Unsafe abortion clinics exposed in Florida: What health inspectors and reporters found.

Unsafe abortion clinics exposed in Florida: What health inspectors and reporters found.

Unsafe abortion clinics exposed in Florida: What health inspectors and reporters found.

How the politics of abortion protects bad clinics.
Feb. 22 2011 7:23 AM

The Sunshine State

What reporters and health inspectors found in Florida's worst abortion clinics.

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Photo of Gregory Coler, Director of the Illinois Dept. of Children & Family Services, Jan. 1979 - Dec. 1983
Greg Coler
William Saletan William Saletan

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

On Sept. 22, 1989, Florida Gov. Bob Martinez called a press conference to address news of dangerous conditions at the Dadeland Family Planning Center, a Miami-area abortion clinic. The revelations, published by the Miami Herald, included a woman's death. They indicated that the state's supervision of abortion clinics was grossly inadequate. Martinez ordered the state Department of Health and Rehabilitative Services to draft emergency regulations for the clinics.

Pro-choice groups didn't take the announcement well. Martinez was leading a campaign to make Florida a model pro-life state. Two months earlier, he had called a special legislative session, scheduled for October, to enact abortion restrictions including strict clinic regulation. So when the governor issued his Sept. 22 order, alarms sounded. Abortion providers called a meeting to prepare legal defenses against the emergency rules. The Florida Abortion Council, which represented the state's leading clinic operators, served notice that it was ready to sue.

The bad news from the clinics was just beginning. On Sept. 25, HRS officials marched into the Dadeland facility, suspended its license, and slapped a "CLOSED" sign on its entrance. Greg Coler, the department's secretary, described what his inspectors had found. The clinic's suction equipment had a dark red residue. The staff couldn't recall when it had last been cleaned. Surgical tools were stored in bloody paper towels. Oxygen tanks were leaking in smoking areas. Expired drugs were kept on hand. "This clinic is the closest thing to a back-alley abortion mill that you can find, considering that abortion is legal," said Coler.

Why hadn't the state noticed these conditions before? Coler pointed to a 1982 order by a federal judge, which had struck down most of Florida's authority to police abortion clinics. Unless the laws were changed to broaden his agency's authority, Coler said he couldn't tighten clinic standards.

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That was fine with FLAC. The council said it wouldn't accept further regulations even if they simply codified standards already required by the privately run National Abortion Federation. "No matter how many regulations you write, people are going to operate illegally," argued FLAC's president. The owner of the Dadeland clinic urged pro-choicers to stand together against Martinez. "Do you see that we're being harassed?" she asked the press. "Do you see that it's the governor doing this?"

Tips from former patients and clinic workers began flowing to HRS. On Sept. 27, HRS inspected and shut down a second clinic. "There was actually an abortion-suction device in this place that had green mold growing in it," Coler reported. "There wasn't any soap in the place, so our inspectors had to go next door to wash their hands." Blood coated the stirrups at one operating table. Dirty emergency equipment was found at the bottom of a packed closet.

Some of the discoveries HRS held up as "horrifying"—repeated use of sterilized surgical tools, for example, or the use of a kitchen colander to strain tissue for lab tests—were safe and common practice. But these characterizations were errors of ignorance, not ideology. A few years earlier, Coler had helped found and finance two groundbreaking  birth control programs in Illinois. Over the past month, he and his staff in Florida had tried to scale back Martinez's regulation schemes. HRS officials were simply embarrassed that a reporter had caught them asleep on the job. They were scrambling to look vigilant.

Rather than help clean up, pro-choice leaders stonewalled. First they complained that the state Department of Professional Regulation was plotting to tighten licensing rules for abortions in doctors' offices. Then they claimed that by failing to crack down on doctors' offices as well as clinics, HRS proved it wasn't really concerned about health. Meanwhile, they cited HRS's regulatory failure as evidence that further regulations wouldn't help. "If they can't enforce the laws that exist," asked a state senator, "why do they need stronger laws?"

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Sensing defeat, Martinez gave up on his original regulatory plan. Instead, on the advice of HRS, he proposed milder sanitation, staffing, and equipment rules drawn from the National Abortion Federation standards—with which half of Florida's abortion clinics already complied—and from standards already imposed on birthing centers. Still, pro-choicers wouldn't budge. "It's ludicrous that the governor himself is willing to admit that 30 of the 48 clinics are doing a fine job, and HRS can't find serious problems in the other 18, yet he wants to waste taxpayer money to impose all these new rules," said Janis Compton, the director of the Florida Abortion Rights Action League.

Two days after the governor's retreat, another political threat collapsed. The Florida Supreme Court ruled that a 1980 amendment to Florida's constitution protected the right to abortion. Even if the U.S. Supreme Court were to overturn Roe, abortion would remain legal in Florida. The grounds to fear state oversight of the clinics were dwindling. And the bad news from HRS kept coming: On the day of the ruling, officials inspected and closed a third clinic. Backup equipment didn't work; medicine was expired; old blood contaminated some instruments. According to Coler's report:

"There were dead cockroaches in the sterilizing room … There was no hot water and the hot water taps had been broken for some time. There was no soap at the clinic's three sinks and there wasn't a single sterile surgical glove in the place. A filthy mop that a veteran public health doctor said stunk of dried blood was stored with medical supplies. The air vents were covered with filth."

This was what remained after a cleaning woman had spent a day scouring the clinic. In the trash, inspectors found corroded instruments apparently dumped just before they arrived.

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Two days later, Deborah Sontag, the Miami Herald reporter who had broken the story of the Dadeland facility, exposed a fourth clinic. According to the clinic's documents and workers, its owner, Dr. Vladimir Rosenthal, had pressured his staff to encourage patients to undergo general anesthesia and had paid employees a commission for each such sale. General anesthesia raised the clinic's fee for a first-trimester abortion from $200 to $300. And at Rosenthal's clinic, Sontag reported, it posed deadly risks:

"Some women switched to general anesthesia at the last moment, the ex-employees said, unaware that they weren't supposed to eat before being put to sleep. As a result, some patients turned blue from choking, the employees said. The anesthetist was forced to suction food particles or saliva from their windpipes, or, in one instance, to perform mouth-to-mouth resuscitation."

HRS had inspected the clinic days earlier but had failed to catch this scam. "It's only harassment," Rosenthal groused to a reporter after the inspection. "I've never been inspected by the state before."

By the eve of the special session, pro-choice advocates had hardened into a wall of defiance. Their resolution was to crush every bill, humiliate Martinez, and hoist his carcass as a warning to other politicians. National pro-choice leaders flew to Tallahassee to beat the war drums. "The chances of enacting anything are nil. That's what the news is," the executive director of the National Abortion Rights Action League declared on Oct. 9. For the governor, she vowed, "this special session will be a crashing disappointment and a major political embarrassment." The president of the Feminist Majority Foundation agreed: "This session is no longer about laws and lawmaking. It's about saving face for Bob Martinez."

Hundreds of reporters and thousands of activists descended on Tallahassee. CNN covered the session live. Network anchors interviewed Martinez. He repeated the clinic horror stories and called again for new laws. Against him, pro-choicers drew a libertarian line. "The world's eyes are on you, and the world's eyes are on Gov. Martinez," one legislator thundered at a rally. "Government, stay out of our private lives!"

Outside the capitol, greeting lawmakers and activists as they arrived, stood a pro-choice protester in what looked like bloody surgical garb. In one hand, he brandished a coat hanger. In the other, he held a poster proclaiming, "THERE WILL ALWAYS BE A CHOICE." That was the tragedy of the hour. To defend choice without regard to its conditions was folly, because choice was never in doubt. Only its conditions were at stake.

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