Abortion proponents assure us that current government oversight of abortion is sufficient to ensure that women are given safe abortions in a clean, caring, sanitary environment. The example of Ronachai Banchongmanie blows this little myth out of the water. Let’s follow his facility over years of inspections. Watch for continued violations in the following areas:
— Infection control (keeping the facility and equipment clean)
— Staffing (having adequately trained, qualified staff)
— Preparation for complications (emergency supplies, arrangements for ambulance and hospital)
— Other medical safety issues (maintaining proper medications, properly monitoring patients, adequate documentation of patient care/condition)
And an autoclave is a piece of equipment used to sterilize medical instruments before surgery or other treatment. Pay attention to how RELSCO cared for the autoclave.
Among the deficiencies cited in May 1979 inspections:
* no lavatory or hand-washing sinks in exam rooms
* sinks in patient care areas not able to be shut off without using hands
* no tracheotomy set available
* no transfer agreement with hospital
* no job descriptions for nursing staff
* employee files lacking resumes of training and experience
* urinalysis not performed prior to surgery
* no written infection control measures
* scrub sink area “in need of a thorough cleaning”
* no system for patients to summon attendant
* drugs not stored safely
* excessive temperature in area where oxygen and nitrous oxide tanks were stored
* 24-hour waiting period for abortions not adhered to
Banchongmanie’s corporation which owned the clinic, RELSCO, did not make the corrections required by the state, but instead asked for a waiver that would allow the facility to operate as-is. (Statement of Deficiencies and Plan of Correction 3-3-79, 3-7-79)
Banchongmanie wasn’t given his waiver to simply operate his abortion facility any which way he pleased. But he wasn’t shut down either. He continued to operate.
Among the deficiencies cited in 1980 inspection:
* no documentation of physician with hospital privileges
* inadequate housekeeping in scrub sink area
* “Written procedures which govern the use of the aseptic technique of scrubbing for performing a surgical procedure was incorrect”
* expired sterile supplies stored on dirty shelf
* no evidence of continuing infection control training
* inadequate documentation in operating room
* emergency drugs outdated
* improper storing of drugs
* illegible entries in medical records
* legal documents in medical records did not identify facility by name or address
(Statement of Deficiencies and Plan of Correction 7-14-80)
Suit by “Sharlee” alleged: abortion at Relsco October 7, 1981; tissues left in uterus, resulting in endometritis; further medical expenses and pain. (Jefferson Circuit Court Case No. 81CI-00963)
In 1982, a hearing officer reported that Relsco’s assistant administrator “stated that all equipment needed to place the applicant in compliance with licensure standards have been installed or put on order.” Relsco, which had been operating with the violations cited above, finally got a license. (Hearing Officer’s Report 12-29-82)
Deficiencies cited in 1983 inspection included: “no evidence of infection control inservice since 11/11/80.” (Statement of Deficiencies and Plan of Correction 5-3-83)
So we see that despite years of violations, Banchongmanie was permitted to keep operating his unsanitary abortion facility. He was finally given a license. And he continued to rack up violations.
So Banchongmanie got his license — and promptly ran up another list of violations at the next inspection. Did he do any better in 1984?
Deficiencies cited in the first 1984 inspection, in May, included:
* counselor, office clerk, receptionist, and bookkeeper performing pregnancy tests
* sterile supplies outdated or not dated
* sterilized equipment stored in dirty, dusty areas
* gas sterilization equipment needed cleaning and it could not be determined to be functioning effectively
* outdated laboratory supplies
* lab equipment needed cleaning and monitored for proper calibration
* outdated medications throughout facility
* infection control minutes noted growth of culture on abortion instrument pan
* procedures did not specify what solutions were being used as disinfectants
* infection control meetings sporadic, no physician documented as attending
* unqualified administrator
* incomplete employee records
* physician not remaining at the facility until all patients are discharged; one document noted physician left at 4:15 but was called back, arriving at 5:15, to attend to patient with complications
* no agreement for ambulance service
* not all medical records legible
* no documentation of medications administered or ordered
* lack of pre- and post-operative nurses’ noted including vital signs
* one RN on duty to supervise both surgery and recovery
* no arrangements for adequate blood supply
* unidentified cups of pills in recovery room
(Statement of Deficiencies and Plan of Correction 5-1-84)
Violations galore. Is anybody surprised? Does anybody think that when the inspectors returned in June, they’d find any substantial improvement in the way Banchongmanie was running his business? Well, evidently hope springs eternal among Kentucky abortion clinic inspectors, who kept expecting Banchongmanie to clean up his act. But, of course, he did no such thing. Deficiencies noted in the June 1984 non-compliance revisit included:
* 6 of 10 patient recliners did not have protective covering
* autoclave room cluttered with boxes, equipment, tissue specimens
* autoclave room sink had loose linoleum around top and sides
* specimens prepared by assistant without gloves
* surgeon did not perform total scrub between patients
* date anesthetic vials opened not noted
* no full-time nurses for operating room and recovery room
* incomplete and/or illegible medical records; records show patients administered Sublimaze but did not document orders
* 5 of 5 records reviewed by the inspectors had been signed by RN, not MD, for medications
(Statement of Deficiencies and Plan of Correction 6-29-84)
Next, we see if things got any better after Banchongmanie was slapped with two inspections in one year.
After one routine inspection, and a follow-up visit that found that Banchongmanie’s facility was still dirty and unsanitary, the abortuary remained open for business.
Among the deficiencies found in an inspection performed on April 12, 1985:
* unlabeled medications stored in open containers on top of recovery room medicine cabinet
* surgeon performing surgery without gown
* uncovered tubing on suction machines
* single-use inhalation mask and tubing re-used, once after falling to the floor
* dates injectables vials opened not noted
* surgery performed on patient with elevated white blood count without documentation of rationale for proceeding with an abortion before investigating the cause of the abnormal blood test
* “floor of clean linen storage room was in need of a thorough cleaning and sweeping”
* soiled item bag next to autoclave stained and full of holes
* dirty ash tray and cup of what appeared to be coffee found in lab
* post-operative exam records incomplete
* insufficient nursing supervision of OR and recovery room
A May 13, 1985 inspection found, among other violations:
* single-use inhalation masks reused, some with lipstick smudges still on them
* medications opened but date not noted
* clean linen room had “lint and other debris” on shelves and dirt build-up around baseboards
* bottle of Brevitol opened and not covered
* autoclave door frames “heavily coated with dust”
* soiled linen container next to autoclaves uncovered and overfilled with soiled surgical linens
* expired or undated sterile supplies including speculum packs and dilators
* patient gowns and linens laundered in staff homes rather than by professional laundry
* OR technician assisted while wearing same gloves he wore when handling radio
* improperly stored medications
* post-operative exam records still incomplete
* two patients documented as having been discharged at 1:30 PM, even though the clock said 1:10 PM and the patients were still present
* still insufficient nursing supervision of OR and recovery room.
A December 1985 hearing recommended another review to see if sufficient progress had been made in correcting deficiencies to warrant re-issue of license. But notice that Relsco continued to operate during this time. (Hearing Officer’s Report 12-5-85)
Next, we see if the state of Kentucky managed to muster any real action regarding Banchongmanie’s unsavory abortion facility.
So a December 1985 hearing recommended another review to see if sufficient progress had been made in correcting deficiencies to warrant re-issue of license. In the mean time, Relsco continued to operate.
The state of Kentucky finally filed for an injunction to halt operations of Relsco in 1987 due to operating in violations of statutes and regulations. (Jefferson Circuit Court Case No. 87CI-08790)
So at last, Relsco was supposedly closed by health inspectors after finding health violations including dirty suction containers in both operating rooms. But closed isn’t closed for an abortion facility. A judge declared the facility free from state oversight because of its status as the private office of Ronachai Banchongmanie. It looked as if the state’s hands were tied. But the decision to declare Banchongmanie’s facility free from oversight was reversed upon another inspection and the discovery that Relsco was using general anesthesia. (Jefferson Circuit Court Action No. 87-CI-0640-MR)
But after all this, Banchongmanie and his Relsco continued to operate.
A suit filed by “Tamika” alleged seeking treatment from Banchongmanie January 14, 1988, at Women’s Health Services, for lower abdominal pain; malpractice resulting in “severe physical and mental pain and suffering, lost time from her regular employment and incurred substantial additional medical expenses.” (Jefferson County District Court Case No. 90C04922)
Suit by “Bianca,” on her own behalf and on behalf of “Kurtis” and “Darrin,” alleged: abortion by Banchongmanie at Women’s Health Services November 30, 1988; patient 22 – 26 weeks pregnant; lack of informed consent (“Had the Defendant Ronachai Banchongmanie or the Defendant Relsco, Inc. or their agents … provided the Plaintiff with the information necessary to give informed consent, the Plaintiff would never have given her consent to the abortion of her twin children.”); failure to inform of twin pregnancy; sent patient home for more money during showing of informed consent video; “the unborn children of [Bianca]…were viable;” “Defendant…intentionally lacerated, crushed, dismembered, killed and aborted the twin children of [Bianca];” December 3, plaintiff passed severed head of fetus; patient contacted Banchongmanie’s office, calls were not returned; patient sought hospital care, passed additional tissues; malpractice, mental distress requiring psychiatric care, , physical injury. (Jefferson Circuit Court Case No. 89CI-06286)
A suit filed by “Randi” alleged: treatment by Banchongmanie at Women’s Health Services July 8, 1989; “serious and painful injuries to her body … and serious and permanent pain and anguish, both mentally and physically.” (Jefferson County Circuit Court Case No. 90CI05439)
Next, we move into the next decade.
The 1980s closed with a string of lawsuits for Banchongmanie and his abortion facility. The ’90s brought a new decade — but apparently no new behavior on anybody’s part.
Investigative findings, 4-17-90, included:
* 8 of 25 abortion patients were prepped, on IV medications, prior to arrival of physician or RN
* suction containers in both ORs dirty
* medications opened and undated
* prep carts dirty, dusty, with open and unlabeled syringes
* dirty disinfectant pans
* instruments not completely submerged in disinfectant
* two shelves of undated autoclaved instrument trays, wrapped in dirty or stained linen
* dirty linens covering equipment
* dirty, filled mop bucket stored in scrub room
* scrub sink dirty, containing two dirty cups, a dirty ashtray
* sink, hopper, and counters extremely dirty and dusty in instrument room
* gauze pads lying open on dirty counter
* box of curettes on floor
* dirty recovery room crash cart
* supplies exposed to dust and dirt in open drawers
* dirty floors in pro-op and post-op rooms, with dirty build up on baseboards and commodes
Banchongmanie reported to investigators that he had plans to remodel his facility to meet minimum state requirements. The question is why anybody would believe him, since he’d been given over a decade already to clean up his act. (Louisville Courier-Journal 6-25-94; Memorandum in Support of Findings ABO#-22113, Investigative Reports ARO-1 Reference No. 21451 & 22113)
Next, did Banchongmanie really turn over a new leaf with the beginning of the new decade?
On June 12, 1990, an investigation verified that Banchongmanie’s abortion facility was operating illegally. “Relsco,” on the first floor of the building, performed pregnancy tests. The receptionist would give each patient an unlabeled paper cup and send her down the hall to a restroom shared by other businesses in the building. Rather than using a lab, the receptionist would do a pregnancy test at her desk and would orally give the patient her results, in the waiting room with no privacy. The receptionist would then dump the urine into a lidless glass coffee jar on her desk. When the jar filled with urine, the receptionist would go down the hallway to the public restroom and dump the urine. She did not wash her hands between tests. Pregnancy tests were performed with kits that were out of date. No counselor saw the patients. If the test was positive, the patient was sent upstairs to “Women’s Health Services.”
The investigation also found out from staff that physicians did not remain on the premises until all patients were discharged. Instead, the doctor left, and instructed staff to page him if there were any complications. The staff also told investigators that patients were not given complete post-operative instructions before discharge. Physicians did not perform any post-operative evaluations of patients unless staff asked him to examine a particular patient. The discharge instructions and medications were given to patients by whatever staff happened to be available, regardless of their qualifications.
The investigation also could not find out if Banchongmanie and his other physicians were washing their hands for examinations or surgery, because they refused to answer any questions about the issue. The pre-operative area was supervised by a registered nurse; the post-operative area had only a licensed practical nurse, and the operating room had only a technician. Staff substantiated that Pitocin was administered intravenously pre-operatively by an LPN without any physician present. Staff also substantiated that improperly trained and supervised staff — including the front desk staff — were participating in all aspects of patient care including surgery.
Staff substantiated that they began preparing patients for their abortions at 7 a.m., but that no physician was scheduled to be in the building until 9 a.m. Staff substantiated that they had no job descriptions, no criteria for performance evaluations, and no formal chain of command for responsibilities within the facility.
During the investigations, patients and their mothers were observed weeping in the hallway and reception area. They were not provided with counseling or even with a private area.
The investigation report described the facility as “dark, dirty, and drafty,” with loose or missing floor tiles in the hallways of both the first and fourth floors. Carpets were littered and filthy. Ceiling tiles were dirty, missing, or water stained. Rooms were cluttered with unused furniture and supplies. The restrooms were dirty, with missing toilet tissue holders or broken. The room for preparing sterile supplies was filthy, “cluttered with unused, discarded equipment and stock supplies.” The walls were chipped, peeling, and dirty. Garbage was overflowing from trash cans onto the floor. Equipment was wrapped for sterilization in stained wrappings, and too much equipment was loaded into the autoclave when it was used. The patient dressing room had brown stains, consistent with blood or Betadine, on the chair. Blankets and recliners in the recovery room were not changed between patients, and staff were not sure if pillow cases were changed between patients. Clean and soiled linens were stored together.
The investigation found that the facility had no policy for how areas were to be cleaned after surgery. Surgical equipment, including forceps and dilators, were expired. Surgical equipment was lying about on dirty, dusty trays. Medications were stored in a dirty, unlocked cabinet in the recovery room. Discharge medications were in packets on a desk. Staff substantiated that whoever happened to be working in recovery would prepare discharge medication packets from bulk jars of medicines. The staff also confirmed that they did not perform many required tests, such as coagulation tests. The equipment used to test for gonorrhea was not working properly. Improperly labeled and out-of-date tissue specimens were found in the refrigerator.
The investigation found that there was no written policy on the examination of abortion tissues. The autoclaves were not checked or tested. Staff handled blood and body fluids without wearing gloves. One registered nurse’s personnel file had no documentation that she was licensed in the state, or that she was trained in CPR. Another nurse, this one an LPN, also had no verification of CPR training, and had an out-of-date verification of license. Yet another LPN was found to not be currently licensed. (Memorandum in Support of Findings ABO#-22113, Investigative Reports ARO-1 Reference No. 21451 & 22113)
Next, surely things must change — right?
So in June of 1990, the state of Kentucky finally did an investigation of Banchongmanie’s practice, and verified appalling misbehavior. In July of 1990, Banchongmanie performed an abortion on “Deann.” She filed suit afterward, saying that Banchongmanie had performed an incomplete abortion, and that on August 2, she required emergency care. She also sued for violation of laws against deceptive trade practices. (Jefferson County Circuit Court File No. 91CI04951)
But Banchongmanie’s facility continued to operate.
Suit by “Arleen” alleged: abortion by Banchongmanie January 23, 1991 at Women’s Health Services; lack of informed consent; Banchongmanie did not secure pathology report or inform plaintiff abortion was incomplete; “Plaintiff carried around in her body the parts of the rotted corpse of her dead baby’s body for approximately two days;” cervix remained dilated; on January 25, patient went to ER, suffering bleeding, cramping, fever; examination revealed “foul discharge” and products of conception, infection; patient hospitalized; D&C and laparoscopy performed May 7; “It was noted during the procedure that the cervical canal was without resistance to the dilator, thereby, causing future problems with carrying a pregnancy successfully.” (Jefferson Circuit Court Case No. 91CI07679)
In a 1991 deposition, Banchongmanie stated that he had read National Abortion Federation standards, and agreed that they “set forth accurately the standards of care for a good abortion clinic” and “ought to be followed,” but that he “don’t know word by word did I follow them or not.” Banchongmanie called his care “good practice…the least complication even nationwide. Why do I have to out of my care, when my care is given with the best result.”
In a 1992 affidavit, Banchongmanie stated that his facility “adheres to all of the Standards for Abortion Care as outlined in the complete manual for National Federation Guidelines.”
In a 1994 deposition, Banchongmanie stated that he had read NAF standards when his clinic was a NAF member, “long time ago,” in the 1970s. He said that he did not read and adhere to NAF standards in 1991, 1992, or 1993. “I don’t adhere to this standard because I don’t read it…I use my own standard.” He also said, “my clinic has been serving the people of Kentucky for long time and we make change, make adaptation and we think our standard is very high and we have great expectations also, we don’t have to go after this standard to follow.”
So decades of inspections, slovenly practices, and lawsuits did not cramp Ronachai Banchongmanie’s style.
By Christina Dunigan
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