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State regulators find problems at a Charlotte abortion clinic

A Charlotte abortion clinic is under state scrutiny after regulators found evidence of conditions one official said placed patients in "immediate jeopardy."

Now back open, A Preferred Women's Health Center was shut down several days in February and was threatened with permanent closure after its first state inspection in more than three years revealed what investigators deemed disturbing problems. "If we feel that the patient's health and safety is in immediate jeopardy, then that's about as serious as it gets," says Jeff Horton, chief operating officer for N.C. Division of Facility Services, which regulates clinics.

The clinic on Latrobe Drive, one of three clinics in Charlotte that performs abortions, had its operating certificate downgraded to "provisional." The status change means its license could be yanked or -- more likely -- restored to full status once inspectors are satisfied with changes at the clinic.

The clinic's chief administrator says the problems that DFS found are the result of misunderstandings and the deliberate ploys of former staff to get another employee fired and to undermine her mission to help women. Most deficiencies, she said, were related to paperwork, not patient care.

The DFS inspectors' report, however, found evidence of disturbing outcomes for several patients.

• Emergency medical technicians found a 25-year-old woman lying on the floor when they responded to a call on Feb. 1. The emergency services report said she was "laying on extremely dirty floor without any type of barrier between patient and floor. Patient has bled on floor and self." That was nearly three hours after clinic records indicated she'd supposedly been discharged in good condition -- a discrepancy a nurse was unable to explain to DFS. Nor could the nurse explain why the patient was on the floor.

• A 33-year-old patient, 17 weeks pregnant, underwent an emergency hysterectomy at a Charlotte hospital after complications developed during a second-trimester abortion at the clinic on July 19, 2006. DFS investigators found indication that records "may have been intentionally destroyed," though they later reappeared without nursing notes missing.

• After problems developed during a second-trimester abortion on Nov. 7, 2006 a 15-year-old girl spent a week in a hospital, where doctors performed a hysterotomy (a Caesarean section), repaired a uterine perforation, removed part of her colon, and installed a colostomy bag. According to DFS records, the doctor took a long time to call 911 after a nurse suggested calling an ambulance. Nor did he want staff to talk with girl's mom who was in the waiting room, according to the DFS report.

• Three days after a 24-year-old patient was transferred to a hospital after an unsuccessful second-trimester abortion, a nurse told DFS inspectors she couldn't remember the patient. Emergency services records indicated the ambulance left on Feb. 6 (2007) with the woman 47 minutes before clinic records indicated she'd had her blood pressure taken.

The inspection also documented serious violations of policy and law: A doctor performed an abortion one icy morning without a nurse present. Patient records weren't adequately kept -- and some records appeared intentionally destroyed. Some equipment lacked evidence of proper maintenance. Patients' vital signs weren't recorded accurately. Patients weren't told if doctors had admitting privileges at nearby hospitals.

Lois Turner, the clinic's chief administrator, says A Preferred Women's Health Center operates according to high standards. She acknowledges mishaps but says her clinic has far lower complication rates than national average.

"We're held to such a higher standard than any other doctor's office or any other outpatient surgical facility," she says emphatically. "We're held to higher standards and that's OK -- I meet them. But we can be put in a bad light with the wrong person."

What happened when DFS interviewed staff in February, she says, was a set up by an employee with personal grudges who wanted a newer hire fired. She believes a staffer called in the complaint. She was absent when DFS inspected the clinic -- a decision she regrets.

The missing personnel records? Their absence was likely due to a disgruntled employee.

The patient that ambulance workers claim they found on a dirty floor in her own blood? The so-called dirty floors were actually clean floors made rusty by zealous cleaning with bleach. The patient, she says, may have tried to get up while a nurse swooned in a different room. "We had two emergencies going on at the same time ... apparently, it was just an unfortunate thing. It could happen anywhere at any time," Turner says.

The incorrectly charted patient records? Simply human error caused by doctors who were focused on patients, not paperwork. "If you're not sitting there with a stenographer, there can be charting errors," she says. "I don't think there was anything more than a doctor not doing it until a couple of days later."

A Preferred Women's Health Center's troubles with the state began Feb. 5, when DFS received a confidential complaint about the quality of care. Two inspectors, both registered nurses, inspected clinic records and interviewed employees on Feb. 8 and Feb. 9.

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