Among reproductive health advocates, it's unclear who knew what. The grand jury report says "some pro-choice and women's health groups learned from Gosnell's patients of their frightening experiences." The report adds that "community groups tried to help women file complaints," but it doesn't name the groups. Last year, after the raid on Gosnell's clinic, Philadelphia news station WHYY reported that Dayle Steinberg, the president of Planned Parenthood Southeastern Pennsylvania, said " she hadn't heard of any problems at [the] clinic until the allegations surfaced in recent days." But according to the Delaware County Daily Times, after this year's release of the grand jury report,
"Steinberg said the news surrounding Gosnell's arrest was not the first time he popped up on her organization's radar. Planned Parenthood had been hearing unsubstantiated rumors about his clinic for several years, Steinberg said. It was not until the last few years that the organization began hearing rumors of his services "not being high quality.""
Somewhere in the chain of rumors, the network of health providers failed to expose what was happening.
At the root of the state's lax oversight, pro-choice legal scholars see a failure to recognize abortion as health care. "By and large, our policymakers have never viewed abortion as a medical procedure—instead placing it under the Pennsylvania Criminal Code—and therefore haven't nurtured a system of abortion care that is woman-focused," write Carol Tracy and Susan Frietsche of the Philadelphia-based Women's Law Project. "The commonwealth's focus has been on denying access, not protecting the health and safety of women who need this medical care." The Department of Health's legal analysis illustrates this mentality. The department assumes—wrongly, in the grand jury's view—that since abortion clinics are regulated under their own subsection of Pennsylvania law, they're immune to dozens of pages of rules that apply to ambulatory surgical facilities.
Gov. Corbett's administrative changes have begun to address this problem. Now there's talk in the legislature of writing these and other changes into law. Several proposed bills aim to equalize regulations and fix the coordination and inspection problems cited by the grand jury. One proposal, drafted by a pro-choice state senator, would "make it mandatory for the Department of Health to immediately respond to any complaints, in addition to doing much more timely inspections." Another, offered by a pro-lifer, would make the inspections annual and impose on abortion clinics " the same safety standards which other health care facilities must meet." A third senator, also pro-choice, is planning legislation that would " require the Department of Health to investigate 'serious events' reported at clinics and share those findings with the Department of State."
Some abortion rights advocates are open to these ideas. But Corbett's changes are stirring old fears. "We just hope this doesn't mean PA, with our new pro-life governor, will slowly slip the way of so many other states … and make it harder for a woman to get a safe abortion," warns the Philadelphia Weekly's politics blog. Other pro-choicers, fearing burdens and restrictions, have spoken out against the whole idea of further regulation. " No new regulations can stop a physician who has decided to disregard the law," Steinberg wrote in an op-ed four days after the release of the grand jury report. Susan Schewel, executive director of the Women's Medical Fund, adds: " Singling out abortion providers for new regulations won't solve the problem. Current regulations are adequate when enforced." Tracy Weitz, director of the University of California's program in " Advancing New Standards in Reproductive Health," says of Gosnell, " the lesson none of us should take is more regulation, because he was already outside the regulations."
The fears of these advocates are understandable. Some pro-lifers are using the Gosnell scandal to promote legislation aimed more at obstructing abortion than at making it safe. Pro-choicers are also correct that many laws, such as restrictions on public funding or insurance coverage of abortions, drive women into the arms of substandard clinics like Gosnell's. But the anti-regulation message of many abortion rights advocates in the wake of the grand jury report is oddly categorical. It's particularly odd coming from progressives who otherwise support consumer protection. In the words of Daily Times columnist Gil Spencer, it " sounds an awful lot like the National Rifle Association."
I'd like to think that in the months ahead, Pennsylvania's abortion providers and pro-choice groups will work with legislators and the governor to fix the regulatory problems that led to the Gosnell fiasco. But I worry that many of them won't. I've seen providers and their allies in the reproductive rights community circle their wagons before. I've seen them deny the significance of bad doctors, dirty clinics, and a woman's death. I've seen them resist inspections and dismiss abortion laws the way the NRA dismisses gun control. I've seen them fight and kill legislation similar to what's being proposed in Pennsylvania. These things happened years ago in a different place, and I'm afraid they could happen again. Tomorrow, I'll tell that story.
Next: The Abortion Industry