Pro choice advocates used to say that abortion should be “safe, legal, and rare.” The Guttmacher Institute, Planned Parenthood’s former research arm, now a stand-alone reproductive rights organization, states: “Abortion providers in the United States are subject to strict evidence-based regulations (such as state licensing requirements, federal workplace safety requirements, association requirements and medical ethics) created specifically to ensure patient safety. ” [1] But just how safe is abortion for a woman in modern-day America? Below, we’ll review the stories of women who were severely injured or even died because of an abortion. We’ll learn about some of America’s most notorious abortion providers. Next, we’ll look at the results of abortion clinic safety inspections across the country. Then, we’ll find out how to check what abortion safety regulations each state has in place. Finally, we’ll learn how to check the safety of a clinic in your local area.

Is Safety the Top Priority in Abortion Clinics?

Whole Women’s Health v Hellerstedt

Evidence suggests that abortion access, rather than safety, is the highest priority within the abortion industry. The most recent example was the landmark 2016 ruling in Whole Women’s Health v. Hellerstedt. The Supreme Court ruled that two measures on the books in Texas would unnecessarily restrict women’s ability  (i.e. create undue burden) to access abortion, because nearly half of the state’s abortion clinics either closed or stopped providing abortion services. [2] A helpful graphic to understand the law and its impact is here.

What the Law Said

These two measures were: 1) The abortion provider must have admitting privileges at area hospitals within 30 miles of the clinic 2) Abortion clinic hallways (or other locations where abortions are performed, such as doctor’s offices) are wide enough to fit an ambulance stretcher through, in case of medical emergency. Let’s look a little further into what these two measures mean.

Admitting Privileges

First, “admitting privileges” means that if an abortion doctor’s patient is admitted to a hospital, he or she can continue to be their primary care provider in the hospital. The abortion provider would effectively be a staff member of the hospital. He or she could place orders and direct the woman’s care. It is true that other outpatient specialists, such as dermatologists or orthodontists, do not have to have admitting privileges at local hospitals. Furthermore, a woman who experiences an abortion complication can go to any hospital that she chooses to receive care. Logically, as with other outpatient specialties, the doctor that performed the abortion would be consulted to get more information about the procedure and the woman’s medical history.

Circuit Riders

Unfortunately, the phenomenon of  “circuit rider” abortion providers muddies the waters. “Circuit rider” abortion doctors may perform abortions in one state one day and fly out that same night to another city where they live or perform abortions. As in several patient deaths mentioned below, patients and their families or medical staff may have trouble contacting these abortion providers when complications do happen.

Admitting Privileges for Late-Term Abortions Make Sense

Requiring admitting privileges for providers of first trimester abortions may seem like overkill. In the case of late-term multi-day abortion procedures, though, having admitting privileges to a local hospital is common sense. Second trimester and third trimester abortions have a much-higher complication rate than first trimester abortions. If a woman starts having problems on day two of a three day procedure, for example, it makes sense to admit her to a hospital for closer monitoring during the rest of the procedure. “Continuity of care” is medical best practice, and in this situation it means that the doctor who started the abortion should be the doctor who finishes it.

Ambulatory Surgical Center Standards

In contrast, requiring that abortion clinic hallways be wide enough to meet ambulatory surgical center standards is clearly common sense. Ambulatory surgery centers require hallways and corridors be wide enough to get a gurney through in case of medical emergency. The case of Karnamaya Mongar, detailed below, makes the necessity of this basic safety measure startlingly clear.

Creating a Legal Precedent

Whole Women’s Health vs Hellerstedt was considered a landmark Supreme Court case because it created a legal precedent. That precedent judged the validity of abortion restrictions in large part based on how they impacted women’s ability to access abortions. Unfortunately, as we’ll see below, when “access” is prized above all else, women lose. They not only lose; sometimes, they die.

Women Injured or Killed After Abortion

Known Victims (since 2003) including gestational age of baby and cause of death, include:

     Sherika Mayo

Sherika Mayo died in 2008 in Georgia after an abortion at 25 weeks. Her cervix and intestine were lacerated and her uterus was perforated during the abortion.  In the recovery room after the abortion, her heart stopped beating due to massive internal bleeding. She was resuscitated and taken to a local hospital, but her heart stopped again and she could not be brought back to life. [3]

     Keisha Marie Atkins

Keisha Marie Atkins died in New Mexico in 2017. She was around six months pregnant, and had a four-day abortion procedure. She developed symptoms of disseminated intravascular coagulopathy, a life threatening blood clotting problem likely brought on by septic shock- a whole body response to infection. The infection was likely because of the abortion, according to her autopsy report. [4]

      Diamond Williams

Diamond Williams died in 2016 in North Carolina just five days after a first trimester abortion. Her autopsy suggests that she died of a severe pneumonia and disseminated intravascular coagulopathy (see above). [5]

     Jamie Lee Morales

Jamie Lee Morales bled to death in New York in 2016 after an abortion at 25 weeks pregnant. Her uterine aorta was severed, her cervix was ripped, and her uterus was perforated. [6]

     Cree Erwin-Sheppard

Cree Erwin-Sheppard died in Michigan in 2016. She reported severe abdominal pain after her abortion, and an ultrasound at a local emergency department showed an incomplete abortion- pieces of her baby and/or other pregnancy tissue was left inside of her. After discharge from that emergency department, she went home to lay down and never woke up. The autopsy report also documented a blood clot in her lung that traveled there from one of her uterine veins, and uterine perforation that bled out internally. She was in her first trimester. [7]

     Lakisha Wilson

Lakisha Wilson died in 2014 in Ohio. She was around 23 weeks pregnant. At some point during or immediately after her abortion, she stopped breathing. She was resuscitated but was declared brain dead and died in a local hospital a week later. [8] [9] [10]

     Jennifer Morbelli

Jennifer Morbelli died in 2013 (see story below)

     Maria Santiago

Maria Santiago also died in 2013, in Maryland. Her vital signs were not monitored after her abortion, so no one noticed when she developed hypoxia (low oxygen levels). Eventually she stopped breathing and her heart stopped beating. She was 12 weeks along. [11]

     Tonya Reaves

Tonya Reaves died in 2012 in Illinois. Her uterus was perforated during her abortion and she bled to death. She was in her second trimester. [12] [13]

     Alexandra Nunez

Alexandra Nunez died in 2010 in New York. She was 16-17 weeks pregnant. She had previous history of Cesarean sections and placenta increta, where the placenta is deeply attached in the uterine wall. This medical history put her at risk for uncontrollable bleeding after an abortion, which she had. CPR was not performed, and 911 was not called for 48 minutes after she stopped breathing and her heart stopped beating. [14][15]

     Antonesha Ross

Antonesha Ross died in 2009 in Illinois. She had a severe form of pneumonia that should have prevented her from having her first trimester abortion. Within hours of the abortion, her heart stopped beating and she stopped breathing. She could not be resuscitated. The abortion clinic that did her abortion closed down for three weeks, and then the abortion provider started a new clinic with the same phone numbers and website. [16]

     Ying Chen

Ying Chen died in 2009 in California. She was given the wrong dosage of anesthesia, and her heart stopped beating. Abortion clinic staff did not respond appropriately, and she was unable to be resuscitated by emergency personnel. She was 16 weeks pregnant. [17]

     Karnamya Mongar

Karnamaya Mongar died in 2009 (see story below)

     Edrica Goode

Edrica Goode died in 2007 in Massachusetts. She developed toxic shock syndrome after cervical dilators called laminaria were placed in preparation for a second trimester abortion procedure.  The laminaria should never have been placed because she had an active vaginal infection. The infection eventually spread throughout her body, and she died 2 weeks later. [18]

     Laura Hope Smith

Laura Hope Smith died in 2007 in Massachusetts. She was not monitored properly after her abortion and never woke up from anesthesia. Clinic staff did not call 911 in a timely manner. She was 13 weeks pregnant at the time of her abortion. [19] [20] [21]

     Christin Gilbert

Christin Gilbert died in 2005 (see story below)

     Tamiia Russell

Tamiia Russell died in 2004 in Michigan. She was at least 6 months pregnant. After her abortion, she hemorrhaged and eventually bled to death. [22]

     Regina Johnson

Regina Johnson died in 2003 in Michigan at 5 weeks pregnant. The same doctor that performed Tamiia Russell’s abortion (above) performed hers. Her vital signs were not appropriately monitored after her abortion, and she stopped breathing. CPR was performed but 911 was not called for over 20 minutes after staff noticed that she was not breathing. [23]

     Holly Paterson

Holly Paterson died in California in 2003 after a medication abortion at 7 weeks pregnant. She developed toxic shock syndrome from clostridium sordelli bacteria (linked in multiple other cases to use of the abortion pill) that spread to the rest of her body and caused her organs to shut down. She died one week after taking the abortion pill. [24] [25] A listing of  known women who died from legal abortions in the United States is here.

Women permanently injured by abortion include:

In 2012, Ayanna Byer experienced sepsis (multi organ system response to infection in the body) requiring hospitalization after a first trimester abortion. [26] [27] In 2010, B.M. experienced was hospitalized for bleeding due to perforation of her uterus during her abortion at approximately 15 weeks. [28] Also in 2010, D.B., 21 weeks pregnant, was hospitalized for a perforated uterus and bowel damage from her abortion. [29] Also in 2010, Roberta Clark, 8 weeks pregnant, was not told by Planned Parenthood that she had an ectopic pregnancy. Her “abortion” did not work because the pregnancy was not in her uterus. Three weeks later, still pregnant, her Fallopian tube ruptured and she was hospitalized for emergency surgery. [30] [31]

Doctors Who Harm

Kermit Gosnell

     House of Horrors

Kermit Gosnell is likely the most notorious abortion provider since abortion was legalized in the United States in 1973. His Pennsylvania “House of Horrors”, discovered in 2010 during a prescription drug bust by the FBI, was the stuff horror stories are made of. His abortion clinic smelled of cat urine due to cats roaming around in the halls. Employee food and the bodies of aborted fetuses shared the same refrigerator. Severed baby feet were found in rows of jars. Fetal body parts were frozen in milk cartons. Medical equipment was dirty, and office furniture was bloodstained.

     Illegal Abortions

Abortions were performed past the state limit of 24 weeks, with testimony from former workers reporting abortions on fetuses nearly 8 months along. Gosnell reportedly joked that one baby was “big enough to walk to the bus.”  Gosnell was convicted of delivering babies alive and killing them by inserting scissors in the back of their necks, snipping their spinal cords.

     Karnamaya Mongar

Unlicensed and unqualified personnel administered sedation medications, leading to the 2009 death of a woman named Karnamaya Mongar. Mongar’s heart stopped beating because she was oversedated, and precious time in resuscitation efforts was lost when paramedics could not get a gurney through the clinic’s hallways.

     Everyone Knew, but Nobody Cared

There is even evidence that numerous regulatory oversight bodies knew what was going on and did nothing.  Pennsylvania Department of Health documents from as long ago as 1989 report failure to pass basic health inspections. [7] [8] Other sources show that organizations as small as local hospitals and as large as the National Abortion Federation (a professional association for abortion providers, similar to the American College of Obstetricians/Gynecologists, known as ACOG) itself knew about Gosnell’s clinic- about the spread of sexually transmitted infections due to reuse of disposable instruments, the women injured by abortion who were admitted to local emergency departments, unlicensed personnel as young as 15 years old administering anesthesia….and did nothing. In 2011, Gosnell was finally convicted of murder and sentenced to life in prison. The full grand jury report is here. An excellent summary of the case is here.

Dr. Steven Chase Brigham

     Not An Actual OB/GYN

Steven Brigham Chase received his MD from Columbia University, but never trained as a gynecologist during his schooling. He was never board-certified for obstetrics/gynecology. Nevertheless, in the late 1980s, he began performing first trimester abortions. He opened his first abortion clinic in 1992 in New Jersey.

     Medical Mayhem

Accounts of his professional misconduct began in 1994,  when he botched two late-term abortions in New York. A review committee for the New York Department of Health disciplined his medical license, saying that he “used inexcusably bad judgment and that his negligence was life threatening.” Over the years, he was implicated in everything from employing unlicensed staff to assist with abortions, injuring women, financial irregularities, inadequate patient record keeping, to using and reusing unclean equipment. Eventually, even the National Abortion Federation banned him from its meetings. Over the years, as he lost his medical license in New York, Pennsylvania, and Florida, he moved from primarily performing abortions himself to owning a chain of abortion clinics, in New Jersey, Maryland, Virginia, and Florida.

     The Final Straw

Between 2009 and 2010, he led a two-state abortion scheme. He initiated nearly 250 late second or early third-trimester abortions in New Jersey, and his partner Dr Nicola Riley finished them a day or two later in the neighboring state of Maryland in an unmarked office building. Late-term abortions were illegal in New Jersey, and Brigham was not licensed to practice medicine in Maryland. Various life-threatening medical emergencies resulted for these abortion patients. Finally, in 2014, New Jersey revoked his last active medical license. An appeal to have his license reinstated was rejected in September of 2018. Remarkably, to date, Steven Chase Brigham continues to own and run multiple abortion clinics. [32] An excellent summary of Brigham’s career and misdoings is here.

Dr. Leroy Carhart [33]

     Late Term Abortion Provider

Dr. Carhart is one of four late-term abortion providers in the country who provide abortions after 26 weeks, with clinics in both Nebraska and Maryland. [34] He was the plaintiff in two late-term abortion cases that made it to the Supreme Court, Stenberg v. Carhart in 2000, and Gonzalez v. Carhart in 2007. To abortion advocates, Dr. Carhart is a hero, providing much-needed terminations for women whose babies are unlikely to live long after birth or will have a physical disability of some kind. He continues to work even after the murder of his good friend and fellow late-term abortion provider Dr. George Tiller in Kansas in 2009. Dr. Tiller’s murder was reprehensible, unjustifiable, and totally at odds with the “respect for all life” that pro-life advocates hold dear.

     There is Another Way

To pro-life advocates, deliberately taking the life of a preborn person mere weeks before delivery, especially anytime after the point of viability at 24 weeks, is unimaginably horrific. Perinatal hospice programs exist for cases as fetal anomalies that are incompatible with life, facilitating the grieving process and letting nature take its course rather than exposing the mother to serious and potentially life-threatening second or third-trimester abortion complications. Deliberately ending the fetus’ life in the womb and then inducing labor and delivery of a dead baby , or tearing it apart and removing it piece by piece, is an act against the woman’s motherhood. It speeds up the process, to be sure, but also makes her, rather than a medical condition, directly responsible for the baby’s death.

     Late Term Abortions have Serious Risks

Furthermore, serious complications after second and third-trimester abortions are significantly higher than after first-trimester abortions. [35][36] Risk of death from second trimester abortion is over 20 times higher than from first trimester abortion. [37] Risk of death from abortion increases by 38% each week starting in the second trimester. [38] Two women who Dr. Carhart has cared for have died, and countless other patients have been transported to hospitals from his abortion clinics.

     Christin Gilbert

Christin Gilbert died in 2005 due to bleeding and infection from her abortion at 28 weeks pregnant. Dr. Carhart was her abortion doctor. Late second and third-trimester abortions are a several days process- first the fetus is killed, then the cervix is dilated, and then labor is induced. Christin, like other women undergoing this type of abortion, stayed at a local hotel in between her multiple visits to the abortion clinic. No monitoring occurs outside of the abortion clinic, even though the woman has received medications that can cause powerful uterine contractions and significant bleeding. Like Christin, women sometimes deliver their dead babies outside of the clinic, and sometimes they bleed too much (hemorrhage). The official complaint filed against Dr. Carhart after her death chronicles the whole timeline. Her family tried to contact the abortion clinic, but Dr. Carhart was unavailable. By the time Christin was taken to the hospital after her abortion, it was too late. [39] [40] [42]

     Jennifer Morbelli

Jennifer Morbelli, another Dr. Carhart patient, died in 2013. She was 33 weeks pregnant and died of massive irreversible internal bleeding due to disseminated intravascular coagulation caused by an amniotic fluid embolism. [43] Disseminated intravascular coagulation is when the blood simultaneously clots in some areas and bleeds out in others. [44] An amniotic fluid embolus happens when the baby’s amniotic fluid enters the mother’s bloodstream. [45] Jennifer’s family tried multiple times to contact Dr. Carhart when she began experiencing symptoms, but were unable to reach him. Her heart stopped 6 times at the hospital before the final attempt to resuscitate her failed. [46]

     Recurrent 911 Calls

In addition to Christin and Jennifer’s deaths, a listing of recent and increasingly frequent 911 calls for Dr. Carhart’s Nebraska and Maryland clinics can be found here and here. Details of a medical malpractice suit filed against him in late 2016 are here.

Dr. George Rutland

Dr. George Rutland of California lost his medical license in 2011 for the second time, after Ying Chen’s abortion death in 2009 was ruled a homicide. Dr. Rutland also lost his license in 2002 for severing a baby’s spinal cord during a delivery and then lying about it to the parents. [47] According to a local news article, “he also was accused of scaring patients into unnecessary hysterectomies, botching operations, lying to patients, falsifying medical records, over-prescribing painkillers and having sex with a patient in his office. He admitted negligence only in the case of the death of a newborn girl who died during a forceps delivery.” [48]

(Dis)honorable Mention:

Other abortion doctors worth (dis)honorable mention include: Douglas Karpen [49], James Pendergraft [50],  Nicola Riley [6], Robert Hosty [52], Robert Rho [53] [54] [55],  Antonio Hodari [56], and Pansour Manah [57].

Survey Says….

Americans United for Life (AUL) is an organization that exists to “protect and defend human life from conception to natural death through vigorous legislative, judicial, and educational leadership.” [58] Their report “Unsafe: How the Public Health Crisis in America’s Abortion Clinics Endangers Women”, released in 2016, documents cases from 227 facilities in 32 states that were cited for over 1,400 health and safety deficiencies between 2008 and 2016. In many cases, the same clinic was cited for the same violations repeatedly, often multiple years apart. In other words, problems were found, no corrections were made, and business was allowed to continue as usual without penalties against the clinic. [59]

Safety violations categories:

1. failure to ensure a safe and sanitary environment
2. patient record documentation failures and privacy violations
3. failure to provide staff adequate training and ongoing education
4. unlicensed and unqualified staff providing medical care, staff performing duties unsupervised
5. expired medicines and medical supplies
6. failure to follow safety protocols
7. missing or outdated equipment for responding to medical emergencies
8. medication safety violations
9. failure to maintain safe building and environmental conditions
10. failure to monitor patient vital signs

Other violations include failure to report sexual abuse of minors, failure to follow abortion reporting requirements.

What safety regulations does my state have in place for abortion clinics?

In  Planned Parenthood v. Danforth in 1976, the Supreme Court found that: “record keeping and reporting provisions that are reasonably directed to the preservation of maternal health and that properly respect a patient’s confidentiality and privacy are permissible.” [60]

New in 2018

The Guttmacher Institute summarizes new abortion restrictions enacted in 2018 here.

TRAP Laws

The Guttmacher Institute lists all TRAP (Targeted Regulation of Abortion Providers) laws currently in effect, temporarily enjoined (not being enforced) or permanently enjoined (will not be enforced) on their website. These types of laws include: 1) physical building standards comparable to surgical centers for outpatient abortion clinics, doctors offices where abortions are provided, and/or clinics where medication pills are dispensed 2) specifications about procedure room size for one or more of the above types of locations 3) specifications for corridor width in one or more of the above types of locations 4) specified maximum distance to the hospital for one or more of the above types of locations 5) transfer agreement with a nearby hospital for one or more of the above types of locations in case of medical emergency caused by or during the  abortion 6) requirement that doctor performing abortion have admitting privileges or alternative agreement with local hospital in case of medical emergency caused by or during the abortion [61]

Guttmacher Institute Responds

In response to these types of laws, the Guttmacher Institute cites statistics that 0.3% or 0.5% (both statistics are cited in their article) of women who undergo an abortion are hospitalized for a complication. (See problems with abortion complication reporting here) The Guttmacher Institute also take issue with reporting anesthesia complications as abortion complications. Grouping anesthesia complications under the medical procedure they were given for is standard medical practice. For example, anesthesia complications are routinely listed as potential surgical complications when patients sign surgical consent forms.

The Life List

Americans United for Life (AUL)’s “Life List” ranks the most and least pro-life states in America based on restrictions and regulations such as mandatory waiting periods before an abortion, mandatory reporting of abortion complications, parental notification or parental consent laws, and more. [62] They report: “Only nine states offer strong legal protections for women; 16 states provide moderate protection, 12 states offer minimal protection and sadly, 13 states are ranked as dangerous for their failure to regulate the abortion industry by holding them accountable for the conditions they create that can endanger women.” [63]

How do I check the safety of my local clinic?

One resource is http://abortiondocs.org. This website lists every surgical and medication abortion clinic operating in the United States. A clickable map and a search function allow users to search for the clinic they are looking at visiting. Any available photos, videos, news stories, and any relevant court documents are included in each listing. [64] Another resource is https://checkmyclinic.org/. Clicking on any state in the map of the United States brings up a list of common abortion restrictions and whether the state allows or prohibits them. Examples include availability of telemedicine (webcam) abortions, mandatory waiting periods, and parental consent laws. Limited information on specific clinics is also listed. [65] http://abortionsafety.com/ is another website that lists malpractice suits against specific abortion clinics, accessible through a clickable map of the country.

Citations
36.  Cassing Hammond MD, and Stephen Chasen MD, “Dilation and Evacuation,” Management of Unintended and Abnormal Pregnancy. Ed. Paul, Lichtenberg, Borgatta, Grimes, Stubblefield and Creinin. (Wiley-Blackwell, 2009), 179[/expand]