NARAL, originally the National Association for the Repeal of Abortion Laws, was responsible for, among other things:
and, perhaps most pertinent in the wake of the Kermit Gosnell debacle --
I told the story of this last in the opening chapter of Lime 5:
In June `970 the State of New York legalized abortion, and in less than a month freestanding abortion clinics began springing up like mushrooms. Before legalization, the national Association for the Repeal of Abortion Laws ... had "publicly pledged assurance that the new law would work in a safe manner" and took it upon themselves to evaluate these new facilities.
Dr. Bernard Nathanson ... began inspecting the new clinics and described the first one he visited as drab, dank, and unsanitary. He then visited a second clinic and described it in a similar manner. The second one was operated by [Harvey Karman], a theatrical arts graduate who had been arrested numerous times in California for performing illegal abortions, including one in which he killed a woman.
Then Nathanson was approached with a challenge. the largest freestanding abortion clinic in the world, [the Center for reproductive and Sexual Health, or CRASH], was in big trouble. Originally touted as a model to prove that first-trimester abortions could be performed safely in outpatient clinics, it was now in danger of being shut down. The clinic's owners asked Dr. Nathanson to take over operations of [CRASH] and save it from suffering the same demise as other New York abortion clinics.
Nathanosn met with the clinic's administrator and she gave him the rundown on the precise problems [CRASH] was facing. She told him that the doctors were "atrocious ... sadists, drunks, incompetents, sex maniacs, thieves, butchers, and lunatics... half of them don't even wash their hands anymore before doing an aboriton, let alone scrubbing. They refuse to use masks or caps, and their mustaches are dragging into the suction machines. I swear, one of these days we're going to lose one of those guys right into the suction trap and the lab is going to tell us the tissue is pregnancy tissue and the abortion is complete."
When Nathanson inspected the facility, he found that it was chaotic, crowded, inadequately lighted, ill-equipped, poorly run, poorly staffed, dirty, and operating with no back-up emergency hospital. He also discovered that staff abortionists were paid on a commission basis and that the more experienced ones would purposely underestimate gestational ages on some patients. The idea was to trick the new abortionists into taking the messy and time-consuming late abortions, leaving the easier, quicker, and more profitable ones for themselves.
As a side note -- this is how the now-popular D&E second-trimester abortion technique was developed, on the fly.
Nathanson's first task was monumental: getting [CRASH] in shape for an upcoming state health inspection. It was clear that without a complete overhaul, it had no hope of passing. Nathanson saw his goal as revamping the operation "to make it into a model clinic for all those that would arise across the nation when the laws [against abortion] fell."
It turns out that CRASH was a model clinic for those that would arise across the nation when the laws against abortion fell. Just not in the way Nathanson had hoped.
First, he ordered up-to-date sterilizing equipment, scrub suits, and lights for the operating rooms. He imposed some discipline on the staff, including medical criteria for screening patients and a protocol for sending high-risk patients to a hospital for their abortions. He knew he could never get the entire clinic into shape, so he focused on the central issue -- the aboriton itself. His theory was that the inspector might overlook irregularities in counseling, record-keeping, recovery, and other areas of the clinic if he could observe a model abortion done in a properly equipped procedure room. To that end, on the day of the inspection Nathanson selected his most qualified doctor, instructed his staff to be on their best behavior, and scheduled the calmest patient.
When the state inspection team arrived, the place was spotless and the staff behaved professionally. The "show abortion" went flawlessly with the patient calm and quiet. Nathanson said that "[the state inspector] was impressed. he was even encouraging as he offered a mild critique of our ridiculous recovery room. As he left, he winked and murmured to me, 'Don't worry.' I knew we were safe for a while."
Of course, after the inspectors left it was back to business as usual. The very next abortion patient at [CRASH] had her uterus perforated and ended up in the emergency room of a local hospital, in serious condition. Nathanson opined that, "If that operation had occurred in [the inspector's] gaze, he probably would have closed down [CRASH] on the spot." Instead, the staff's command performance allowed the facility to keep its license, and they eventually moved to even bigger facilities.
However, Nathanson was becoming disillusioned. the clinic's administrators seemed to have a ghoulish preoccupation with doing more and later abortions. Suspicious that the lab was not doing proper pathology reports, Nathanson had a staffer extract a section of liver from a cadaver and send it to the lab. the report came back "pregnancy tissue." The wife of one of the doctors reported that her husband was having nightmares, another that her husband had developed a drinking problem. Four marriages ended in divorce and affairs between staffers were common. Nathanson resigned his position at [CRASH], and eventually renounced his "pro-choice" position. He went on to become an outspoken opponent of legalized abortion.
However, [CRASH] flourished despite its numerous problems. In 1984, 1985, and 1986, [CRASH] was cited by the state for a lack of medical supervision and administrative control. Also in 1986, it was cited for primary medical deficiencies, because it had no anesthesiologist on staff and was improperly administering anesthesia.
Unfortunately, these warnings apparently went unheeded. On August 10, 1988, 19-year-old "Christine" underwent a 14-week abortion at [CRASH]. Despite her obvious signs of distress shortly after the procedure, the clinic did not instigate emergency procedures for almost an hour. After finally being transported to Cabrini Medical Center, Christine was pronounced dead from complications related to anesthesia. ....
During a subsequent health department investigation, authorities found that Christine's post-operative condition was listed on clinic records as "pink, responsive, alert," even though by that time she had already gone into respiratory arrest. Investigators eventually determined that the note was written before the abortion even began. Among their other findings were that [CRASH] "did not employ proper monitoring equipment or procedures, ... had no working EKG machine, ... had no [cardiac defibrillator] available," and that "neither the surgeon nor the nurse were properly knowledgeable about CPR procedures and techniques." They were also critical of what they called "an inordinate delay on the aprt of [CRASH] in calling for an ambulance."
In addition to issues directly related to Christine's death, the health department inspections conducted in 1988 determined that ARS 12 routinely placed patients at "continuing and serious risk" by employing "procedures and equipment that were grossly irresponsible and in contravention of accepted medical practice." Among specific allegations were that the facility:
Had no one on staff who was qualified to administer anesthesia Did not employ proper procedures or equipment for administering anesthesia Did not administer preliminary test dosages to determine a patent's sensitivity to anesthetic drugs Used dosages of anesthesia that were twice as high as specified in the clinic's in-house procedure manual Maintained no procedures or devices to accurately gauge the amount of anesthesia being given, estimating dosage "by eye" Conducted pre-operation medical examinations and medical histories that were cursory and inadequate Had no functioning emergency equipment on-site Had a number of emergency medications that were past their expiration date Had no one on staff with current CPR training Did not document respiration and pulse prior to anesthesia Had insufficient lighting in operating rooms Lacked proper hand-washing sinks ion exam rooms, and had no soap or paper towels at either the scrub sink or recovery room bathroom Improperly stored oxygen and nitrous oxide canisters Had unsanitary conditions, including stained scrub sinks, dirty walls and floors, trash stored in operating scrub room, blood on two wheels of the operating room table, red make-up stains on the rim of oxygen and nitrous oxide masks, uncovered and dusty tubing on suction machines....
During this time, the medical director of [CRASH] was [David Gluck]. The facility, however, was unable to produce any documentation verifying his credentials or qualifications and there was virtually no evidence that he provided any meaningful medical supervision. Despite the fact that one investigation was conducted a full two weeks after Christine's death, there was no indication that [Gluck] had personally reviewed the matter or directed that any reforms be instituted. Similarly, they uncovered 18 patient medical charts that showed complications, and not one indicated that it had been reviewed by [Gluck].
I'd also add that it's amazing that they actually found 18 records that noted complications at all, since the dead patient had been charted as "pink, responsive, alert."
The account of what shoddy operations arose when abortion was legalized in New York was given at length by Nathanson in Aborting America, which he published in 1979. Seedy mill after seedy mill has been uncovered since then.
We've known, clear back to before Roe, that left to themselves, abortionists would run shoddy, dangerous shops. The only surprise in the Kermit Gosnell story is that a prosecutor -- and some in the mainstream media -- are taking it all so seriously instead of giving it a nod and a wink and looking away.
ADDENDUM: See Nathanson's The Silent Scream in its entirety here.