Tuesday, February 06, 2007

Is she really no longer your problem after she walks out the door?

From the National Abortion Federation Clinical Guidelines
Policy Statement: Most serious abortion complications are detectable in the immediate postoperative period. Appropriate and accessible follow-up care is essential to patients' well-being.


Standard 7: The facility must provide an emergency contact service on a 24-hour basis where calls are triaged in accordance with appropriate law. The facility must assure physician referral if indicated.

Just to make it clear: This is a "standard".
STANDARDS are intended to be applied rigidly. They must be followed in virtually all cases. Exceptions will be rare and are difficult to justify.

From the College of Physicians & Surgeons of Ontario:
The facility provides all women with verbal and written information on discharge. There is a 24 hour contact number through which a woman can obtain emergency care, both physical and psychological, for any problem arising relating to an abortion.

From Best Practice in Abortion Care:
Community-based abortion services must have such protocols to facilitate a rapid and appropriate response in emergent situations.


Christina Dunigan said...

I used NAF's Clinical Guidelines because they typify what's expected of a properly operated abortion facility. The fact that this particular set was promulgated in 1996 doesn't mean that suddenly, in 1996, abortion practitioners had an epiphany and said, "Gosh! Aftercare! What an innovation! Why don't we start doing that!" Which you seem to believe.

The point -- which of course is lost on you -- is that it's considered the abortion facility's responsibility to have an after-hours number the woman can call to consult with problems. The purpose is twofold:

1. Triage. A medically trained person, familiar with abortion aftercare, can assess the woman's symptoms and let her know what is an appropriate course of action. This might involve having a physician phone in a prescription for her, instructing her to seek care at an emergency room, or making an appointment for a follow-up visit at the facility. If you do any research you'll see that this has been a standard for a long time.

2. Being available to medical professionals treating the woman. If she does go to the emergency room or another doctor, somebody can pull her chart and let the caregivers know what the results were of pre and post abortion tests and examinations, the course of the abortion, any medications she was given, etc.

This is not rocket science.

Christina Dunigan said...

Tlaloc, I used to so ab/mal litigation support. I think I know better than you do what's expected from an abortion facility and when they're deviating from the standard of care. My familiarity with standards of care comes from having worked for the people lawyers called for help when they were pursuing a lawsuit against abortion practitioners.

My assessment of where their responsibilities lie is based on the real world.

You, on on the other hand, clearly just personally prefer that a clinic have no responsibility for patients after they scrape them out. But medical responsibility is not based on what Tlaloc personally thinks is reasonable. It's based on what the medical community has agreed is the standard of care. And shoving her out the door with a pat on the back is only adequate to people like you.

Christina Dunigan said...

You choose to see every action, every motive, in the worst possible light.

Vanessa Preston:

"To the credit of Boyd and the Fairmount staff, emergency procedures were immediately instituted. An ambulance was summoned, and Boyd and a nurse performed CPR and got Vanessa's heart to beat again."

"Boyd, to his credit, reported Vanessa's death to the Centers for Disease Control. He also wrote a medical journal article about her death, warning other abortionists that DIC could occur during second-trimester evacuation abortions."

Christina Dunigan said...

What the clinic was supposed to do was have their triage person (typically a nurse trained in abortion triage) assess her symptoms and instruct her what to do next. In Carolina's case, this might well have been, "Get to the nearest emergency room." But they didn't tell her anything because they didn't return her calls. This led to a delay in seeking treatment, allowing the infection to take hold.

How was Carolina, a layperson, to judge if her symptoms were severe enough to warrant a trip to the emergency room? She wasn't a nurse, she wasn't trained to make that sort of call. So she was put in a position of waiting until a it was clear even to a layman that a trip to the ER was in order.

The patient has no way of knowing what's normal, just the pain of recovering from surgery, versus something to be alarmed about. That's why the standard of care is for a 24-hour medical on-call staff person. So that somebody who has training in abortion aftercare is assessing these things.

Christina Dunigan said...

And as we already discussed it isn't clear whether she even spoke english, nor is it clear whether the clinic was open during the holidays.

I've lived in a country where I don't speak the language. I've either sought out medical/dental providers who spoke English, or brought a Korean-speaker with me. I find it hard to imagine any medical facility catering to the poor in the Miami area not having Spanish-speaking staff, but even assuming that this place had no Spanish-speaking staff, they could have at least returned the call, could have at least had a little card staff could read that said, "If you have a medical problem, please go to your doctor or call 911." This is Miami we're talking about. It's not like the clinic was in Frog Knot, Arkansas, where nobody speaks Spanish.

That said, whether or not they were open over the holidays is irrelevant, because standard abortion care is to have a 24/7 hotline to handle aftercare.

Christina Dunigan said...

The pretty obvious logical response is to then go to or call a medical facility that IS open. Like... er... a hospital?

Not if what you're calling for is to find out if your symptoms are cause for alarm or not. Again, the standard of care is a 24/7 hotline, where there is somebody trained in abortion triage.

Imagine for a moment that you're poor and uninsured. Are you going to go waltzing into an emergency room when you're not even sure if your symptoms are normal or not? Or are you going to think about the two children you're feeding and clothing and sheltering and keep trying to get hold of the people who are supposed to be manning a 24/7 triage line for you?

Christina Dunigan said...

Can you show that this was a standard in 1996 and that the clinic in question was required or voluntarliy agreed to operate under this standard (i.e. was it either the law or required by some agreement they entered into)?

Oddly enough, I don't have access to Florida's 1996 regulations for abortion clinics. Fancy that! What you're postulating is that in 1995, it was standard operating procedure for abortion clinics to shove them out the door with a pat on the back, and the very next year suddenly out of the clear blue sky a 24/7 hotline became the standard.

But I'll tell you what -- I posted the question to NAF's site:

I'm having an online discussion with somebody about standards of abortion care. I provided a link to your Clinical Guidelines as evidence that 24/7 phone service for emergency aftercare questions is the standard. The other person says that since your Clinical Guidelines were published in 1996, there is no evidence that any kind of aftercare was standard or expected prior to 1995.

When did a 24/7 aftercare hotline become the standard of care in abortion practice? Recommendations by NAF, PP, the CDC, the ACOG, or some other reputable body would be adequate evidence. Was it considered the standard of care in 1995?

Now, they may recognize my name and decide not to answer me. (I'm the one who did the "sting" for "Lime 5", after all.) But you can contact them.

Phone: 202-667-5881
Email: naf@prochoice.org
Hotline: 800-772-9100

Christina Dunigan said...

People decide for themselves when they need to go to an emergency room every day.

Yes, but it's also fairly common to wait until symptoms are alarming -- especially for somebody who is currently under a doctor's care and still attempting to contact said doctor for advice. With a woman who is suffering abortion complications, symptoms that don't seem particularly alarming may need immediate care.

Christina Dunigan said...

Tlaloc, I'm finding it very difficult to imagine malpractice so heinous that you'd actually find fault with the clinic for it.

Christina Dunigan said...

I don't know the outcome of the civil case. I no longer work in an environment where somebody's buying expensive court documents and putting them on my desk to read.

After reading several thousand of them, though, I think I have more of a clue about what constitutes malpractice than somebody who hasn't abstracted a single case.

Christina Dunigan said...

It's hard to read case after case of young women -- young girls, some of them -- traumatized, maimed, or dead for no good reason, and not start to get where you have a grudge against the people who hurt them.

Christina Dunigan said...

That's understandable, but then you are getting a skewed persepective. What you aren't doing is reading the hundreds of cases where a woman is extremely grateful for an abortion for every one horror story.

Well, we can set aside the fact that I'm not going to find a woman grateful for an abortion to be particularly sympathetic. Because that will get us into a slogfest over exactly what's destroyed in an abortion. I know you see valueless tissue of no more consequence than a hankie full of snot, and you know I see a baby. So let's set that aside.

Let's look at what I've been immersed in. The very first abortion deaths I learned of were Gloria Aponte and Ellen Williams. Hanan Rotem (who killed Gloria) was letting an untrained receptionist administer general anesthesia. Dadelanc (the mill where Ellen was killed) was so disgusting that one abortionist quit working there and said that he wouldn't bring a dog there. Ellen came to them with raging peritonitis; they gave her tea and a bottle of oral antibiotics and sent her home to die. How many happy customers would these guys have to have before you'd say, "Well, this excuses what they did to Gloria and Ellen"?

There's a young woman in New York who has been blind since she was 12 years old, because of fetal bone fragments that got into her bloodstream and lodged in her brain. She had to have a hysterectomy. At age 12. The people who did that to her successfully blocked the lawsuit filed on her behalf on the grounds that she turned out to be over 24 weeks pregnant, so technically her abortion was illegal, and in New York you can't sue for damages you suffer while you're participating in an illegal act. They were never prosecuted for this illegal abortion; they just used its illegality to weasel out of compensating the family for the expenses they were stuck with. How many happy customers would these guys have to have for you to say, "This offsets the damage they did to that girl."

I'm willing to grant that Curtis Boyd didn't intend Vanessa Preston any harm, that he ran a professional facility with adequately trained staff and that they did everything in their power to save her. I'm willing to grant that he meant well doing an abortion. I can't blame Curtis Boyd for Vanessa's death. But she's the exception.

Leaving seriously injured patients unattended, shoving them out the door to die, sticking an eviscerated woman into a taxicab... At what point does the "but he has many satisfied customers" kick in and make this sort of thing excusable?

Christina Dunigan said...

Tlaloc, here's my answer from NAF:

It is difficult to answer your question about when the guideline for emergency care following an abortion was established. Medical standards for ambulatory care following surgery, has generally included follow up care, including 24/7 emergency referral systems. Whether or not abortion clinics were in compliance with this medical standard in 1995 is unknown, as NAF did not have a complete monitoring system in place until 1999. Standards of practice for ambulatory care may be the best evidence we have supporting the inclusion of this guideline in our Clinical Policy Guidelines.

Christina Dunigan said...

But don't pretend that that bad doc is more than .01% of all the doctors doing abortion.

Where do you get that number from? Do you even know how many abortionists there are, and what percent of them have been disciplined or sued for quackery?

Christina Dunigan said...

Tlaloc, I cut Curtis Boyd slack because he seemed to mean well. And I think Warren Hern, Suzanne Poppema, David Grimes, and Michael Burnhill mean well. (Or meant well, in Burnhill's case, since he's pushing up daisies now.) I don't universally dismiss them as quacks.

But when even the Feminist Women's Health Center noted that nearly 90 percent of abortionists at freestanding clinics are on probation with the medical board, I'd have to say that it's not just my perception that these guys are prone to quackery.

Christina Dunigan said...

Yes, I hate abortion regardless of whether or not the woman is happy about it, just as I hate any other instance of Person A having Person B put to death for reasons of Person A's preference.

Let's turn this around, shall we? You think that Ashli is totally an unsympathetic character. You want her to bite down, shut up, and be grateful that her baby's dead. Does that mean you wish Ashli ill, just because you find her unsympathetic? Just because her anguish only annoys you?