Phoenix -- An abortion practitioner too busy eating his lunch to check on a mother who was bleeding heavily after a botched abortion. Abortion facility staff members so inexperienced that they didn't know where the pens were. An abortion facility administrator who asked for medical help 20 minutes away rather than from the hospital across the street.
And when it was clear the mother was in serious trouble following the legal abortion, the abortion practitioner's phoned-in advice: "Well what do you want me to do_ Call 911."
A Phoenix police investigation report, obtained by The Arizona Republic, painted a picture of medical chaos and irresponsibility on the day 33-year-old Lou Anne Herron died after going to the A-Z Women's Center for a legal abortion. The Republic also obtained copies of a police investigation into a full-term unbon child who was nearly aborted at the abortion facility two months after Herron's death.
The Maricopa County Attorney's office is looking at the reports to decide whether to charge John Biskind, 72 -- the abortion practitioner who performed Herron's abortion April 17 and delivered the unidentified baby -- and Carol Stuart, 61, the abortion facility administrator.
The police investigation included interviews with women, abortion facility workers and former employees. It found:
- Staff members did not believe their own blood pressure measuring instruments because Herron's readings were so low.
- Herron asked for pain medication but staff couldn't give her any because she was supposed to bring it herself.
- Abortion facility records showed Herron had relatively low to normal blood pressure readings minutes after employees called 911. Dr. Patricia Graham, a medical reviewer working with the police, believed the abortion facility records were faked.
What happened at the A-Z abortion facility to Herron was "so far below acceptable levels, it was scraping rock bottom," Graham said. Herron "would have survived with a minimal amount of care and treatment from Biskind," Graham told investigators. Graham is director of ambulatory services and perinatal addiction clinic at Maricopa Medical Center.
Biskind in August gave up his Arizona medical license, avoiding one investigational probe into Herron's death. In September, he surrendered his medical license in his home state of Ohio.
Herron arrived at A-Z, at 8 a.m. April 17. She had been told to get there early and wait her turn. Earlier sonograms of her unborn child revealed her baby was too advanced to fall before Arizona's limit on late-term abortions. Michelle Price, an abortion facility employee who took the sonograms, said she believed the most accurate reading was 24 weeks and two days.
She also knew that Biskind wanted the sonogram to come within legal limits.
Michelle told police that Biskind had told her "when you do an ultrasound you can turn the probe at different angles and get different results." Many employees recalled the flap over Herron's series of sonograms.
One abortion facility employee told police that she asked Biskind why he was performing an abortion on a woman so far along in her pregnancy. Biskind and Stuart, the abortion facility administrator, told the employee that it was none of her business, she told police.
The next day, Herron returned to the abortion facility. The night before, she had called a friend, Barbara Blanc, for a ride to and from the abortion facility. Even though she had known Blanc for 15 years, she hadn't told her that she was pregnant. She didn't want anyone to know, Blanc told police.
Herron had already paid $1,250 to A-Z, either in cash or by credit card. She was the first person in the abortion facility that day.
While Herron was waiting for the procedure to start, Stuart was telling personnel that they were going to be short-staffed.
According to A-Z's operating records, Herron started the abortion around 12:30 p.m. Her abortion took longer than normal, about 45 minutes, employees told police. Herron was taken to the recovery room where Theresa Jimenez, who had been working at the abortion facility for only a week and half, was stationed.
Her job at the abortion facility was Jimenez's first job as a medical assistant. She had been hired to answer phones and draw blood, not to work in the recovery room, where a registered nurse should have watched over women following their abortions. Jimenez told police she didn't even know where the recovery room's records or pens were kept.
Jimenez told police it was obvious from the start that Herron was having problems. Georgina Obeso, another medical assistant who had only worked at the abortion facility for a month, said Herron was bleeding so heavily that the blood was down to her knees.
The more senior abortion facility employees saw how heavily Herron was bleeding and went to tell Biskind. Lopez said he got mad that she interrupted his lunch. "Go talk to Carol," Biskind told Lopez.
Later, Biskind went in to check on Herron, Jimenez said. He got an intravenous tube started and told Herron there was nothing to worry about, Jimenez said. Biskind told the staff to clean up the bloody sheets and put down fresh bedding so they could tell if she was bleeding any more, medical assistant Michelle Price said.
Also during this time, Stuart called the Family Planning Institute in Scottsdale, another abortion facility, asking an employee from there to drive to A-Z to help out because they were having problems. Two Scottsdale employees said Stuart's call came around 2 p.m. The police timed how long it took to get from the Scottsdale clinic to A-Z: 20 minutes and that was with one red light, according to the police report.
Around the same time, Herron's friend Blanc had returned to the abortion facility. While in the waiting room, she could hear Herron saying "Help me, my legs are numb." She then heard someone tell Herron, "There's nothing wrong with you."
Jimenez told police she remembered talking with Blanc, telling her that everything with her friend was fine. Jimenez told police she wished she would have told Blanc "Something is wrong, and you should get her out of here."
Abortion facility employees remember clustering around Herron as she grew more pale. Jenil Begay, a three-year abortion facility employee who performed ultrasounds, said they could barely hear a heartbeat and told Stuart to call 911.
Both she and Deryl Whitlock, the employee who drove in from Scottsdale, again told Stuart to call 911. Stuart looked at them like they were "looney," Begay told police.
Stuart wanted to call Biskind. No employee was sure when Biskind left the clinic. Pager records subpoenaed by the police show that he wasn't paged by A-Z until 4:12 p.m.
When he called in, Price told him that they couldn't find a pulse and Herron's breathing was really slow. "Well what do you want me to do_ Call 911," Biskind callously told her.
The abortion facility made the 911 call at 4:17 p.m. According to the 911 tape obtained by police, employees also asked "Can we have you come to the side door, right on 10th Street and try not to use the sirens."
When paramedics arrived at the abortion facility, Herron was on a gurney and the sheets underneath her were soaked with blood, said Capt. Arnie Barajas of the Phoenix Fire Department. Herron appeared completely pale, cold and dead, he told police. She had probably been dead for a while, Barajas said.
The next day, Stuart contacted employees and told them not to talk about Herron's death. In the weeks after Herron's death, at least three employees resigned. At least two employees, including Whitlock, wrote detailed notes -- obtained by police -- about the botched abortion.
Whitlock died in a May 3 traffic accident after reportedly having sevre emotional reactions to Herron's abortion-related death. She had a blood-alcohol level of about 0.23 percent, according to an autopsy report. Her notes from the abortion were found on the floorboard of her car and turned over to police.
About two months after Herron's death, the abortion facility was rocked again -- this time by a botched abortion on a 17-year-old patient.
Biskind was performing an abortion on a girl June 30 and had a test that showed the teen to have been pregnant for about 23.6 weeks. But the girl was actually 37 weeks along and ended up giving birth to a baby girl.
The test -- one of six ultrasounds performed by an employee supposedly trained at the abortion facility -- was conducted with a broken machine, the employee told police. Obeso, the medical assistant, took separate ultrasound photos of the teen, Stuart picked out the best one and Obeso then discarded the rest, Obeso said.
The baby girl was adopted immediately and taken to Texas, where she remains, Phoenix police Detective Mike McCullough said. She is evaluated regularly, but fortunately does not appear to have any lasting injuries from the botched abortion, he said.
According to police, the teen had broken up with a boyfriend in February and was pregnant. She and her mother decided she would have an abortion and picked out the A-Z abortion facility from a phone book ad. They traveled to the Phoenix clinic, with $1,250 cash in hand.
On the day of the abortion, the teen was first on the schedule and her mother was told the abortion would take 15 minutes. An hour passed. The mother, in a waiting room, worried about her daughter. But staff members assured her the teen was all right, and "it was just taking longer than expected," she said. She wanted to see her daughter, but was told to be patient.
Then, she told police she began to hear her daughter crying loudly from a back room. Again, she asked to see her but was told no.
According to accounts by clinic staff, the teen was placed in a recovery room but Biskind didn't stay with her to monitor her. He performed at least one abortion in the meantime, if not more.
The teen continued to cry out, so loudly Stuart at one point told her to stop because she was scaring the other patients, medical assistant Marianna Pierce told police. The contractions were coming and, Pierce thought, the baby would ollow any minute. Why, she asked Davis, was the teenager still at the abortion facility instead of a hospital across the street_
Biskind assured them that when the teenager was ready to give birth, he would deliver the baby. Sometime later, the teenager gave birth. Pierce and other abortion facility employees said they wanted to call 911, but were told not to by Biskind. He reportedly said he didn't want any "hysteria" at the abortion facility and didn't want to "make a scene."
The baby, wrapped in a sheet with injuries to her head -- a skull fracture and several lacerations -- was taken by employees across the street to Good Samaritan Regional Medical Center. The police report said the baby was full term.