Abortion safety regulation: Why good clinics refused to cooperate with Florida health inspectors.

Abortion safety regulation: Why good clinics refused to cooperate with Florida health inspectors.

Abortion safety regulation: Why good clinics refused to cooperate with Florida health inspectors.

How the politics of abortion protects bad clinics.
Feb. 24 2011 10:21 AM

Fighting the Gestapo

Why good abortion providers refused to cooperate with Florida health inspectors.

The Back Alley: How the Politics of Abortion Protects Bad Clinics, part 6

Photo of Mary Grizzle, courtesy the Florida  Attorney General
Mary Grizzle
William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

On Nov. 22, 1989, one month after the Florida legislature rejected abortion clinic regulations sought by Gov. Bob Martinez in a special session, the U.S. Supreme Court case that had inspired his proposal was settled out of court. The case, Ragsdale v. Turnock, involved an Illinois law that required abortion clinics to meet the same construction, equipment, and personnel standards imposed on outpatient surgery clinics. In the settlement, Illinois clinic representatives accepted sanitation standards, four annual inspections, and a few other requirements. In exchange, the state scrapped a host of exorbitant demands. "We achieved by negotiations exactly what we brought the suit to get," said an attorney for the clinics.

In Florida, no such reconciliation was brewing. A week after the special session, the Florida Senate appointed a select committee to resolve questions of clinic safety. At its head sat Sen. Mary Grizzle, a pro-choice Republican. She had tried to dissuade Martinez from calling the special session. Grizzle remembered several girls who had disappeared from her community in the years before Roe. Pregnant and desperate, they had turned to a local doctor who did illegal abortions. Rather than expose his butchery and their crimes, they had bled, suffered, and died. If Grizzle had anything to say about it, abortion would never again be illegal—or unsafe.

On the day Ragsdale was settled, Grizzle sent a survey to every abortion clinic licensed by the state. She requested a list of the clinic's active doctors and staff "to determine the numbers and types of health care professionals" involved in abortions. Many providers recoiled. For years, pro-life extremists had identified, tracked down, and harassed doctors who performed abortions. The providers feared that the lists would fall into the hands of those extremists. They protested to John Wilson, the committee's staff director. They also contacted Charlene Carres, a lawyer and lobbyist for the ACLU and Protectors of Women's Abortion Rights, an alliance of 34 Florida clinics. Carres advised them to withhold the names and told Wilson that he would have to subpoena the lists to get them.

On Dec. 1, Grizzle sent the providers a second letter. She acknowledged their concerns and promised that the lists would be "kept absolutely confidential." But without more detail as to who would see the lists, Carres wasn't satisfied. She was furious that the state Department of Health and Rehabilitative Services, in a style she likened to that of Hitler's Gestapo, had recently staged surprise inspections of clinics based on reports from pro-lifers. Who, she wondered, was pulling the government's strings?

Testifying before Grizzle's committee on Dec. 5, clinic owner Patricia Windle explained the providers' fears. She described "the climate of terror" around them: kidnappings, bombings, and burnings. She recalled how some pro-lifers, bent on driving clinics out of business, had pursued ambulances carrying patients with complications. These activists, she alleged, had invaded patients' hospital rooms and pressured them to sue clinics and their doctors for malpractice.


In the eyes of many providers, inspectors were part of that terror. "Inspection is an obvious avenue for harassment," Windle's husband and business manager wrote in an op-ed  in early January. "Several of us have been victimized by inspectors trying to exceed their authority for their own personal religious agenda." The state was part of the problem; it couldn't be part of the solution. "We do not choose to dance with a wolf in inspector's clothes," Mr. Windle concluded.

Carolyn Pardue, the lobbyist for Planned Parenthood and the Florida Nurses Association, found the impasse embarrassing. She was a central figure in the pro-choice coalition and had worked hard to defeat Martinez in the special session. But her clients weren't abortion providers. They were medical professionals with a broader agenda. Not a single Planned Parenthood clinic in Florida performed abortions.

Planned Parenthood's distance from the front lines of abortion care bred distrust among the providers. In their eyes, Planned Parenthood's administrators didn't understand the realities of abortion delivery. And if further clinic regulations were adopted, it would bear none of the costs.

Pardue refused to be cowed. Planned Parenthood's Florida affiliates referred several thousand women to abortion providers each year. If any of those providers screwed up, her organization could be sued. For that reason, the Planned Parenthood Federation of America regularly and thoroughly inspected any clinic or doctor's office that sought patient referrals for abortions. This responsibility made Planned Parenthood fairly tolerant of clinic regulation. How could it oppose standards less stringent than its own?


When the providers refused to share basic information with Grizzle's committee, Pardue lost her patience. She enlisted her Planned Parenthood affiliates to extract the cooperation of the clinics to whom they referred women. Another pro-choice lobbyist fetched Grizzle's list of clinics and spent two days on the phone begging their owners and managers to return the survey, at least reporting the number of doctors, nurses, and other medical staff they employed.

Of the 44 active providers, 26 eventually completed the survey. Four refused to provide the information. Fourteen others sent no reply. Half a dozen told John Wilson, the committee staff director, that they wouldn't answer the survey no matter what pledges of confidentiality the committee gave them. Some who did reply called it an inquisition and excoriated Grizzle. Some said the state had no business interfering in doctors' judgments. From the Miami clinics came no such outbursts—just a deep, disquieting silence.

Wilson read the state's files on every clinic. He examined the standards enforced by Planned Parenthood and the National Abortion Federation. He conferred with providers to determine which practices were normal or sensible. On March 5, the committee released his report. It found "no evidence to indicate that complication rates or deaths from abortions are above what would normally be expected based on national statistics." On the other hand, abortion clinics faced no sanitation requirements, and under a 1982 court injunction imposed by federal judge Jose Gonzalez, Jr., "any legislation enacting new standards for sanitation and health care in abortion clinics would be unenforceable." That injunction, Wilson observed, had limited HRS inspections so severely that the now-infamous Dadeland clinic, in the months leading up to its exposure by the Miami Herald, had twice passed muster.

Beyond that, the report found several additional problems. Clinics frequently failed to disclose to HRS the names of all their doctors. Sometimes, on patient-treatment records, they concealed the names of the responsible physicians. HRS staff seldom, if ever, checked with Florida's Department of Professional Regulation to make sure that the doctors listed by the clinics were licensed. And although the best way to detect bad treatment was to review patient records, often the only records examined by inspectors were those selected by clinic staff. If a clinic had botched a few cases, the inspector would never find out.


Charlene Carres, the clinics' lobbyist, was unmoved by the report's findings. Testifying before the committee, she dismissed the safety inquiry as a front for pro-lifers:

"[T]hose people who are presenting information to this committee ... in an effort to show, without much documentation or any, that there is a safety problem with abortion in Florida, consist solely of those individuals who would like to see abortion made illegal because they consider it murder. Those of us who feel that abortion is an option that people must have available are not presenting evidence to this committee that abortion is anything other than safe as it currently stands or at least as safe as comparable procedures in this state."

It was a perfectly self-fulfilling argument. First make sure no one on your side admits there's a problem. Then point out that anyone asserting a problem is on the other side. But the binary war that had raged in Florida for eight months was changing. Pardue and Carres were no longer on the same side. The pro-choice lobby was coming apart.

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