Two stories converged last week highlighting the touchy issue of abortion from different angles. Together, they say a lot about how this nation treats women in need of reproductive health care, especially when their access is limited by education, money and geography.
The story you know about involved a grisly "house of horrors" in West Philadelphia, where a doctor and his untrained staff allegedly performed illegal, dangerous procedures on poor, minority and immigrant women, killing at least one patient and many viable infants.
The story you may have missed is less sensational but still notable. It was a report on religiously affiliated hospitals that, because of their anti-abortion policies, deny the most effective emergency treatment for women having miscarriages and ectopic pregnancies.
I am not implying that the cases are equivalent. But they do have something in common: Women seeking treatment being denied the standard medical practices while regulators turn a blind eye.
The Philadelphia story is like an acid flashback to the days of back alley abortions, with untrained hacks in dirty rooms preying on desperate women. The grand jury's description of goings-on at the so-called Women's Medical Society clinic are so grotesque as to defy belief.
According to the report, clinic owner Dr. Kermit Gosnell, 69, was not an ob-gyn; his wife, who worked with him, and eight employees had no medical credentials at all. They were all arrested Wednesday.
Third trimester abortions are illegal in Pennsylvania. Yet the report said Dr. Gosnell often forced labor in the third trimester, delivered viable infants and cut their spinal cords with scissors. He is charged with killing seven newborns as well as a woman who received a fatal drug overdose.
Just as unbelievable is that the place operated for 32 years with almost no oversight. Repeated complaints and 42 lawsuits were ignored by health officials and regulators in both Republican and Democratic administrations. When the clinic was raided in February, it was because of narcotics. Apparently, it's OK to criminally exploit poor women, but dispense drugs illegally and you're in trouble.
Those who believe human life begins at conception will say that what happened in this clinic isn't that different from what happens in abortion clinics every day. They will be wrong.
In the 38 years since Roe v. Wade, women in this country have obtained 50 million safe and legal abortions from qualified professionals in reputable facilities. That's 50 million cases where women did not bleed to death leaving their children motherless, or contract infection or disease from dirty equipment.
According to the National Abortion Federation, more than half of all abortions in this country are done in the first eight weeks; 88 percent in the first trimester; under 2 percent past 21 weeks. Third trimester abortions -- from 28 weeks on -- are allowed only in dire circumstances, and even then, Pennsylvania requires a second doctor to be present to treat a viable newborn.
Like it or not, women have always sought abortions and always will. If those in Philadelphia had access to reputable clinics, none of those horrors would have occurred.
Claire Keyes, director of the Allegheny Reproductive Health Center in East Liberty for 30 years until her retirement two years ago, said the story left her with "a crushing sadness."
The clinic, she said, "was exploiting the poorest and least capable women. Unfortunately, such inequity in access is getting worse all the time.
"This isn't about abortion," she went on. "It's about one sick individual not doing his job and the monitors not doing theirs. We need all parts of government and service delivery being accountable."
Which brings us to the second story, the one about hospitals operating under religious directives and denying women the standard emergency care for miscarriage and ectopic pregnancies. Sometimes patients are not even told they can get that care elsewhere.
"Below the Radar," a new study from the National Women's Law Center, documents the effect of religion-based practices through interviews with 25 physicians and administrators at 16 Catholic hospitals in 10 states.
For example, standard care for certain ectopic pregnancies requires administering methotrexate. But doctors said the drug was banned at their hospitals because it is used in early medical abortions. So patients were sent to other hospitals or subjected to surgery that could have been avoided.
One doctor reported potentially fatal tubal ruptures because of unnecessary delays, even when serious symptoms were evident.
In cases of miscarriage, Catholic hospitals delayed treatment while performing tests that were not medically required. Even when nothing could save the fetus, doctors had to wait for the fetal heartbeat to stop before treating the woman. This raised the risk of hemorrhage and infection.
Dr. Robert B. Holder, an ob-gyn at a Catholic hospital in Arizona, described a woman who came to the emergency room after miscarrying one twin. Together, they decided on a uterine evacuation to complete the miscarriage. But the hospital declared that decision "unethical." He had to send her to a secular hospital 80 miles away.
"She didn't receive the treatment she was entitled to in her local community hospital," the doctor said.
The 30-page report has other such stories. Repeatedly, women assumed they would be offered the best treatment for their diagnosis, only to find that religion, not medicine, was running the show.
The law center has filed a complaint with the Department of Health and Human Services, urging an investigation of these practices and enforcement of laws that protect a patient's health.
Both these stories are examples of reproductive health care policies and procedures gone wrong. Only when women's well-being is the top consideration will they get the medical treatment they need and deserve.
Sally Kalson is a staff writer and columnist for the Post-Gazette ( firstname.lastname@example.org , 412 263-1610).