Sep 05, AU Edition

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BAD CHOICES
A New South Wales abortionist will stand trial in November for manslaughter after an alleged illegal termination that went terribly wrong – the first such prosecution in New South Wales in over two decades. Investigate’s Claire Morrow has the inside story of Dr. Suman Sood’s many brushes with the law, and sheds light on just what happens when young women in crisis get caught up in Australia’s abortion industry
The mother was a 20-year-old woman who had the support of her parents and boyfriend to continue the pregnancy. She was recently employed after a period of unemployment without benefits. She was concerned about money. Her parents offered to raise the child, but the pregnant young woman thought they might be moving overseas, and didn’t want that for her child. ‘I thought about it (having the baby) and knew I wouldn’t be able to raise a child,’ she said. ‘I was sad about that and then angry, I knew what I had to do.’
Thus begins the tragic story of an unnamed young woman whose decision to terminate her twenty-something week pregnancy in the office of Dr Suman Sood has led to manslaughter charges, revelations of fraud, and shed light on what Australian women get when they think about exercising their ‘right to choose’.
The young woman was not even eligible for an abortion when she turned up at Sood’s clinic: after 20 weeks gestation, terminations are only performed in hospital, and only in cases of rare or compelling circumstances. And one can only begin to imagine the storm of emotions surrounding her decision: while on the one hand she clearly cared about the baby, on the other hand, she felt that she couldn’t go through with the pregnancy – that, somehow, it was her duty to abort.
The young woman claims she received little in the way of counseling and that Sood told her the procedure would cost $1,500 (and that she needed some of that money on the day – she only had $400 on her). The young mother alleges that Dr Sood inserted a pessary into her vagina and gave her two tablets ‘to soften up the baby’ to take by mouth, with instructions to return the next day to complete the procedure.
Rather than returning for the ‘completion’, the young woman went into labour early the next morning and her baby was delivered prematurely at 3:30 in the morning, on the toilet, by the distressed and surprised mother, who rushed to hospital shortly thereafter. Before the birth, she alleges that she had called Dr Sood in alarm. Sood’s response was to tell her to take some Panadol; she advised her patient that she was suffering Braxton-Hicks contractions. It was not until the baby arrived at the hospital that doctors realized he was alive. He died around 8 am the same day.


Dr Sood’s defense is an affidavit she wrote weeks after the event. In it, she states that she had seen the patient on a Saturday, advised her that she could not lawfully terminate a pregnancy beyond 20 weeks, suggested she think it over, and if she still wanted an abortion, she should return on Tuesday for a referral to a Queensland clinic, where abortion could be obtained at her stage in pregnancy.
Sood states that on the Monday in question, she was not working at the clinic (this is the day the mother alleges that Dr Sood started the abortion procedure). That doesn’t mean Sood was not around, however: by sheer coincidence, when the patient went to the clinic for tummy cramps that day, Dr Sood was indeed there to ‘fetch something’, and did examine the woman. At this point Sood says she assessed her young patient as having Braxton-Hicks contractions, gave her two ‘Tri-Profen’ analgesics, and told her to go home and take some Panadol. Imagine her surprise when she heard the poor girl went into premature labour and had the baby. Nothing to do with her, right?
Sood’s defense raises a number of questions. Why did she wait weeks to file an affidavit, given the seriousness of the incident? What was she doing at her clinic, randomly fetching something – knowing that she would be at work the next day? And having shown up, what would induce her to see a patient whilst there if she had been well and was due to return the following day if she needed a letter? Unless she was, as prosecutors allege, halfway through an illegal abortion.
Sood’s patient’s baby, meanwhile, being at 21-24 weeks gestation, would have been approximately 20cm long, kicking, sleeping and hearing in the womb, a fully formed human, his gender clear, in miniature. The baby survived his premature delivery but died a few hours later. Premature babies have been known to be ‘viable’ at this stage, if the mother goes into labour which cannot be stopped. Oddly, if Dr Sood had had the foresight to kill the baby in utero and keep a close eye on her patient, she would never have been caught. One wonders – if she was in principle willing to perform a late-term abortion – how much practice she may have had.
So just who is Dr Sood? To make a long story short, she is the owner of the private Australian Women’s Health Clinic in the Sydney suburb of Fairfield, and has what might politely be called a checkered past. People keep alleging that has made money in less-than-honest ways. And she was in fact found guilty on of Medicare fraud (96 counts) earlier this year but went straight back to work.
On the 8th of February this year, Dr Sood faced 96 charges of dishonestly obtaining Medicare benefits. At trial it was revealed that Dr Sood was bulk-billing patients through Medicare and also charging them an out of pocket fee; around $120 for a 12 week pregnancy, and $1,100 for a 19 week pregnancy. Now a doctor can charge whatever she likes for a medical service in private practice, but Medicare refunds a flat $144.30 for an abortion. If a doctor wants to charge $200, $500 or $3,000 upfront, she is entitled to do so. The mother then takes her receipt to a Medicare office and receives $144.30 back. Unless she has reached the Medicare safety net, in which case she receives $144.30, plus 80% of the difference. If the doctor bulk bills the patient (many doctors in private practice bulk bill poor patients) the patient gives no cash up front, Medicare pays the doctor directly, and the doctor is not entitled to receive any more money.
The charges followed a raid on Sood’s practice on 30 October 2001. Moments before her arrest, Dr Sood was seen by an employee shoving bundles of receipts under medical waste. Perhaps she was hoping the Health Insurance Commission investigators would be too squeamish to look there. A nurse at the clinic, Minna Zoretic, testified that she had seen Dr Sood dumping papers in a bin. Ms Zoretic had also worked on reception, and taken money from patients for abortions. Ms Zoretic had worked as a nurse, receptionist and counselor at the clinic, although she had no qualifications in counseling. Dr Sood was sentenced to 300 hours of community service and fined more than $20,000, but went back to work.
The baby who died after a premature birth, allegedly induced by Dr Sood, had a mother who was ‘counseled’ at the clinic by Minna Zoretic, who again has no counseling qualifications.
abort.jpgInvestigate has also learned that Dr Sood was once investigated by the NSW Industrial Relations Commission for a kickback scheme wherein she was alleged to have received $25 for each sample she sent to Westpath Services, a pathology company. Dr Raghubir Singh – another doctor working at the clinic – has alleged that Sood received between $8,000 and $10,000 a month from the scheme. And she has been the subject of a number of complaints to the Health Care Complaints Commission (HCCC scheme), but has continued to work.
Under NSW law, one doctor’s opinion that a woman’s physical, mental, social or economic health might suffer as a result of pregnancy or birth is sufficient to warrant a legal abortion. The doctor in question can be the abortion doctor who will profit. Apparently their medical scruples are beyond reproach. To detain someone against their will in a mental health institute because they are a danger to themselves or others requires two doctors, and the case must be heard by a magistrate within 48 hours. To kill a baby, the opinion of a doctor with a vested interest meets the letter of the law.
A doctor who provides abortion is a general practitioner who has decided to provide abortion. Abortion is not routinely taught in medical schools; one must profess an interest, and once one has become a GP, approach a clinic and learn on the job. If a doctor knows what to do in a technical sense, there is no theoretical law to prevent them from hanging up their shingle as an abortionist. There are no licensing requirements. There is an Association of abortion providers, which has voluntary membership. The association sees itself as promoting women’s health, using the safest techniques, and keeping up with ‘best practice’. Dr Sood was not a member. One wonders why.
Dr Sood is not the first person in NSW to be charged under the Crimes Act for performing an illegal abortion, just the first to be charged in more than 20 years. In 1981, Dr George Smart was charged with performing an illegal abortion in circumstances similar to this current case. The teenage girl who he aborted had been refused abortion at other services, and was more than 20 weeks pregnant. Like Dr Sood, Dr Smart was not a member of the relevant professional association, and was on the outer edge of that community. He was reportedly not liked or trusted by other abortion doctors, and could not find other abortionists to testify on his behalf. Smart was found guilty, and lodged an appeal. The case law would have been challenged on appeal, but Smart died before the appeal was heard, so the law was not challenged, and has not been clarified since.
The burden on the prosecution is to prove that Dr Sood was trying to cause a miscarriage (or, more accurately, a stillbirth; babies delivered after 20 weeks must be registered with Births Deaths and Marriages) and gave her prostaglandin. This can be proven or disproven by blood tests the hospital may or may not have run at the time they admitted the young woman. Because it is a criminal case, the standard of proof required is high. The young woman would probably win a civil case. In the civil area, the laws could be tested and clarified. And indeed a number of civil charges have been brought against abortion providers across Australia, for assault (if the woman has not given informed consent, than any contact with her body is presumed to be assault) or nervous shock. These cases have always been settled out of court, meaning that the law is not challenged or clarified in court, and that the woman is bound by a confidentiality agreement not to discuss the case.
Law relating to unborn children is terrifically confused, and varies by state. If a 39-week pregnant woman is stabbed, and the baby dies but the mother lives, no one has been murdered. If a 24-week premmie baby is stabbed, then it has been murdered. Abortion is legal in different circumstances in different states. The majority of general practitioners feel that they do not have a clear understanding of abortion law.
In NSW, counseling is not a legal requirement prior to abortion, although most best-practice publications suggest that it should be available. In order to legally consent to any medical procedure, the patient must give informed consent. The interpretation of this in relation to abortion seems to be that the woman should have an understanding of what will be done to her body and consent to anaesthetic risks and so forth. There is no expressed need to give her any information about the baby.
To find out more about the consequences of terminations on Australia’s women, Investigate spoke to Melinda Tankard-Reist, the author of the 2002 book Giving Sorrow Words and the forthcoming Defiant Birth: Women who Resist Medical Eugenics, and an advocate for Australian women suffering from post-abortion grief. In her 2002 book she discusses the case of the Australian woman who was led into a room for abortion ‘counseling’ and told to press ‘play’ to hear the recorded message.
‘The hundreds of women I have spoke to didn’t feel that they had made an informed choice or gave informed consent…abortion is sold as something quick and simple and easy. The providers’ attitude is that any pregnancy in less-than-perfect circumstances should be aborted. It’s the sensible thing to do’, she says, adding that she believes the fact that so many women ‘choose’ abortion is a sign that there is something terribly wrong with society.
‘This is a Band-aid solution where a woman is abandoned to her so-called autonomy, and if she suffers emotionally after the abortion is told to keep her mouth shut, that she is the ano- maly…this is a sacred right…any questioning or discussion is out of order.’
Anti-Abortion-Demonstration.jpgTankard-Reist reports that of the hundreds of women who answered her advertisement to talk about grief after abortion, a large number asked if they were the only woman who had felt that way, and called.
In Australia pregnancy decision-making counseling is provided primarily by groups that have a combination of church and government funding. As are, in fact, many other social services such as drug rehabilitation programs, and injecting rooms. The staff at these centres are likely to be pro-life themselves, but have chosen to help women by offering free telephone and face to face support during pregnancy. Investigate test-called two of these services, under the guise of Karen, a 19-year-old student who was 14 weeks pregnant and seeking an abortion. In both cases the counselors took neither a pro Nor con position, and I found ‘Karen’s’ discussions with the services to be sympathetic and focused on providing non-judgemental support to discuss the options.
In NSW, non-directive pregnancy counseling that includes referral for termination is provided by the Bessie Smythe Foundation. Margaret Kirkby, Centre Director for Bessie Smyth spoke to Investigate about abortion and the legacy that counseling, or lack thereof, can create. While Ms Kirkby is resolutely pro-choice, she admits that Bessie Smythe ran an abortion clinic until 2002, but found that it was economically impossible to keep providing abortions to all women in need while also offering ethically adequate counseling: ‘At the end of the day, it is a small business. Running a service in a way that all women have access to extensive counseling is not financially viable. We believe that providing counseling for 100% of clients is good practice. But it’s not covered by Medicare. [These services] do the best they can. They are staffed by people who are caring and committed’, Kirkby said.
In many, but not all cases this would seem to be true. One may disagree with their moral reasoning, but in many cases these individual people are doing the best they can to assist women the way that seems right to them.
But while she admits women may feel grief and loss – she calls it ‘hitting a wall’ – after an abortion, Kirkby resolutely refuses to accept the existence of what many call Post Abortion Stress Syndrome; she claims that it is a right-wing anti-abortion myth designed to scare women and blame abortion providers. Also, it is not listed in the Diagnostic and Statistic Manual of mental disorders. (A slightly odd argument coming from someone like Kirkby, in that implies that the patriarchal medical old-boys of the DSM IV are the best judges of womens’ mental health issues.)
Some abortion providers in NSW allow for counseling which is included in the up front fee, if the woman books the counseling ahead. Some providers do this, but if the woman does not have an abortion on the day of the counseling, she is charged an extra $50 fee – and $50 is a lot of money in some circumstances. Other clinics refer women who seem distressed or unsure to a psychologist, who charges his or her own fee. Some clinics, such as the multinational Marie Stopes, provide no counseling at all, under any circumstances. They either send you home or run you through the system. Those are the choices.
In June this year Natasha Stott Despoja tabled a motion in parliament to force pregnancy counseling services to disclose ‘this service does not refer for termination’ in any advertisement. She felt it was misleading women to provide pregnancy advice from a service that didn’t seek to increase the Australian abortion statistics. She did not discuss in the motion any need for abortion providers to advertise that ‘this clinic has a financial interest in your having an abortion.’
Kirkby told Investigate that ‘compulsory counseling would be an insult to women…it could lead to a situation where women were forced by the state to do certain things, such as view pictures of babies, or wait 72 hours after the counseling before the abortion’, as is the case in some American states. ‘Counselling women must be non-directive, and focus on the woman’s needs…It could also create a situation where counseling was about ticking off boxes, not about supporting women’. Tankard Reist agrees that it would be terrible to force women to view pictures or read information against their will but counters that ‘all information should be freely available; it is absurd and shows the poor state things are in that we even need to discuss the need for counseling’.
Regarding the ‘national tragedy’ of abortion rates in Australia, most people would agree that it would be a good thing to lower the rate of abortion. There are tremendously difficult issues involved in thinking about abortion, the least of these being the lack of data. Health Minister Tony Abbott caused an uproar when he suggested that there were 100,000 terminations performed each year, but the fact is that hard numbers are tough to come by. Most Australian states do not keep records of abortions; Medicare data tells us how many women have had procedures for which they claimed a Medicare rebate, but those numbers are fuzzy as well as some of these procedures will have involved women who have had a miscarriage or stillbirth, and many other women will never claim the Medicare rebate. Some trends show the overall abortion rate decreasing, but it is equally plausible that this is a reflection of miscarriage management, which has trended towards a non-interventionist approach over the last decade as women are no longer routinely given D&Cs after miscarriage.
Arbitrary time limits on abortion are also confused. Why 20 weeks, why not 19, or 21? Is a cleft lip enough of a disability to warrant a termination? What about a 90% chance the baby has Down’s Syndrome – versus a 10% chance that the baby is fine? The current government rhetoric on women’s issues is struggles to mash together a jumble of moderate and conservative attitudes into a cohesive policy. So we want less abortions, but we don’t want more women on the single parent’s pension.
The poorest and most disadvantaged women have the hardest time getting access to everything, including abortion and counseling. Yet they have more abortions, and surely would benefit from more counseling.
The abortion debate is too often about choosing sides, and not enough about civilized respectful discussion of the issues by non-like minded people. Fred Nile can’t keep himself from interrupting pro-choice speakers, and pro-choice pollies can’t stop themselves from name-calling in response. The issue is not ‘settled’, and the majority who think they have an opinion haven’t challenged it, and are going on a gut reaction.
We need to think very seriously about how women are treated in our society, and that a NSW abortion clinic advertises ‘Accidental and Unplanned pregnancy is a fact of life. Dealing with it can be emotional and stressful’. The implication would seem to be that abortion is a fact of life, but it’s just one of those crosses we women have to bear. We should accept that obviously we will not be able to finish our degrees, make enough money, achieve what we want and need, if we become pregnant.
I prefer this quote provided by the American organisation Feminists for Life which has as its slogan, ‘Abortion is a sign that we are not meeting the needs of women’: ‘When a man steals to satisfy hunger, we may safely conclude that there is something wrong in society – so when a woman destroys the life of her unborn child, it is an evidence that either by education or circumstances she has been greatly wronged.’
The abortion-breast cancer debate: Is there a link?
Many studies have suggested a link between abortion and breast cancer, to the effect that abortion is a risk factor for breast cancer. Not all women who have abortions get breast cancer, there are a myriad of risk factors, and more than one form of breast cancer. Nevertheless abortion is a modifiable risk factor – unlike family history, for example, it can be avoided.
The Abortion Providers Federation of Australia acknowledges that a number of reputable studies have shown a link, but calls for more studies, and their website implies that no conclusions can be drawn. It is, however, accepted that early first full-term pregnancy (i.e. before 24 years of age), increased number of pregnancies, and length of time breastfeeding all decrease breast cancer risk. This is not debated.
An independent link is thought to be due to the proliferation of new breast cells in early pregnancy. If the pregnancy is continued, these cells become mature and less vulnerable to cancer. In most cases of miscarriage, there is a gradual decline in the hormones that cause this proliferation. In some miscarriages, and all abortions, the hormone change is rapid.
The first study to examine the abortion-breast cancer link among American women was published in 1981 and reported that abortion ‘appears to cause a substantial increase in risk of subsequent breast cancer.’ A 140% risk elevation was reported. [Pike MC et al., British Journal of Cancer (1981;43:72-6]
The only statistically significant study of American women using medical records (rather than histories) reported a 90% increased risk of breast cancer among women in New York who had chosen abortion. [Howe et al. (1989) Int J Epidemiol 18:300-4]
Critics of the link rely on the problem of reported history. This argument supposes that women who are healthy under-report their history of abortion (which is well established), but also that women who have breast cancer defy this general trend and accurately (or with exaggeration) report their abortion history.

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