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Steven C. Brigham. Kermit Gosnell. Two names that have been attracting a lot of notoriety in the news this year thanks to the fact that authorities have finally intervened to put a stop to their illegal practice of medicine in “abortion clinics” that sound more like horror sets than places where people actually go for medical care.
Both men may have been licensed to practice medicine at the time of their crimes, but what they were performing was illegal abortions; dangerous procedures in filthy clinics with untrained staff and improper instruments. Patients died under their “care” and that of their associates at the clinics they ran. Ultimately, their licenses were suspended in multiple states.
There's a lot to talk about when it comes to examining the cases of these two men, whom the media tend to refer to as “rogue abortion providers.” This euphemism conceals a lot about who they were and what they were doing; to call them abortion providers at all is really rather an insult to responsible, ethical, and compassionate care providers who offer abortion services. They might better be termed “abortionists,” people working on the shadowy fringes of the law to exploit patients.
A certain set of circumstances had to come into play for them to exist at all, because these kinds of situations do not occur in a vacuum. Both men had practices fed by the growing anti-abortion movement in the US. As the country continues to crack down on access to abortion, women are forced to turn to more and more desperate measures to get abortion services, which is good news for men like this. But not such great news for women.
Outlawing abortion, or limiting access to it, doesn't make abortion go away. It drives women underground, and often into dangerous conditions because they have no realistic alternatives; when there's not a free and open market, women have to rely on a network of informants to find clinics, and may be going against their families, partners, and communities to seek out termination. These kinds of conditions are prime ground for illegal clinics to flourish, because men like Gosnell and Brigham know that their patients have no alternatives, and will be afraid to report unsafe conditions.
Of course, this is a problem for low-income women. Wealthy women and those in the middle class with the right connections can always access safe, discreet abortion services, just as they did in the pre Roe v Wade days. The people harmed most by restrictions on abortion are low-income women, particularly women of color, especially undocumented immigrants who are afraid of the authorities and thus unable to report clearly unsafe and illegal conditions at clinics.
In a country with growing class divides, the contents of your bank account determines the kind of care you can access. When it comes to abortion, a critical service with a ticking clock constantly reminding the patient of the urgency of the situation, wealth equals safety, and poverty drives patients into the waiting rooms of men like Kermit Gosnell.
Thanks to backwards and outdated attitudes, government health programs in the US won't cover abortion services, so women who might otherwise be able to access monitored health care are driven to the underground. The back alley, if you will; in Gosnell's case, that was almost literal, with white patients and patients of color having separate entrances, waiting rooms, and standards of care. Of course, when those same women develop complications from their illegal abortions, the government health care programs they're on are forced to pick up the pieces.
What's perhaps especially troubling about the cases of Brigham, Gosnell, and their ilk is that numerous reports were filed against them before any regulatory authorities took action. Physicians and other medical professionals filed complaints, as did hospitals encountering patients who needed emergency treatment after procedures received in their clinics. Social workers and other people interacting with low-income women also expressed concern about the abortionists working in their communities and the risk to patients.
Reports stacked up, and no one made a move. People documented filthy conditions, patient deaths and serious injuries, and clear signs that something was going deeply wrong behind the doors of these so-called abortion clinics. Any number of regulatory agencies could have stepped in at any time. The practice of medicine in the United States is very heavily regulated; health departments, state boards of medicine, building departments, and other agencies could have staged clinic inspections and demanded a closer look at these facilities.
In a rather odd twist, thanks to the heavy regulation of abortion in this country, the book could have been thrown at these clinics hard and early in a way that it can't be at other types of clinics. While laws singling out abortion clinics (known as TRAP laws) aren't something that should be supported, because they're designed to limit abortion access and patient choice, they could have been used for good, for once. Certainly the unspeakable horrors happening in many of these clinics were illegal for any type of medical procedure, but especially for abortions.
Records dating back decades indicate a long list of complaints against people like Brigham and Gosnell, and in Brigham's case, people in multiple states were raising the alarm. Yet, authorities apparently didn't make any move to inspect these clinics and act against the men -- even after patients had died as a direct result of procedures performed under the supervision of these men.
What, exactly, was going on here?
State officials and regulatory authorities have been quick to scrabble for excuses. They claim that there wasn't enough communication between agencies, making it difficult to identify and track trends. They suggest that claims were being “evaluated” but that action takes time. Or they say they just can't comment on ongoing investigations.
One wonders whether the response would have been as sluggish if reports had been pouring in about a clinic patronized primarily by wealthy patients. If people practicing illegal medical procedures on primarily white patients would be given the same effective pass by the officials who are supposed to look out for patient safety. If, perhaps, there was an even darker political agenda going on here in states where some of the same officials responsible for regulating medical practice are undoubtedly opposed to abortion.
The longer people are allowed to practice illegal abortion, the more awful their crimes become, and the more terrible the consequences for their patients. Which makes for a truly fantastic coup for anti-abortion advocates. Single-minded in their determination to make abortion impossible to access for patients across the United States, they view these events like Christmas in July; they can barely keep their smirks off their faces in their fraught opinion editorials and public appearances in the wake of the unmasking of yet another house of horrors.
After the death of a Latina woman as a result of a procedure performed at a Baltimore clinic, anti-choicers took to the streets with their usual gruesome fetus photographs. They also dug up her medical records and photographs of her, violating medical privacy to name her and adopt her as their own personal symbol. These tactics are common in a movement that appears to know no shame when it comes to exploiting personal tragedies; at least Savita Halappanavar may have had a chance to exercise some autonomy in deciding whether her name should be released before she died of septicemia following an Irish hospital's refusal to provide her with an abortion. Her family was the first to release her name, rather than a crowd of strangers.
The right views these cases as a great opportunity. They provide the perfect chance to attempt to slam through TRAP laws, on the argument that such conditions should never be allowed to exist again, and that abortion clearly needs to be more tightly regulated. Lawmakers point to the awful conditions and the suffering endured by patients as evidence that abortion is a dangerous medical procedure and providers need to be watched more closely; despite the fact that abortion is actually extremely safe, with a very low complication rate when performed by competent providers in an appropriate environment.
In the name of “protecting women,” but really limiting access to abortion, they attempt to force through laws that make it harder and harder for legitimate providers to offer reproductive health services. In response, more and more abortionists spring up, filling the gap for desperate women who don't have a choice. They can't get to safe services because they cost too much or are only available through exclusive private networks, and that leaves them facing the Kermit Gosnell's of the world.
Facing them alone, and without the backing of the inspectors and agencies who are supposed to be looking out for them. If there's one lesson we should be learning from these cases, it's not just that abortionists are alive and well in the United States and the only way to protect patients is to keep abortion legal and make sure access remains free and clear, but that something is going deeply wrong in our regulatory system. Medical providers with multiple complaints against them from a variety of sources should not be allowed to continue practicing without evaluation.
Physicians with complaints on their records about drug abuse, patient deaths in other contexts, and other issues are promptly investigated and can face stiff penalties. But men like these are allowed to continue practicing despite the fact that they're endangering patients. Why is that? Why are regulators collectively accepting of situations where women are facing emotional trauma, infections, loss of fertility, and death at the hands of abortionists?
For all that the right claims to be so deeply concerned about patient safety, to the point of extra special regulations just for abortion clinics, it's odd that the practice of illegal abortion is persisting. Oh, wait, it's not odd at all, because that's what happens when a culture effectively criminalizes a routine medical procedure.
The sexism and misogyny rife throughout our culture play a key role here, as does the reach of the anti-choice movement. There's another Kermit Gosnell out there racking up medical complaints right now, and no one is making a move to stop him.