This facility’s license expired on May 31. They have been granted permission to continue to provide abortions without a license by Judge Michael Stelzer.

Update: The state health department released the statement of deficiencies and requested a plan of correction by June 18, 2019. The following is a summary of the violations on the inspection report, which is uploaded below as a pdf:

  • Three patients remained pregnant after surgical or medical abortions and required follow-up surgical abortions
  • A fourth patient was hospitalized with life-threatening complications following an abortion at 21 weeks of pregnancy.
  • Medical residents (students) performing some of these abortions were not properly supervised.
  • It took three abortion attempts by a resident, a fellow and a physician to successfully abort one pregnancy.
  • The facility failed to report these complications to the state.
  • Surgical abortion was performed at 10 weeks.  The patient contacted Planned Parenthood approximately three weeks later. reporting the continuing pregnancy.
    • The record indicates Patient #2 contacted Planned Parenthood on June 14, 2018, at 1:05 p.m., and spoke to staff. The record documents the patient contact as follows, “PT called stating “I don’t believe the AB worked, my stomach is still getting bigger, I’m still throwing up! I just don’t think he got it all.”
    • The facility did not schedule a second attempt at abortion for over two weeks, during which time the pregnancy progressed from the first trimester to the second trimester.
    • Facility performed the second abortion attempt without providing any additional informed consent. even though the five weeks’ delay resulted in material changes, both in the degree of risk to the patient and in fetal development.
    • Because this physician travels to St. Louis from out of town, the delay in scheduling the second attempt appears to have been driven by the physician’s convenience. rather than the patient’s best interest.
    • This patient ended up in the hospital with sepsis two days after her procedure.
  • The inspector interview the facility medical director to inquire why there was no follow up with this patient when she called to report a continuing pregnancy. When asked how soon the facility should respond to a patient who reports symptoms of continuing pregnancy, he stated he would expect that the facility would accommodate the patient, “As soon as we can.” When asked if 15 days was too long a time period, he stated, “Patients have complicated lives …I do not know why a patient would not come back for 15 days.”
  • A “therapeutic” abortion was performed on a high-risk patient who was 21 weeks and 5 days pregnant resulting in hemorrhage.
    • The abortion attempt failed.
    • She was transported to the hospital where she was said to be “critically ill” and had emergency surgery.
    • The ACOG recommendation for a patient with her prenatal diagnosis is that the abortion is performed in a facility with blood products and the capacity for interventional radiology and/or hysterectomy. This facility has none of those.
    • This complication was life-threatening and most likely preventable.
  • The referral laboratory was found to be out of compliance. Though this facility has documented failed abortion attempts, the physicians report never having contact with the pathologist to report incomplete abortions. When products of conception are sent to the lab and analyzed, if all of the parts are not present, policy states they are to contact the facility within 24 hours. One physician stated she has never had any communication with a pathologist on any abortion she has performed.
  • The physician obtaining informed consent was not the same physician who performed the abortion.
  • Five of the seven physicians who provided care in the medical records reviewed refused to be interviewed to assist in the investigation.
  • When interviewed, the physician was asked if the failed abortions on the patient who had three attempts were considered to be a complication. She stated, “No, because then we had a plan for medication abortion. We still had a plan to complete the procedure for her.” When asked if she knew if a complication report was filed regarding the surgical abortion, she stated, “I don’t know, but I don’t consider that to be a complication, so I wouldn’t necessarily expect one to be”.
  • Medical Director was interviewed. When asked if it was his expectation that a complication report is completed for an abandoned surgical abortion, he clarified, “So the decision to change the route of the termination from surgical to medication abortion? No. My understanding of when a post-abortion complication report is required is after the abortion is completed.” He confirmed knowledge of the statutory requirement to complete and file an abortion complication report for every complication. He further stated, “We follow that requirement.”
  • The facility did not maintain accurate medical records.
    • Supervising physicians were documenting in records that they were present for the procedure and agree with the treatment plan and follow up before the procedures were even performed. This documentation should be completed post-procedure.
    • Other patient notes were being entered weeks and sometimes months after their encounter.

Previous Health Violations:

  • Expired meds, IV fluids, and supplies.  Some as old as 6 years (repeated violation)
  • Staff using single dose injectable medications for more than one patient to “save money” (repeated violation)
  • The bin with emergency supplies in it “covered in dust” confirming that the supplies had not been checked in quite some time
  • The staff did not log their abortions over 18 weeks gestation as required by law.
  • Fire extinguishers were not tested
  • No background checks on employees
  • Patient’s not given their Patient Bill of Rights as required by law
  • Medications not stored properly (repeated violation)
  • Staff did not wear personal protective equipment to ensure protection from bloodborne pathogens as they cleaned surgical instruments. The likelihood of splashes and splatters is great.
  • Tears in the exam tables; these tables could not be cleaned to ensure that women were not exposed to infections
  • There was dust covering equipment and supplies all over this clinic
  • The refrigerator had not been cleaned in over 1 1/2 years according to a staff member (health care assistant) who had been working in the clinic for that period of time. He had no idea who was responsible for that.
  • The clinic did not send fetal tissue for pathology evaluation as required by Missouri law
  • Failed to properly sterilize instruments that are used from woman to woman
  • Medication refrigerator temperature was recorded as “out of range” with no intervention or resolution for several days. Anything stored in this refrigerator was compromised.
  • Staff used heating pads on patients in recovery that were clearly marked “for household use only”
  • No infection control training on staff
  • No orientation on staff
  • Failed to maintain an accurate record:
    • Medication orders were not timed, dated or signed by the doctor
    • Lactate Ringers were not recorded as ordered
    • Medications documented as administered by nurses had no dosage and were not timed, dated or signed by a nurse
    • Oral sedation was given, but the name of the medication and who administered it was not recorded
    • One woman was recorded as receiving medication to increase uterine contractions nearly five hours after she had been discharged from the center.
  • Patient’s vitals were not recorded every 15 minutes before patients were discharged

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DISCLAIMER: All of the inspection reports on this site were acquired through public records request to state departments of health and public records online.