Ruling expected soon in disciplinary case initiated by pro-life groups
By Cheryl Sullenger
Albuquerque, NM – New documents, including transcripts of a Medical Board disciplinary hearing held in November, 2012, indicate that late-term abortionist Shelley Sella committed four acts of gross negligence during a 35-week abortion on a woman with a history of previous Cesarean Section that resulted in a ruptured uterus.
The documents were released recently by the New Mexico Medical Board in response to an open records request made by Tara Shaver of Project Defending Life. Both Mrs. Shaver and Operation Rescue had filed the original complaints with the NMMB after receiving a 911 recording of a medical emergency that took place at Southwestern Women’s Options, a late-term abortion clinic in Albuquerque, on May 12, 2011. The records also show that it is the position of Sella and her attorney, Joseph Goldberg, that the complaints should not have been considered by the Board due to the fact that pro-life activists filed them.
The NMMB plans to issue a formal “Decision and Order” on the case against Sella on February 7, 2013. Possible discipline ranges from public censure to license revocation.
Also on the agenda is the appointment of a Task Force to amend Board regulations on Complaint Procedures.
“The New Mexico Medical Board should be thanking us for filing these complaints, not devising ways to cut us out of the complaint process based on our deeply held convictions,” said Troy Newman, President of Operation Rescue and Pro-Life Nation. “We have uncovered an extremely dangerous abortion practice taking place on a weekly basis that is seriously endangering the lives and health of women. Instead of criticizing us for bringing this to the attention of the Board, they should be grateful that we uncovered the violations during dangerous late-term abortions that fall well below the standard of care.”
After hearing two days of testimony from Sella and two expert witnesses before Hearing Officer David K. Thompson, Administrative Prosecutor Daniel Rubin has recommended that Sella be disciplined for “gross negligence” for breaching the standard of care during her treatment of a patient referred to as “ML”. Those four breaches included:
Administering Misoprostol, a uterine contracting agent, during a “trial of labor after cesarean” or TOLAC. Sent M.L. to a hotel where she could not be monitored after administering misoprostol. Administered Misoprostol and Pitocin, another uterine contracting agent, simultaneously. Attempted to abort ML’s fetus in a clinic rather than a hospital.
“The Respondent [Sella] was well aware of the risks of uterine rupture associated with her treatment of M.L., but willfully ignored such risks,” wrote Rubin in his Closing Arguments and Proposed Finding of Fact, dated January 4, 2013.
The case has national implications and could affect ability of abortionists to continue doing risky third trimester abortion in “stand-alone clinics” using a drug that is known to cause unpredictable and often powerful contractions.
Disturbingly, Sella worried, (as if it was unthinkable), that women with previous C-sections “would be forced to carry a pregnancy to term,” should there be an adverse ruling.
“It is possible that this case will set a new standard of care for third-trimester abortions, which those currently doing this barbaric procedure cannot meet. The implications are huge,” said Newman.
Currently, there are no set national standards for third trimester abortions that are currently being done in four “stand alone” clinics throughout the United States. Abortionists that admit to doing the procedures, in addition to Sella and her New Mexico associate Susan Robinson, are Lee Carhart in Germantown, Maryland; Warren Hern in Boulder, Colorado; and Josepha Seletz in Los Angeles, California. Sella told the Board that she is currently training Carmen Landau to do third trimester abortions in Albuquerque.
Misoprostol poses risks of rupture
The case began when ML, a 26-year old woman with a history of a previous cesarean section delivery, traveled to Southwestern Women’s Options, a late-term abortion clinic in Albuquerque, New Mexico, for an abortion of her pre-born baby at 35 weeks gestation. Her New York physician recommended the abortion after the baby was diagnosed with an abnormally large head and brain. The baby’s head was estimated to be the size of a baby at 40 weeks. Sella agreed to do the abortion on the basis of the fetal anomaly and the supposed distraught mindset of the patient.
Sella argued strenuously that obstetric standards and warnings issued by the American College of Obstetricians and Gynecologists simply did not apply to abortions. ACOG does not support the trial of labor after cesarean (TOLAC) in a non-hospital setting and prohibits the use of Misprostol to induce or augment labor in women with histories of previous cesarean deliveries.
Misoprostol, also known as Cytotec, was originally developed to treat stomach ulcers but was later discovered to have the unfortunate side effect of initiating uterine contractions in pregnant women. Misoprostol use in abortion is unpredictable and can cause intense uterine contractions.
Despite the risks, Misoprostol is used in two ways during a third trimester abortion. First it is administered vaginally to “ripen” the cervix and prepare it for the delivery of the dead baby. Secondly, it is administered buccally (between the cheek and jaw) to induce or augment labor.
Women who have had previous C-Section deliveries like ML are at greater risk for uterine rupture during labor. Misoprostol dramatically increases that risk and that is why ACOG considers it to be too dangerous to use on these women.
The Tiller Protocols
Sella claimed that protocols developed by Wichita abortionist George Tiller should be used for the standard of care for third trimester abortions rather than the tougher obstetrical, ACOG standards.
However, Dr. Gerald L. Bullock, an expert for the Board, testified that obstetrical standards are appropriate because there is essentially no difference between the procedure used in a third trimester abortion and an instance of a women in her third trimester whose baby has spontaneously died in the womb. Obstetrical standards are the unquestioned standard in the latter circumstance.
Sella learned to do the third trimester abortion procedure from the late George Tiller. Sella testified that she worked for Tiller at his infamous late-term abortion clinic in Wichita, Kansas, from 2002 until his death in 2009. Tiller developed the controversial abortion process and was considered the national authority on third trimester abortions.
Not mentioned in the Sella disciplinary proceedings was the fact that Tiller faced an 11-count petition for illegal late-term abortions brought by the Kansas State Board of Healing Arts that would likely have cost him his medical license, had he lived.
Another Tiller associate that also worked with Sella in Wichita, Ann Kristin Neuhaus, had her medical license revoked last year on a nearly identical petition. Both the Neuhaus and Tiller actions were based on complaints filed by Operation Rescue.
Sella testified that she uses the Tiller protocols in third-trimester abortions as do all other abortionists that do these grisly procedures, which are opposed by nearly 90% of Americans.
The testimony at Sella’s November disciplinary hearing revealed a time-line of events that led to ML’s uterine rupture and subsequent transfer to UNM hospital for emergency surgery. It paints a graphic picture of what can go wrong when abortionists consider themselves exempt from accepted medical standards.
May 10, 2011
On the morning of May 10, 2011, ML arrived at Southwestern Women’s Options (SWO) in Albuquerque for her first appointment. ML has been interviewed by a telephone “counselor”– likely an unlicensed and unqualified clinic worker — who took information about her state of mind and medical history – including her history of previous cesarean section – and relayed it to Sella and her associate, Susan Robinson, who also does third-trimester abortions at SWO. The two consulted and agreed that ML was a good candidate for the Induction abortion used at SWO.
On the day of ML’s arrival, Sella initiated “fetal demise” by vaginally injecting Digoxin into ML’s fetus. This drug stops the baby’s heart. After an ultrasound confirmed that the baby was dead, the patient’s cervix was packed with laminaria, which are seaweed sticks that slowly expand and dilate the cervix in preparation for labor and delivery. Sella then administered 100 micrograms of Mispropstol vaginally for the purpose of “softening the cervix.”
Dr. Bullock testified on behalf of the prosecution that the standard dosage of Misoprostol generally used for induction of labor is 50 micrograms, half of the dosage given by Sella when there was no intention of inducing labor. Afterwards, ML was sent to her hotel where no monitoring of her condition occurred. Dr. Bullock considered this a serious breech in the standard of care.
Sella testified that she intended to use the frequent dosing of Misoprostol along with numerous laminaria insertions and removals to prepare ML’s cervix for labor induction on the fourth day. Sella denied that she was inducing labor by administering Misoprostol vaginally on the first day.
To that, Dr. Bullock responded, “Well, yeah, I would agree that she probably intended to soften the cervix, but whether you intend to induce labor or not, that is what it did, and the lady came back in the second day in the late evening in active labor, and you can’t call that spontaneous labor, and you can’t call that spontaneous labor. This was Misoprostol induced labor. If the lady had stayed at home and hadn’t been at the clinic, she would have never gone into labor that day.”
On the second day, May 11, ML returned to the clinic in the morning. Sella changed out her laminaria, gave her another dose of Misprostol, and again sent her back to her hotel with instructions to take yet another dose of the drug at 3:00 pm. ML took the drug as instructed.
At about 5:00 pm that same day, ML returned to the clinic for another laminaria change and Misoprostol dose. However, while Sella was inserting new laminaria, she inadvertently broke her bag of water.
While it is unknown exactly when ML’s contractions began, Dr. Bullock testified that this incident likely stimulated the onset of labor. In fact, there was great debate from expert witnesses about the times and dosages of Mispropstol and other medications administered to ML due to confusing medical records kept by the clinic, including some inaccurately recorded dosage times.
The onset of labor prompted ML report back to the clinic for a third time on May 11, the second day of the process, near the midnight hour. Sella was forced to scrap her plan to begin labor on the fourth day of the abortion and took steps to manage ML’s labor in preparation for an early delivery.
The final day
At shortly after midnight on May 12, Sella checked the progress of ML’s cervical dilation and again administered Misoprostol. At the same time, Sella began to give her patient Pitocin, another uterine stimulant that is not supposed to be used simultaneously with Misoprostol.
It is estimated that the Misoprostol was in ML’s system along with the Pitocin for 3½ hours. Meanwhile, ML was given pain medication, sedated, and placed in the gurney room. She was supposed to sleep through the night in mild labor and be checked for progress again around 7 am. There was never any testimony concerning how well ML actually did through the night or what her pain/comfort level was during this ordeal.
The large size of the baby’s head created an increased risk of uterine rupture, a fact was apparently ignored by Sella, as noted in the Board documents. ML had received a lower transverse incision during the surgical delivery of a previous child. That incision type is supposed to be less likely to rupture that the classical vertical incision, but even so, that did not prevent the Sella’s reckless practices from inflicting harm.
In the morning of May 12, Sella removed the laminaria and checked ML’s cervix. Sella had intended to collapse the skull in order to make it smaller and easier to deliver. However, she could no longer feel the baby’s head as she had expected. She conducted an ultrasound and discovered that the baby was now lying sideways in the womb. At that moment, she suspected that the uterus had ruptured.
Sella had an office worker call 911 and request an emergency transport for ML to UNM. Since Sella has no hospital privileges, she had to call one of three abortionists from the UNM Center for Reproductive Health, a stand-alone abortion clinic affiliated with the UNM Medical Center, to treat ML at the hospital. But those abortionists have problems of their own. Several 911 calls placed from the UNMRHC that have been obtained by Project Defending Life and Operation Rescue indicate a regular pattern of botched abortions at that facility as well.
A 7.5 pound baby?
It took 24 minutes from the time 911 was called for ML to arrive at the emergency room.
Once there, ML was rushed into surgery where her dead baby was removed and her uterus repaired. A unknown hospital physician noted on her chart that the baby weighed 7.5 pounds. Sella vigorously disputed that assessment. She opined that the baby was never weighed and that ultrasound measurements placed the baby’s weight at 5 pounds, 13 ounces. We may never know the truth.
“There is little difference if the baby weighed 7.5 pounds or just under 6 pounds. This was a baby that was the size of many full term babies. The entire revolting discussion on the record attempting to justify this is completely barbaric,” said Newman.
“A thousand wonders”
Dr. Bullock noted that the rupture occurred when the baby’s over-sized head came down and stretched the c-section scar, where the uterus was weak. The head broke through the scar and tore the uterus, forcing the baby – at least partially – into the woman’s abdominal cavity.
“Well, you know, everybody was really lucky this time, because quite often, particularly the way this rupture went, it was a thousand wonders that it didn’t extend another centimeter into the uterine arteries, which would have had a horrendous bleeding episode if that had happened,” he said.
Dr. Bullock described ML’s injuries and the harm done to her:
“Yes, the understood harm is going to be another cesarean, a scar that went caddywhompus, the scar that went crossways…all the way down to the cervix, which will make it more hazardous. In fact, one of the doctors at UNM said that she should not get pregnant again.”
Rules written in blood
The written Closing Argument document submitted by Board prosecutor Daniel Rubin states that no specific national standard exists with respect to late-term abortions and that obstetrical standards should be applied in this case.
“In other words, these late-term abortionists just make things up as they go along,” noted Newman. “According to Sella’s own testimony as well as her expert witness, Phillip Darney – himself an admitted late-term abortionist – all third-trimester abortionists are engaging in horrifically dangerous procedures with drugs that should not even be used in settings where there is no access to immediate emergency care. Yet, they continue to insist that the higher obstetrical standards should not apply to them. But each one of those rules in written in blood. ACOG and other standards prohibit the conduct that Sella engaged in because at some point, someone died from similar circumstances.”
Defense expert’s vested interest
Darney is the head of the Bixby Center for Global Reproductive Health at the University of California San Francisco. This is the same organization that is training non-physicians to do abortions. The training program made news last when a California lawmaker proposed changing the law to allow these non-physicians to do abortions without the supervision of licensed doctors.
Darney had every reason to speak favorably about Sella’s third-trimester abortion protocols. He admits that he does abortions at the Women’s Option Center in San Francisco General Hospital and that some of those abortions are in the third trimester. Darney’s organization also as established a training program through the University of New Mexico that uses Sella and Southwestern Women’s Options as a training facility for abortionists in his program.
Shadowy world of regulatory gaps
In the end, ML’s unfortunate experience has revealed a shadowy world of regulatory gaps where abortionists make up their own rules. In the abortionist’s world, time-tested standards of care simply do not apply. They simply make up their own. This is a world where abortionists can subject women to dangerous practices that would not be tolerated in any other medical discipline, yet expect to be treated like they walk on water.
By filing these complaints, Project Defending Life and Operation Rescue have attempted to close those gaps and return the abortionists to the real world of medical accountability and ethics.
Abortionists often consider themselves a special class that is exempt from the mundane rules that apply to everyone else. That arrogant attitude is fed by liberal politicians and other pro-abortion society-influencers. Earlier this month, Sella was featured along with Robinson, Hern, and Carhart in a film that premiered at the Sundance Film Festival called “After Tiller.” The four third-trimester abortionists were lionized and applauded for their bravery in providing abortions for which few have the stomach.
One has to wonder how much courage it really takes to kill a defenseless baby in the womb and inflict upon vulnerable women dangerous practices that fall well below national standards.
To illustrate this, one can imagine that on one hand, there is a 35-week pregnant woman with a history of c-section that hasn’t felt movement for awhile and is tragically informed that her baby has died in the womb. On the other hand, there are women like ML, who has her 35-week baby killed by an abortionist. At that moment, one might think that both women share a common circumstance, but nothing could be further from the truth.
The first woman will be treated according to the highest standards of medicine in order to protect her life, her health, and her future fertility, while women undergoing abortions are subjected to dangerous practices, prescribed drugs that endangered their lives, and as in ML’s case, robbed their ability to bear children.
“Sella was glowingly presented in her disciplinary hearing as an expert who was ‘well trained’ in third trimester abortions. If this is the best abortionists have to offer, it just isn’t good enough,” said Newman. “We cannot and will not stand idly by while women are abused by the reckless indifference of the abortion cartel. We will continue to hold abortionists accountable for their negligence, just as we have endeavored to do with Sella. As far as the Board’s highly anticipated decision goes concerning her professional fate, we are simply praying for justice.”
Closing Argument and Proposed Findings of Fact (prosecution) Opening Brief on behalf of Sella Closing Brief on behalf of Sella Findings of Fact and Conclusions of Law (Sella) Hearing Transcript, Nov. 29, 2012. Part 1 Hearing Transcript, Nov. 29, 2012. Part 2 Hearing Transcript, Nov. 30, 2012. Part 1 Hearing Transcript, Nov. 30, 2012. Part 2 More on Sella’s Background