The regulation of abortion providers has historically been a thorny, bitterly contested issue in Florida. In the late ’80s and early ’90s, politicians began scrutinizing the sordid and illicit practices of the state’s abortion clinics. Then as now, pro-choice groups and the clinics themselves fiercely resisted attempts to tighten regulations on Florida’s abortion industry.
To some extent, that resistance proved futile. Florida has tightened its abortion restrictions over the years — just this July, for example, the state implemented a 24-hour waiting period after abortion counseling. But data from the Guttmacher Institute show that between 1991 and 2011, the legal-abortion rate in Florida remained steadily higher per 1,000 women ages 15-44 than the national rate (23.7 percent vs. 16.9 percent in 2011).
It appears that tighter regulations haven’t reduced Florida’s abortion rate because a majority of clinics in the state don’t follow them.
Since January 1, 2008, just over half of listed Florida abortion clinics (42 of 81) have been cited for violations of state law, according to inspection records obtained from the Florida Agency for Health Care Administration (AHCA) by National Review. Problems ranged from unsterile instruments and unmaintained ultrasound machines to unreported serious injury, illicit second-trimester abortions, and failure to obtain legally required parental consent. Many clinics did not even have a licensed physician acting as medical director.
Some of the worst offenders filled pages of inspection reports with violations, often repeatedly neglecting to implement state-mandated corrective measures.
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One particularly egregious offender, A Woman’s World Medical Center in Fort Pierce, Fla., filled 68 pages with violations over the course of five inspections. A Woman’s World was cited twice in about a year for failing to maintain sterilized, functioning instruments. The vital signs of patients receiving second-trimester abortions went unmonitored. Administrative assistants without proper certification performed ultrasound examinations on women. The clinic lacked written procedures, including for preventative maintenance, pre- and post-operative care, emergency measures, incident reports, and medical-record keeping. And it was cited twice for lacking orientation and in-service training.
A Woman’s World is joined by other clinics with a high number of citations and repeat offenses, several of them particularly severe.
An unannounced September 2008 AHCA inspection of A Woman’s Choice in Miami revealed that the clinic did not train its personnel to provide proper care to patients undergoing second-trimester abortions. Nor was the clinic keeping adequate personnel records, leading orientation training, or providing in-service training.
Two months later, the inspectors returned for another unannounced visit and found that none of the training deficiencies had been corrected. Inspectors recorded the same violation again in 2010. They’ve also cited the clinic for lacking a defibrillator and having an unmaintained emergency crash cart, expired supplies and medication, and inadequate instruments.
Though the requirements regarding cleanliness and equipment have been hotly disputed, some citations seem beyond the pale. In 2010, All Women’s Clinic in Fort Lauderdale was cited for failing to report a gruesome uterine perforation within ten days of the injury. The perforation had occurred during an abortion procedure, when a suction tube penetrated too deeply into the woman’s uterus.
#share#The issue of abortion-clinic regulation could theoretically cut across ideological lines, but those most concerned about it tend to be pro-life advocates.
“The abortion industry cannot self-regulate,” Mallory Quigley, spokeswoman for pro-life Susan B. Anthony List, tells National Review. “There’s an untold number of instances of negligence and abuse within the industry. All states would do well to take a look at what’s happening in Florida, as with Planned Parenthood. This is a prime time to ensure laws are being enforced.”
‘The abortion industry cannot self-regulate. There’s an untold number of instances of negligence and abuse within the industry.’
In the realm of practical politics, pro-lifers see the regulation of clinics as a losing issue for their opponents, because pro-choicers “refuse to compromise — they’re unwilling to grant even the smallest regulation,” John Stemberger, president of the pro-life Florida Family Policy Council, says. “Because of [pro-choicers’] unwillingness to allow even ordinary regulations — such as laws requiring hallways to be big enough to carry a stretcher through to an ambulance — they’re losing the legal and public debate.”
Last month, Florida representative Carlos Trujillo (R.) filed a bill that would regulate abortion clinics like ambulatory surgical centers. It’s unclear how such a measure would improve the current situation, given that many clinics already neglect existing regulations.
“Generally speaking, these clinics have been somewhat untouchable in the way things function,” Stemberger notes. “You can have these laws on the books, but enforcing [them] has not been done consistently.”
Elizabeth Nash, senior state-issues associate for the pro-choice Guttmacher Institute, believes that abortion clinics cannot be regulated like ambulatory surgical centers, because the services such centers provide “are more invasive [than those provided by abortion clinics]. I do think that this is probably a very complicated issue, and you must have context for these inspection reports.” She recommends comparing the nature of the procedures and care offered in surgical centers with those offered in abortion clinics in order to see how the two could be regulated differently.
Peter Lohrengel, the executive director of the Florida Society of Ambulatory Surgical Centers, says his group is against the Trujillo bill for a simpler reason: “We’re opposed to being associated with abortion clinics. We don’t want to pick up the negative perception for a service we don’t even provide.”
#related#Still, if it were strictly enforced along with existing regulations, the law could make a difference. Consistent punishment might eventually force repeat-violator clinics out of business, even if their licenses aren’t revoked.
A Woman’s Option in Hialeah was fined $200 13 times between 2008 and 2012 for neglecting to submit monthly reports on the abortions it performed. In 2009, A Woman’s Option also failed to get parental consent for a minor’s abortion and to employ a licensed physician as medical director, both violations of state law. Corporate records show that A Woman’s Option, Inc. was voluntarily dissolved in May of 2011.
Stemberger says he is hopeful that cultural changes will lead to stronger enforcement in the future, forcing other clinics to clean up their acts or close.
“Until now, there’s been this unspoken Teflon — clinics have just gotten away with stuff,” he says. “In some sense, culture matters more than the law. As a cultural consensus forms within institutions and among people that abortion is morally wrong, the law will start being better enforced.”
— Celina Durgin is a Collegiate Network fellow at National Review.