One of the big questions that's come up in the Gosnell case is what role poverty played in leading women to choose his cut-rate clinic, which abortion-rights advocates report offered prices considerably lower than at other facilities in Philadelphia.
It's never been easy for women to get outside funding for abortion. But during the period when it was illegal in most states, some groups of women pooled funds to help each other obtain them and travel to providers in distant locales. These groups grew after the legalization of abortion, and especially after legislation barred Medicaid from paying for abortions in 1977. A network of the groups, called abortion funds, banded together in 1993 into the National Network of Abortion Funds. The local fund serving Philadelphia is the Women's Medical Fund, which has been operating since 1985 to help fund abortions for women who make up to 150 percent of the federal poverty level and who lack insurance or have insurance (such as Medicaid) that does not cover abortion. The fund does not perform abortions, but works with an array of clinics in Philadelphia to pay them directly when women show up unable to pay for them.
Did this Women's Medical Fund, which says it helped 1,532 of the poorest women get financing for their abortions last year, ever work with Kermit Gosnell's Women's Medical Society?
"No," said Executive Director Susan Schewel. "Nope. Never."
"We had heard stories over the years about care that seemed inappropriate," she told me. "We had no idea -- no idea -- of how horrible things were there."
Schewel, a former nurse practitioner who has been with the fund for 10 years, said that some of the women her group spoke with on its abortion-related Help Line had previously had experiences at Gosnell's facility, and that she personally tried to work with two women to file complaints to the Pennsylvania of Department of Health about him. In both cases, the women found the complaint process so onerous and the telling of their stories so personally difficult that they failed to complete the paperwork and abandoned the effort.
The Health Department complaint process "was way too burdensome" for the women, she said, "not to mention the stigma, to have to tell your story aloud to state officials."
So why didn't she complain on her own? "It really had to be a patient," she said. There was no clear channel for independent third-party complaints like hers.
Her story confirms what's laid out in the grand jury report, which recommended both making the complaint process easier and allowing complaints from victims to be made anonymously when accompanied by the complaint of a named health-care provider:
The Pennsylvania Department of Health makes it next to impossible to file a complaint concerning abortion providers. ... When persistent lawyers, like Semika Shaw's; and doctors, such as Dr. Hellman, the Medical Examiner from Delaware County, and Dr. Schwarz, Philadelphia's Health Commissioner, have registered complaints anyway, they have been uniformly ignored. DOH did not inspect Gosnell's clinic even after Karnamaya Mongar died.
We applaud the current Secretary of Health for reinstituting regular inspections of abortion facilities. But the department must also develop an effective, easy, and responsive complaint process. Complaints should be accepted by telephone (a toll-free 800 number should be instituted), online, or in writing - in any manner, that is, in which a citizen might choose to complain. Every complaint should be logged in and investigated. The complainant should be informed that the department has received the complaint and should be provided with a means of following up to check its status. When fellow doctors, public health agencies, or law enforcement agencies file complaints, they, obviously, should be taken seriously and should trigger immediate investigations, including unannounced inspections.
The Department of State has a complaint process, and a complaint form, for filing complaints against doctors. The complaint process should be made easier and more responsive. Complaint forms to health care-related boards should be tailored to medical concerns and assure confidentiality of patients' records. Forms should be available in common foreign languages and should be simple to understand and fill out. Complaints should also be accepted by telephone and internet, with the phone number published online. Patients should be allowed to remain anonymous, but third-party complainants should be identified. Hearings, if necessary, should be offered locally.
Schewel emphasized that she had no idea how bad things were at Gosnell's clinic: "We just didn't know. We thought there were little odds and ends of problems, but nothing like this .... All of us were completely surprised to learn how bad it was."
So why wouldn't her feminist fund work with him? Stories like the following, which she says one woman told her: the people caring for the woman, who had "her procedure" late at night, wore lab coats but had no name tags.
"I think that's not OK," she said. "I think it's required by regulations to wear a name tag. It never occurred to us that these would be unlicensed people wearing lab coats."
Pennsylvania passed a law in late 2010 that made the identification requirement even more stringent, mandating that in the years ahead all medical personnel wear photo IDS with their names and credentials in block letters.