-Caveat Lector-

Abortion:  A Dirty Industry
Source:   Citizen Magazine; July 2001

Pro-life legislators and activists in several states are beginning to win
the war over regulating abortion clinics.

By Karla Dial (Karla Dial is a freelance writer in Colorado Springs,
Colo.)

It started in 1992, when two Charleston abortion-clinic workers went to
the South Carolina Department of Health and Environmental Control with a
horrific tale.

The doctor for whom they worked didn't just abort babies-he ground their
tiny bodies in a kitchen garbage disposal, flushing what was left down the
drain and into the public sewer system.

Because first-trimester abortion clinics weren't regulated in South
Carolina, the state could only investigate possible violations of the
Hazardous Waste Management Act. But when state Sen. Glenn F. McConnell,
R-Charleston, saw a television station's three-part expos on the problem,
he turned his outrage into action.

"There's more regulation now in a veterinarian's clinic than an abortion
clinic," McConnell said in launching hearings into the matter. During
those hearings before the General Assembly in 1994, women told what they
saw while undergoing abortions: bloody sheets, bloody cots, dirty
bathrooms- even a dog in the operating room. The bill that emerged from
those hearings- proposing to regulate abortion clinics' sanitation, staff
qualifications and disposal procedures-was signed into law in January
1995.

But that law has yet to be enforced. For the last six years, the abortion
industry has fought regulation in court, claiming that imposing even
minimal standards of care on clinics is unconstitutional and medically
pointless.

The need for regulation doesn't just exist in South Carolina. To date, 16
states have some type of law on the books regulating abortion clinics;
seven others have introduced legislation to do so this year. In at least
two of those states-Arizona and Texas-regulations are still tied up in
court.

But time is running out for South Carolina abortion clinics. Last August,
the Fourth Circuit U.S. Court of Appeals ruled 2-1 that the state
regulations "serve a valid state interest" of ensuring appropriate care
for women and neither restrict a woman's right to abortion nor make it too
expensive. Though the abortion industry appealed the decision to the U.S.
Supreme Court, the justices turned it away in late February without
comment, allowing the Fourth Circuit decision to stand. South Carolina's
abortion clinics now have until July 1 to comply with the 27 pages of
regulations handed down by the Department of Health and Environmental
Control.

South Carolina provides a model for other states to follow-and the Supreme
Court's decision provides hope for those attempting to regulate their
local abortion clinics while running a gauntlet of legal challenges.

"The abortion industry, on this issue, keeps saying the regulations
interfere with a woman's right to choose. That's just not the case," said
Kevin Caiello, interim president of the Palmetto Family Council in South
Carolina.

"[This Supreme Court decision] makes it clear that the regulations are not
putting limits on abortion, they're not unconstitutional, and the
arguments against them have not passed judicial muster. The abortion
industry has really been getting a free ride for a long time, and I think
this court decision says that's just not going to be tolerated."

Drawing the line

One would think the statewide attention drawn to the case of LouAnne
Herron-who bled to death after Dr. John Biskind punctured her uterus in a
Phoenix abortion clinic in 1998 (see "She didn't have to die," June 2001)-
would have effected some kind of substantive change in Arizona. Though a
law regulating Arizona abortion clinics was passed in 1999, the New York-
based Center for Reproductive Law and Policy immediately sued to block it
from taking effect. As a result, Arizona women are still receiving
abortions in unlicensed, unregulated clinics-and state Sen. Sue Gerard,
chair of the Senate Health Committee, doesn't see that changing any time
soon.

"There are multiple reasons why it's being held up in court, but one of
them is equal treatment under the law," Gerard said. "There's all kinds of
health care taking place in doctors' offices without regulation, and that
needs to be addressed as well. Problem is, we couldn't figure out how to
do it. We don't want to make every pediatrician and ophthalmologist be
licensed as a hospital. So that's the problem-where to draw the line."

But to Holly Gatling, executive director of the Columbia-based South
Carolina Citizens for Life, that line is obvious.

"Our response to that is when there's a crying need within the family
practice for these minimum standards, the Legislature can deal with that,"
she said. "The Fourth Circuit Court of Appeals says it's not a violation
of the Constitution to regulate one type of clinic. What you can't do is
regulate one facility and not the entire industry. It's all or none."

Skip Hulett, a former district judge and president of the Texas Justice
Foundation in San Antonio, agreed.

"Every state has a legitimate interest in protecting women who undergo
such a dangerous procedure as abortion. How often do we see a patient of a
podiatrist who can no longer have children, who suffers emotionally for
the rest of his life and needs blood transfusions? When you have an
industry that depends so much on secrecy, I think there's a greater need
to ensure the safety and health of the patients."

Hulett knows what he's talking about. The Texas Justice Foundation has
represented women injured by abortionists since the state's licensing and
regulation laws became tangled up in the judicial system in 1999.

Texas passed laws in 1998 requiring doctors' offices to be licensed as
abortion clinics if more than 51 percent of their yearly business was
dedicated to pregnancy termination-licenses that cost each of them a
$2,500 application fee and force them to meet strict rules on equipment,
credentialing and training of personnel while undergoing surprise
inspections. Doctors caught running unlicensed facilities could be
punished by a $4,000 fine and up to a year in jail.

But that "51 percent" clause provided a huge loophole abortionists
shamelessly exploited, said Teresa Collett, a professor at South Texas
College of Law in Houston. By performing a urinalysis on a pregnant woman
her first visit, a blood test the second and an abortion on the third,
abortionists could claim that only 33 percent of their business practice
was dedicated to abortions and thus avoid licensure. So the Legislature
instead set the limit at 300 abortions per year.

"That number, interestingly enough, was suggested by one of the Texas
family-planning groups," Collett said. "The initial legislation proposed a
smaller number-10 abortions per year [per office]. But the abortion
providers complained that was far too low, that you could do that many and
not even be an abortion provider. So the Texas Family Planning Association
provided the 300 number, and the Legislature relied on their expertise.
The New York City lawyers who flew in to challenge our law attempted to
characterize it as nothing more than political compromise, when in fact it
came from the providers themselves."

Around the circuit

The Center for Reproductive Law and Policy helped several Texas
abortionists challenge the law in 1999, and the trial court blocked its
enforcement. Three amendments-requiring abortionists to "enhance patient
dignity, maintain and enhance the patient's self-esteem and provide
quality of care which meets or exceeds the expectation of the
patient"-also were enjoined.

On April 13, the Fifth Circuit U.S. Court of Appeals heard the case
regarding the preliminary injunctions. While the three "self-esteem"
amendments were struck down as too vague, the court found that the state
does not violate the Constitution by licensing clinics performing more
than 300 abortions per year and that states can regulate the training of
abortion-clinic workers.  The case has been returned to the lower court
for a full trial, the date of which had not been set at presstime.

"I think it's very clear the Fifth Circuit is saying there's a legitimate
state interest to protect the health and safety of Texas women, and this
licensing requirement is rationally related to that interest," Hulett
said. "It's constitutional. The trial court is going to have to follow
that.

"If you look at the regulations, they're requiring people who do
[abortions] to have written infection-control procedures, to have
qualified staff, to be subject to annual on-site inspections by state
inspectors. If they don't have anything to hide, they wouldn't be fighting
these regulations."

Aborting for dollars

Running a sanitary, aboveboard business might not seem like such a hard
thing to do. But in the case of abortion clinics, said Carol Everett, who
once owned several in Texas, doctors stand to lose money by changing the
way they do things-a lot of money.

Everett, founder of an Austin crisis pregnancy center called The Heidi
Group, pocketed $25 for every abortion performed in her clinics in the
late 1970s. During her last month as a clinic owner, in 1983, she cleared
$13,625. And prices have gone up since then.

According to data provided by The Heidi Group, first-trimester abortions
in the United States average about $300, of which the abortionist pockets
$100. The goal is to perform 10 to 12 abortions per hour-a rate that will
allow him to earn between $1,000 and $1,200 in the time it takes most
people to take a lunch break. And for second- and third-trimester
abortions, the fee is higher-an average $3,000, of which the abortionist
keeps half. Though they take longer-he can only squeeze in three each
hour-that's still $4,500 an hour.

"You put the woman on the bed, pad beneath her," Everett said. "You never
change the hose [in the suction machine]. You don't wash your hands. You
just run in, do the abortion, then literally run across the hall to do the
next one. At the end of the day, the clinic pays the abortionist in cash,
leaving it entirely up to him what he reports to the IRS."

After Texas' abortion-clinic regulations became law in 1998, the number of
abortions performed in the state dropped 9 percent in 1999-the largest
one- year drop in state history. It is unclear whether that drop is a
result of the regulations or just consistent with the national trend of
fewer abortions being performed that year; however, it is clear that while
83 abortion clinics were operating in Texas in 1998, there are currently
only 52, according to the Heidi Group.

"We believe that when you start protecting the health of women, abortion
clinics start going away," Everett said.

The final conflict

For South Carolina, Texas and any other state with abortion-clinic
regulations, the toughest battles remain on the horizon-enforcing the law.
To be truly effective, every agency in the state has to be committed to
the law; this, too, is far from universally assured.

"Passing regulations is a great idea, but it's only important to the
extent that you enforce them," said Mark Crutcher, founder of Life
Dynamics, a group that brings malpractice suits against abortionists
around the country. "We've seen a lot of cases in the past where states
pass a bill, but the enforcement is left up to an agency that's very
pro-abortion. So you never know what the impact of it is going to be until
you know whether they're going to enforce it, or what the penalties for
violation are.

"If it's a $200 fine, it was a complete waste of time to do it."

So what can pro-life citizens do to ensure that their state's laws are
reasonably enforced?

Holly Gatling suggests they get on the phone.

"Politicians do respond to constituent calls," she said. "Call your state
senator and representative and say you're interested in this. Contact your
local crisis pregnancy centers, see what kind of information they have. Go
to your pastor. Ask him to authorize a Respect Life committee in your
church."

Carol Everett talked to everybody who'd listen-framing the issue in a
context that couldn't be ignored as right-wing religious fanaticism.

"We talked about the abortion problems in Texas," she said, "people not
being licensed, janitors doing abortions. We talked about protecting the
health of women."

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