Did the Hyde Amendment keep Kermit Gosnell in business?

By now, the facts are well known. Kermit Gosnell, a physician in charge of Women’s Medical Society in West Philadelphia, was charged last week with the deaths of a former patient via a botched abortion and seven infants who were born alive and then murdered. The grand jury report of the investigation is here and another post on the matter is here.

Some pro-choice advocates are blaming restrictions on abortion and abortion funding, such as the Hyde Amendment for the tragedy. For instance, Amanda Marcotte, writing for RhRealityCheck.org, asks, “Why can’t anti-choicers accept that restricting abortion means more predators like Kermit Gosnell will get customers?” Susan Schewel, executive director of the Women’s Medical Fund, a group that funds abortion for low income women, suggests that the lack of Medicaid funding caused by the Hyde Amendment drives women to low cost horror factories such as operated by Gosnell. In a letter to supporters about the Gosnell tragedy, Schewel writes, “This prohibition on Medicaid payment for abortion leaves desperate women vulnerable to sub-standard providers.

The problem with this line of thinking is that Gosnell was able to accept Medicaid funding, at least for vaccines. The grand jury report indicates that he took insurance payments, at least some from Medicaid via a City of Philadelphia program that paid for vaccinations. I have also learned this afternoon that he was a network provider for the insurance giant Aetna until early 2010.

According to the grand jury report, at least one pro-choice group, the Delaware Pro-Choice Abortion Fund paid for abortions at Gosnell’s clinic. The issue here was not access but lack of oversight. Incidentally, I can find no indication that the pro-choice funding group ever checked up on Gosnell.

If Medicaid paid for abortion, yes, Gosnell’s clients would have had free or nearly free services, but without oversight, those free services could have been pretty costly. The issue here is oversight, or rather the lack of it, and let’s not forget why that oversight was lacking. Kenneth Brody, Department of Health lawyer said there was consideration given to restarting abortion clinic regulation in 1999. However, the decision was not to inspect. Why? Brody told the grand jury:

…there was a concern that if they did routine inspections, that they may find a lot of these facilities didn’t meet [the standards for getting patients out by stretcher or wheelchair in an emergency], and then there would be less abortion facilities, less access to women to have an abortion.

Gosnell was performing procedures that few others would do even if the Hyde amendment was not in force. But those Medicaid did allow (rape, health of the mother), he did perform, at least according to this rate sheet obtained at Gosnell’s clinic.

I agree with the Philadelphia grand jury; the massacre in Philadelphia was due to a lack of oversight impure and painfully simple.

PA Senate to hold hearings on failure of abortion clinic regulation

I just received this statement from Erik Arneson, Communications and Policy Director for Sen Dominic Pileggi, PA Senate Majority Leader, Speaking about the case of Kermit Gosnell and the grand jury report on the atrocities alleged at the Women’s Medical Society in Philadelphis, Arneson said:

The grand jury report shows a massive systematic failure by the state agencies responsible for overseeing this facility. We intend to hold at least one public hearing to examine the problems in detail.

I hope the hearing will be sufficient to cover the “massive systemic failure” as well as any other factors that led to the scandal in Philadelphia. Given the scope of the situation, I suspect one hearing may not be enough.

PA Abortion clinic inspections stopped to avoid barriers to abortion

The grand jury report on Kermit Gosnell’s Women’s Medical Society in Philadelphia carefully details the shocking negligence of many people. From those responsible for regulating health under two administrations to outside certifying agencies, many people knew something was wrong in West Philly and they did little or nothing. Here is a passage (pp.148-149) from the grand jury report that finds a change in policy regarding abortion clinics when Governor Tom Ridge took over from Bob Casey. In essence, the change in regulatory posture was justified by the belief that such negligence would make abortions more accessible.

Since February 2010, Department of Health officials have reinstituted regular inspections of abortion clinics – finding authority in the same statute they used earlier to justify not inspecting.

Staloski blamed the decision to abandon supposedly annual inspections of abortion clinics on DOH lawyers, who, she said, changed their legal opinions and advice to suit the policy preferences of different governors. Under Governor Robert Casey, she said, the department inspected abortion facilities annually. Yet, when Governor Tom Ridge came in, the attorneys interpreted the same regulations that had permitted annual inspections for years to no longer authorize those inspections. Then, only complaint driven inspections supposedly were authorized. Staloski said that DOH’s policy during Governor Ridge’s administration was motivated by a desire not to be “putting a barrier up to women” seeking abortions.

Brody confirmed some of what Staloski told the Grand Jury. He described a meeting of high-level government officials in 1999 at which a decision was made not to accept a recommendation to reinstitute regular inspections of abortion clinics. The reasoning, as Brody recalled, was: “there was a concern that if they did routine inspections, that they may find a lot of these facilities didn’t meet [the standards for getting patients out by stretcher or wheelchair in an emergency], and then there would be less abortion facilities, less access to women to have an abortion.”

Brody testified that he did not consider the “access issue” a legal one. The Abortion Control Act, he told the Grand Jurors, charges DOH with protecting the health and safety of women having abortions and premature infants aborted alive. To carry out this responsibility, he said, DOH should regularly inspect the facilities.

Nevertheless, the position of DOH remained the same after Edward Rendell became governor. Using the legally faulty excuse that the department lacked the authority to inspect abortion clinics, Staloski left them unmonitored, presumably with the knowledge and blessing of her bosses, Deputy Secretary Stacy Mitchell and a succession of Secretaries of Health. The department continued its do-nothing policy until 2010, when media attention surrounding the raid of the Gosnell clinic exposed the results of years of hands-off “oversight.” Now, once again, the regulations, which have never been modified, apparently allow for regular inspections. This is, and always was, the correct position. The state legislature gave DOH the duty to enforce its regulations; the authority and power to do so are implicit in that duty. The department abandoned this responsibility without explanation, and without notice to the public or the legislature.

This is a scandal which requires an investigation. The legislature in PA developed statutes which required clinics to be investigated and the law was not followed. The new chief executive in PA, Tom Corbett, is reportedly upset about this case. I hope he turns his upsetness into action.

I should also mention that I have contacted the DOH’s chief counsel in PA for comment but have not had a reply.