The problems exposed in Florida's fight over abortion clinics — state neglect, pro-choice denial, and the relegation of abortion to the shadows of medicine —didn't end there. They have surfaced in other states, too.
On Sept. 2, 1989, two weeks before the Miami Herald exposé in Florida, the Boston Globe disclosed that Dr. Howard Silverman, the owner of Massachusetts' biggest chain of abortion clinics, had admitted to sexual misconduct with a female patient. Based on the patient's complaint, Silverman had lost his authority to admit patients to nearby hospitals in the event of complications. Despite this, he continued to perform abortions. Unlike other providers in the area, Silverman used dubious advertising tactics, refused Medicaid patients, and apparently reaped huge profits. Although his three clinics handled more than 10,000 abortions per year, he disguised them as doctors' offices, thereby evading the state's abortion clinic regulations.
Like the exposed clinic operators in Florida, Silverman portrayed his unmasking as an attack on abortion rights. And, as in Florida, the Globe found that colleagues had known of his misconduct, as well as his generally bad reputation, but had kept it secret. "The question was: Who was going to tell?" an anonymous source in the pro-choice community told the Globe. "Do we go public with it and hurt the whole movement or do we keep quiet and deny women the chance to make an informed choice about who does their abortion?" A spokeswoman for Mass Choice, the state affiliate of the National Abortion Rights Action League, was outraged at the secrecy:
"The fact that he is still practicing after he's admitted assaulting a woman is frightening. And I certainly want to know more about who knew and why they didn't say anything. If they think they were protecting the abortion rights movement, they could not have been more wrong. They certainly were not protecting the women of this state."
A few days later, Chicago abortionist Arnold Bickham was arrested for practicing medicine less than a year after losing his license for gross malpractice. In the malpractice case, a woman had hemorrhaged and gone into shock after an abortion at Bickham's clinic. According to testimony at his license revocation hearing, Bickham, calling the woman "lazy," had shoved her out the door in a wheelchair. Before that, the state had suspended Bickham's license for performing abortions on women who weren't pregnant, and sometimes without proper anesthesia. No one could be sure how rare these offenses were, since abortion clinics in Illinois hadn't been regulated or inspected for four years, thanks to a court injunction like the one in Florida.
Another horror story surfaced in Maryland a week after the fight in Florida began. A woman lapsed into respiratory trouble while under anesthesia for an abortion at the Hillview Women's Medical Surgical Center. Despite having no anesthesiologist on hand, the clinic's medical director continued the operation. The patient went into cardiac arrest and died. A year later, a similar crisis developed. Again, there was no anesthesiologist. This time, clinic workers tried to revive the woman with the wrong drug and couldn't get the clinic's emergency oxygen equipment to work. The woman was left paralyzed, unable to walk or talk. Three years later, she died.
The clinic's owner, Barbara Lofton, blamed reports of her recklessness on the pro-life views of the local paramedic chief. He denied that he held such views. Months later, on 60 Minutes, Lofton's former employees and patients alleged that she had practiced medicine without a license and had nearly killed a patient by botching her abortion. CBS correspondent Meredith Vieira reported that "many pro-choice leaders knew about problems at Hillview but didn't want them publicized. National Abortion Federation head Barbara Radford admitted she was just hoping we would go away."
Nor were these leaders eager to address the underlying problem: Maryland had no laws for abortion clinics or outpatient surgery centers. Anesthesia and emergency medicine in these facilities were unregulated. That was why Lofton had moved her clinic to Maryland when the District of Columbia ordered her to stop performing abortions without a clinic license. A pro-choice legislator in Maryland had sought to regulate clinics but had met resistance from her colleagues. "There's only so much of a willingness to try to push ... the pro-choice movement to do what I think is the responsible thing to do," the lawmaker lamented, "because they then treat you as if you're the enemy."
Over the years, similar cases have turned up in other states. Pennsylvania's Kermit Gosnell scandal may be the latest and biggest of these regulatory failures, but it isn't the only one. On Wednesday, the attorney general of Delaware, Beau Biden, filed five complaints against two Delaware doctors and a clinic owner for impersonating a physician, prescribing controlled substances without a license, and failing to report what they knew about Gosnell. And three weeks ago, the Philadelphia Inquirer reported:
"Pennsylvania's system of oversight—or lack of it, in the grand jury's view—may not be unusual. For five months last year, New Jersey regulators received complaints that abortion doctor Steven Brigham, 54, was running a secret, cash-only, late-term abortion business using a risky interstate scheme—one for which he was disciplined in the 1990s. Just as in the Gosnell case, regulators took no public action against Brigham—until a police raid forced them to."
The Gosnell and Brigham cases, according to the Inquirer, "illustrate a host of problems, including a feeble complaint system, spotty clinic inspections, poor communication among oversight agencies—and the reluctance of doctors to punish their own."
Brigham's case is still unfolding. Allegedly, he circumvented state regulations by inducing labor in New Jersey and completing the abortions in Maryland. (Gosnell allegedly used a similar tactic in Delaware.) One woman had to be airlifted to a Baltimore hospital to treat critical injuries from the procedure. When police raided Brigham's Maryland clinic, they found no medical records for the patient. But in another grim parallel to the Gosnell case, they found 35 late-term fetuses and fetal body parts, also without records.
Despite the raid, a trail of botched abortions, and license suspensions in New York and New Jersey, Brigham is still operating clinics in New Jersey, Maryland, Virginia, and Pennsylvania. Last year, Pennsylvania's Department of Health, fresh from the gruesome discoveries at Gosnell's uninspected facility, approved Brigham's transfer of his clinics to his mother's company, thereby helping him evade an order that was supposed to bar him from owning abortion clinics in the state. The order forbidding clinic ownership "does not apply" to Brigham's mother's company, a health department spokeswoman told the Inquirer.
And guess where Brigham has opened his latest franchise? Florida. "There is nothing in Florida law that would prevent Dr. Brigham from having part ownership in these entities," a spokeswoman for Florida's health regulation agency told the Inquirer. "Unless there are specific allegations," such as practicing medicine in Florida without a license, "there is nothing for the agency to investigate."
Twenty years after the clinic regulation fight in Florida, it seems that little has changed.
In Pennsylvania, the outlook is better. The state's oversight of Gosnell was awful. But last year, embarrassed by his exposure, officials inspected Pennsylvania's other 22 clinics and found only minor deficiencies. Prodded by the grand jury report, the state's new governor, Tom Corbett, is moving to fix the system. Last week he fired several state officials faulted by the grand jury, and he imposed new rules similar to the ones defeated in Florida. Abortion clinics will be inspected every year, and the two agencies that monitor doctors and clinics will be networked.
Corbett, like Florida's Bob Martinez, is pro-life. But unlike Martinez, Corbett has imposed his rules by executive order rather than legislation. And he has avoided turning clinic safety into a broader political fight. " This is not a pro-life, pro-choice issue," Corbett declared as he announced the new procedures. "This is a public safety issue." Abortion rights advocates, in turn, have held their fire. Dayle Steinberg, the president of Planned Parenthood of Southeastern Pennsylvania, says Corbett's rules will " help women feel more confident about the current standards being enforced."
The question now is what pro-choicers will do as bills to codify the new rules advance through the Pennsylvania legislature. Such bills were in the works before Corbett's announcement. The state's House majority leader says Corbett's order won't stop them, and Corbett says lawmakers are free to pass them, thereby making his changes permanent. Some pro-choicers are uneasy. "The laws on the books were sufficient, had they been followed," the Inquirer's editorial board argues. " Harrisburg doesn't need to engage in a crackdown on abortion providers."
To me, the lesson of Florida is that pro-choicers should surrender this categorical aversion to legislation. And pro-lifers should respect the neutrality of clinic safety regulation instead of using it to impede abortions. Driving good doctors and clinics out of this field—or making it harder for women to find or afford them—will create more Gosnells, not fewer. If you want abortion to be practiced and monitored as carefully as other kinds of medicine, don't segregate it. Integrate it.
I hope Corbett, the legislature, and Pennsylvania's pro-choice community can keep their cool in the months ahead. Nobody wants another Gosnell. Nobody should want another Florida, either.