Danger in the Heartland

Planned Parenthood of Greater Iowa (PPGI) opened a clinic in Storm Lake, Iowa in 1985. It was popular with young women, mainly due to the fact that it was staffed with female nurse practitioners plus it operated on a sliding fee scale which made it affordable for low income families. In April 1991, I applied to work at the clinic as a Family Planning Assistant and was thrilled to get an interview. The interviewer asked me if any of my friends would think less of me for working there. At the time, I had no idea what she was talking about. I got the job, started work and loved it. Within a couple of weeks, the Manager’s position opened. I again applied and was interviewed. This time I was asked what I thought about abortion and I told her I believed it was murder. She disagreed with me, saying that “the fetus wasn’t viable” so it really wasn’t ending a life. Surprisingly, I was offered the position of center manager.

All management staff was expected to observe at least one day of surgical abortions. In the early 1990s the closest abortion center was the Central Clinic in Des Moines. I naively drove to the clinic totally unaware of what I was about to witness. During the eight hour day, the doctor did about 30 abortions. Some of the women were further along in their pregnancy than they had indicated in their paperwork. Each of the “contents of the uterus” was placed in a clear glass bowl and then examined under a light. After looking at this for most of the day, there was one bowl that clearly contained three perfect, tiny arms. I asked why there would be one more than the usual two. “Twins” was the response. I immediately asked if the mother would be told that she had been carrying twins. They said it might upset the patient so that information was never shared with any mother.

Watching a full day of abortions was grueling. I had two beautiful little daughters and was very thankful to get home and wrap them in my arms. Knowing that so many women were faced with unplanned pregnancies only doubled my determination to teach and prevent the need for abortion. This is exactly what I did for the next 17 years.

All center managers met regularly in Des Moines for updates and training. It was at one of these meetings in mid 2008, that the Health Services Management Team announced that all clinics would be offering a new program called Telemed Abortions. Considering all the issues that every surgical abortion center had with security, protestors, staffing, complications, etc., this was a stunning announcement.

Their plan was to install computer equipment capable of connecting a doctor in Des Moines with a patient at any one of the 17 outlying centers. The doctor and the patient would be able to see each other via webcam which would supposedly constitute a doctor’s visit. After determining that the patient was a good candidate for a medical abortion, the doctor could push a button in her office in Des Moines which would open a drawer at the center. Inside of the drawer were 2 different medicines—one to kill the baby, taken immediately at the clinic and a second one to take later at home which would cause contractions and eventually expel the dead baby.

As if this was not shocking enough, they went on to say that all staff, medical and non-medical alike would be required to do vaginal ultrasounds. I asked what the qualifications to do this invasive procedure were and was told that “if you are breathing, you can do a vag ultrasound.” My boss went on to say that it helps if you have played a video game because it’s a lot like running a joystick.

Financial issues and budget crises were an ongoing event, so it was hard to believe that there was funding for a major project like this. Apparently a private donor was willing to purchase all the computer equipment, fiber optics and state-of-the-art ultrasound machines for all PPGI clinics.

The meeting droned on. Every concern was met with sheer resolve and cold determination. “Is this even legal?” someone asked. They said “every ‘I’ is dotted and every ‘t’ is crossed” and nothing could stop them. I asked if they would be notifying doctors and hospitals in each community and was told that they definitely would not be sharing any information. Center managers were instructed not to discuss the plan with anyone outside of PPGI. They wanted to establish a standard of care, with a goal of 500 to 1000 abortions completed before any public announcement was made.

Abortions would be done through 63 days from conception. We were all familiar with using the morning after pill, also called Plan B, but this was only used up to five days after unprotected intercourse. The jump to 63 days was huge. Some of the managers were very excited. It meant that patients would no longer have to drive to a surgical center. Abortions would be available in every town where PPGI had a clinic. Neither would anyone have to wait for an abortion. Once fully trained and staffed, medical abortions could potentially be offered any hours a clinic was open. If a woman came in and had a positive pregnancy test, she could instantly be offered an abortion. “Forty five minutes, in and out” we were told. One manager said “It’s about time women can get an abortion whenever and wherever they want. It’s no different than getting a Pap smear.”

There was a timetable for implementing the program in each center. Storm Lake was scheduled to be the last clinic in the agency to do them, with a start date of July 2009. The thought of telemed abortions seemed so preposterous to me that I seriously doubted that it could actually happen. Still, I voiced my concerns to management and peers. I couldn’t imagine myself doing a medical procedure like a vaginal ultrasound. I was concerned about safety—for the patient, for my staff and for myself. How high would the complication rate be? Women were going to take this second pill at home? Alone? Often working with very limited staff at the Storm Lake center, I wondered about security, at the center but also at my home. How would this affect my kids? Having endured the national publicity created by the quest for records after the discovery of a deceased infant in 2002, I was very acquainted with controversy and angry opponents. I’d always been so vocal about the fact that we were all about preventing abortions. Now I was going to be forced to be involved in every aspect of an abortion. What would our local doctors think when women started coming in with symptoms of an incomplete abortion? My boss said they were contemplating just telling patients that if they had to go to the emergency room they should neglect to mention the two powerful drugs they had just taken to end their pregnancy. “After all” he said, “it’s really no different than a miscarriage.”

Soon, the larger centers started doing webcam abortions. Staff was abuzz. The new ultrasound machines were so high-tech that little fingers and toes could be seen. Even some long-time surgical staffers struggled when they would see images of the baby they were about to abort.

This program was, and no doubt continues to be, a mega money maker for Planned Parenthood. Charging the same amount as a surgical abortion, but with very little overhead, the profit margin is great. No longer is a physician required to travel to a clinic to perform an abortion. Inner-agency, it was touted as “The First in the Nation”, with a plan to market the protocol to every Planned Parenthood affiliate in the country.

As a single parent, I was very uneasy to think of losing my job. I had good pay, great benefits and much-needed health insurance for my whole family. But I knew I could never do what they were asking.

By December of 2008, they were ahead of schedule. Storm Lake would soon be doing telemed abortions. I continued to voice my concerns and was fired. Human Resources said they were downsizing but I don’t believe that was the real reason I was terminated. They were soon advertising for a full time position at the Storm Lake center.

Planned Parenthood of Greater Iowa has now consolidated with Planned Parenthood of Nebraska, becoming Planned Parenthood of the Heartland. Telemed abortions will be spreading across the land unless laws are passed. Even many pro-choice folks are troubled by the thought of abortions being done by non-medical staff, in rural clinics with no doctor on site and no medical support in the community. It is imperative that we raise awareness of this new and dangerous way of providing abortions.

thayer@iw.net