An increased scrutiny of Illinois abortion clinics in the wake of revelations about a "house of horrors" in Philadelphia revealed that some facilities had gone up to 15 years without inspections, and two now have closed after regulators found health and safety violations.
The renewed oversight by state regulators led to the permanent closure of a clinic in Rockford earlier this month, following the closing of a clinic in suburban Chicago last October, according to documents obtained by The Associated Press through a Freedom of Information Act request.
One of those facilities _ the Women's Aid Clinic in Lincolnwood _ closed when the owner decided to surrender its license rather than pay a $36,000 fine or endure an expensive legal fight with the state. The fine was for violations including the clinic's failure to perform CPR on a patient who died after a procedure. Its owner told the AP her clinic was safe and she felt victimized by the surprise inspection after 15 years.
While Illinois is working on the backlog of neglected inspections, the documents reviewed by the AP show that a few abortion clinics in the state still haven't been checked in more than a decade. One in Chicago hasn't been inspected in 16 years. Another in the suburb of Wood Dale was last inspected nearly 15 years ago.
State officials attribute the lag to a lack of funds and resources, noting that the state's 24 trained health inspectors are responsible for inspecting nearly 2,000 facilities.
Anti-abortion activist Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, said Illinois is "one of the most pro-abortion states in the nation" and he believes it gave the clinics "a pass." The state has shown "a systematic unwillingness to step away from the ideology and look at these facilities objectively," he said, calling for more stringent inspections.
State regulators say ideology isn't involved.
The closure of the two clinics has invigorated the efforts of anti-abortion groups to shut down others throughout the state. Abortion-rights advocates are worried the state's heightened surveillance will restrict access to abortion for Illinois women. The closed Rockford clinic was Winnebago County's only abortion provider, making the closest ones now in Madison, Wis., or the Chicago suburbs.
Other states _ Kansas, Virginia, Pennsylvania and Utah _ are tightening regulations for abortion clinics following the 2010 raid on a Philadelphia abortion provider that regulators had ignored for years.
Authorities there described a filthy "house of horrors" where late-term abortions were routinely performed by untrained staff, and viable newborns died by having their spinal cords cut with scissors. Dr. Kermit Gosnell, 70, is awaiting trial on charges he killed seven newborns and one patient. He has denied the allegations. His wife and six clinic employees have pleaded guilty to lesser roles in the clinic operation.
Those reports also spurred the Illinois Department of Public Health into action, said Karen Senger, who supervises licensing and regulation of health care facilities in the state. The documents show the state began quietly increasing the inspections of its clinics last year.
"It was a departmental decision," Senger said, adding the Philadelphia case "gave us a focus" and motivation to find out "when was the last time we were in these facilities?"
Not for years, it turned out.
In 2011, Illinois inspectors visited all nine licensed abortion clinics that are defined as pregnancy termination centers, a category that limits them to first-trimester abortions and no other procedures.
The Northern Illinois Women's Center in Rockford and the Women's Aid Clinic in Lincolnwood were among those. The state found health and safety violations and issued emergency license suspensions that closed both temporarily. The clinics' operators have opted to remain closed.
Owners of the clinic in Rockford worked out a settlement with the state that would have allowed it to reopen with a reduced fine of $9,750. But they announced this month that trouble hiring new staff and lack of support from some in the Rockford community had persuaded them to close for good. The clinic operators did not respond to messages conveyed through an attorney.
Larissa Rowansky, a co-owner of the Women's Aid Clinic in Lincolnwood, said her clinic helped women and provided the best care that a professional clinic could provide.
But Illinois inspection reports detail citations for practices such as frozen TV dinners stored in a biohazard lab refrigerator that also held placental or fetal tissue. The clinic's dusty equipment, lack of a supervising registered nurse and failure to perform CPR on a patient who later died also drew citations.
Rowansky said that patient didn't need CPR because she was speaking to emergency workers when she was taken to a hospital after her abortion. The patient "lied about her condition," Rowansky added, saying the woman had bronchial pneumonia and was too ill to have an abortion.
The other violations uncovered by the state inspectors were technicalities, Rowansky said.
"It was unfair," she said of the state's inspection last year, the first in 15 years.
A separate inspection of the building resulted in more citations for fire hazards. Fixing the problems and paying the fine would have cost more than a year's revenue, Rowansky said.
"I tried to help women to get legal abortions," she said. "If someone wants to work against that, there's nothing I can do."
The inspection sweep of the nine clinics didn't include other centers that perform more services than first-trimester abortions and are classified as ambulatory surgery centers. Anti-abortion groups said there are four such centers. Senger said she doesn't know how many surgery centers perform abortions.
State records reviewed by the AP show some of those centers have gone uninspected since the mid-1990s. Senger said the department intends to inspect those and other surgery centers this year.
The state's inspectors are spread thin, responsible for on-site safety and health inspections of facilities ranging from hospitals to dialysis centers to home health agencies. Lack of money prevents the state from hiring more inspectors, said health department spokeswoman Melaney Arnold.
"The department would like the regulation of all licensed health care facilities to be on par with how long-term care facilities are regulated," she said, "meaning a survey is done at each facility every year and whenever we receive a valid complaint."
Illinois law doesn't specify how frequently either type of abortion clinic must be inspected. Both kinds must renew their licenses annually, but no inspection is required with that. After an initial licensure fee of $500, a renewal costs $300.
A third type of health facility providing abortions isn't licensed or inspected in Illinois. These clinics are considered to be similar to doctors' offices, which aren't licensed by the state, and the majority of their services aren't surgical procedures. Planned Parenthood clinics fall into this category.
"Let's bring them all under some sort of regulation regime," Scheidler said.
Sharon Levin, vice president of the National Abortion Federation, a standard-setting body for providers, said the Philadelphia case is unusual and shouldn't be used as a basis for a crackdown.
State regulators should inspect abortion clinics as often as they do other similar medical facilities, Levin said, but 15 years between inspections is excessive.
"We have clinical policy guidelines and we regularly inspect our members ..." she said, "but we would consider 15 years too long."
Illinois Rep. Jack Franks, a Marengo Democrat who supports abortion rights, is glad the state has stepped up its inspections.
"Abortions are legal in this state. They need to be safe," Franks said. "I want to make sure women getting these aren't being treated improperly."