SPECIAL REPORT: PLANNED PARENTHOOD’S PARTIAL-BIRTH ABORTION BUSINESS
22 January 2019
Planned Parenthood is the biggest abortion provider in America. As a franchise of over 50 regional affiliates overseen by Planned Parenthood Federation of America, the organization is responsible for over 330,000 abortions every year, making up over a third of the national market. Many Planned Parenthood locations, including its flagship Margaret Sanger Clinic in New York City, commit abortions for any reason up to 6 months of pregnancy.
Planned Parenthood abortion doctors readily admit that their late-term abortion procedures present ethical and legal dilemmas that even professional abortionists find challenging.The ever-increasing size and familiarity of the second trimester fetus blurs the line between abortion and infanticide for even the most hardened professionals, and preterm infants have now been recorded as surviving as early as 5 months.
This is nowhere more readily apparent than in the grotesque partial-birth abortion procedure method, in which a living fetus is extracted intact from the womb only to be killed in the process of delivery. The concern to draw a bright line in the law between elective abortion and infanticide led Congress to enact the Partial-Birth Abortion Ban Act in 2003, which the U.S. Supreme Court upheld in 2007. The federal partial-birth abortion (PBA) law prohibits procedures where a fetus, while still alive, is partially delivered, with the intent to take action to kill the fetus after he or she has been delivered to certain anatomical landmarks:
(a) Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both. […]
(b) As used in this section—
(1) the term “partial-birth abortion” means an abortion in which the person performing the abortion—
(A) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and
(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus;
Although federal law has prohibited partial-birth abortions for 12 years, CMP’s investigative journalism surfaced troubling admissions that Planned Parenthood—the biggest abortion business in the country—has never honestly attempted to comply with the law and has instead actively circumvented it. On undercover footage, Planned Parenthood medical directors and executives described abortions involving intact, living fetuses and procedures identical to those prohibited by law—and they routinely pointed to specific Planned Parenthood protocols as providing the legal loophole to do so. New primary-source documents, never before released publicly, now corroborate these statements on the videos, which a federal appeals court recently ruled were evidence that Planned Parenthood commits criminal partial-birth abortions.The ongoing revelations about Planned Parenthood’s participation in harvesting and selling aborted baby body parts show the incentives that major abortion centers have to resort to illegal methods such as PBA, and increase the urgency for U.S. Department of Justice and other enforcement agencies to hold Big Abortion accountable to the law.
Planned Parenthood’s Admissions on Undercover Video
At a business lunch meeting on July 25, 2014, Planned Parenthood’s then-Senior Director of Medical Services, Dr. Deborah Nucatola, described to potential baby body parts harvesters the custom techniques that she and other Planned Parenthood abortion providers could use to get more intact body parts from late term abortions:
PPFA:I’d say a lot of people want liver. And for that reason, most providers will do this case under ultrasound guidance, so they’ll know where they’re putting their forceps. The kind of rate-limiting step of the procedure is the calvarium, the head is basically the biggest part. Most of the other stuff can come out intact. It’s very rare to have a patient that doesn’t have enough dilation to evacuate all the other parts intact.
Buyer:To bring the body cavity out intact and all that?
PPFA:Exactly. So then you’re just kind of cognizant of where you put your graspers, you try to intentionally go above and below the thorax, so that, you know, we’ve been very good at getting heart, lung, liver, because we know, so I’m not gonna crush that part, I’m going to basically crush below, I’m gonna crush above, and I’m gonna see if I can get it all intact. And with the calvarium, in general, some people will actually try to change the presentation so that it’s not vertex, because when it’s vertex presentation, you never have enough dilation at the beginning of the case, unless you have real, huge amount of dilation to deliver an intact calvarium. So if you do it starting from the breech presentation, there’s dilation that happens as the case goes on, and often, the last, you can evacuate an intact calvarium at the end. So I mean there are certainly steps that can be taken to try to ensure—
Buyer:So they can convert to breech, for example at the start of the—
Shockingly, the series of steps that Planned Parenthood’s Senior Director of Medical Services described—flipping the fetus to a feet-first presentation, carefully pulling the body out intact in order to gradually increase the dilation of the patient’s cervix, and finally being able to remove even the fetal head in one piece—matches up precisely with the legal and clinic definitions of partial-birth abortion.
This was not the only time that Planned Parenthood medical directors informed CMP investigators that late-term fetuses could be delivered intact at Planned Parenthood facilities in the interests of obtaining more marketable body parts. On February 28, 2015, Dr. Jennefer Russo, the Medical Director of Planned Parenthood Orange & San Bernardino Counties, told CMP investigators, “I think, most of us have trained to not have full intact specimens,”but admitted, “It happens sometimes, but it’s pretty rare. But, we try,”when discussing PPOSBC’s relationship supplying fetal organs and tissues to baby body parts sales companies Da Vinci Biosciences and DV Biologics.
The DV Companies were successfully prosecuted in 2017 by the Orange County District Attorney for selling aborted fetal body parts from Planned Parenthood for profit against California and federal law. The companies admitted guilt in a $7.8 million settlement, and the Orange County District Attorney credited CMP’s undercover video work for prompting the successful case.
Other Planned Parenthood medical directors confirmed that the delivery of an intact fetus is something that can predictably occur in the practice of 2nd-trimester abortion. On April 7, 2015, Dr. Savita Ginde, the Vice President and Chief Medical Officer of Planned Parenthood of the Rocky Mountains, told CMP investigators inquiring about 2nd-trimester procedures at her clinic that, “Intact is less than 10%,”and remarked,“Sometimes, we get, if someone delivers before we are able to see them for a procedure then they are intact.”
Of note, feticides like digoxin cannot be used in an abortion that will yield fetal body parts for sale and experimentation, because the digoxin kills the tissues and cells and renders them biologically inert.
Feticides like digoxin typically serve two purposes for abortion providers. The federal partial-birth abortion ban is only operative if the fetus is alive at the time of the partial-delivery during the abortion. It does not apply to a fetus who is already dead at the time the procedure is done—for example, if the fetus has been killed using a feticide like digoxin. If the fetus has been killed with digoxin before the abortion, it also obviates the problem of an intact fetus being alive outside the womb and the provider being involved in a fetal homicide.
When Dr. Russo remarked on being able to obtain fully intact fetuses at PPOSBC, she also stated that PPOSBC was not using digoxin to kill the fetus before the abortion, because there was “a nationwide shortage of dig[oxin].”
Dr. Nucatola explained that many abortion providers turned to digoxin in the wake of the federal PBA law in order to ensure compliance with the law. But she also described a second way Planned Parenthood doctors might approach the problem in cases where digoxin was not used:
Providers who use digoxin us it for one of two reasons. There’s a group of people who use it so they have no risk of violating the Federal Abortion Ban. Because if you induce a demise before the procedure, nobody’s going to say you did a “live”—whatever the federal government calls it. “Partial-birth abortion.” It’s not a medical term, it doesn’t exist in reality. So some people use it to avoid providing a “partial-birth abortion.” […] The Federal Abortion Ban is a law, and laws are up to interpretation. So there are some people who interpret it as, it’s intent. So if I say on Day 1, I do not intend to do this, what ultimately happens doesn’t matter. Because I didn’t intend to do this on Day 1 so I’m complying with the law.”
Dr. Suzie Prabhakaran, the VP of Medical Affairs for Planned Parenthood of Southwest and Central Florida explained this Planned Parenthood “intent” loophole for the partial-birth abortion ban as a “checkbox” that abortion providers simply have to mark in the patient record: “So, like, there’s like a checkbox that says, “I intend to u”–so it would be before the procedure, you do your evaluation, you write, ‘I intend to utilize dismemberment techniques for this procedure.’”
Tram Nguyen, the Surgical Center Administrator for Planned Parenthood Gulf Coast, told CMP investigators on April 9, 2015: “We cannot really intend to complete the procedure intact—you can’t intend to, but it happens.”Nguyen confirmed that PPGC abortion providers use an “intent statement” to simply “document” a non-culpable purpose before the abortion, regardless of the actual conduct of the procedure itself: “There’s an intent statement which you have to document.” The federal Fifth Circuit Court of Appeals found these admissions were evidence of Planned Parenthood’s violation of the federal partial-birth abortion ban, finding that Nguyen “stated, sarcastically, that while federal law (prohibiting partial birth abortions) restricts a facility from intentionally retrieving an intact fetus, PPGC can make it happen by signing a form that they did not so ‘intend.’”
Planned Parenthood’s Manual of Medical Standards & Guidelines
For the first time, CMP is now releasing primary source PPFA documents that confirm the existence of the “intent statement” loophole for the partial-birth abortion law that Planned Parenthood medical directors frequently invoked. This so-called “documentation” requirement as prescribed by PPFA is completely untethered from the actual requirements of the federal law, and indicates that Planned Parenthood is more intent on circumventing the law than following it faithfully.
Planned Parenthood Federation of America publishes a national Manual of Medical Standards & Guidelines, which sets the operating protocols for all Planned Parenthood locations nationwide. The Senior Director of Medical Services is responsible for maintaining the Manual of Medical Standards & Guidelines (MS&Gs).The 2014 version presented in this release was maintained by Planned Parenthood’s then-Senior Director of Medical Services, Dr. Deborah Nucatola, and was controlling at the time the medical directors made their statements on undercover video.
While the MS&Gs Standards for surgical abortion state that “Mid-trimester abortion must be performed in a manner that complies with the federal Partial Birth Abortion Ban Act of 2003 (the ‘federal abortion ban’),”the Standards and Guidelines for the medical records of the abortion offer Planned Parenthood abortion doctors a loophole to feign compliance with the PBA law. The abortion records Standards require “Documentation of the Federal Abortion Ban at 2 stages,”such that the Planned Parenthood abortion doctor first:
Prior to abortion procedure, must document intent to comply with Federal Abortion Ban
- By use of fetocide
- By umibilical cord interruption
- By plan to evacuate the uterus using multiple passes [of the forceps] to remove the fetus in multiple parts
- By plan to evacuate uterus entirely with suction
- Other (describe)
And then second:
After completion of abortion procedure, must document that fetal demise occurred before the procedure or before passage of the anatomical landmarks outlined in the Federal Abortion Ban and technique employed – options include:
- Ultrasound prior to the procedure confirmed absence of fetal cardiac activity
- Umbilical cord was transected and lack of pulsation was confirmed prior to procedure (by palpation or ultrasound)
- Multiple passes were used to remove the fetus in multiple parts
- The uterus was evacuated entirely with suction
- Other (describe)
A standard for authentic medical records would simply require that the doctor record what actually happens in the abortion procedure. A requirement that the abortion provider “must document” a clean outcome in the medical record after the abortion procedure is a way to ensure that regardless of what actually happens in the abortion, Planned Parenthood’s record will appear spotless. The federal 5thCircuit Court of Appeals questioned this surprising aspect of PPFA’s Medical Standards & Guidelines when it was raised at a recent hearing, saying of the federal Partial-Birth Abortion ban’: “Well it’s not a matter of ‘documenting’ it, it’s complying with the actuality of it.”
This is the same “intent” documentation that Dr. Prabhakaran described as simply a “checkbox,” and which Dr. Nucatola, the author of the MS&Gs, explained saying, “So if I say on Day 1, ‘I do not intend to do this,’ what ultimately happens doesn’t matter.”
While PPFA’s Manual of Standards & Guidelines lays out such an elaborate paperwork scheme to deal with the partial-birth abortion law, the Manual has no similar requirements or protocols to “document compliance” with the federal Born-Alive Infants Protection Act or state fetal homicide laws. Yet surprisingly, the Manual of Standards & Guidelines sections and forms dealing with later 2nd-trimester abortions actually state that labor and delivery is a distinct possibility in Planned Parenthood’s late-term abortion practice.
The MS&Gs state that using digoxin (absent in fetal organ and tissue harvesting cases) “decreases the risk of a live birth”, but the same MS&Gs manual also notes that digoxin may fail to kill the fetus in 8% of cases, potentially up to 15% of cases depending on the dosage.The MS&Gs further state that “Onset of labor – can result in delivery outside the PP health facility”in some botched digoxin cases, and that labor and delivery “before the in-clinic abortion”is a possible outcome of Planned Parenthood’s cervical preparation protocols for 2nd-trimester abortion.
Indeed, during a presentation at Planned Parenthood’s Medical Directors Council conference in 2015, one medical director asked, “Was there any difference with expulsion rate?”with new experimental cervical dilation protocols before abortion, compared with “using miso[prostol] that next day, because that’s when we see our expulsions.”A CMP investigator asked Dr. Nucatola, “Those are fetal, or dilator, expulsions?”and Dr. Nucatola replied, “Fetal.”Chillingly, the presenter, Dr. Alisa Goldberg of Planned Parenthood of Massachusetts, answered the audience question this way: “We had one patient in the miso, in the miso[prostol] arm who was in the process of expelling [the fetus], and she went into the procedure room and had the procedure completed so she didn’t quite expel.”These appear to be prima facieadmissions of illegal partial-birth abortion and born-alive infant cases.
Also shockingly, Dr. Nucatola testified before the House Energy & Commerce Committee’s Select Investigative Panel on the issue of fetuses delivered alive during a late-term abortion procedure that “our affiliates don’t provide obstetrical care. So therefore, they don’t know how to manage a term infant or a premature infant.”However, Planned Parenthood’s national medical protocol documents and the candid statements of its medical directors indicate that the births of premature infants during abortion procedures are predictable and anticipated.
Partial-Birth Abortion and Planned Parenthood’s Baby Body Parts Business
The business relationship that Planned Parenthood established with fetal organ and tissue procurement companies like StemExpress, Advanced Bioscience Resources, and Novogenix Laboratories provided financial incentives for Planned Parenthood abortion provides to take advantage of the loopholes in the Manual of Medical Standards & Guidelines to commit partial-birth abortions and obtain more intact, marketable fetal body parts.
For example, Planned Parenthood Mar Monte signed a contract with StemExpress in which StemExpress would only pay Planned Parenthood Mar Monte for “products of conception”—defined in the contract as “any fetal organ”—that were “determined in the clinic to be usable.”Meanwhile, Planned Parenthood Pacific Southwest was only paid under its contract with ABR for each fetal specimen actually “provided to ABR,”which ABR’s contract template clarifies means “provided to and used by ABR.”These qualifiers mean that even if a pregnant woman consents to fetal tissue procurement from her abortion, Planned Parenthood will not get paid if StemExpress or ABR cannot obtain any saleable “products of conception” from her abortion.
ABR’s and StemExpress’ customer demand typically requires late 2nd-trimester aborted fetal organs and tissues. In order to have viable stem cells, the body parts from the aborted fetus must be as intact as possible and a feticide like digoxin cannot have been used to kill the fetus before the abortion procedure. High quality organs are also easier to identify and more likely to be harvested from a fetus that is aborted intact, instead of a fetus that is torn apart through a dismemberment abortion procedure.
Since Planned Parenthood only gets paid for the fetal specimens that are “usable” by the procurement companies, and StemExpress and ABR need viable, intact, late-term body parts, contracts such as these create a perfect storm of market demand to make illegal partial-birth abortions and even born-alive infant cases far more likely and desirable.
Cate Dyer, the CEO and founder of StemExpress, admitted this to CMP investigators in May 2015: “Oh yeah, I mean, if you have intact cases, which we’ve done a lot, we sometimes ship those back to our lab in its entirety.”Holly O’Donnell, a former procurement technician for StemExpress, also testified that she observed this practice: “I remember it was my day off and I went on my laptop and AIM popped up and they were working. And I read a message saying that the doctor had aborted a fully intact fetus, fully intact. And StemExpress was sending it straight to the lab.”
This was not the only time a procurement company working with Planned Parenthood described experiences with fetuses being delivered alive in an abortion clinic. In June 2013, ABR Procurement Manager Perrin Larton told an undercover actor:
I literally have had women come in and they’ll go in the OR, and they’re back out in 3 minutes, and I’m going,
“What’s goin’ on?”
It is critical to remember that the abortion cases slated for body parts harvesting described by procurement company representatives are all cases where the fetus cannot have been killed before the procedure by digoxin, and therefore is alive at the time of delivery.
Dr. Katharine Sheehan is the longtime Medical Director for Planned Parenthood of the Pacific Southwest who still provides abortions for the affiliate. In March 2004 during the federal Partial-Birth Abortion lawsuits, Dr. Sheehan testified under oath that fetuses coming out completely intact during the abortion procedure was a predictable part of her late-term abortion practice at Planned Parenthood Pacific Southwest:
Q. Dr. Sheehan, have you ever had a situation where the fetus comes out intact or partially intact?
A. Yes, I have.
Q. And how often does that occur?
A. It comes out partially intact very frequently; completely intact, less so. Just last week I was working with a resident from UCSD, and we had three of our 12 cases proceed so that the body of the fetus came out completely intact.
Q. Do you have a preference as to whether the fetus comes out intact or partially intact?
A. I definitely do. I prefer it come out intact.
(Dr. Sheehan Direct Examination, 188:5-15)
Q. Are there situations where you were doing a D&E and there was sufficient dilation to remove the fetus, except for the head?
Q. And does it happen — how often does that happen?
A. That happens fairly frequently. In fact, I have been working with a resident from UCSD, as I alluded earlier, and just last week three of our 12 procedures proceeded in this way.
Q. And why is it frequent that the fetus emerges except for the head?
A. The head is the largest part of the fetal body.
Q. And what do you do when that happens? What is your procedure?
A. Typically, I continue to put traction on the fetal body. If it is able to slide through the cervical aperture, then it will.
(Dr. Sheehan Direct Examination, 193:5-21)
Q. And Mr. Simpson also asked you a series of questions about the percent of time when you were able to remove the fetus intact. Do you remember that series of questions?
Q. And I believe you indicated it was one percent of the time?
Q. In that line of questioning, what did you mean by “intact”?
A. I mean when the entire fetus is completely intact.
Q. So does the one percent include the situation where the fetus is removed up to the neck and then a further procedure is used to complete –
A. No, I mean the fetus is entirely intact when it’s extracted.
(Dr. Sheehan Redirect, 271:20-272:8)
According to her medical license, Dr. Sheehan is still practicing at Planned Parenthood Pacific Southwest in San Diego.If any of the abortions Dr. Sheehan described in sworn testimony were to yield fetal tissue for ABR (which had already been working with PPPS for 5 years at the time of Dr. Sheehan’s testimony), the fetus was alive at the time of the abortion procedure and these “intact” fetuses represent partial-birth abortions, and in the case of a fetus “entirely intact,” a born-alive infant.
Applying Dr. Sheehan’s 1% rate of “entirely intact” fetuses, stated in her testimony, to PPPS’s 17,000 abortions per year yields an estimate of 170 born-alive infants per year at Planned Parenthood Pacific Southwest between the San Diego and Riverside abortion centers.
In December 2016, the Senate Judiciary Committee and the House Select Investigative Panel made criminal referrals of Planned Parenthood and the procurement companies to the FBI and the U.S. Department of Justice for selling aborted fetal organs and tissues for profit, and in December 2017, DOJ announced that Planned Parenthood and the procurement companies were under active investigation.As the federal appeals courts have now confirmed, CMP’s undercover evidence indicates that Planned Parenthood also violates the partial-birth abortion law. The corroborating documents from Planned Parenthood’s late-term abortion protocols make it imperative that law enforcement and regulatory authorities take into account the severe violation of human rights and dignity that this disturbing part of Planned Parenthood’s abortion business represents.
Harris, Lisa H. “Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse,” Reproductive Health Matters, 2 Sept 2008. https://www.tandfonline.com/doi/full/10.1016/S0968-8080(08)31396-2
11 March 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4787615/
Dr. Deborah Nucatola conversation with undercover investigators, 25 July 2014: https://www.youtube.com/watch?v=dMX7gIPEVss
See Dr. Nucatola conversation 25 July 2014, http://www.centerformedicalprogress.org/wp-content/uploads/2015/05/PPFAtranscript072514_final.pdfand https://www.youtube.com/watch?v=H4UjIM9B9KQ
Dr. Jennefer Russo conversation with undercover attendees at Planned Parenthood Medical Directors Conference, 27 February 2015: https://www.youtube.com/watch?v=5w8oLs6VsFs
Langhorne, Daniel, “Firms reach $7.8 million settlement over allegations of selling fetal tissue,” Los Angeles Times, 9 Dec 2017. https://www.latimes.com/local/lanow/la-me-fetal-tissue-20171209-story.html
See also OCDA Press Release: http://orangecountyda.org/civica/press/display.asp?Entry=5406
Dr. Savita Ginde conversation with undercover investigators at Planned Parenthood Rocky Mountains, 7 April 2015: https://www.youtube.com/watch?v=X8QOC20DiPY
See Society of Family Planning Clinical guidelines for “Induction of fetal demise before abortion” https://www.contraceptionjournal.org/article/S0010-7824(10)00019-3/pdfand “Labor induction abortion in the second trimester” https://www.contraceptionjournal.org/article/S0010-7824(11)00057-6/pdf
Dr. Deborah Nucatola conversation with undercover investigators, 25 July 2014: https://www.youtube.com/watch?v=9w6f_c0DReE
27 February 2015: https://www.youtube.com/watch?v=K-JZU7ckYTY
Tram Nguyen conversation with undercover investigators at Planned Parenthood Gulf Coast, 9 April 2015: https://www.youtube.com/watch?v=S7sHYoVQneI
28:50 in recording of 5thCircuit argument Planned Parenthood v. Smith, 17-50282, June 4, 2018: http://www.ca5.uscourts.gov/OralArgRecordings/17/17-50282_6-4-2018.MP3
presentation of Dr. Alisa Goldberg, “Optimizing cervical preparation before second trimester D&E,” recorded at Planned Parenthood Medical Directors Conference, 27 February 2015: https://www.youtube.com/watch?v=v0jcHE0aHrk
page 22 of Select Investigative Panel Final Report: https://archives-energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/documents/Select_Investigative_Panel_Final_Report.pdf
Cate Dyer conversation with undercover investigators, 22 May 2015: https://www.youtube.com/watch?v=E2-ZE0JTxgw
Holly O’Donnell interview, 27 December 2014:https://www.youtube.com/watch?v=FzMAycMMXp8
Perrin Larton conversation with undercover attendees at International Society of Stem Cell Research meeting, 13 June, 2013: https://www.youtube.com/watch?v=fWJb78ynVT8
Planned Parenthood v. Ashcroft, transcript of proceedings March 30, 2004: http://www.priestsforlife.org/pba/caday2.pdf
License G 30650 for Dr. Katharine Sheehan, registered at corporate address of Planned Parenthood Pacific Southwest, https://search.dca.ca.gov/details/8002/G/30650/ab25943ae8b1f011a1db0f9a1cb3f539
See https://www.grassley.senate.gov/news/news-releases/grassley-refers-planned-parenthood-fetal-tissue-procurement-organizations-fbiand https://archives-energycommerce.house.gov/news-center/press-releases/select-panel-refers-numerous-entities-further-investigation-possible
Fandos, Nicholas, “Justice Dept. investigating Fetal Tissue Transfers by Planned Parenthood and Others,” The New York Times, 8 Dec 2017. https://www.nytimes.com/2017/12/08/us/politics/planned-parenthood-fetal-tissue-transfers-federal-investigation.html