Clinics Avoided : Abortion: Few Doctors at the Front

For three months, Lynne Randall has been searching for a full-time staff physician for the Atlanta abortion clinic she runs.

Randall tried to advertise, she said, but only one OB-GYN publication would accept any notice with the word abortion in it. Medical recruiters turned her down cold.

She has also contacted at least 20 doctors. Some said they could earn far more money and prestige in private practice. Others felt that the future of abortion is too uncertain in a conservative state such as Georgia. And there is always the fear of harassment: Randall’s Feminist Women’s Health Center has been a target of pickets, vandals and bombing threats.

Although surveys show that obstetricians and gynecologists overwhelmingly favor the right to abortion in a general sense, when it comes to the real world, most prefer to have nothing to do with the procedure.

Slander as Tactic

“That’s been one of the major victories, if you please, that we have had in the United States,” said Dr. John Willkie, president of the National Right to Life Committee, the largest anti-abortion group. “Here we consciously use the word abortionist . It is a stigmatizing, a derogatory term.”

It used to be easy to find young doctors willing to moonlight in abortion clinics for extra money and experience. Now, “there seem to be fewer and fewer people who want to do it, not from the ethical point of view, but (from the standpoint of) ‘I don’t want to get involved in that tumult,’ ” said Dr. Alan Altman, who is involved in OB-GYN training at Brigham and Women’s Hospital in Boston.

Dr. David Grimes, now of the USC medical school, recalled a similar experience he had trying to recruit a young gynecologist to work part time in an abortion clinic several years ago in Atlanta. “I can make more money in my office seeing vaginitis patients at no risk at all to me,” the doctor told Grimes.

Even in Los Angeles, where the political climate is relatively favorable, “we have trouble getting physicians to work in our clinics,” said Dr. Joan Babbott, president of the local Planned Parenthood Federation.

In communities where sentiment against abortion is strongest, clinics often must fly in doctors from elsewhere. Dr. Amy Cousins of Manhattan, for example, travels almost 200 miles to perform abortions two days a week at Southern Tier Women’s Center in Binghamton, N.Y., where the radical anti-abortion group Operation Rescue has its headquarters.

Operation Rescue has recruited tens of thousands of protesters to physically block and sometimes invade clinics throughout the country, including in Los Angeles. Harassment, however, was a part of daily life for doctors who performed abortions well before Operation Rescue’s demonstrations became widespread last year.

The Alan Guttmacher Institute, a nonprofit research group, reported in 1985 that almost half of all abortion providers reported having been targets of picketing, bombing threats, floods of calls jamming their telephone lines and the like.

Sometimes the tactics are even rougher. Dr. Curtis Boyd recalled being horrified when one demonstrator outside his Dallas clinic began asking about his children by name. “How’s Kyle?” the man wanted to know. “Has he had any accidents lately?”

When a handwritten death threat was left in the mailbox at his home, Boyd took it seriously enough to move his family out of town for a while. Shortly after midnight last Christmas, someone went beyond threats: Boyd’s clinic was set on fire, causing $100,000 in damage. It was one of three Dallas clinics burned that night.

Although Boyd is determined to keep his clinics in Texas and New Mexico operating, he admitted that “If you aren’t really committed to the work, with that kind of harassment you tend to stop doing it.”

Shrinking Availability

Apparently, many others have quit.

The number of abortion providers nationwide dropped by almost 10% between 1982 and 1985, the Guttmacher Institute reported. About 82% of the counties in the United States had no abortion facility in 1985; three years earlier the figure had been 78%.

In some states, women must travel hundreds of miles to abortion services.

Although they lack more recent data, activists on both sides of the issue say they believe these trends have continued, even accelerated.

For some doctors, the decision not to perform abortions is a moral one.

“I just feel that fetal life is human life,” Dr. William Gallivan of Orange, Calif., said.

When abortion was legalized nationwide in 1973, Gallivan said, he thought it would be used only in rare and dire circumstances such as rape, incest and pregnancy that endangered a woman’s life.

But now, as many as one out of three pregnancies ends in abortion. “It’s just too convenient,” Gallivan said. “Patients have two, three or five abortions. It just doesn’t mean anything any more.”

Minority Viewpoint

In his profession, Gallivan’s opposition to abortion puts him in a minority. The American College of Obstetricians and Gynecologists found in a 1985 survey that 75% of its members believed abortion should be a matter of a woman’s personal decision.

Of those who supported choice, however, only a third said that they performed abortions. Fewer than 2% of all OB-GYNs perform more than 25 abortions a month, the group’s survey found.

As a result, the vast majority of abortions now take place in large clinics, rather than in the hospitals or private doctors’ offices that handled them in the first years after abortion prohibitions were lifted.

Most physicians give practical reasons for referring abortion patients to clinics: It is far less expensive for the women--one-quarter the cost they might pay in a hospital--and they stand to get better treatment from specialists in the procedure.

Other physicians also noted that performing abortions increases an already formidable risk of being sued.

Troubled by Attitude

Many also acknowledged what Dr. Andrew B. Dott, a New Orleans OB-GYN, described as a desire to “keep their hands clean.”

Dott, who said he performs a “very minimal” number of abortions in his practice, said he is troubled by his profession’s attitude toward abortion.

“Obstetricians who run abortion clinics have been looked at askance from the rest of the obstetrics profession. It’s like, ‘What’s the matter? Can’t you make a living practicing other types of medicine?’ ” Dott said.

More and more doctors, however, may have to weigh the consequences of refusing to perform abortions. “The Supreme Court decision is going to make a lot of people uncomfortable,” Dott said.

What the Supreme Court did last month was signal that it is willing to allow the states more leeway to restrict abortion.

Abortion is virtually certain to remain legal in some states, but could be severely restricted in others. For young and poor women unable to travel to another state, such laws could present an almost insurmountable obstacle.

A Toll in Lives

“Doctors are going to start to see their patients with self-induced abortions, and they’ll see a couple of their patients die. I don’t think most physicians can live with that,” said Barbara Radford, executive director of the National Abortion Federation, an association that includes 300 clinics and doctors.

Dr. Martha Brewer does not make abortion a part of her New Orleans practice because, she said, “it’s not convenient (and) it’s not politically very popular to do them in the office.”

Louisiana is considered one of the states most likely to outlaw abortion, and “that’s where a lot of us are going to get into a real moral quandary,” Brewer said.

Performing an illegal abortion could mean fines, jail and loss of her medical license, she said. “What weighs on the other side is women dying.”

One implication of the U.S. Supreme Court’s decision last month could be a drastic cutback of abortion training for doctors. The court upheld a Missouri law that, among other things, bans use of state hospital facilities for abortions.

Training Less Available

Public hospitals are where OB-GYN residents are most likely to be taught how to perform an abortion. Already, the number of residency programs offering mandatory or optional abortion training has dropped sharply, the Guttmacher Institute found.

If lawmakers in other states follow through on pledges to enact legislation identical to the Missouri law, they could take many public hospitals out of abortion services and thus significantly reduce the number of places where a young doctor can learn the skills.

Even more alarming to abortion rights advocates is an Illinois case, Turnock vs. Ragsdale, that the court is to hear this fall. At issue is a law that would require abortion clinics to be equipped as hospitals.

Illinois officials say the law will assure those seeking abortions of top-quality care, but pro-choice groups say it is a thinly disguised effort to drive clinics out of business or make their services prohibitively expensive.

“You’ll have no access to abortion services in this country if they uphold Ragsdale,” Radford said.

Doctors who have been practicing 20 years or more can recall the toll that illegal abortions took before the Supreme Court established, in its Roe vs. Wade decision, a woman’s right to have the procedure.

“Every day that I was a resident, I remember somebody either dying as the result of an (illegal) abortion, or so critically ill that we were concerned about whether the patient was going to survive,” said Dr. Ezra Davidson, chairman of the department of obstetrics and gynecology at King-Drew Medical Center in Los Angeles and president-elect of the American College of Obstetricians and Gynecologists.

Davidson insisted that outlawing abortion will not dissuade most of the desperate women who seek it.

Difficult to Stop

“It is very difficult to impose some outside set of regulations or laws that will govern (childbearing decisions). We know that women are going to have abortions. It is unbelievable, the extent to which they are willing to take risks to do it,” Davidson added.

But for now, as long as abortion is available elsewhere, many physicians say they cannot afford to jeopardize their practices by performing abortions themselves.

That was what one Southern doctor, who spoke on condition of anonymity, reluctantly decided several weeks ago.

Although he is staunchly pro-choice, the 43-year-old obstetrician had always felt emotional and moral tugs on the question of abortion.

“How can anybody in medicine not have mixed feelings?” he said. “I have to destroy a certain amount of life to help a patient who feels that her life has been destroyed.”

Called ‘Abortionist’

For more than a decade, he would perform an abortion only when a regular patient pleaded that she would be uncomfortable going to a clinic. In some years he might do six abortions; in other years, none at all.

Nonetheless, he said, word got around that he was “an ugly abortionist . . . (despite the fact that) I also deliver 80 or 90 babies a year.”

Most of his nurses refused to assist in abortions, and the doctors who were powerful at his hospital “were downright hostile, and they can destroy you,” he said.

When a patient suffered a serious complication--a perforated intestine--from an abortion he performed several weeks ago, the doctor decided he could do no more.

“I have a wife to feed, a child,” he said. “I have to make a livelihood.”

SIXTY-EIGHT ARRESTED

Sixty-eight anti-abortion protesters were arrested in South San Gabriel. Metro, Page 1