"The clinic reeked of animal urine, courtesy of the cats that were allowed to roam (and defecate) freely. Furniture and blankets were stained with blood. Instruments were not properly sterilized. Disposable medical supplies were not disposed of; they were reused, over and over again. Medical equipment — such as the defibrillator, the EKG, the pulse oximeter, the blood pressure cuff — was generally broken; even when it worked, it wasn't used. The emergency exit was padlocked shut. And scattered throughout, in cabinets, in the basement, in a freezer, in jars and bags and plastic jugs, were fetal remains. It was a baby charnel house."
– Grand jury report in First Judicial District of Pennsylvania, Jan. 14, 2011.
Earlier this year, people who support and oppose abortion rights were joined in their disgust and horror over the appalling conditions at Dr. Kermit Gosnell's Philadelphia clinic. Gosnell, 72, was found guilty of murdering three babies born alive during illegal late-term abortions.
How could Pennsylvania allow the clinic to remain open in such abysmal condition for so many years?
A number of states, some prompted by the Gosnell case, have been debating more stringent health and safety requirements for clinics, along with more restrictions on abortions.
Texas lawmakers recently passed a law that prohibits abortions after 20 weeks and requires abortion clinics to meet the standards of hospital-style ambulatory surgical centers. These are mini-hospitals, bristling with high-tech surgical equipment designed to deal with emergencies that could arise from riskier surgeries done under general anesthesia. The law also requires doctors to hold admitting privileges at a local hospital.
Wisconsin law now requires that women undergo an ultrasound before having an abortion and requires doctors to hold hospital admitting privileges.
North Carolina has passed law that requires stricter standards at abortion clinics and eliminates insurance coverage for abortions for city and county employees.
The laws in Texas, North Carolina and elsewhere aren't identical — some are more restrictive, some less. Nevertheless, they likely will be challenged in court. The core of the debate: Do these laws promote patient safety or are they designed to put abortion clinics out of business by piling on expensive and unnecessary regulations?
Why hasn't this debate been more visible in Illinois? Well, there has been some debate, but efforts to require abortion clinics to meet hospital-style standards have languished in the Illinois House.
Illinois settled on safety standards several years ago.
In the late 1970s, new state regulations required that any facility that performed abortions be outfitted as an ambulatory surgical center.
In 1985, a Rockford doctor challenged those regulations as medically unnecessary and intended to make it more difficult for women to obtain abortions. U.S District Court Judge John Nordberg agreed that the regulations were so strict they denied women access to abortions. Officials "failed to demonstrate a compelling, or even a rational, basis for the statutory and regulatory scheme," he wrote. A federal appellate court upheld the ruling.
After a yearslong legal battle, the two sides settled on a consent decree, leaving Illinois with tighter regulations.
The vast majority of the 41,000 abortions performed in Illinois annually are done in the first trimester, generally under local anesthesia. They do not require a high-tech surgical suite. Many abortions are done "medically," with drugs that require no surgical intervention.
Medical facilities that devote more than half their practice to surgeries, abortion or other types, must abide by elaborate ambulatory surgical center standards. Those rules impose extensive physical plant and administrative requirements on the facilities. They include exam room sizes, hallways widths and ceiling heights, and requirements for operating suites and emergency medical equipment.
Clinics that perform only early abortions under local anesthesia operate under the same general umbrella but with slightly less stringent requirements for emergency equipment. Their exam rooms can be smaller and their doorways need not be as wide. They do not need to have a full operating suite or special heating and air conditioning systems.
Medical venues in which surgery is not a predominant part of the practice fall under separate state regulations that govern all medical providers and do not focus on physical plant requirements.
These are reasonable regulations. The more pressing issue in Illinois, though, has been whether the state adequately regulates abortion clinics to make sure the state's rules are followed.
The state requires clinics to report on the abortions they perform, including details on complications that arise during procedures. But the Tribune reported in 2011 that that reporting system was unreliable. The Associated Press reported that abortion clinics in Illinois hadn't been inspected for up to 15 years. After regulators stepped up enforcement, two Illinois clinics cited for violations gave up their licenses to operate. State officials say they have stepped up reporting requirements and that all abortion clinics have now been inspected within the last three years.
The Illinois legislature seems unlikely to make substantial changes in the health and safety rules governing abortion. The state has a responsibility, though, as it does with other medical procedures, to monitor that its rules are being followed.
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