Records show abortion clinics already inspected, cited

By Craig Jarvis and Caitlin OwensAugust 1, 2013 

  • Abortion debate plays out on several stages

    July 7, 1999 DHHS suspends operations at A Woman’s Choice of North Carolina in Greensboro.

    Feb. 9, 2007 DHHS suspends operations at A Preferred Women’s Health Center in Charlotte after an inspection.


    May 10 DHHS suspends operations at A Preferred Women’s Health Center in Charlotte after an inspection.

    July 2 DHHS inspects the Baker Clinic for Women in Durham. The Senate unexpectedly unveils legislation crafted from three abortion-related bills.

    July 3 The Senate gives final approval to the bill after a lengthy debate that draws more than 500 protesters to the Legislative Building.

    July 5 The Baker Clinic for Women receives notice of its suspension.

    July 6 Thomas Stith, Gov. Pat McCrory’s chief of staff, receives notification of the suspension via email. July 8 McCrory expresses reservations about the Senate bill; Baker Clinic’s suspension is made public.

    July 10 McCrory warns that he will veto the Senate’s bill unless his concerns are resolved. House members and the McCrory administration craft a new bill, which the House approves the next day and the Senate on July 25.

    July 29 McCrory signs the abortion bill.

    July 31 DHHS announces the suspension of operations of Femcare, which is considered to be the only clinic that could meet potential new standards.

The state has closed three abortion clinics in the past three months for violating health and safety regulations. Until now, the state had suspended just two clinics in 14 years – in 2007 and 1999.

The sudden flurry of suspensions comes amid a highly charged political environment that has seen an unprecedented anti-abortion campaign by the state legislature over the past three years, leading to lawsuits, mass protests and praise by those who oppose the medical procedure. On Monday, Gov. Pat McCrory signed a bill requiring state regulators to write tougher regulations, which have not been updated since 1995, for abortion clinics. He said the bill would ensure the safety of women.

A review of state Department of Health and Human Services inspection records shows that the state’s 16 abortion clinics are periodically inspected and have been written up for “deficiencies” ranging from poor record keeping to more serious violations.

While the documents don’t indicate more inspections than usual this year, the rate of clinic closings suggests a more aggressive stance by regulators. The deficiencies justifying closing the three clinics are similar to problems that in past years have not led to suspensions, records show. DHHS says the current deficiencies posed an imminent threat.

At the same time, emails The News & Observer obtained through a public records request show that there has been political interest in the inspections at the highest levels of state government.

The messages show that the governor’s office and GOP legislators were kept apprised of the Baker Clinic closure in Durham on July 5, two days after lawmakers suddenly introduced a sweeping abortion bill. Emails over the July Fourth weekend show that key figures were notified of the closure before it became public.

Included in the email loop were Matthew McKillip, a McCrory campaign staffer who is now a senior adviser at DHHS; Thomas Stith, the governor’s chief of staff; Chloe Gossage, a former Civitas Institute staffer who is a senior fiscal analyst at the legislature; and Adam Sholar, a former law clerk to state Supreme Court Justice Paul Newby who is now director of intergovernmental relations for DHHS.

Republican members of a health and human services legislative committee – along with one conservative Democrat – were also notified by email from a high-ranking DHHS official. Other Democrats on the committee were not informed.

A spokesman for DHHS said the emails were part of the agency’s standard practice of keeping the governor’s office and the legislative leadership informed.

“I think it just came as a courtesy email to let us know an action had been taken by the department,” Sen. Louise Pate, a Mount Olive Republican who is on the committee, said Thursday. “I think it means that maybe DHHS is doing its job, or at least reacting to complaints.”

State-clinic relationship changing

In arguing for the abortion bill’s passage last month, Republican legislators relied on reports from DHHS.

“There’s a blatant disregard for standards,” Rep. Jacqueline Schaffer, a Charlotte Republican, said on the House floor, citing figures provided by DHHS showing multiple citations at clinics.

Those who oppose abortion hail the recent closings of clinics in Durham, Charlotte and Asheville as proof that a crackdown with new regulations is needed to protect women. But abortion-rights supporters argue that it proves the system in place already works, since state inspectors caught the problems.

The state said it didn’t have enough inspectors to visit the clinics and hundreds of other facilities more than every few years. The new state budget doubles the number of inspectors to 20.

Paige Johnson, vice president of external affairs for Planned Parenthood of Central North Carolina, which owns several clinics in the state, said her group is concerned about the spate of closures. She said clinics have worked well with inspectors over the years.

“Our relationship with the state has always been a partnership ensuring women are safe and cared for respectfully, and not a kind of gotcha,” Johnson said. “There’s been a flurry of attention from the governor’s office and DHHS. What about hospitals, ambulatory surgical centers, assisted living facilities? What has changed to make the state focus on abortion providers? Is it about politics?”

The state health agency says the inspections were routine.

A review of inspection reports shows that the reasons most clinics are written up is typically for gaps in protocol and for record-keeping errors. But sometimes, the violations appear more serious, such as for using a single-dose vial of a narcotic for multiple patients instead of discarding it after the first use, or for allowing a medical office assistant instead of a doctor to examine biological material after the procedure.

Registered nurses inspect the clinics for DHHS to make sure they comply with state licensing requirements. The clinics’ laboratory practices are evaluated under federal guidelines, and most of the violations typically relate to improperly handling blood.

Comparison drawn to Gosnell

This year’s suspensions began with A Preferred Women’s Health Center in Charlotte, the same clinic suspended in 2007. The clinic was inspected in March, the same month that a developing national story was giving anti-abortion advocates and state legislators more ammunition.

A Philadelphia abortion provider, Dr. Kermit Gosnell, was accused of killing three infants and a patient. North Carolina legislators said concerns over the Gosnell findings caused them to question the safety of clinics here. Gosnell was found guilty in May. That same month, DHHS investigators revoked the Charlotte clinic’s license after determining that staffers were orally administering a liquid drug used to induce abortions. The drug is meant to be injected or taken in pill form, according to the state report.

The findings revealed an “imminent threat to the health and safety of patients.”

On Wednesday, the state closed Femcare in Asheville, citing “egregious violations,” including torn anesthesia masks, a dirty operating room floor and unchecked emergency equipment. The clinic is the only one in the state licensed as a same-day surgical center, and its license was suspended for not being in compliance with that standard.

“The nation was rocked by the horrors of the Gosnell abortion clinic in Philadelphia, but apparently we have our own ‘Gosnells,’ ” Tami Fitzgerald, executive director of the N.C. Values Coalition, said in a statement released Thursday.

Femcare had not been inspected for compliance with state regulations since 2006, but its laboratory has been inspected under federal regulations four times since 2008. The clinic issued a statement saying it hasn’t changed the way it operates since the 2006 visit, but that it was just notified of new standards due to “increasing regulations” two weeks ago. DHHS on Thursday disputed that and said the standards hadn’t changed since 2003.

Rh testing concerns

Femcare’s license was suspended because it was seen as an “imminent danger.” The Baker clinic in Durham was deemed a “potential imminent threat” because of its testing procedures for the blood antigen RhD. However, violations related to Rh testing are not uncommon. While no two clinics show identical inspection results, more than two dozen clinics have received statements of deficiencies related to Rh testing. These include using expired control testing material, failure to follow correct testing procedures, keeping testing materials at an unacceptable temperature and not using control tests on certain days.

RhD testing determines a woman’s blood type, which is either Rh-positive or Rh-negative. Rh-negative women, who constitute about 15 percent of the population, must receive an extra shot to protect future pregnancies from antibodies that could develop if the woman is exposed to Rh-positive blood during the abortion.

John Baker, the Durham clinic’s owner, said he thinks the suspension shows that the health agency is “doing its job and doing it well.” But he also said he thinks the target legislators have put on clinics isn’t about women’s health.

“This has nothing to do with patient safety,” he said. “Legislators around the country are trying to legislate abortion out of existence. They can only go so far, so they go as far as they can.”

Jarvis: 919-829-4576

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