Fourteen-Week-Olds Cost $250-Cash

The Report Newsmagazine
02-28-2000

One Woman's Story Prompts Calls To Investigate A Vancouver Late- Term Abortionist

by Celeste McGovern

A 19-year-old patient lay on Lorena Kanke's examining table late last November, her legs in the vulnerable position determined by the abortionist's foot stirrups. She didn't want to be there. She was wondering why she had to pay $250 cash for this abortion, and she didn't even want it. A sign in the waiting room said she would have to pay $150 if she cancelled her appointment without two days' notice. She wanted to have this baby. She hadn't wanted to sign the form donating the fetal tissue to medical researchers, either. She was crying-"sobbing," she recalls. Dr. Kanke seemed to her to be pretending not to notice. The Vancouver doctor completed the first step of terminating a 17-week pregnancy: inserting into her cervix two laminaria-match-width sticks of seaweed (or its synthetic equivalent)-that dilate the fist-tight smooth muscle that opens up into the womb so that an abortionist can fit her instruments inside.

It was 8:30 a.m., and the young woman was supposed to return to Dr. Kanke's office on West Broadway that afternoon to have more laminaria inserted. The following morning she was scheduled to meet Dr. Kanke at Vancouver General Hospital (VGH) to complete a second trimester dilation and evacuation (D&E) surgical abortion. Instead, she became something of a rarity: someone who went part way through an abortion, changed her mind, and talked about it. Megan (not her real name) is expecting her baby in April. Her circumstances are difficult and she wishes to remain unnamed but she spoke to The Report because she says she hopes other women can avoid what she went through.

Based on her revelations, the B.C. chapter of Campaign Life Coalition and the Kelowna-based Pro-Life Resource Centre have requested the Medical Services Commission to investigate Dr. Kanke for extra-billing patients.

There are other questions apart from whether women seeking abortion are exploited financially, however: How many women, like Megan, are pressured into abortions? Are they adequately informed when they consent? And are they given any choice in the matter of "donating" their fetal tissue?

It was to have been Megan's second abortion. She'd had her first last April when she was eight weeks pregnant. In October, when she discovered she was pregnant again, her immediate reaction was: "I don't think I can get this abortion. It is so hard for me to deal with the first one. It was a child. Even to this day I wonder, was it a boy or a girl?" But Megan and her boyfriend's families are religious and the couple was afraid of the scandal her pregnancy would cause. There were financial pressures too, since her boyfriend works only part-time and she is a student. They scheduled an abortion for October 22 at the Everywomen's Health Centre in Vancouver.
In the clinic waiting room she signed a consent form and answered a questionnaire asking if she felt pressured to abort, ticking off boxes indicating she felt it was not her own decision. In the operating room, Megan sat on the table in a dressing gown as the technician began explaining the first trimester abortion procedure. "I just started crying," she recalls. At that point, the technician opened her file and read the questionnaire. She suggested Megan postpone the surgery.

Outside the clinic, Megan says, her boyfriend was "fuming." He swore at her all the way home, yelling that she'd "made a big mistake." "The baby's in my stomach," she replied.

Later, the couple weighed the abortion decision. "He said, 'I love you and I want to be with you in the future but I just can't handle this now.' I said, 'Okay, I'll get it done.'"

Two days before the next appointment, the clinic called Megan to cancel it. She was told a staff member who was to dilate her was unavailable, and by the next available appointment she would be beyond the clinic's 12-week gestation cut-off. She was referred to the Elizabeth Bagshaw Women's Clinic. Megan went to her family doctor next, and had an ultrasound that revealed she was already 14 weeks pregnant-two weeks beyond what she was told at the Everywomen's clinic. By the time she could be scheduled at the Bagshaw Clinic, she would be 16 weeks-beyond their 14-week cut- off. A receptionist at the clinic scheduled her to see Lorena Kanke working out of VGH.

Dr. Kanke, a 57-year-old obstetrics and gynecology specialist, was the first medical director of the Everywomen's clinic when it opened in 1988. "

Abortion is an emotional issue," she said at the time, wiping tears from her eyes during an interview with a Vancouver Province reporter. "I'm a woman, a mother, a doctor and I care about the well-being of other women." A few months later she left the clinic, citing her own busy practice and the pressures of being a single, divorced mother to her 10-year-old daughter, who disliked abortion.

Megan says she felt ashamed after her first, mid-November appointment with Dr. Kanke, whom she recalls remarking that condoms are poor contraceptives and that Megan was obviously delaying her abortion. Megan says she paid $ 10 for a blood test and was given two forms to sign: one outlining the risks of abortion, the other declaring the fetal tissue property of the hospital which could be used for research. The latter troubled her and she told her boyfriend later: "I don't want our baby experimented on."

She felt she had to sign the waiver for the abortion. Megan was given two appointment cards for the same day a week later-on the back are handwritten notes indicating her to bring $50 and $200 cash. Cheques, money orders, credit cards were not accepted, she was told, but no one explained the procedure.

Megan cried in the car on her way to her next appointment. She says her boyfriend told Dr. Kanke "she's really upset today" when they arrived, and claims the doctor replied, "That's how most women feel." A sign in the waiting room indicated Megan would be charged a $150 cancellation fee if she didn't give 48 hours notice. She says she asked Dr. Kanke "What's the procedure like?" and was told simply that it was not too difficult.

Physician Jon Cope described various second trimester abortion procedures at a 1997 symposium on abortion at the University of British Columbia. "[I] t is physically unpleasant," he told the gathering, and therefore "tends to be concentrated in just a few hands." The dilation and extraction method is the "preferred method at VGH," he said, and he proceeded to detail it. Eight to 10 laminaria sticks are usual, he said, with more being required if the doctor wants "the fetus to be retrieved whole."

This, he added, clearly referring to partial-birth abortion in which the baby's body is delivered before its brains are scrambled and vacuumed out, is a procedure that has had much "negative publicity" and political attention.

"It is advisable to use the biggest forceps that you can get through the cervix to morcellate the fetus," Dr. Cope continued. The need to "visually check the parts as they are retrieved" is "necessary to...ensure complete evacuation but is part of the reason that second trimester abortion is not popular amongst surgeons. All those here who do second trimester abortions will agree that the most difficult ones are those between 14 and 17 weeks. In these, there is a tendency for the uterus to form an 'hourglass' and the head and part of the trunk to be trapped in the upper part and difficult to retrieve. The passage of large, recognizable fetal parts by the women some hours or days later is extremely distressing for the woman and her family."

Immediately after the laminaria were inserted Megan began to feel ill. She also began to feel angry. She took some pills and forms Dr. Kanke was offering her in the waiting room and stormed out. Later her boyfriend returned to the doctor's office to ask if $100 would be enough for the procedure because that was all he had on hand. Megan says he was told it was not.

By afternoon, however, Megan had changed her mind. She went to a family doctor and asked to have the laminaria removed. The doctor, who prefers not to be identified, says he was concerned that the patient was being pressured to abort and that she seemed ill-informed of the procedure. "He showed me the things that were inside me. I was just shocked. I didn't know what she had done." That evening, Megan saw her baby on an ultrasound for the first time. "It was huge. I saw his hands moving to his face." Her boyfriend was affected too, she says. "He said, 'I think God is telling us something.'"

In January, Megan called Dr. Kanke's office and taped a request to have her $50 returned since she did not go through with the procedure. The receptionist explained it was for the two laminaria, and the $200 fee was for six or eight additional laminaria that would have been inserted later.

B.C.'s Medical Services Plan (MSP) pays doctors $26 for each laminaria insertion visit on a day other than the abortion surgery. The surgery itself earns them $134 for a 14- to 18-week fetus and $150 if the fetus is older than 18 weeks. Physicians are allowed to pass material costs that MSP does not cover (such as those for laminaria) on to their patients, but the Medicare Protection Act allows the charges on a strictly "not-for- profit" "cost-recovery" basis. Source Medical, a surgical equipment supplier to B.C. hospitals, sells laminaria by the dozen for $100, with 10% discounts for high-volume purchasers. An Internet supply company offers laminaria by the dozen for $72. Extra-billing violations could result in a doctor losing her billing number. Dr. Kanke, who billed MSP for $229,475 in 1998-99, declined to comment.

The Pro-Life Resource Centre's Ted Gerk, who asked the Medical Services Commission to investigate Dr. Kanke, is also concerned about the kind of information given to women seeking abortion. An abortion consent form from the Elizabeth Bagshaw Clinic, for example, states: "I may not change my mind and decide not to have an abortion after the laminaria are inserted because...I may not be able to continue my pregnancy without serious complications." Mr. Gerk has also filed a freedom of information request with VGH for information on fetal tissue collection and use.

Amanda Marshall, a spokeswoman for VGH, confirmed that Dr. Kanke works for the hospital, but replied to this magazine's requests for laminaria fees and information regarding fetal tissue use by denying that the hospital performs D&E abortions.