Hospital pays $8.7M settlement

Saturday, July 31, 1999

Premature baby was abandoned with dead foetuses

National Post

VANCOUVER - A legal battle involving a child with brain damage who was left to die in a hospital room with dead foetuses has ended with a financial settlement of $8.7-million, possibly the largest such payment in Canadian history.

The child's adoptive mother, Margaret Renaerts, and her child had sued Vancouver General Hospital, a doctor and several nurses after the baby, Ximena, was born prematurely and left for 40 minutes before being resuscitated.

Ximena's natural mother, Nadine Bourne, then 22, had been admitted to Vancouver General on Dec. 16, 1985, after suffering complications from an incomplete abortion at a Bellingham, Wash., clinic three days earlier.

She was scheduled for a "dilation and curettage" the next morning to remove what remained in her womb, but gave birth at 3 a.m. to Ximena in a bedpan. The foetus had been aborted at 26 weeks and weighed less than two pounds.

Despite the baby crying and gasping for air, a nurse left the baby to die in a room used to store dead foetuses. The hospital's supervising nurse came on the scene 40 minutes later and ordered a Code Blue -- an emergency resuscitation of the baby.

Thomas Berger, a former B.C. Supreme Court judge who has returned to practising law, had argued that the hospital was negligent for failing to keep Ximena warm, clear her airway and provide oxygen, which caused the baby to suffer brain damage.

An out-of-court settlement was reached last year, but only became public this week when the judgment containing details of the settlement was released at the Vancouver Law Courts.

Although the hospital had requested it remain sealed, the judge found that to seal the settlement portion of the court file would defeat the intent of legislation concerning infant settlements.

B.C. Supreme Court Justice Paul Williamson said in his 29-page written judgment, released this week it was "the highest settlement ever achieved in a case of this kind."

"The legislature intended, in my view, that infant settlements would be open to public scrutiny in order that the public may be assured that the best interests of infant plaintiffs have been reasonably protected," the judge noted.

The settlement had been reached two days before a 20-day trial was set to begin. It totalled $8-million plus $500,000 for costs and almost $200,000 for disbursements.

About $3-million was placed in a structured settlement to provide $10,000 a month for the infant, who has severe cerebral palsy and requires 24-hour care. She will also get $100,000 a year for a five-year period beginning in 2003.

At the time the previously confidential settlement was reached last year, Ms. Renaerts called it a bittersweet victory for Ximena, whom Ms. Renaerts and her husband adopted six years ago after the child had been in a number of foster homes.

"It's wonderful we reached a settlement, but Ximena is still living with a disabled body," she said. "No one can buy or pay for good health."

Ximena, now 12, is severely physically disabled and mentally handicapped.
She is confined to a wheelchair, can talk and crawl but has a mental age of a 3-year-old.

Ms. Renaerts, having heard rumours of the circumstances of the child's birth, initially spoke to a lawyer, Charles Lugosi, in 1992. Two years later, Mr. Lugosi retained Mr. Berger's law firm to help investigate and prosecute the civil lawsuit that was filed.

The judge noted the investigation by lawyers "was most difficult and time- consuming, given the less than forthcoming attitude of the hospital."

He concluded that because of the magnitude of the numbers, $1.8 million would be a reasonable fee for the lawyers acting for the plaintiff.

It was estimated that the time devoted to the case was worth $835,000 and almost $200,000 was spent on other costs, including flying to Spain to do an examination for discovery of one of the defendants, who had moved overseas and refused to return to Canada.

The hospital declined comment yesterday.

Archives: Aid urged for abortion survivors

Vancouver Sun May 30, 1986
- by Terry Glavin

Somewhere in B.C. there is a normal, healthy child, not yet live years old, who survived an abortion attempt in Vancouver some years ago.

The child was rushed to the intensive care unit at Children's Hospital after a woman, across town at another hospital, delivered a live fetus during an abortion procedure known as the prostaglandin method.

The procedure, also called a prostin abortion, induces labor by the injection of a harmone and is generally used when the fetus has reached a stage of development beyond 16 weeks. It Is a common procedure in B.C. hospitals.

Other methods, used early in gestation, include the dilation-evacuation method and the saline abortion. Hospital policy in Canada denies an abortion once a fetus exceeds 20 weeks.

It is not unknown in B.C. for a fetus to survive a prostin abortion only to die, usually within minutes, either for lack of immediate attention or because It was so underdeveloped.

But in this specific case, the fetus survived long enough to be rushed to the premature infant ward at Children's hospital, and after being cared for by a team of doctors over a period of several weeks, the infant was subsequently discharged. Nothing more is known about the child, and doctors will not discuss the matter further.

Now, a group of about 50 B.C. lawyers wants the provincial government to take a serious look at abortion survivors.

"We admit these are uncharted waters and there are a variety of scenarios," said anti-abortion activist George Carruthers, spokesman for Advocates for Human Life.

"But children, if they are out there with handicaps because they are survivors of late abortions, should have a remedy, a mechanism, to entitle them to compensation for damages."

Carruthers said he is not proposing that the child cared for at Children's Hospital be informed of the circumstances surrounding the birth, only that the government establish a process to ensure the rights of abortion survivors are protected.

"(But) if the abortion caused severe damage to the child, the child could have the option of seeking compensation under the common law tort of assault."

Mindful of doctor-patient confidentiality, doctors at the Children's Hospital premature infant ward were reluctant to discuss details that could lead to the identification of the child.

But neonatologist Dr. John Smyth, specialist at the premature infant ward who worked with the team of doctors assigned to treat the baby, confirmed the case. He added that the affair raised serious questions about medical practice in such cases.

Incidents traumatic

"For people doing my job...it's a dreadful contradiction," said Dr. Smyth.

"It's kind of strange that at one point you have a fetus that is considered suitable for disposal and just a very few weeks later, vast amounts of time, energy and resources are expended to keep the baby alive."

Norah Hutchinson, spokesman for the Concerned Citizens for Choice on Abortion, said instances of abortions that produce children instead of dead fetuses are tragic, painfully traumatic for everyone involved, and totally unnecessary.

But unlike Carruthers, who says the live-birth abortions demonstrate that abortion, is "the killing of an unborn child, no matter how you dress it up," Hutchinson says the cases demonstrate that women should have more ready access to abortions without the delays posed under the mandatory therapeutic abortion committee system.

Clinics backed

Abortions in Canada are illegal unless they are approved by a legally constituted therapeutic abortion committee, usually affiliated to hospital adminisratIon boards.

Hutchinson said abortions should be decriminalized and the system should be replaced with abortion clinics to prevent delays.

The likelihood that the woman will suffer complications arising from an abortion increases about 2O per cent with each week of gestation from seven weeks onward, she added.

"Maybe Carruthers should try and get abortions out of the Criminal Code," she said. "Then maybe these things wouldn't happen."

But Carruthers says such occurrences will inevitably continue so long as abortion is legal, and pointed to Centers for Disease Control statistics in the United States - where there is virtually no "red tape" ,- which show that 13,000 abortions occur every year after the 20th week of gestation.

Carruthers said legislation should be enacted requiring medical personnel to provide medical assistance to abortion survivors, and the provincial government should establish a public inquiry into the number of children born during the process of an abortions.

Hospital sensitive

When he was first interviewed earlier this mouth, Dr. Ian Grant, medical coordinator at Vancouver General HospItal, said he doubted reports that an infant was treated after being aborted and had survived until childhood.

He said he would raise the question with hospital obstetricians and get back to The Vancouver Sun with answers.

Several days later, Dr. Grant said: "The situation is this - the chance of producing a fetus that exhibits signs of life is extremely rare, usually because the process of the prostin inevitably kills it."

He said the obstetricians he questioned have never witnessed a fetus exhibiting signs of life, but he said VGH obstetricians conceded having heard of such situations.

Won't watch it die

"But if there's any sign of life, then that's it. We (would) call the resuscitation team and we (would) try to save it.

"If you see life, you're not going to stand around and watch it die, especially if it's young."

But it happens, says Kathy Harper, a registered nurse who teaches prenatal classes in Vancouver and works part-time in the VGH operating room.

Harper said she once responded with a practical nurse to a prostin abortion patient's nurse-call alarm and when she arrived in the patient's, room she found that the patient had delivered, on her own, a live infant in a bedpan.

She called the head nurse, and was told to take a coffee break. That was the last she heard of it, she said.

For some nurses, assisting in prostin abortions - no matter what their personal views on abortion may be - is a task they refuse to take on.

For Kathryn Larouche, a 30-year-old post-partum nurse at Grace Hospital who spent a year in the VGH ward where prostin abortions were performed, the abortion left scars. When she resigned from the ward, five other nurses resigned along with her.

During her year in the VGH ward, she said she saw three infants die after they were delivered live during the prostaglandin procedure.

She added that she assisted in "hundreds" of prostin abortions and is not "judgmental" about women who choose abortion.

Larouche, who stresses that she disagrees with the tactIcs of the anti- abortion movement, says she has since undergone counselling treatment to help her cope with the idea that she was "aiding murder" during her year assisting in abortions.

"We were supposed to turn the other way," Larouche said of the live birth incidents. "We weren't supposed to do anything, There were a couple of people - I don't want to say who. They told us, 'Don't do anything. Leave it alone. It will die'"

Delayed death

In her first live-birth experience, Larouche said the woman undergoing the abortion asked her what was wrong. Larouche said all she could do was tell her to wait a moment, and when signs of life were no longer evident, Larouche cut the umbilical cord.

"I didn't want to look," she said. "I didn't want to see more. The limbs were moving, but I couldn't look long enough to see any breathing.

In the prostin abortion, the fetus is not dismembered, as in the more common suction method and the dilation-evacuation method. Neither does at involve the injection of saline solution to dehydrate and kill the fetus.

The prostaglandin method involves the injection of a hormone which simply induces labor and the woman evacuates from her womb a whole fetus, usually into a bedpan.

In almost every prostin abortion, the fetus exhibits no sign of life because it is "kiIIed" in the process of labor and is simply "delivered" and removed for disposal.

Dr. Grant said Hospital policy prohibits abortions when the fetus is determined to be 20 weeks or older because after 20 weeks, "you can produce a living child."

The fetus that lived and was treated at the Children's Hospital's "preemie"
ward went on to become the only known case in B.C. of an infant reaching childhood after surviving an abortion.

But there were other survivors.

In 1974, The Vancouver Sun obtained records of an abortion at Vancouver General Hospital in which a was born in the process of an abortion and lived for 24 hours.

In the controversy that ensued, severaI other cases came to light, including a 1970 case at Royal Columbian Hospital in which an abortion produced a live infant who was left to die in a pan.

Another well-known incident was the 1979 Baby Grieve case, in which a baby was born during an abortion performed on a mentally retarded inmate of the Glendale institution in Victoria.

The child lived for 10 hours. The birth and death were registered with the department of vital statistics and a coroner's inquest determined that the Criminal Code had been violated, because no recognized therapeutic abortion committee approved the abortion, but the mater was dropped.

Archives: Cocke to investigate late abortions

Vancouver Sun, May 11, 1974

By Karin Moser

Health Minister Dennis Cocke will launch a personal investigation into reports that some B.C. Hospitals have aborted fetuses more than five months old.

In a telephone interview from Victoria, Cocke said Friday he would look into the case of a baby girl aborted at Vancouver General Hospital several months ago.

A confidential record of the case obtained by the Vancouver Sun indicates the baby was born alive but lived only 24 hours.

The mother had been aborted because she was "distraught" about being over 40 and pregnant.

The baby weighed nearly 2 1/2 pounds, "a weight," said one gynecologist, not affiliated with the hospital, "comparable to a six- or seven-month old fetus."

Cocke said he was under the impression that all hospitals performing abortions were staying within the maximum 12 to 14-week limit.

"I really wasn't aware that so many hospitals are carrying out abortions on 20-week-old fetuses."

Section 251 of the Criminal Code permits abortions only when a hospital committee determines that continuation of pregnancy "would or would not be likely to endanger her (the mother's) life or her health."

At Richmond General Hospital, a fetus more than five months old was aborted two months ago, according to hospital administrator Hugh Ross.

Ross said the abortion committee really "clamped down after that one and we're not doing any abortions now over the 16-week period."

"That baby died because of the saline solution used in the abortion procedure," he said.

He said the board decided then that there is no really valid reason for performing an abortion at such a late date and fetuses at five or more months would not be aborted.

Richmond General carries out 300 abortions a year.

Surrey Ald. Bonnie Schrenk said, in an interview, she learned of an abortion "of a five-month-old fetus" at Burnaby General within the past 12 months.

"That baby lived four hours after the abortion," she said.

Dr. Harold Zimmerman head of the hospital's medical advisory committee, said he is unfamiliar with such a case, but he added that he has held the position only since "the beginning of this year and I don't really know what went on before that."

He stressed that doctors at Burnaby General are "leaning over backwards" not to go over the five-month limit and, if possible, not over 16 weeks.

"What we get, though, are women coming back two or three times and actually using abortion as a form of contraception. This is terrible and some of our doctors are now refusing to do a second abortion.

"One doctor told a patient recently that he'd do the first one and that's the chance he was giving her but her wouldn't do a second one for her."

Dr. Chapin Key, executive director at VGH, expressed shock when informed of the case at his hospital.

He said a quick investigation appeared to indicate the doctor miscalculated the age of the fetus and believed it be in the neighborhood of 18 weeks instead of 21 weeks at which its abortion was reported.

"This is the first case of an infant being born aborted over five months of age in all the 10,000 abortions we've carried out in the last three years," he said.

"But I can't stress enough that women should begin assuming some responsibility for their own bodies and actions so that doctors won't be confronted with this steady stream of late, unwanted pregnancies."

A check of some other Lower Mainland hospitals indicated that hospital administrators knew little, if anything, of abortion policies in their institutions.

At Lions Gate Hospital, Dr. John Bragg admitted he "didn't know" the cut- off limit for abortions.

"I really haven't looked into our policies on abortions for the last two or three years," he said.

Dr. Jim Corbett, the hospital's recently-appointed medical co-ordinator said abortions are rarely performed at Lions' Gate over 14 weeks.

"We're pretty careful about that and most of the abortions are done at 10 to 12 weeks."

In rare instances, he said, they are being conducted on a four-month old fetus.

Surrey Memorial Hospital administrator Margaret Woodward, confessed that "hospital policy doesn't really spell out a cut-off date for aborting fetuses."

"But to the best of my knowledge doctors in this hospital are not carrying out any abortions beyond 19 weeks."

Asked if she could say how many abortions had been performed there in the past year, Mrs. Woodward said she did not have the figures readily available.

"Furthermore, our board is very reluctant to release such figures because they next thing you know, people are comparing, saying that maybe we're doing more than Royal Columbian so it must be easier to get an abortion here and then our doctors are besieged with requests."

"Quite frankly our doctors simply aren't that anxious to perform abortions."

New Westminister Coroner Doug Jack, said he has put "the clamps" on late abortions following an incident "four years ago in which a baby of 24 weeks (six months) was aborted, put in a pan and left to expire there.

"I keep a really close eye on the abortion situation at Royal Columbian," he said "and I can assure you there is no way a fetus over five months is being aborted.

"Most of the abortions are performed at eight or ten weeks."

Evidence is accumulating in B.C., other provinces and throughout the world, that more abortions are being made readily available at later dates and for less valid medical reasons than ever before.

The recently-produced Foulkes report on the future of health care of British Columbians calls for increased abortion facilities and pressure on the federal government to remove abortion from the Criminal Code.

Last year, a United Community Services study revealed that more than 8,000 abortions were performed in B.C. hospitals.

Some of the women had had one or two previous abortions and refused after each procedure to employ proper means of contraception.

Aborted babies in B.C. dying in mothers' arms

Explodes `blob of tissue' myth, says Respect Life office

By MARNIE KO
FOR THE B.C. CATHOLIC
April 19, 1999

Since 1995, at least 16 British Columbia babies have been born alive during mid- to late-term abortions.

B.C.'s coroners service says several babies lived more than an hour after birth, but none beyond six hours, "and in many instances the infant died in his or her mother's arms." All the infants were issued death certificates.

The largest baby, according to B.C.'s vital statistics department, weighed 4.9 pounds and was born in 1997 to a North Vancouver woman more than seven months pregnant.

Most of the live-birth abortions occurred at B.C. Women's Hospital in Vancouver. Ministry of Health spokeswoman Michelle Stewart said induced, late-term abortions are done for genetic reasons. Genetic terminations occur when the pregnancy is planned but the fetus is perceived as having undesirable characteristics, defects, or abnormalities that will result in the infant's death at some time in the future.

Stewart admits women having a late-term abortion should be prepared to deal with a live baby. "In cases where the pregnancy is induced, indeed there is a chance that the baby will breathe when it is born, and the women are aware of that before; they are advised by the hospital that that is a possibility."

Stewart says a baby that exhibits any sign of life, including heart beat or muscle movement, is registered as a live birth.

According to B.C.'s chief coroner Larry Campbell, who concluded an investigation into the live births last month, 11 out of the 16 live aborted babies were born to women 23 weeks pregnant or less, and the infants' expected survival rate would have been "30 per cent or less even if there had been no congenital abnormality."

Campbell has no intention of stepping into the volatile abortion fray. In a March 15 letter to pro-lifer Ted Gerk, who first requested the investigation in February, Campbell said the death of a viable infant born after a mid- or late-second-trimester abortion would not be under the mandate of the coroner's office, regardless of when it occurred or how long the infant survived after the abortion. The coroner said his mandate is only to "investigate death if unexpected."
Peter Ryan, director of the Respect Life office of the Vancouver archdiocese, says the reports "explode the myth that abortion only destroys a blob of tissue."

With 100,000 abortions every year in Canada, there are reports that babies up to 35 weeks gestation (three to five weeks away from due date) have been born alive after abortion.

Methods of abortion vary and include fetal dismemberment, suctioning of the uterus and developing baby inside, poisoning the uterine environment, or induced labour contractions, which deliver a premature baby unable to survive outside the uterine support system.

Stewart says that a late-term abortion in B.C. is often performed by inducing labour before the baby can survive outside the womb without medical help. She also says there have not been many such cases of infants surviving for extended periods. "I believe there has been one such case, not many, and again, the family was aware of that possibility, and faced a very obviously, very tragic situation and a very terrible decision."

She said she's "taken aback by allegations" that anyone had expressed concern over late-term abortions and practices and said it hadn't come to the attention of the ministry.

"First and foremost, abortion is a legal medical service in this country, and that's No. 1," she said, stressing that the ministry supports women's reproductive choices.

Since 1992, which recorded only one incident of an abortion live birth, there has been an increase in live aborted babies, reports the B.C. vital statistics agency. Years 1996 and 1997 each saw six reported cases of babies born alive during abortions. Statistics indicate these abortions occurred between 19 weeks gestation (just under 5 months pregnant) and 29 weeks gestation (over 7 months pregnant).

Campbell said that 11 of the infants were 23 weeks gestation or less and all cases involved "significant congenital anomalies." Of these it is unknown how many were lethal anomalies that would result in the infant's death sometime after birth, and how many were disabilities such as Down's syndrome.

The coroner said that the method of abortion in these cases was "medical induction of labour" through "oral misoprostol with local prostaglandin" inserts into the woman's vagina.

He assured Gerk that "All infants died within six hours of birth, with the majority (56 per cent) succumbing within one hour or less, and with well over half of those cases surviving less than 15 minutes."

According to the coroner, those with longer survival times "usually" were "cared for with compassion and dignity in a pattern akin to the palliative care model and in many instances the infant died in his or her mother's arms." There were nine boys and seven girls.

Penny Ballen, vice-president of women's and family health programs at B.C. Women's Hospital, refused comment on the matter, saying only that giving details of what went on during an abortion or "discussing this terribly sensitive information" would "create danger for women and their providers. They'd be at serious risk." Ballen says the public should be aware that abortion "is a difficult and extraordinarily painful area." Ballen refused to say whether abortions were producing live babies and said she had no further comments because "the media is not the place to discuss this issue. It would create serious risk and I'm not prepared to do that."

An employee of B.C. Women's Hospital involved in abortion services (who refused to give a name for fear of risking firing) says, "These terminated babies had problems, defects ... doctors said they were going to die anyway. Sure, I think it should have happened on its own, and maybe the Down's (syndrome) babies would have lived decent lives ... but some people don't want babies that aren't perfect and `normal.'"

Staff at Vancouver's Elizabeth Bagshaw Women's Clinic on Granville Street could not be reached for comment.

This isn't the first time that British Columbia officials have dealt with public outcry over late-term abortion and terminations for babies with "genetic defects." Ximena Renaerts, a 13-year-old quadriplegic who was born three days after her 22-year-old mother had an abortion at a U.S. Planned Parenthood clinic, reached an out-of-court settlement with Vancouver General Hospital and nine doctors and nurses last summer.

Renaerts, who will require care for the remainder of her life, was left to die in a hospital closet after the hospital diagnosed her as an "incomplete abortion."

Court documents alleged that Vancouver General Hospital nurses ignored the weak cries of the infant struggling for breath in the bedpan and put her in a room reserved for dead fetuses. Forty minutes later, a trauma team was called to suction the baby's airways and provide oxygen, but Renaerts suffered cerebral palsy, brain damage, and was left a quadriplegic from hypothermia and lack of immediate life-saving treatment.

In 1974, Dennis Cocke, then the British Columbia Health Minister, launched a personal investigation into reports that fetuses older than five months gestation were being aborted. In one such case, reported by the Vancouver Sun after it obtained records of an abortion at Vancouver General Hospital, a baby was born alive but died 24 hours after the abortion attempt.

British Columbia isn't the only province where reports of babies surviving abortion are surfacing. Alberta Report magazine last week outlined the grim experiences of nurses on the postpartum unit of the Calgary Foothills Hospital who were forced to administer medication that induces labour, against their religious and moral convictions.

One nurse told Alberta Report "abortions are done in hospital from 14 weeks gestation up to 23 or 24 weeks. After 23 weeks, it's pretty dicey because we're getting into viability ... babies can survive" the induction which is intended to terminate the pregnancy with a dead baby.

With the coroner's lack of jurisdiction in the matter of late-term abortions, Gerk is convinced that nothing short of a public outcry will change the situation. He admits he isn't ready to let the matter rest. "I want to see a Canada-wide investigation into late-term abortion ... staffed with doctors who are not associated with the provision of abortion services. The next step would be a ban on all abortions over 20 weeks, which is when these babies can survive abortions."

Ryan said the way the aborted babies are treated reminds him of "the ancient practice of abandoning newborn infants to die by exposure," and he wants to know whether society is prepared to intervene, "or will nurses, for example, be compelled to stand by and let babies who could survive die?"

The real answer, said Ryan, is legislation protecting infants from being aborted in the first place, "but I worry that as a society we have become so hardhearted on abortion that even now we will refuse to act."

SIDEBAR

Vancouver doctor Jonathan Cope, who presented a paper called "Late Abortion Techniques" at UBC's Medical Symposium on Abortion in 1997, lists a number of reasons women have late-term abortions: "women are awaiting results from genetic testing, women don't know they are pregnant, woman are abandoned by the father which is a common reason, particular areas (of British Columbia) give women difficulty getting referrals (for an abortion), (there is) fear of parental retribution, or that the husband (of the pregnant mother) wants a boy."

He explained that second-trimester abortions "in British Columbia tend to be concentrated in just a few hands because late-term abortions are physically unpleasant. They aren't popular among surgeons" because, as he described in his symposium presentation Secrets for a Successful Evacuation, infants are almost fully developed, clearly look like babies, and can survive outside the womb.

Cope wrote, "It is advisable to use the biggest forceps that you can get through the (woman's) cervix to morcellate (a medical term meaning to cut up) the fetus.... Visually check all the parts as they are retrieved.... This is part of the reason that second- trimester abortion is not popular among surgeons. All those here who do second-trimester abortions will agree that the most difficult ones are those between 14 and 17 weeks ... there is a tendency for the uterus to form an `hourglass' and the head (of the baby) or part of the trunk to be trapped in the upper part and difficult to retrieve. The passage of large, recognizable fetal parts by the woman some hours or days later is extremely distressing for the woman and her family."

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.