This story first appeared in Carolina Public Press and is published by N.C. Health News through a content-sharing agreement.
By Jon Elliston
Carolina Public Press
ASHEVILLE — When state health inspectors suspended Western North Carolina’s only abortion clinic’s operations in the aftermath of a heated debate over a new abortion law last summer, some observers questioned the timing.
Now, Carolina Public Press has obtained internal records from the N.C. Department of Health and Human Services that shed light on behind-the-scenes political and public relations maneuvering surrounding Femcare’s three-week closure.
While the documents stop short of pinpointing who or what prompted the mid-July inspection of the Asheville-based clinic – Femcare’s first comprehensive review in almost seven years – they do show:
- How two lawmakers involved in introducing new abortion-related restrictions across the state began asking DHHS about Femcare’s inspection history, and those of clinics in Charlotte, Durham, Fayetteville, Wilmington and Winston-Salem, before the law was passed.
- How Femcare’s unique status as an ambulatory surgery center put it in the crosshairs of policy debates.
- How DHHS staged an unusually orchestrated announcement of Femcare’s suspension, and how top aides to Gov. Pat McCrory were involved in spreading the word about the suspension to the media.
- How DHHS and the McCrory administration – including the governor himself – responded to a flood of reporters’ requests for more information and attempted to reframe initial reports about what Femcare’s suspension meant.
The documents include some 30,000 pages of material, from emails to memos to inspection reports, though most are duplicates of press releases and news reports. DHHS released the files to Carolina Public Press last month following a public records request first filed in October 2013. Key excerpts from the release can be read below.
Femcare in the spotlight of a statewide debate
The documents provide some clarification of the role this single clinic played in state politics regarding abortion access and health care regulations – a dispute that garnered national attention. It began a year ago, when a bill seeking to tighten North Carolina’s abortion restrictions was introduced in the state Senate.
During hearings on the bill in May, it emerged that only one of the state’s 16 abortion clinics, Femcare, was licensed as an ambulatory surgery center, subjecting it to a more stringent set of standards than most abortion clinics were held to.
The same month, a legislator started to press DHHS for details about Femcare’s inspection history, records show.
State Sen. Warren Daniel, a Morganton Republican, was a sponsor and chief proponent of the bill. On May 16, Daniel’s legislative assistant, Andy Perrigo, emailed DHHS staff with questions about clinics in Asheville, Charlotte, Fayetteville and Winston-Salem.
Regarding Femcare, he asked, “is the clinic not on the ‘to be inspected list’?”
A DHHS employee responded by noting that the department’s inspections of abortion clinics “are unannounced.” Other documents in the newly released records note that the state’s abortion clinics are fully inspected, on average, every three to five years.
In early June, Perrigo asked the department for more information on Femcare’s inspection history, as well as those of abortion clinics in Charlotte, Fayetteville and Wilmington, according to other emails provided by DHHS.
A month later, on July 11, an aide to Rep. Sarah Stevens, a Republican from Mount Airy who sponsored the House’s version of the abortion bill, asked DHHS in an email for information on “the types of problems found in the abortion clinics that were not closed” during recent inspections.
A resulting records check at DHHS noted that Femcare hadn’t been cited with any major deficiencies since 2006, the date of the clinic’s last licensure inspection. Small problems had cropped up in other, more limited inspections at the clinic since that date, but they had been quickly rectified, the documents indicate.
A week later, on July 18 and 19, DHHS performed an unannounced inspection at Femcare, setting the stage for the clinic’s suspension. On July 23, Dr. Lorraine Cummings, who owns Femcare, emailed DHHS to report on her initial steps to fix problems turned up in the inspection. She had ordered some new medical equipment to replace items found to be deficient, scheduled a fire drill, hired a contractor to maintain plumbing and medical gas lines, and directed a staffer to to update the clinic’s infection control plan, among other measures, she wrote.
Meanwhile, in Raleigh, the abortion debate was reaching a fever pitch, as protesters showed up in legislative chambers and a version of the abortion bill caught flack for being bundled with motorcycle safety provisions. On July 11, the House passed a version of the bill, and on July 25, the Senate did as well.
A publicity push about Femcare’s suspension
McCrory had pledged during his 2012 campaign for governor that he wouldn’t tighten abortion restrictions, and he threatened to veto an early version of the 2013 abortion legislation.
But on July 29, the governor signed the new abortion law, which added a slew of new rules while saying that they should be enforced “without unduly restricting access” to abortion services. Among other provisions, the law directed DHHS to plan for how it would require clinics to meet ambulatory surgery standards and to deliver that plan to the N.C. General Assembly by April 1, 2014.
Two days later, on July 31, DHHS suspended Femcare, citing 23 rules violations that “revealed an imminent threat to the health and safety of patients,” as a department press release put it.
Issuing the release, which was titled “DHHS Takes Action to Protect Health and Safety of North Carolinians,” was a departure for the department: DHHS had recently suspended two other N.C. abortion clinics, in Charlotte and Durham, without issuing releases regarding those suspensions.
This time, the recently released records show, DHHS and McCrory administration staffers made a concerted effort to publicize a clinic’s suspension. In the days leading up to the announcement, for example, DHHS prepared a background briefing document about the clinic and sent it to department staff who would likely be fielding questions about Femcare.
Then, Ricky Diaz, DHHS’s chief spokesperson at the time, sent early word of the suspension to an Asheville Citizen-Times reporter. “I’m giving you a 5 minute heads up on this,” Diaz wrote the reporter in an email that shared the release a few minutes before it went public at about 5:30 p.m. on July 31.
Once the release went public, McCrory’s top spokespersons quickly helped spread the news.
At 5:36 p.m., Kim Genardo, then the governor’s communications director (and a former political reporter for WNCN, the Raleigh-based NBC affiliate), forwarded the press release to a reporter at the Raleigh CBS station, WRAL. “Now here is a story …” she wrote in a message prefacing the release.
Two minutes later, Ryan Tronovitch, another McCrory press aide, shot a similar message, with the press release, to two Raleigh-based Time Warner Cable News reporters. “Now this is an actual story,” he wrote.
In Asheville and across the state, news outlets pounced on the news and quickly filed reports. Both Diaz and Kevin Howell, DHHS’s legal communications coordinator, worked late into the evening monitoring the early press coverage and sharing it with top department officials and McCrory administration staff, the records show.
‘Pushing back’ after the initial reports
In one of the early reports, Asheville’s ABC affiliate, WLOS, said on its website that “the only clinic that could provide abortions in North Carolina, under newly passed regulations, has its license suspended.” Minutes later, Diaz forwarded the report to other top DHHS staff and wrote, “I pushed back on this on the phone w/ the reporter.”
Later the same evening, WLOS shared a statement from Cummings, Femcare’s owner and sole doctor.
“Since the state’s last site visit in August 2006, there have been no changes in our operating protocols, but increasing regulations require us to make changes,” Cummings wrote in a prepared statement. “Standards that were acceptable when we were last inspected have changed and, as soon as we were notified of them two weeks ago, we began the process of meeting each one of them.”
Meanwhile, other news outlets published reports suggesting that North Carolina’s new abortion law was behind Femcare’s suspension. DHHS and the McCrory administration staff moved quickly to counter that notion.
At 10:09 p.m. on July 31, Diaz forwarded Cummings’ statement to WLOS to DHHS Secretary Aldona Wos, other top department officials and key aides to McCrory.
The next morning, DHHS scrambled to prepare a rebuttal letter to Cummings, which it ultimately sent to administration officials and reporters as well. “These regulations have not been revised since 2003,” the letter said. “Therefore, it is inaccurate to suggest that increasing or changing regulations led to the closure of your facility.”
Cummings, who was recently contacted by Carolina Public Press to respond to the new records release, declined to comment.
For the next couple of days, the department and McCrory’s office disputed the notion that new restrictions or political considerations had prompted Femcare’s suspension. The governor himself reacted to one report, according to the records.
On Aug. 2, USA Today‘s website published a brief Associated Press report on the matter, which began: “North Carolina’s health agency has closed three abortion clinics in three months for violating health and safety regulations that previously did not cause suspensions.”
According to the new records, McCrory read the report and promptly sent a message to his spokesperson, Genardo, and Jonathan Felts, then one of the governor’s senior advisers. “USA just did a hit piece on abortion clinics closing that must be changed ASAP,” he wrote in the email from his iPhone. Genardo forwarded the message to Diaz, adding, “Need to pushback and make corrections where needed ASAP.”
Femcare re-opens without fanfare
After several days of reports about whether Femcare’s suspension signaled a new crackdown on abortion in North Carolina, the news tapered off.
On Aug. 23, the clinic quietly re-opened, having addressed all of DHHS’s concerns and gotten its state license to operate restored.
In the days that followed, DHHS fielded another round of reporters’ questions about Femcare, and, when asked, provided documents noting the end of the suspension. But this time, the department, which had recently staged the publicity push about the suspension, issued no press release on the matter.
Key Documents From Nc Dhhs Femcare Files (Text)
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There are a lot of regulations regarding medical gas.