No IV Fluids at Louisiana Abortion Clinic, But Business Continues As Usual

In my previous article, I discussed the poor judgment shown by the medical staff at the Planned Parenthood abortion facility in St. Louis when dealing with a patient with placenta accreta in April 2019. In this article I will discuss certain problems at the Delta (abortion) Clinic in Baton Rouge, Louisiana.

A medical emergency occurred at Delta Clinic on March 15, 2019. On that day a woman referred to by State officials as “Patient #1” received an abortion there in her 15th week of pregnancy. Records indicate this was at least her seventh pregnancy. She was known to have previously had 5 cesarean sections and then a miscarriage that resulted in heavy bleeding. These are indicators that should prompt a physician to suspect that she might be at risk for placenta accreta, as multiple c-sections can make women susceptible to the condition.  Previous heavy bleeding can also indicate a uterine scar from the c-sections that holds a propensity for accreta.  An ultrasound can give information about the placenta and whether it is lying over the uterine scar, but there is no indication in the record of whether or not an ultrasound was done.

Right after Patient #1’s abortion began at 12:19 p.m., her blood pressure was 148/90, and her pulse was 92. The abortion was finished at 1:02 p.m., and by that time she had lost about 300 cc of blood. At 1:06 p.m. her blood pressure had fallen to 90/55 and she was semiconscious. The clinic monitored her as her blood pressure fell. At one point, it was down to 78/56. Eventually, EMS (Emergency Medical Services) was called, and they arrived at 2:11 p.m. — over an hour after Patient #1’s abortion had ended and her blood pressure had fallen to 90/55. They immediately assessed her, and at 2:16 p.m. her blood pressure was 88/59 and her pulse was 109. They started an IV and left for the hospital, arriving at 2:54 p.m.

Why did EMS start the IV, and not Delta Clinic? Because Delta Clinic had no IV fluids in the facility. Yes, you read that right: Delta Clinic performed an abortion on Patient #1 with no IV fluids on hand in case of an emergency.

Once Patient #1 was at the hospital, she was quickly evaluated by the ER physician, and an additional 800 cc of blood loss was noted. An OB/GYN resident also examined her, and she was sent for a D&C for suspected retained products of conception, which were found. During the surgery she lost another 400 cc of blood. Because the bleeding still continued, a balloon tamponade was put in to try to stop it.

Abortions Continue, Despite No IV Fluids

Meanwhile, back at Delta Clinic, things were proceeding as “normal.”  In other words, abortions were continuing. However, someone had called the Louisiana Department of Health (DOH). This was almost certainly either someone from the hospital or from EMS because even if there were sidewalk counselors who witnessed the ambulance, they would not have known (1) the seriousness of the patient’s condition and (2) that the clinic had no IV fluids.

By 4:17 p.m., the DOH was talking to the Delta Clinic administrator.  At 4:20 p.m. the Director of Nursing was spoken to.  At 4:30 p.m., DOH discovered that the physician was aborting Patient #3’s baby with Patient #2 scheduled to go next.

What this means is that Delta Clinic was performing abortions on women knowing that there were no IV fluids in the facility. While the staff could potentially make excuses for why they didn’t know that there were no IV fluids when Patient #1 needed them for her emergency, they were in full knowledge that they had no IV fluids for potential emergencies thereafter. This caused the DOH to declare an “Immediate Jeopardy” situation against the clinic, thereby shutting it down until further notice and eventually issuing fines.

Not to be deterred, Delta Clinic sought to remove the Immediate Jeopardy as soon as possible by quickly and thoughtlessly throwing together a Plan of Repair (POR). It’s readily apparent that their concern was for getting business going, not providing a safe environment for their patients.

Plan of Repair #1 was rejected because it stated that Delta Clinic would keep “an adequate amount of IV fluids and necessary IV start kits on hand” without actually stating what amount that was and without consulting with the nursing or medical staff.

Plan of Repair #2 was rejected because, while listing amounts of IV fluids, there was no input from the nursing or medical staff on what would be considered “adequate”.

Plan of Repair #3 was rejected because, while saying that Delta Clinic would provide a balloon tamponade, they had no such balloon on site.

Plan of Repair #4 was rejected because, while saying that Delta Clinic would provide certain emergency medications in the emergency kit, examination of the actual emergency kit revealed that several drugs were missing or expired. The following day the medical director was asked about the drugs and balloon presented by the Administrator in POR’s #3 and #4. The medical director stated that he would not use a balloon, nor was he going to use the drugs that were listed in the emergency drug list. He also said that it was the responsibility of the administrative staff to maintain the emergency supplies, not his.

Eventually Delta Clinic came up with a Plan of Repair that the DOH accepted. It was rather long and complete, but in my opinion it did not deal well with the issue of suspected placenta accreta. The only allowance the clinic made for suspected accreta was to start an IV before the abortion, rather than waiting to see if the patient hemorrhages. As stated by the Missouri Department of Health in the case of the Planned Parenthood abortion clinic in St. Louis in the case of placenta accreta:

If a surgical abortion is to be performed, given the high risks of such a procedure. an ACOG [American College of Obstetricians and Gynecologists] Committee Opinion states that a second-trimester abortion on such a patient should be performed at a facility with blood products and the capacity for interventional radiology and/or hysterectomy[.]

This raises more questions about Delta Clinic: Why was this abortion performed there rather than in a hospital?  Why does the Louisiana Department of Health allow this to happen?

Could it be that the physicians have no privileges at a local hospital, as June Medical Services v. Gee (a case involving another Louisiana abortion clinic that will be heard by the Supreme Court next month) argues over? If a physician has no privileges at a local hospital, the only option for him doing an abortion is at the clinic or referring her to a physician who does have hospital privileges.  If he has privileges, he could at least consider the safety of his patient and choose to perform an abortion at a facility where blood, surgery, and interventional radiology are available.

What Happened with Patient #1?

After being admitted to the hospital in “guarded condition” — a rather vague term — she had the D&C and balloon placement.  According to the DOH inspection, she had a hysterectomy on March 16, 2019 (the day after her abortion), losing another 500 cc of blood (making a total of 2000 cc recorded loss).  She received four (4) units of blood as of March 17, 2019, but her condition after that time is not recorded in the inspection.

To reiterate: Placenta accreta is a serious complication of pregnancy. When suspected, the woman is best treated in a facility with surgery, blood, and interventional radiology available whether she is aborting or delivering.  Allowing abortion in outpatient settings for these patients is dangerous, and allowing them at Delta Clinic could have been deadly.

When “pro-choice” advocates argue against requiring hospital admitting privileges for abortionists, they show that their primary concern is protecting the abortion industry, not women’s health.

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