Legal Abortion Deaths, Part II: Missreported, Unreported, & Covered Up

LEGAL ABORTION DEATHS, PART II: MISREPORTED, UNREPORTED & COVERED UP

by James A. Miller

Beginning in 1979, the Centers for Disease Control undertook a new surveillance of ectopic pregnancy-related mortality, and published its first ectopic pregnancy surveillance report in 1982. As a result all deaths associated with ectopic pregnancy, whatever connection they might have with induced abortion, were excluded from the abortion death totals and the Annual Abortion Surveillance Reports.1

The CDC's new rule had a most pernicious effect: ectopic pregnancy deaths subsequent to induced abortions would no longer be counted in the abortion death totals but now all such deaths automatically would be dumped into the pregnancy/childbirth maternal mortality statistics. The relation of such deaths to legal abortion would never be known, it at least by the general public. And once again the invidious comparisons between the alleged safety of legal abortion and the supposedly greater danger associated with child-bearing could be more easily made.

The CDC also went back over all the older Abortion Surveillance Reports and removed all the ectopic/induced abortion deaths which had been counted previously; at least 10 such deaths were removed in this fashion.

In a 1990 article regarding the incidence of ectopic pregnancy concurrent with induced abortion, CDC researchers disclosed that from 1972 through 1985 a total of "24 women who underwent an induced abortion died as a result of a concurrent ectopic pregnancy" Of course, under the 1979 CDC guidelines, none of these deaths would be counted as abortion-related, not even the three cases reported in which the deaths occurred "during [the] abortion."2

New York City alert: A smoking gun?

In June 1987, Dr. Stephen Joseph, New York City's then-Commissioner of Health, issued an "ANESTHESIA ALERT" to all "Gynecologists, Anesthesiologists, Administrators, and Others Concerned With the Provision of Abortion Services," warning of the risks to abortion patients from the routine "use of general anesthesia for induced abortion."

The "Alert" noted that general anesthesia was "more commonly used in New York City than other places for performing abortions" and that the Alan Guttmacher Institute, Planned Parenthood's research arm, had "estimate[d] that in 1982, 66.1 percent of all abortions in New York were done under general anesthesia, or a combination of heavy sedation and local anesthesia." This compared with just "21.8 percent in other parts of the United States."3

The real eye-opener in the "Alert" was found in several statistics cited in the third paragraph of the short document:

"During the period between 1981 and 1984, there were 30 legal abortion-related deaths in New York City ..." These 30 deaths constituted "17.0 percent of all legal abortion- related deaths in the United States during that period, although only 12.3 percent of all induced abortions were performed in New York City." "One third of these 130 deaths, namely] 10 were due to general anesthesia." "...in the rest of the United States less than 10 percent of abortion related deaths were due to general aesthesia (12/ 146)."

Several observations are in order:

1) During the 1981-1984 time period during which Commissioner Joseph said New York City had suffered "30 legal abortion-related deaths," the CDC reported a total of "just" 42 legal abortion deaths throughout the entire United States. If the CDC death total is correct, New York City would have accounted for 71.4 percent of all U.S. abortion deaths while performing "only 12.3 percent of all [the] induced abortions" in the United States during that four-year period.

2) But Commissioner Joseph was quite explicit in stating that New York

City's "30 legal abortion-related deaths" constituted "17.0 percent of all legal abortion- related deaths in the United States during that period." Following Commissioner Joseph, simple division (30 divided by 0.17) yields a total of 176 legal abortion-related deaths throughout the United States during the years 1981-1984! (Yet the CDC reports "just" 42 abortion deaths in that period, less than 25 percent of the total derived from Commissioner Joseph's figures).

3) Commissioner Joseph's figures regarding the ratio of U.S. abortion deaths outside of New York City which were due to general anesthesia- 12 of 146-provides some confirmation of his total abortion death figure for 1981-1984: 146 deaths in the United States exclusive of New York City, plus 30 abortion deaths in New York City, adds to 176 total abortion deaths throughout the country, the very figure previously derived from Joseph's "17.0 percent" statistic. At the very least, the document's abortion figures are internally consistent. But are they correct?

Most of the 10 New York City abortion-anesthesia deaths in that time period can be verified. An article in the CDC's own MMWR report substantiates seven of those anesthesia deaths and lists four more abortion deaths from "other causes," all occurring between January 1980 and June 1985.4

Another report states that of the "ten abortion related deaths occurring 1980-84, in eight the cause of death was anesthesia-related."5 Combining the data from these two reports, it is seen that eight of the 10 anesthesia deaths (80 percent) which Commissioner Joseph cited have been accounted for as well as 12 of the 30 abortion deaths (40 percent). It's not a perfect match, but it's all there is, and the figures are definitely well in the ballpark.

A call was made in early August 1995 to the New York City Health Department to see if Joseph's figures were still accepted, or if a correction had been made subsequently. A statistician for the health department stated that as far as he knew the numbers "were correct" and, moreover, he knew former Commissioner Joseph and was confident he would not make an error in his statistics. Unfortunately, when the health department employee realized why I was interested in the dichotomy between Joseph's statistics and the ones issued by the CDC, he became quite belligerent, started an argument, and hung up.

Obviously, further investigation must be done. If Commissioner Joseph's numbers are correct, over 130 abortion deaths between 19801984 would have been misreported or covered up.

Maryland abortion deaths

The year 1989, for which the CDC has yet to report abortion death figures, was a very unlucky one for women undergoing abortion in the state of Maryland. There were at least three abortion deaths that year, all clustered in just one of the states's 23 counties, Prince George's. A fourth woman who also underwent an abortion in Prince George's County in 1989 finally expired in late 1992 as a result of the overwhelming injuries she suffered in her abortion.

None of the deaths is listed as an induced abortion-related death by the Maryland Department of Health. Indeed, only one of the deaths is listed as a maternal death; that one was an ectopic pregnancy death subsequent to an induced suction abortion. When this writer queried the CDC about this cluster of abortion deaths, it was discovered that they only knew of the ectopic death. Of course, as previously discussed, ectopic deaths are now never linked by the CDC with an earlier abortion, no matter how proximate a cause of death the abortion might have been.

In two of the death cases, however, the CDC will never be able to learn about the connection with abortion, or even pregnancy for that matter, since the autopsy reports have been deliberately miscoded by the Office of the Chief Medical Examiner of the State of Maryland!

Consider the facts:

In one case a 16-year-old girl, who underwent an abortion without her parents knowledge or consent, died from severe internal hemorrhage and an air embolism, the result of her abortionist's carelessness in causing a "laceration [that] extended into the vagina, cervix and the [uterus]." Although the medical examiner stated on the front page of the autopsy report that the injury occurred as a result of a "therapeutic misadventure," and termed the death an "accident," he did note, on the next-to-the-last line of the last page, that the injury occurred during an "evacuation procedure which resulted in perforation of the uterus."9

Back on the front page, however, the death was incorrectly coded under the International Classification of Diseases, 9th Revision, the system used throughout the world to accurately record the cause of deaths. Instead of using the specific codes pertaining to abortion injuries 635.1: a legally induced abortion complicated by ... excessive hemorrhage, and 635.2: complicated by damage to pelvic organs, and 635.6: complicated by embolism, the medical examiner hid the truth of what really had occurred by utilizing codes N867 and E870.

An "N code" describes the nature of the injury while an "E code" designates the external cause of the injury. N867 simply indicates that the injury was to the "pelvic organs" and E870 designates an "accidental cut, puncture, perforation, or hemorrhage during medical care." Note that in using these particular codes the medical examiner has managed to completely hide the fact that the injury occurred during an abortion, and was in fact, caused by the abortion. Indeed, with the codes chosen, there is no way that the death can even be identified as pregnancy-related.

No one searching death records for abortion or pregnancy-related cases would ever think of pulling up for examination a female death coded in the upper 800's-abortion and pregnancy death code numbers range between 630-676.

A second case involved a woman who went "into general cardiac arrest while under general anesthesia" during her abortion, as a result of which her "brain was deprived of oxygen for at least 12 minutes." After three days of "no brain activity," doctors at the hospital to which she had been removed -discontinued life support systems."'

Once again the same Chief Medical Examiner of Maryland signed the autopsy report, and once again one had to go to the very last page of the autopsy report, this time to the third from last line, to discover that an abortion was involved.8 This time around the death codes utilized were N977 and E980, the former indicating that the death resulted from -poisoning by other and unspecified drugs and medicinal substances," while the latter designated a "poisoning" in which it cannot be determined -whether [it was] accidentally or purposely inflicted."

Again, no researcher would think of looking for an abortion-related death among codes numbered in the upper 900's. The medical examiner has again managed to code a death so as to completely omit any connection with abortion. An accurate coding would have been 635.7: legally induced abortion with specified complication-in this case, an anesthesia overdose-along with the appropriate E code for the two anesthetic agents administered, E933 (Chlorpheniramine) and E937 (Phenobarbital). These E codes correctly identify the anesthesia as being administered for "therapeutic use"; the E codes utilized by the medical examiner are more appropriate for a suicide or an accidental poisoning.

Another 1989 case-the woman who eventually died more than three years after the abortion-involved the same clinic as the anesthesia case (above). In this instance an anesthesia overdose was also administered, resulting in massive brain damage from the deprivation of oxygen. The patient, rendered a paraplegic and mentally impaired, eventually died of pneumonia. Although this victim's life basically ended a few minutes after her abortion began, the death will never be classified as abortion-related due to the time interval involved.

With the CDC currently reporting 10 or fewer abortion deaths per year throughout the entire nation, one cannot help but wonder how, in just six months, one Maryland county of some 750,000 population (.3 percent of the nation's population) could have four (or three) abortion deaths within its boundaries.

Another New York report In 1988 the New York State Department of Health issued a report on Maternal Mortality in the state during the years 1980- 1986.9 The study examined all upstate New York "deaths assigned a cause of death in the ICD-9 range of codes 630-676." (Note: codes numbering in the 800's and 900's were not even considered, but those were the ones utilized in the Maryland cases previously discussed).

Through such record-matching, -27 deaths were identified... [as] associated with induced abortions in upstate New York." The researchers estimated that "at least 47 additional [abortion-related! deaths may have occurred in New York City" but, due to different record keeping systems in the City, a similar search could not be undertaken. (Former Health Commissioner Joseph's numbers are looking

better all the time.)

Of the newly found 27 upstate abortion-related deaths, three were recorded as "indirect" maternal deaths, nine as non-maternal deaths, and 15 were not reviewed. Thus at least 25 percent of the newly discovered abortion deaths were "missed" and not properly recorded in the State's statistics.

The three new upstate "indirect" maternal abortion deaths represented 150 percent (!) of the two that were previously known (both in 1980). And who knows how many more such instances might be found among the 15 cases -not reviewed" or even among the nine which were labeled -non-maternal"?

James A. Miller is HLI's director of research.

Taken from the December 1995 issue of "HLI Reports." To subscribe contact: HLI Reports 7845 Airpark Road, Suite E Gaithersburg, MD 20879

1 CDC Abortion Surveillance Report, Annual Summary 1978, November 1980 (issued), p. 7; Annual Summary 1979-1980, issued May 1983, p. 9; and Annual Summary 1981, issued November 1985, p. 9, respectively.

2 "Ectopic pregnancy concurrent with induced abortion: Incidence and mortality," , Vol 162. March 1990, pp. 726-30.

3 "Anesthesia Alert," Stephen C. Joseph, M.D., M.P.H., Commissioner of Health, The City of New York. June 5, 1987.

4 Morbidity and Mortality Weekly Report (MMWR), Vol. 35, No. 37, 19 September 1986, CDC, p. 579

5 "Changing patterns of maternal mortality in New York City during the past 20 years (1965-1984), undated, New York City Department of Health, p. 4.

6 Maryland Autopsy Report No. 89593, (Erica Richardson).

7 , 13 August 1990, pp A1, 6 AT 6.

8 Maryland Autopsy Report No. 89-1873, (Debra Gray)

9 "Maternal Mortality in New York State: 1980-1986, New York State Department of Health, November 1988, pp. 3-4.