Clinics Closed~ Rarely Inspected

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Clinics Closed~ Rarely Inspected
Mon, 08-20-2007 - 10:39am

Inspections of N.J. licensed abortion clinics are rare

By MICHAEL CLARK Staff Writer, (609) 272-7204
Published: Sunday, August 19, 2007
Health officials inspected only one of the state's six licensed abortion clinics in the past two years - despite a requirement that they be investigated every other year - before complaints eventually brought inspectors to two of the clinics, a Press investigation has revealed. Those two clinics were then closed immediately due to health violations that posed "immediate and serious risk of harm to patients."
The investigations of the Alternatives clinic in Atlantic City and Metropolitan Medical Associates in Englewood, Bergen County, marked the first time those clinics had been inspected in six and five years, respectively.

The abrupt closing of the Atlantic City clinic at the end of June exposed locally the potential dangers women face at such unmonitored facilities. But a statewide records request by The Press of Atlantic City shows the problem extends throughout the state. Inspections are sporadic at best and, when they do occur, discovering serious violations is common.

Inspections remain overdue for the three other abortion centers - by as much as seven years in the case of the Planned Parenthood clinic in Shrewsbury, Monmouth County. The last inspection reports for all six clinics recorded violations.

The state Health Department could not confirm that only these clinics provide abortions because it does not keep a tally of all abortion providers in the state. They are broadly categorized as ambulatory-care facilities.

Health inspectors' absence at the clinics is part of a statewide issue that reaches beyond abortion clinics - only 17 percent of all licensed ambulatory-care facilities are inspected every two years, according to department spokesman Tom Slater.
Slater attributed the lack of oversight to the drastic increase in New Jersey-licensed health facilities since 2000 and the minimal increase in new health inspectors. According to Slater, the number of ambulatory-care facilities in New Jersey has nearly doubled since 2000, rising from 594 to 1,003. In that time, only 23 more inspectors have been hired, giving the department a total of 171.

"There has been a nationwide attrition in the health work force," Slater said. "The Baby Boomers are retiring. Those are the type of people that took public jobs. And we are competing with the private sector."

Slater emphasized that even if routine inspections are overdue, any complaints received by the department are promptly investigated.

"These facilities are staffed by licensed professionals and part of their licensure requirements is that they uphold the highest of standards," he said. "We have confidence that they will continue to do that and notify us if there is a problem."

Health Commissioner Fred M. Jacobs is on vacation and was not available for an interview, Slater said.

Although Slater does not believe the lack of inspections contributes to the potential harm of patients, Sen. Joe Vitale, D-Middlesex, disagrees.

"It certainly can contribute," said Vitale, who has been chairman of New Jersey's Senate Health Committee for four years. "If you talk about infections, which are certainly common in hospital settings, if these places are unclean and are going uninspected, patients could be at risk."

The senator compared the state's obligation to inspect the clinics with motor-vehicle inspections.

"While I'm sure that (drivers) care that their car is safe, they're not going to know about every problem the car may have, which is why we have state inspections," he said. "I have confidence in the physicians, but they may not be aware of every issue. The state has an obligation to step in and ensure that these facilities are safe."

But state-licensed clinics are not the only possible destination for women seeking abortions. There are more than 20 private clinics within the state, which can perform abortions as much as 14 weeks into a pregnancy. Although those clinics can be inspected by the state's Division of Consumer Affairs, which represents the Board of Medical Examiners, the division has no standards to routinely inspect the private clinics.

Unlike the state Health Department, Consumer Affairs refuses to release inspection reports of any private clinic under its jurisdiction, nor will it comment on when it last inspected any facility, according to Jeff Lamm, spokesman for the division. He also refused to discuss general inspection practices.

Contrary to the division's confidentiality policy, the techniques implemented by inspectors with the Health Department are on display in their public reports, and are clearly thorough. The violations outlined in the six most recent abortion clinic reports are equally extensive.

Although Pilgrim Medical Center in Montclair was the only abortion clinic whose routine inspections were up to date, several state violations were found in 2005. These included providing unspecified medical services without a license and lacking an oxygen supply to patients in one operating room.

Patients' dried blood and blood residue were common discoveries in some of the state's licensed abortion clinics, including the Montclair clinic, where investigators revealed that the base of the clinic's operating tables were "soiled and caked with dried blood" and the floors below the tables were "soiled and stained with blood residue."

Inspectors found dried blood under the leg pads on procedure tables at Atlantic City's Alternatives in June and forceps encrusted in "brownish blood-like residues" at Metropolitan Medical Associates in February.

"Abortions aren't really surgery, they aren't sterile procedures," an Alternatives employee told inspectors after being questioned about infection control.

A badly hemorrhaging Metropolitan patient wound up undergoing surgery at a Newark hospital, which alerted officials to problems at that clinic. After its closing, Metropolitan failed one follow-up inspection before being reopened in March.

Alternatives remains shut nearly two months after its June 22 closing, because it has yet to submit a corrective action plan, according to the state Health Department.

While Metropolitan and Alternatives were closed upon their respective inspections, Pilgrim Medical Center remained open, according to Slater.

The clinic that went the longest without state inspection was Planned Parenthood of Central Jersey in Shrewsbury, whose most recent inspection was conducted Jan. 4, 2000. According to the report, the clinic's license had expired five days prior to the inspection, but president and CEO Phyllis Kinsler, who has been at the clinic for more than 20 years, said the clinic's license has never elapsed.

"Our license was being renewed, that's why there was an inspection, it was a routine renewal inspection," said Kinsler, who briefly disputed the inspection date, saying that the last examination "seems more recent than that."

Before the state's 2000 visit, officials hadn't been to the Shrewsbury clinic since 1996, violating the department's standard well before the dramatic increase in ambulatory-care facilities that Slater mentioned.

"I can't say that not following up on routine inspections is the worst thing they could be doing," Kinsler said. "Would we all like more resources in health care? Of course. It doesn't mean they're not doing their job."

But abortion opponents claim there's motivation behind the state's lack of oversight.

"I think it's been a long-standing position of the state that abortion is the great untouchable of law and politics," said Marie Tasy, executive director of the anti-abortion group New Jersey Right to Life.

Republican Representatives Chris Smith and Scott Garrett reiterated Tasy's comments in their letter to Health Commissioner Jacobs shortly after Metropolitan Medical Associates was shut down.

"It is our greatest concern that in the state's haste to appear supportive of abortion rights, it is failing to safeguard the health and safety of the vulnerable young women who seek abortions in New Jersey," the letter reads.

Jay Jimenez, the Health Department's chief of staff, responded to the letter a day before Alternatives was shuttered, again claiming that limited resources prevent the likelihood of routine inspections and assuring them that the department "is taking steps to hire and train an increased number of surveyors."

Slater discounted the representatives' suggestion, referencing the Alternatives investigation as a prime example of the state's thorough inspections.

"The complaint that we received did not close the facility down," he said. "When we got there inspectors saw other violations. I think that speaks volumes that, no matter what complaint we receive, if we see things that are deficient we will take proper action."

While the Health Department works to ensure that any complaint regarding a facility is adequately checked, Slater said officials are starting to cross-train the current staff to allow more of them to do inspections.

Vitale says he hopes to work with the department to re-evaluate resources and see if there is a more efficient way to operate while meeting standards.

Meanwhile, New Jersey's Public Advocate Ronald Chen, who has the authority to sue government agencies, has begun researching Health Department records to gather more information on the lack of timely inspections.

"We have requested information from the Department of Health," said advocate spokeswoman Nancy Parello. "We are still in the fact-finding stage."

Tasy, who filed a request with Chen's office in July, claimed the agency has said it is checking to see whether the health-inspection problems extend beyond abortion clinics