NOTE: This article is the first of a two-part series on two Ohio abortion facilities. This article will focus on the closing of the Capital Care facility in Cuyahoga Falls. A subsequent article will focus on the pending closure of the Center for Choice in Toledo.
A close look at state records sheds light on why, specifically, authorities had to step in and take decisive action—and reveals that most previous news reports haven’t told the whole story.
Inspectors from the Ohio Department of Health visited the Cuyahoga Falls Capital Care abortion facility on February 14 and found a host of violations detailed in a 36-page inspection report [PDF]. The most serious of these violations were drug-related, which is why the DEA got involved—just as it did in the case of notorious abortionist Kermit Gosnell’s Women’s Medical Society.
The most striking findings from the inspection are explained below.
Stealing Women’s Blood
To provide accurate lab test results, a clinic’s reagents need to be tested each day with both Rh+ and Rh- blood.
Rh- blood is relatively rare, with less than 15% of the population in the U.S. being Rh-. Instead of buying known Rh- blood, Capital Care was drawing up blood from their repeat customers who were Rh- and keeping the blood for the next two weeks in the refrigerator to use each day.
A typical patient would have a finger stick to perform the test. These “repeat” patients had an entire tube taken.
A staff member told inspectors that “many of the facility’s patients underwent frequent surgical procedures at the facility.” There is so much wrong here, one scarcely knows where to begin.
One thing is certain: Capital Care was counting on these Rh- women to show up repeatedly to supply them with blood.
However, there was no doctor’s order for any of these women to have a tube to be drawn instead of just a finger stick, “nor was there documentation the patient was made aware of the blood sample’s intended use.”
In other words: Capital Care was stealing women’s blood.
Worthless Medical Records
Inspectors reviewed 19 patient medical records. Six of these were worthless.
One record (for “Patient #6”) deserves to be quoted in full:
Patient #6 was admitted to the facility on 12/05/12. Review of the surgical procedure documentation revealed there was no documented evidence the identification of the patient was checked, a physical exam was completed, or that a beginning or ending time for the procedure had been recorded. Review of the checklist before anesthesia revealed no vital signs were checked before or after IV sedation.
Records for five other patients were nearly as bad:
Patients #33, #36, #37, #39 and #43 were admitted between 10/29/12 and 02/14/13. The medical records were noted to be either illegible and undecipherable in regards to the surgical procedures performed by the physicians. The physicians’ post operative orders were illegible and surgical procedures lacked beginning and ending times.
At the risk of stating the blindingly obvious, keeping accurate medical records is critically important. If they cannot be read, they are worthless. If they’re empty, they’re worthless.
Inaccurate Staffing Records
Medical facilties in Ohio are required by law to have staffing schedules, on-call schedules, and payroll records available for review for the previous two years. Inspectors reviewed the past 12 months of Capital Care’s records, and three months were missing in their entirety.
The schedules the facility did have listed the physician on duty for the day, but not nursing personnel. Payroll records were worthless, too. They indicated that a particular nurse may have worked on a Tuesday in January, but do not specify which Tuesday.
Because of the lack of accurate schedules, inspectors could not easily determine if the facility had adequate staffing. There were also demonstrable errors on the schedules (e.g., surgeries performed on days when it did not indicate surgeries were to be performed).
Inadequate Nurse Staffing
Abortion facilities in Ohio are required to have at least two nurses on duty at all times, at least one of which must be a registered nurse (RN). They are also required to have a nurse with advanced cardiac life support (ACLS) certification in the recovery room at all times.
Capital Care had an LPN (a licensed practical nurse; LPNs have significantly less training than RNs), saving their RN for the operating room to administer IV drugs.
This presents an extremely dangerous situation for any post-anesthesia patient who may have trouble in the recovery room.
In short, Capital Care did not have enough nurses to be safe.
The Biggest Problem: Drugs
A Capital Care medical assistant (identified to in the inspection records as “Staff D”) was administering controlled substances. She was also signing the Controlled Substance Count Sheets and stated that she only gave medications when the physician directed her to do so.
But the law doesn’t allow that. A physician may not delegate to an unlicensed person the administration of a controlled substance.
What’s more, controlled substances are federally regulated and need to be counted by two people. The clinic’s own practice was that the count would be done by the RN and witnessed by the managing physician. But inspectors found that for one medication schedule, counts were missing a witnessing signature seven times. Another medication schedule was missing a witnessing signature ten times.
As if these problems weren’t big enough, Capital Care was operating without an Ohio State Board of Pharmacy license. Their old license had expired on December 31, 2012. State law also doesn’t allow a medical facility to provide surgical procedures with medication administration without a valid pharmacy license.
Additionally, Capital Care was operating without a valid Drug Enforcement Administration (DEA) Controlled Substance Certificate. Their old certificate had expired a full year earlier, on December 31, 2011.
When inspectors reviewed the Capital Care’s controlled substance log, it indicated that all of the facility’s Fentanyl (a painkiller) was used up. According to the log, there was none in the entire facility.
But inspectors found a portable box on top of a file cabinet in the administration office. It was double-locked, but could have been picked up and taken away, as it was not secured to anything.
A week later, on February 21, DEA staff arrived at the facility to “conduct a review of the pending application.” (Presumably, the clinic’s administration had since contacted the DEA about getting their Controlled Substance Certificate up to date.) The double-locked box kept on the on the file cabinet was opened and revealed the presence of six syringes containing Fentanyl.
After an interview of Staff C, Staff D [ed. note: Staff D was the medical assistant who had been illicitly giving out narcotics], and Staff J and observation of the stored controlled substances, the controlled substances were removed from the facility by DEA staff.
This is what closed Capital Care.
Note that DEA didn’t remove just the Fentanyl. They removed “the controlled substances.” All of them.
This is what happens when the DEA pays you a visit and finds you’ve lied on your drug records.
It’s impossible to operate an abortion clinic without pain medications. Without a license from the DEA and without a license from the state pharmacy board, and with proof that the facility has falsified drug records and allowed a non-licensed staff member to administer narcotics, the jig is up.
Many people forget that it was an investigation brought by the DEA that led to Kermit Gosnell’s downfall.
Now, with the closing of Capital Care, the DEA has brought down another abortion clinic that was anything but “safe and legal.”