Abortion clinics inspected, cited more frequently

Ohio health department officials have more frequently inspected and cited the state’s 11 remaining abortion clinics under Republican Gov. John Kasich than any other governor in the last decade.

Pro-life advocates say the governor is simply following the state’s health facility inspections laws diligently compared to his predecessors, in order to ensure women are getting safer services at abortion clinics. Meanwhile, pro-choice proponents worry the administration might be playing political football at the expense of the facilities.

With the state shedding three abortion clinics last year, three more clinics at risk for closure and Ohio’s lawmakers passing more aggressive regulations for abortion clinics, this newspaper requested copies of inspection reports from 2004 to present from the state health department.

More than 25,000 abortions were performed at one of Ohio’s facilities in 2012, including two operating within the Greater Cincinnati region and one in the Dayton area. More frequent state inspections at these clinics could turn up issues that might impact the health and safety of thousands of women seeking termination surgeries every year.

Not doing their job?

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Inspections and citations of the abortion clinics could be up in recent years because previous governors failed to order the inspections on the abortion clinics, specifically, Mike Gonidakis, the president of Ohio Right to Life, said.

“It boggles my mind to think that two grown men, who were elected by the citizens of Ohio, would purposely choose not to do their job,” Gonidakis said of Kasich’s predecessors, Democratic Gov. Ted Strickland and Republican Bob Taft. “For some reason, for far too long, (abortion clinics) weren’t being inspected until the Kasich administration came into office.”

Same-day surgery centers, including abortion clinics, must be inspected annually and pay an inspection fee of $1,750 in Ohio to earn their license renewal.

Gonidakis said his organization tried to press the health department, under the former governor, to increase abortion clinic inspections — a tactic he’s not had to use since Kasich took over.

But some abortion clinic representatives question if the health department has been doing its job, recently. At least two abortion clinics told the Journal-News that they haven’t received any reports from their latest annual inspection, leaving the clinic operators to wonder if they’re following state health guidelines properly, said Jennifer Branch, a Cincinnati attorney who is actively defending a Sharonville abortion clinic and another one in Toledo in a legal fight against the state to stay open.

She said the Sharonville clinic still hasn’t received a report from an inspection that was conducted last year and no such report showed up in the public records request this newspaper filed for all inspection reports within the last decade.

“There’s been a trend: they come out, do inspections, and we never hear back from them,” Branch said. “It’s been unnerving waiting to see what the state is going to say. You don’t know if the clinic is in compliance or not.”

Same goes for Cincinnati-based Planned Parenthood of Southwest Ohio, which never got word back on its annual inspection that took place over two days last June, Rick Pender, a spokesman for the facility, said.

Officials at the Ohio Department of Health declined a telephone interview for this story, took weeks to respond to questions and would only communicate via email through a spokeswoman. A spokesman with Kasich’s office also directed questions for this story to the health department.

It took health department officials three months before making 72 inspection reports of 11 abortion clinics during the last 10 years available to this newspaper. This newspaper also initially requested inspection reports for all same-day surgery centers in the state’s biggest counties but withdrew that request once a health department spokeswoman advised that the public records would take months, if not more than a year, to obtain.

Once available, the abortion clinic reports show that under Kasich, a pro-life Republican who took office in 2011, the 11 clinics have been cited at least 100 times and inspected at least 40 times.

That’s a stark contrast compared to the Strickland and Taft administrations; under Strickland, abortion clinics were inspected 19 times and cited six times while under Taft they were inspected 13 times and cited 71 times during the last three years of Taft’s governorship. However, one of the clinics included in this analysis didn’t open up until 2011 and another began operating in 2010.

The former health director under Strickland did not return phone calls at his work place seeking comment.

Just last year, those same clinics were inspected at least 10 times and cited a total of 29 times by the health department.

Most citations handed out last year hinged on paperwork infractions, such as failing to record a patient’s discharge, not listing job descriptions in staff files or failing to record when medical employees were last given tuberculosis vaccines. Other violations included storing boxes directly on the floor or stained and dusty equipment.

Some violations found at the clinics during the last decade did include cleanliness issues, including one citation given in 2011 at a Columbus clinic called Cleveland Avenue Professional where the inspector note “what appeared to be blood” dripped into the sink, soiled areas ranging in color from brown to red on a patient bed and a “reddish-brown splatter” on a wall, which a staff member said he or she forgot to clean up.

A health department spokeswoman said in an email that same-day surgery centers were not inspected “consistently” prior to 2011 and that the department has worked to “create a more consistent and predictable licensure inspection process to ensure the quality of care and patient safety.”

Owners of same-day surgery centers were rarely inspected up until about five years ago, Randy Leffer, the executive director of the Ohio Association of Ambulatory Surgery Centers, said.

“I don’t know if it’s annually (now) but ambulatory surgery centers are definitely seeing inspectors more frequently,” Leffer said. “If they’re being visited more frequently, (the inspectors) are probably going to see more issues.”

“Chilling effect”

Under the Kasich administration, the health department has also more frequently conducted re-inspection and complaint inspections, which cost clinic operators $875 each.

Thirteen re-inspection or complaint inspections reports have been filed since 2011 but only 12 total were conducted under Strickland and Taft. The health department also handed out a $25,000 fine to a Toledo abortion clinic last year for not having a written patient transfer agreement with a hospital — the agreement had expired just 24 hours before the penalty was given out — and that was the only time in the last decade the health department gave a fine to any of the 11 abortion clinics analyzed. The fine came on the heels of new state legislation passed last year that bans abortion clinics from entering into patient agreements with public hospitals.

Pro-choice proponents want the clinics inspected to ensure they’re safe but they don’t want the clinics to be unfairly targeted for inspections, either, Kellie Copeland , executive director of NARAL Pro-Choice Ohio, said.

“Anecdotally, I’ve heard people say they feel like the inspectors are looking for violations, not just looking for safety issues,” Copeland said of the workers at abortion clinics. “There’s been kind of a chilling effect. I think ideally, you want the health care community and the health department to be collaborating. I don’t think you want an adversarial relationship.”

Inspections can sometimes result in the closure of an abortion clinic.

That happened last year with a Toledo abortion clinic, when the health department’s then-Director Theodore Wymyslo proposed revoking the clinic’s license and fined the owner $25,000 after finding violations during an April 2013 inspection. The clinic didn’t fight the license revocation and closed last year, leaving Toledo with one abortion clinic.

And, Gonidakis hopes to see the health department shut down more facilities if they have significant violations. Ohio Right to Life hopes to see at least four of the abortion clinics operating in the state close this year, including Women’s Med Center in Sharonville and Planned Parenthood Southwest Ohio in Cincinnati.

“I think the goal will be to hold (the clinics) accountable,” Gonidakis said. “If mistakes are made and laws are not followed, we can only hope that the department of health will take full action and close the clinics. I think we’re an environment today where (Ohio) is enforcing the regulatory laws, but by doing so, we’re protecting women’s health.”

Politics at play?

Abortion clinic inspections have become a political affair — ultimately jeopardizing the safety of women — before.

In 2011, an abortion doctor out of Philadelphia was found to be operating a gruesome clinic, where he and his staff would routinely stab and kill live babies. The clinic hadn’t been inspected for 17 years, in part because Republican and pro-choice Gov. Tom Ridge ordered inspectors not to look at Pennsylvania’s abortion clinics, for political reasons, in 1993, according to a grand jury report.

The discovery of the Philadelphia clinic, forced the state to make “significant management, personnel and cultural changes” to the health department in 2011, when a new governor took the helm, Aimee Tysarczyk, a spokeswoman for Pennsylvania’s health department said. The facilities are now inspected annually, just like in Ohio, and must submit to unannounced inspections, including on the weekends and evenings.

The state also posts inspection reports of all ambulatory surgical facilities online for public viewing. According to Pennsylvania’s online records, the 19 abortion clinics operating in the state were inspected a total of 32 times and inspectors noted a combined 11 violations during their visits — less than half of the number of violations found at Ohio’s clinics.

There is no evidence in any of the inspection reports to suggest that abortion clinics in Ohio were operating at all like the one in Philadelphia despite lacking frequent checks by the state. Still, Gonidakis, of Ohio Right to Life, said Kasich’s push to review the clinics more frequently could prevent a similar abortion business from operating here.

“It’s definitely sent a loud wake up call to the abortion industry that business as usual is over,” Gonidakis said.

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