and wonder what else Planned Parenthood and their allies are hiding across the state,” Ohio Right to Life president, Mike Gonidakis, told World Magazine, a Christian publication. Gonidakis, who is also a member of the State Medical Board of Ohio, then asserted, “Capital Care’s violations prove that the abortion industry does not operate as a health provider and is reckless.”

Such is the latest weapon in the anti-choice rhetorical arsenal: Since the arrest, trial, and conviction of rogue abortion provider Kermit B. Gosnell, anti-choice campaigners, publications, and politicians have exploited that case to argue for state and federal laws that further erode the constitutional right to abortion.

Their strategy is to make such laws seem necessary by insinuating that abortion providers are, as a group, engaged in unsafe or unscrupulous conduct. A key tactic is to tar all providers with the crimes of Gosnell, who was convicted in May of three counts of murder and one count of manslaughter, and last week pleaded guilty to federal drug charges for dispensing drugs illegally in his West Philadelphia clinic.

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However, a close reading of the state inspection report on the Ohio clinic shows that the problems identified there—while serious—were of a different order of magnitude to anything found at Gosnell’s clinic, according to reproductive health professionals.

“I think drawing that comparison is extremely confusing to people because it’s inaccurate,” said Charlotte Taft, executive director of the Abortion Care Network, a nonprofit membership organization of abortion providers and allies. “To say that this particular clinic has multiple deficiencies, which are not appropriate for a functioning health care practice, is not the same as saying therefore it is similar to Gosnell. These are a world apart.”

Gosnell has been convicted of murdering newborn infants. Evidence at trial indicated that he snipped their spinal cords by stabbing them with scissors through the back of the neck.

The jury also convicted Gosnell of manslaughter in relation to the case of Karnamaya Mongar, a 41-year-old immigrant who underwent an abortion on November 19, 2009, but died from an overdose of anesthesia the following day. Mongar reportedly experienced severe pain during the procedure, and one of Gosnell’s associates—an unskilled worker—testified during Gosnell’s trial that the rogue doctor continued the abortion even as Mongar “turned grey and her breathing slowed.”

According to the grand jury report, women who arrived at Gosnell’s clinic were given potentially lethal drug cocktails by an unsupervised high school student. Unlicensed and untrained workers gave women drugs that were intended to initiate their abortions, and left them—frequently semi-conscious—in a filthy waiting room where seats were stained with blood and the floor was littered with cat feces. Inspectors also discovered jars containing the feet of fetuses, and leaking bags of biological waste that had been stored in the basement instead of promptly removed by a biohazard service.

Nothing in the Ohio report on Capital Care Network remotely resembles these findings. The Ohio report does not allege that any patients were actually harmed at the Capital Care clinic, or that illegal abortions were performed there. And though there were some serious problems with the facility, it did not remotely resemble the putrid conditions found at Gosnell’s clinic.

Some of the most serious problems identified at Capital Care related to an apparent lack of oversight from clinic administrators, reproductive health experts told Rewire.

For instance, the clinic had allowed its pharmacy license to lapse, and failed to document required staff training in infection control measures. Inspectors also found many gaps in the facility’s quality assurance program, according to the health department’s report, and the clinic did not have the required agreement with a hospital to accept transfers of its patients.

The facility had also incorrectly noted the remaining amounts of fentanyl, a potent pain medication, leading departmental inspectors to confiscate six syringes filled with the drug. Key staffers lacked the required qualifications in cardiac resuscitation, and inspectors noted multiple problems with resuscitation equipment. And the clinic could not provide evidence of all patients’ written consent before procedures such as inserting a device to dilate the cervix or drawing blood for use in future blood-type analyses.

Experts told Rewire that these amount to serious violations.

“I’m not going to downplay the importance of these findings,” said Taft. “The violation of these regulations are not necessarily indications that patients were harmed; however, they are indications that the practice was not being conducted according to the standards that women deserve.”

Other shortcomings identified by the Ohio inspectors, though, were unlikely to ever pose a risk to patients. For instance, the clinic was pinged because it could not prove that all patients had been provided with an ultrasound of their fetus prior to their procedure. Laws that require forced ultrasounds have been widely criticized as invasive, medically unnecessary, and a potential source of trauma for patients.

The only alleged violation that echoes the practices found at Gosnell’s clinic was that Capital Care allowed certain controlled substances to be administered to patients by a worker who lacked the required credentials to do so. But the report also states that the worker at the Ohio clinic—who had a medical assistant degree—only administered the medications at the direction of a physician, and there is no indication that a patient was ever harmed as a result of this practice.

Taft said that the comparisons between the situation at Capital Care and the Gosnell case are disingenuous and make a mockery of Gosnell’s victims.

“This is a very poorly run clinic with multiple deficiencies, but I don’t think there is anything that puts them in the same category as Gosnell,” she said.

Capital Care Network once ran up to five abortion clinics—four in Ohio and one in Fort Wayne, Indiana—and the Cuyahoga Falls location is not the only facility that has run into regulatory troubles. In August 2012, the state health department said it planned to revoke the license for a Capital Care clinic in Toledo, but agreed to allow it to remain open after the company paid a $25,000 fine and acquired a hospital transfer agreement, according to documents provided to Rewire by the state.

The owner of Capital Care Network, Terrie Hubbard, did not reply to requests for comment for this story.

As in every medical field, there are occasional cases of true rogues in the field of reproductive health, as Rewire reported last week. For that reason, legitimate abortion providers support meaningful regulations and inspections to ensure they are enforced. But distorting the facts does not serve the goal of ensuring safe abortion access, according to Kellie Copeland, executive director of NARAL Pro-Choice Ohio.

“We want abortion to be legal so that it can be safe, and so that it can be appropriately regulated,” Copeland said. “That’s why you do an inspection: so that if there are paperwork issues or, god forgive, patient safety concerns, it’s uncovered so it can be corrected.”

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.

News Abortion

Texas Pro-Choice Advocates Push Back Against State’s Anti-Choice Pamphlet

Teddy Wilson

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated since 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature.

Reproductive rights advocates are calling for changes to information forced on pregnant people seeking abortion services, thanks to a Texas mandate.

Texas lawmakers passed the Texas Woman’s Right to Know Act in 2003, which requires abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated or revised since it was first made public in 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature. 

The Texas Department of State Health Services (DSHS) in June published a revised draft version of the pamphlet. The draft version of “A Woman’s Right to Know” was published online, and proposed revisions are available for public comment until Friday.

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John Seago, spokesperson for the anti-choice Texas Right to Life, told KUT that the pamphlet was created so pregnant people have accurate information before they consent to receiving abortion care.

“This is a booklet that’s not going to be put in the hands of experts, it’s not going to be put in the hands of OB-GYNs or scientists–it’s going to be put in the hands of women who will range in education, will range in background, and we want this booklet to be user-friendly enough that anyone can read this booklet and be informed,” he said.

Reproductive rights advocates charge that the information in the pamphlet presented an anti-abortion bias and includes factually incorrect information.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet was medically inaccurate, according to a study by a Rutgers University research team.

State lawmakers and activists held a press conference Wednesday outside the DSHS offices in Austin and delivered nearly 5,000 Texans’ comments to the agency.  

Kryston Skinner, an organizer with the Texas Equal Access Fund, spoke during the press conference about her experience having an abortion in Texas, and how the state-mandated pamphlet made her feel stigmatized.

Skinner told Rewire that the pamphlet “causes fear” in pregnant people who are unaware that the pamphlet is rife with misinformation. “It’s obviously a deterrent,” Skinner said. “There is no other reason for the state to force a medical professional to provide misinformation to their patients.”

State Rep. Donna Howard (D-Austin) said in a statement that the pamphlet is the “latest shameful example” of Texas lawmakers playing politics with reproductive health care. “As a former registered nurse, I find it outrageous that the state requires health professionals to provide misleading and coercive information to patients,” Howard said.

Howard, vice chair of the Texas House Women’s Health Caucus, vowed to propose legislation that would rid the booklet of its many inaccuracies if DSHS fails to take the thousands of comments into account, according to the Austin Chronicle

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by legislators and organizations that oppose legal abortion care. 

The American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to DSHS that said the organization has “significant concerns with some of the material and how it is presented.”

Among the most controversial statements made in the pamphlet is the claim that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

Texas Right to Life said in a statement that the organization wants the DSHS include “stronger language” about the supposed correlation between abortion and breast cancer. The organization wants the pamphlet to explicitly cite “the numerous studies that indicate undergoing an elective abortion contributes to the incidence of breast cancer in women.”

Rep. Sarah Davis (R-West University Place) said in a statement that the state should provide the “most accurate science available” to pregnant people seeking an abortion. “As a breast cancer survivor, I am disappointed that DSHS has published revisions to the ‘A Woman’s Right to Know’ booklet that remain scientifically and medically inaccurate,” Davis said.

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

DSHS spokesperson Carrie Williams told the Texas Tribune that the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

“We carefully considered medical and scientific information when updating the draft booklet,” Williams said.