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“The abhorrent conditions
and practices inside Gosnell’s clinic are directly attributable
to the Pennsylvania Health Department’s refusal to treat
abortion clinics as ambulatory surgical facilities”
Editor’s note. Abortionist
Kermit Gosnell is charged with eight counts of murder. “How Did
This Go On So Long?” is one of the key sections in the Grand
Jury’s 261-page report. Today’s except show that the Department
of Health’s abortion regulations were absurdly inadequate to
protect women.
Pennsylvania’s abortion
regulations, written by the Department of Health, are totally
inadequate to protect the health and safety of women at abortion
clinics.
The abhorrent conditions
and practices inside Gosnell’s clinic are directly attributable
to the Pennsylvania Health Department’s refusal to treat
abortion clinics as ambulatory surgical facilities. But even if
DOH’s position with respect to whether abortion clinics are ASFs
[ambulatory surgical facilities] were reasonable – which it is
not – that interpretation would not excuse the department’s
abdication of its duty to afford women who go to these clinics
the same types of safeguards that plastic surgery patients
receive. This is because – whether a facility is called an
ambulatory surgical facility, a hospital, or a freestanding
abortion clinic – the legislature with the Abortion Control Act
has charged DOH with the duty to write and enforce regulations
that protect the health and safety of women undergoing abortion
procedures.
DOH’s position is that one
subsection of the abortion regulations – 28 Pa. Code §29.33 –
contains all of the rules necessary to ensure that women will be
protected. But patients at any other ASF are protected by 30
pages of rules and regulations. 28 Pa. Code §§ 51.1 et seq.
Gosnell’s clinic, which operated for decades with impunity,
constitutes more than sufficient proof that one subsection of
regulations, without monitoring, licensing, or inspections,
offers inadequate protection. Given that DOH [Department of
Health] is capable of writing and enforcing regulations that are
comprehensive and enforceable, such as those governing ASFs, we
question whether DOH officials have even tried over the decades
to protect women who go to clinics for abortion procedures. The
ASF regulations, for example, require that patients undergoing
every other kind of ambulatory surgery be monitored with
high-tech equipment while under anesthesia. The abortion
regulations, on the other hand, require that the facility have
the high-tech equipment, but do not require that it be used (28
Pa. Code § 29.33(1) and (2)). There is not a single provision in
the abortion regulations relating to infection control (nothing
to prohibit Gosnell from eating cereal while doing procedures,
for example, or from reusing single-use instruments, or from
allowing sick, flea-infested cats in the procedure rooms),
whereas several pages of rules cover infection control at ASFs.
Most importantly, the
abortion regulations include no requirement for DOH ever to
inspect or monitor abortion providers. The Grand Jury was
astonished to discover that abortion clinics in Pennsylvania,
unlike any other health care facility, are apparently supposed
to operate on the honor system. Many abortion clinics deliver
quality care because that is their mission. But what if a
particular doctor’s mission is to maximize profits by cutting
corners? He may hire unqualified staff, reuse instruments,
administer expired drugs, tolerate unsanitary facilities, and
use obsolete and broken equipment – until one or more of his
patients dies. Then, after law enforcement gets involved, DOH
might take action.
This is what happened in
Gosnell’s case. It is not a workable system for regulating
health care facilities that perform one of the most common
surgical procedures, or for assuring safe medical care for the
women of Pennsylvania.
The laws and regulations
designed to protect viable late-term fetuses and infants aborted
alive can only be effective with Department of Health oversight.
In contrast to the
provisions of the abortion regulations that are supposed to
protect women’s health at abortion facilities, those designed to
protect late-term fetuses and infants born alive should have
been sufficient to accomplish that purpose. Late-term fetuses,
because of their advanced gestation and likely viability, are
accorded certain legal rights. Pennsylvania’s Abortion Control
Act strictly prohibits abortions “when the gestational age of
the unborn child is 24 or more weeks.” The only significant
exception is to prevent the pregnant woman’s death or the
“substantial and irreversible impairment of a major bodily
function of the woman.” 18 Pa.C.S. §3211(b)(1).
Pennsylvania law also
requires medical practitioners to resuscitate babies that are
born alive. The Abortion Control Act states: “All physicians and
licensed medical personnel attending a child who is born alive
during the course of an abortion or premature delivery, or after
being carried to term, shall provide such child that type and
degree of care and treatment which, in the good faith judgment
of the physician, is commonly and customarily provided to any
other person under similar conditions and circumstances.” 18
Pa.C.S. §3212(b).
Gosnell routinely
performed abortions beyond the 24-week limit. He was ruthless in
severing the spinal cords of viable babies outside their
mothers’ wombs. This conduct clearly constitutes prosecutable
criminal behavior. In order for district attorneys to be able to
prosecute, however, the crimes must first be detected. This is
DOH’s job – to ensure that violations of Pennsylvania health
care laws are detected. Its inspectors must review files as part
of their inspections. They must look at ultrasound tests and
pathology reports on second-trimester fetuses. They must make
sure that informed and parental consent forms have been signed
and that abortions have been reported to DOH.
Instead, Pennsylvania
officials have created what amounts to an honor system, a system
conspicuously lacking in regulatory oversight or enforcement. If
DOH abdicates its responsibility to monitor and inspect abortion
clinics, the protections that the Abortion Control Act provides
to prematurely born infants and unborn post-24-week fetuses
become meaningless to those willing to break the law. The
wrongful death of a viable fetus is deemed a homicide. DOH must
ensure that the law is applied to protect those least able to
protect themselves.
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