Md: ‘No deficiencies’ found in care of woman who died after abortion


Dr. LeRoy Carhart travels between Nebraska and Germantown, Md., where he performs late-term abortions. (Katherine Frey/The Washington Post)
May 24, 2013

Maryland health officials investigating the case of a woman who died in February after an abortion late in pregnancy at a Germantown clinic found “no deficiencies” in her care at the clinic, according to results released Friday.

The 29-year-old woman died after an abortion performed by LeRoy Carhart, one of a handful of doctors nationwide who publicly acknowledge performing late-term procedures. Carhart has been the focus of protests by antiabortion groups, especially after the murder conviction of Philadelphia abortion provider Kermit Gosnell this month.

A broader survey by the Maryland health department into all 16 of the state’s surgical abortion facilities, however, did find that the Germantown clinic was among 12 clinics that had a range of deficiencies. None of the problems presented an immediate and serious threat to the health and safety of patients, the department found.

But state health officials found life-threatening deficiencies at another provider, Associates in OB/GYN Care, which operates surgical abortion clinics in Silver Spring, Cheverly, Frederick and Baltimore. The health department suspended the provider’s license to operate three of its four clinics in March and reinstated them about three weeks later after the facilities fixed the problems, which related to preparing for and responding to emergencies, including the cardiac arrest of one patient.

This month, health department officials suspended the licenses of all four clinics after they found additional “serious deficiencies in the medical oversight of patient care.” An unlicensed technician at the Baltimore clinic had given an abortion-inducing medication, misoprostol, to a woman without a doctor present and before any doctor or licensed health-care professional had any contact with her, in violation of state regulations, investigators found. When a doctor arrived, the doctor declined to complete a surgical abortion because the “facility is not equipped to do this procedure safely.”

The woman was 13 to 14 weeks pregnant with triplets, the clinic’s operator said.

The woman eventually went to another of the operator’s clinics, where a surgical abortion was completed with no complications, health officials said.

Investigators later determined that it was standard, unwritten protocol at all four clinics to give misoprostol to all patients who were at least 11 weeks pregnant, even if the patient had not been evaluated by a doctor and even if no physician was present.

After an administrative hearing Tuesday, the health department’s chief regulator ordered the suspensions to continue. Among the reasons, she noted, was that the clinics’ operator ”did not accept responsibility” for the unwritten protocol and blamed it on a single doctor.

In a statement, Associates in OB/GYN Care said it was disappointed with the suspension. ”We think it’s unfair,” said Bridget Wilson, communications outreach coordinator. She said the suspension was based on actions of a single independent contractor physician and not part of the facilities’ overall procedures. “When we learned of the issue, we forbade the office staff from following this physician’s request,” she said.

The suspensions were among the first actions taken by the state health department since Maryland adopted new regulations last year requiring all surgical abortion facilities to be licensed. They were established in part after a botched abortion at an Elkton clinic in 2010.

“We will suspend licenses when we feel like they pose a risk to patients,” said Joshua Sharfstein, Maryland’s health secretary.

In the case of the Germantown clinic, the health department began an investigation shortly after the woman’s death Feb. 7. Officials interviewed clinic staff, reviewed medical records and the clinic’s policies and procedures, and consulted with the state medical examiner’s office.

In a letter Friday to state legislative leaders, health department officials said they “identified no deficiencies with respect to this complaint.”

But the department did find numerous deficiencies at Germantown Reproductive Health Services during its broader inspection of all surgical abortion clinics.

The most common deficiencies found in Germantown and the 11 other clinics involved lapses in providing information about the professional credentials of clinic physicians, maintaining a sanitary environment at all times and providing a discharge diagnosis in the medical record. Health officials said all of the physicians had the educational and certification requirements to perform surgical abortions. There was no evidence that the other deficiencies resulted in harm to patients.

At the Germantown clinic, nurses were not properly trained to give sedation medication. The clinic’s medical director was not properly credentialed. One nurse’s license had expired the year before.

Inspectors also found that the clinic failed to develop and put in place policies and procedures for emergencies if patients had to be transferred to a hospital. They also found that staff were filling syringes multiple times from vials of medicine intended for one-time use, and that staff failed to pre-clean dirty surgical instruments using an enzymatic cleaner (instead of bleach, water and dish soap) before sterilization.

The clinic said that it had remedied the problems or had plans underway to do so and that none of the deficiencies had a negative impact on patients. On the medication, for example, it is using vials in different dosages. It is also using an enzymatic cleaner on surgical instruments as part of its cleaning process.

Lena H. Sun is a national reporter for The Washington Post, focusing on health.
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