Abortion-clinic inspections intensify
Since Republican Gov. John Kasich took office, state health inspectors have reported 17 times as many violations a year in Ohio abortion clinics as during the tenure of his predecessor, Democrat Ted Strickland.
Although no one can prove a cause and effect absolutely, hundreds of records examined by The Dispatch show that not only the number of violations but also the types of violations found at abortion clinics during the health department’s inspections during the past 10 years
have differed greatly depending on who is the governor.
Only a handful of administrative violations — staff-performance evaluation, infection-control policies and procedures, disaster planning and transfer agreement — were found at Ohio’s current eight clinics in the four years when Strickland was governor.
A wider range of violations, including “safety and sanitation” and “adverse events,” have been found in the almost-seven years that Kasich has served. For example, an oralsuction machine at one abortion facility was found coated with a heavy layer of dust and dirt.
The health department also is performing nearly four times as many inspections per year under Kasich as it did during Strickland’s single term.
Since Kasich was sworn in as governor on Jan. 10, 2011, health department employees have reported 149 violations during 62 inspections at the eight clinics that have remained open under both governors. Kasich opposes abortion rights except in the event of rape or incest or when the life of the woman is in jeopardy.
Under Strickland, who generally supports abortion rights, nine inspections of the eight current clinics unearthed five violations during his term from Jan. 10, 2007, to Jan. 10, 2011. The clinics seemed almost exempt from state inspections: Four were examined in 2007, one was in 2008 and four were in 2009; none was inspected in 2010.
“I have no recollections of this event being a topic of discussion in the governor’s office, nor did the governor’s office give guidance or direction to the health department on how to carry out inspections of abortion clinics,” said Amanda Wurst, Strickland’s former press secretary. To be fair, Ohio had several more abortion clinics while Strickland was Here is a breakdown of inspections and violations found at the eight abortion clinics operating in Ohio, plus details of some of the violations: Capital Care Network
Location: Toledo, Lucas County
24 violations found in nine inspections in past 10 years
In Capital Care Network’s latest inspection, in April, five violations were found, all stemming from not following protocol for transferring patients to a local hospital in case of medical emergency.
State inspectors say Capital Care Network did not follow its “medical-emergencies policy” on April 1 after a patient suffered “possible perforation of bowel in cavity” following an abortion.
The doctor who performed the procedure “wrote to transfer the patient to the hospital for an ultrasound” after the abortion, according to the report. An employee then drove the patient and her companion to a Toledo hospital.
When asked why the policy for “Medical Emergencies” was not followed, a Capital Care Network employee said: “I guess the doctor didn’t feel it was that much of an emergency,” according to the inspection report.
As a result, the health department has proposed fining Toledo’s last standing abortion clinic $40,000.
Founder’s Women’s Health
Location: Columbus, Franklin County
32 violations found during eight inspections in the past 10 years
An inspection on April 30, 2013, found that a physician at Founder’s did not carry malpractice liability insurance, which has the potential to affect all patients at the clinic, according to health department records.
During a March 14, 2012, inspection, “the facility failed to ensure four of four operating room tables were maintained in a safe manner.”
The inspection report noted that a medical-equipment company is authorized by the table manufacturer to order motors for the failing tables. “This will rectify any problems,” the inspection report reads. The motors were ordered on March 30, 2012, and April 3, 2012, according to the inspection report.
Northeast Ohio Women’s Center
Location: Cuyahoga Falls, Summit County
37 violations found during seven inspections during the past 10 years
An inspection on July 11, 2017, showed that the facility “failed to ensure the equipment for emergency use was maintained with current expiration dates,” which has the potential to affect all patients at the facility.
Planned Parenthood Bedford Heights
Location: Bedford Heights, Cuyahoga County
24 violations during six inspections in the past 10 years
During a Dec. 1, 2016, inspection, it was revealed that a patient who was a minor had an abortion in August 2016. The patient’s guardian signed the informed consent, but the patient did not.
An inspection on March 11, 2014, found that pieces of medical equipment were past their expiration dates, which has the potential “to negatively impact all patients.”
Planned Parenthood East Health Center
Location: Columbus, Franklin County
15 violations during nine inspections in the past 10 years
The oral-suction machine was coated with a heavy layer of dust and dirt during the inspection on March 15, 2012.
During the Aug. 20, 2015, inspection, it was discovered that a 17-year-old patient had a surgical procedure in July 2014, and the clinic didn’t obtain a signature of the patient’s parent or guardian.
Planned Parenthood Southwest Ohio
Location: Cincinnati, Hamilton County
13 violations during eight inspections in the past 10 years
An inspection on June 6, 2013, revealed that after a patient began bleeding during an abortion in March 2013, she was transported to governor, and he had to make sweeping budget cutbacks when the Great Recession hit.
The Dispatch obtained state healthdepartment inspection reports from the past 10 years regarding the eight abortion clinics still operating in Ohio. In that decade, the clinics had 71 inspections that found 154 an emergency department, and the clinic did not have documentation that the medical records accompanied her.
Preterm
Location: Cleveland, Cuyahoga County
Three violations during 14 inspections in the past 10 years
A patient was transported to a hospital after additional bleeding from an abortion during a surgical procedure in July 2011, but the facility failed to ensure that her medical records accompanied her. This was discovered during an inspection on March 21, 2012.
Preterm filed a lawsuit separate from Capital Care Network challenging the legality of transfer agreements, the ban on public hospitals from providing them, and a requirement that doctors inform pregnant women about the detection of a fetal heartbeat before receiving an abortion.
Women’s Medical Center, Dayton
Location: Dayton, Montgomery County
Six violations during 10 inspections in the past 10 years
During an inspection on June 12, 2015, it was discovered that a patient had come in for the second day of an abortion procedure, but the patient showed “signs of recreational drug abuse.” It was noted that she was unable to walk or engage in coherent conversation. The patient was taken to a hospital, but there was no documentation in the medical record that the patient was asked whether she wished to take back her consent due to her altered state.
The Department of Health is trying to close the clinic, which is functioning without a legally required written transfer agreement or state-approved variance.
Planned Parenthood of Southwest Ohio and Founder’s in Columbus are without such agreements, but they are operating under waivers from the health department.
Women’s Medical Center of Dayton has struggled with meeting the requirements for a transfer agreement. Twice in 2015, Department of Health Director Richard Hodges denied the facility’s variance request. violations.
Even with the obvious stepped-up enforcement under Kasich, Greater Columbus Right to Life executive director Beth Vanderkooi said she believes that his personal position on abortion has not influenced the health department’s work.
“I don’t necessarily think his pro-life stance means that he should, or that he has kind of weaponized the Department of Health
against abortion clinics,” Vanderkooi said.
Seven years ago, Ohio had 16 abortion clinics. Dr. David Burkons, owner of Northeast Ohio Women’s Center in the Akron suburb of Cuyahoga Falls, said the number has been cut in half mainly because of a state requirement that a clinic have a transfer agreement.
All Ohio ambulatory surgical centers, which include abortion clinics, are required to obtain a transfer agreement with a local hospital to take patients in the event of a medical emergency. In 2013, Ohio legislators and Kasich banned publicly funded hospitals from entering into transfer agreements with abortion clinics.
“The transferagreement thing is a ridiculous thing,” Burkons said.
“The transferagreement rule was tailor-made for many in the General Assembly and those who are intent on faith-based law and rule-making,” former state health-department bureau chief Roy Croy wrote in a November 2016 letter to the editor published by The Dispatch. “This is especially true in that often, faith-based hospitals are the only reasonably accessible choices for any health-care requirements to include reproductive health.”
Croy would not comment for this story, expressing frustration that his past complaints have changed nothing.
Capital Care Network, a Toledo abortion clinic, has a lawsuit challenging the legality of patient-transfer agreements, the ban on public hospitals providing them, and a requirement that doctors inform pregnant women about the detection of a fetal heartbeat before they undergo an abortion. The Ohio Supreme Court heard arguments in the clinic’s case in September. Inspection process
Facilities do not receive notification before an inspection takes place, said Melanie Amato, spokeswoman for the health department.
The department “follows up on all complaints, and the severity/nature of the complaint determines the time-frame within which surveyors show up unannounced at the facility to conduct an investigation,” Amato said in an email.
Abortion clinics are classified as ambulatory surgical facilities, which provide outpatient-surgery services. Such clinics fall under one of many categories: abortion; aesthetic; dental; ear, nose and throat; eye care; gastrointestinal; general surgery; orthopedic; pain management; podiatric; spine; urology; and women’s services. Ohio had 268 such facilities in operation as of Friday.
Abortion clinics also appear to have more inspections per year that find more violations than do non-abortion surgical clinics. The Dispatch requested records from the general-surgery clinics of Cuyahoga, Franklin, Hamilton, Lucas, Montgomery and Summit — the same counties that also have abortion clinics. In the past five years, 61 violations were found during 51 inspections of the specified 36 surgical centers in those counties.
The eight current abortion clinics in those areas had 134 violations during 54 inspections in the past five years.
“Mainly since the Kasich administration took over, we seem to be held to a different standard than other clinics are,” Burkons said. “They seem to be going after abortion clinics to a much greater extent than other non-abortion surgical centers.”
His clinic, the
Northeast Ohio Women’s Center, had the most violations: 37 in the past 10 years.
“We’ve, I think, been held to a somewhat different standard just because of the politics involved,” Burkons said.
Scrutiny of clinics
Jamie Miracle, NARAL Pro-Choice Ohio’s deputy director, said abortion clinics are not treated equally with other ambulatory surgical facilities in Ohio.
“We definitely feel like there’s been a lot more scrutiny,” Miracle said.
About 50 types of violations were found at the eight clinics in the past 10 years. The category “safety and sanitation” came up 12 times, the most of any violation.
Amato acknowledged in an email that the state agency “may give ambulatory facilities opportunities to correct violations or take other action.”
It perplexes Denise Leipold, executive director of Northeast Ohio Right to Life, that abortion clinics repeatedly have violations yet remain open.
“Abortion clinics seem to get a slap on the wrist more than anyone else does,” Leipold said.
To that point, state inspection records show that a November 2016 inspection at Northeast Ohio Women’s Center revealed 17 violations. During the clinic’s next inspection in July, 12 of those violations remained, and two new violations appeared.
In addition to the violations found at Northeast Ohio’s Women Center, 13 were found at the other seven clinics that were still present during the next inspection. 9 5
Records from the 36 nonabortion facilities show no repeat violations in the subsequent inspections.
Ed Sitter, executive director of Greater Toledo Right to Life, said the health department should conduct inspections of abortion clinics more often.
Twenty-seven ambulatory surgical facility clinics, including half of Ohio’s abortion clinics, are operating despite having expired licenses, according to the health department’s website, as of Friday afternoon.
Oddly, that’s a violation.
“Clinics are allowed to continue operations after a license is expired as long as they have a pending application” with the department, Amato said in an email. “They can apply for their renewal license on the day that their license expires.”
Megan Henry is a fellow in the E.W. Scripps Statehouse News Bureau.