Of 18 cases reviewed, the possibility that the pregnancy was below the 26-week legal cutoff for elective abortions ranged from 1% to 25% in 11 cases, and up to 50% in three or more cases. In other words, at least 78% of the abortions reviewed were more than 50% likely to have been done after 26 weeks, in violation of state law.

Midtown held that these abortions were mostly for suspected fetal abnormalities, which was not relevant to Georgia law, which limited these very late abortions to serious threats to the mother's life or health.

In most cases, there was no estimate of uterine size. In 95% of the cases reviewed, the physician did not sign off on the physical history.

In 67% of records reviewed, the autopsy weight for the fetus was 1000 grams or more. In one case, the weight was 1400 grams.

In the cases of Patient 3 and Patient 7, no fetal abnormalities were noted on examination by the pathologist, but the patients were not counseled about the fact that they may have inadvertently aborted healthy fetuses.

The compliance officer also questioned the lack of an autopsy for a fetus supposedly removed after suspected in-utero death. This failure not only meant that Midtown did not confirm that the fetus had been dead before the procedure had begun; it also meant that the parents were deprived of information about what had caused the fetal death, and were therefore left in the dark about risks to future pregnancies.

In one multiple pregnancy it was evident that a third fetus was aborted but not expected.

Patient 14's fetus lived a short time after it was expelled.

In some cases there were wide discrepancies among fetal measurements which are not explained and which might have been due to fetal anomalies which patients should have been informed of, or due to errors which should have been addressed.

What does all this mean? It means that Midtown Hospital was very likely performing elective third trimester abortions under the guise of fetal abnormalilty -- even though Georgia law did not allow third trimester abortions for fetal abnormality -- and disguising these abortions as legal late second trimester abortions.

A 1993 review indicates in that in the case of Patient 7, there was "no estimate of gestational age clinically. "The report suggested that this was a 28 week gestation. Was this report ignored by the responsible physician? ... Why is the femur so short? Is it abnormal as is written on the report? Good medical practice would dictate that the nature of the anomlay be identified. Dwarfism is not sufficiently precise. The more common causes of short limb dysplasia are associated with ultrasound identifiable abnormaliies of the head, spinal column, and bone to mention a few. ... A hole in the heart is another non specific finding. I am surprised that it would be written on a report. Was this a suspected ventricular or atrial septal defect? Other causes for a short femur include measuring length on a tangential view or measuring another long bone. If one suspects short limb dysplasia all long bones must be measured. Is this micrimelia, mesomelia, or rhizomelia? The patient should be referred if the sonlolgist can not be more speciffic than making a diagnosis of dwarfism. ... There are too many discrepancies in this case. ... I feel 99% confident that this was a third trimester abortion. The diagnosis of dwarfism is based on an extremely superficial ultrasound evaluation, at least as represented in the chart, and a statement in the nursing notes. The gross examination by the pathologist did not corroborate this finding. Furthermore, this diagnosis would only make it more likely that the gestation was beyond 26 weeks. Again, I am perplexed by the absence of a work-up that would assist this family in assessing future risks for having an abnormal pregnancy."

Source of quotes: letter from Policy Compliance Officer 4-27-93

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