This week, the Supreme Court of the United States will consider Whole Woman’s Health v. Hellerstedt. In this lawsuit several abortion providers have challenged two safety provisions of a law, House Bill 2, the Texas Legislature passed in 2013 by overwhelming margins. While dismissed by abortion providers in Texas as unnecessary, one should consider the source of the criticism. The state’s safety inspection reports of the lead plaintiff, Whole Woman’s Health, show serious violations that endanger the health and safety of the tens of thousands of patients on whom they perform abortions every year.
The first provision requires physicians who perform abortions to have admitting privileges at a local hospital. In the event of a serious complication that requires the woman to be rushed to an emergency room, the physician should be able to follow his or her patient and continue treatment at the hospital. Without privileges, the physician would essentially abandon the patient. It is worth noting that it is extremely common for practicing physicians of all types to have privileges, including many abortion doctors.
The second provision increases safety standards at licensed abortion facilities to the level of outpatient surgery centers (Ambulatory Surgical Centers or ASCs), which perform the same or similar procedures. Patients can expect that common outpatient procedures like colonoscopy or cataract removal will be performed in an ASC, the standard of care. Even dilation and curettage following a miscarriage will likely be performed in a hospital or ASC operating room. We note that dilation and curettage is the most common method of abortion used in non-ASC abortion facilities, yet they fail to provide the same standard of care as women receive after a miscarriage.
The lead plaintiff, a for-profit business called Whole Woman’s Health (WWH), operates a multi-state chain of abortion facilities including four in Texas — one in Fort Worth, one in McAllen, and two in San Antonio. They formerly operated abortion facilities in Austin and Beaumont, which they have elected to close.
The outspoken owner and CEO of Whole Woman’s Health, Amy Hagstrom Miller, has strenuously opposed legislation in Texas to raise the standard of care at abortion facilities, to provide women with information, and to protect the health and safety of women.
Hagstrom Miller often speaks to the media about the “high-quality” and “safe” abortions they offer. The reality at her abortion facilities is starkly different, according to state inspection reports we have obtained through public information requests dating back to 2011.
Texas’ Department of State Health Services (DSHS) performs unannounced annual inspections of licensed abortion facilities consistent with state law that has existed for decades. When the inspectors find violations, the inspection reports are available to the public and the media, but the only violations available to the public are those that “would pose a health risk to a patient at the facility.” Staff and patient names as well as violations that do not pose a health risk are omitted or redacted.
Texas Alliance for Life obtained the inspection reports for Whole Woman’s Health facilities from 2011 through 2015 through public information requests.
The results are at times shocking. At a minimum the inspection reports show a callous disregard for the health and safety of the women who obtain abortions at the facilities. Whole Woman’s Health consistently and repeatedly fails to meet basic safety standards. Many violations involve the failure to properly sterilize the surgical instruments that are used from woman to woman.
Hagstrom Miller repeatedly made claims about the “high-quality” and “safe” care women receive at her abortion facilities at the same time her facilities are failing to comply with even the current safety standards in Texas.
… staff were not trained in the sterilization process, the facility failed to staff a trained nurse, the suction machines had rusty spots, the floors were stained and discolored, the staff were not properly trained in CPR, and the facility failed to provide proper emergency equipment.
In October of 2011, the Whole Woman’s Health blog featured a post lamenting state laws, stating, “On top of all of that, we’re also subject to regular, random inspections by the state. Each carries their own large list of detailed, state-mandated rules and regulations that we follow and abide by.”
Despite claims that Whole Woman’s Health “follow[s]” and “abide[s] by” the state’s safety standards, earlier in 2011, in March, DSHS inspectors found that employees in Fort Worth were not properly sterilizing equipment, and they had expired medications and equipment available for use in patient rooms. Further, drugs used to cause medical abortions were being store in an unlocked and unsecured cabinet. The inspection report from March 15,can be found here.
In November of 2011, on their blog, Whole Woman’s Health claimed that “Whole Woman’s Health has been working to transform healthcare for a long time now, and both we and some of our patients are in awe of what we’ve accomplished. . . We provide procedures in safe, aggressively inspected facilities . . .”
That same month, on November 17, DSHS found a number of alarming violations at the now closed Whole Woman’s Health Beaumont facility: staff were not trained in the sterilization process, the facility failed to staff a trained nurse, the suction machines had rusty spots, the floors were stained and discolored, the staff were not properly trained in CPR, and the facility failed to provide proper emergency equipment.
…before last session’s sonogram law took effect in February, her facilities in Beaumont, McAllen and Fort Worth relied on telemedicine.
In an article in the Texas Tribune on November 20, Hagstrom Miller complained about the implementation of a new sonogram law, passed the previous year with overwhelming support in both houses of the Legislature. The sonogram bill, intended to provide women with adequate medical information before they consent to abortion, requires a physician to meet with a patient 24 hours before an abortion to explain risks of the abortion procedure and alternatives to abortion, much as one would expect before consenting to virtually any other medical procedure.
According to the article, “Amy Hagstrom Miller, CEO of the abortion provider Whole Woman’s Health, said that before last session’s sonogram law took effect in February, her facilities in Beaumont, McAllen and Fort Worth relied on telemedicine. A technician would perform the sonogram and a physician based in Austin would review the patient’s medical records, then videoconference with the patient to answer any questions.”
The article continues, “She said the effects of the law have been starkest at the clinics that previously used telemedicine, because those clinics often only have a physician on site two weekends a month.”
Despite Hagstrom Miller’s complaint that she was unable to bring physicians into her facility, DSHS inspection records from December 19, show that she failed to staff the facility with even a licensed vocational nurse (LVN) with the required experience. Further, among other violations, the staff were unable to perform the proper sterilization of surgical instruments.
… “numerous rusty spots on the suction machines used on the patient,” “expired drugs,” unlabeled “pre-filled medication cups,” “a large hole in the cabinet flooring … [that] had the likelihood to allow rodents to enter the facility,” as well as numerous other health and safety violations.
While discussing legislation that would require abortion facilities to meet ambulatory surgical center standards, on March 25, the Texas Tribune quotes Hagstrom Miller as saying, “There’s no recent spike in risk or safety incidents that this regulation is responding to. It’s pure politics.”
Then on July 8, during the consideration of House Bill 2, Hagstrom Miller said of Whole Woman’s Health, “We have over 40 years of safe abortion on record in Texas.”
Despite her claims of safety, the following month state inspectors visiting the Whole Woman’s Health facility in San Antonio found egregious violations of safety standards, and the inspectors’ report from August 29, is nothing short of alarming. Staff were not trained in proper sterilization procedures, the sterile processing room was susceptible to cross contamination, and the sterilization solution they were using was ineffective.
Despite the inspection results from August 29 and September 4, on September 5 Hagstrom Miller stated, “The point of this legislation was to make abortion inaccessible. It wasn’t about safety. Because there is no safety problem around abortion in Texas.”
The following month on October 29, following a district court ruling in Planned Parenthood v. Abbott, a lawsuit brought by abortion providers to challenge two provisions of Texas law, in which a federal district judge temporarily suspended the admitting privileges requirement and some of the regulations regarding drug-induced abortions, Hagstrom Miller stated, “This decision will keep thousands of women safe and allows our Whole Woman’s Health clinics to continue to provide compassionate, professional care to women in our communities.”
Despite claiming to provide “safe,” “compassionate,” and “professional” care to women, earlier that same month on October 3, an inspection of the Whole Woman’s Health Beaumont facility found “numerous rusty spots on the suction machines used on the patient,” “expired drugs,” unlabeled “pre-filled medication cups,” “a large hole in the cabinet flooring … [that] had the likelihood to allow rodents to enter the facility,” as well as numerous other health and safety violations.
In March of 2014, after the admitting privileges and medication abortion safety standards went into effect, Whole Woman’s Health announced the closing of two of their abortion facilities — one in McAllen and one in Beaumont. On March 6, the Texas Tribune quoted Hagstrom Miller saying that “the new abortion regulations could lead to a public health problem. ‘We didn’t change the amount of women in the community who are still going to need the service,’ she said. ‘We just blocked their access to getting it safely.’”
Just one week later, on March 13, DSHS inspectors found that Whole Woman’s Health in Austin had failed to provide women with a telephone number to call in the case of an emergency, a clear violation of state law.
On August 6, in a column in TribTalk, Hagstrom Miller says that “For over 11 years, Whole Woman’s Health has been proud to provide high-quality, compassionate and professional reproductive health care services to the women and families of Texas. But after already being forced to shutter three of our five Texas clinics as a direct result of HB 2, the fate of our other clinics and, more importantly, the availability of safe, professional abortion care for the women of Texas hangs in the balance.”
These statement comes just about five weeks after a June 24 inspection of the Whole Woman’s Health Fort Worth facility found that surgical instruments were not sterilized properly, nor were the instruments stored properly after sterilization.
On November 13, Hagstrom Miller released a statement proclaiming, “I own and operate 8 high quality independent abortion care clinics in 5 states – Texas, Illinois, Minnesota, New Mexico and Maryland.”
Three of these “high quality” abortion facilities were inspected in October and November, and state inspectors found a combined 43 pages of safety violations at facilities in San Antonio, Fort Worth, andMcAllen. The violations included unqualified personnel, “cracks” and “rips and tears” in the vinyl covers on the exam tables, suction machines “covered in dust,” improper sterilization of instruments, clean medical supplies three feet away from where the body parts of aborted babies were examined, failure to “store hazardous cleaning solutions and compounds in a secure manner,” and many other egregious violations.
We have heard a lot from the owner of Whole Woman’s Health about the “high-quality” and “safe” care women receive at her abortion facility, but Hagstrom Miller misrepresents the truth. Americans deserve to know that Whole Woman’s Health consistently fails to meet even minimal standards set for them in Texas today.
Hagstrom Miller should not be believed, and Texas abortion providers should not be allowed to continue performing substandard and dangerous abortions on women. Women who choose to undergo abortion should expect to receive the same standard of care as women receiving comparable procedures.
That is why the Supreme Court should reject their baseless claims and uphold Texas’ common sense safety standards for abortion.
Texas Alliance for Life has filed an amicus brief in Whole Woman’s Health v. Hellerstedt. The brief can be found here.