Warren Hern, likely the last U.S. doctor to openly specialize in abortions performed late in pregnancy, authored a textbook on how to properly do abortions. In it, he quotes a colleague, Robert Crist, who had experience with abortions late in pregnancy: “Abortion is a simple procedure except for the uterus’ complete intolerance for bad technique.”
Bad technique — that’s what it comes down to when speaking of what transpired in a filthy Philadelphia abortion clinic where blood-stained blankets and fetal body parts in milk jugs were found. Its proprietor, Dr. Kermit Gosnell, was charged Wednesday with performing illegal late-term abortions. (More on Time.com: Why the Pa. Abortion Doc’s Case Is About Poverty, Not Roe v. Wade)
Hern makes the case that it’s really not about when an abortion is performed. What’s more important is how it’s performed.
Hern emphasized that while he has no personal knowledge of how Gosnell operated at the Women’s Medical Society, his clinic in a low-income neighborhood of West Philadelphia, he chalks it up to incompetence.
“It’s horrifying,” says Hern. “It’s a question of applying good principles of surgery and medical practice to whatever you’re doing and doing the safest thing you can for the patient.”
Colorado, where Hern practices, does not restrict when abortions can be performed. Pennsylvania, like most states, does; it bans them after 24 weeks. (More on Time.com: Late-Term Abortions: Q&A With the Last Remaining Doctor Who Performs Them)
For sure, late abortions have the potential to be more dangerous than first-trimester abortions. The fetus is larger, the uterus is larger, and there is a greater chance of serious complications. But early abortions can be deadly too if they’re not done properly.
Hern declined to make a direct association between Gosnell’s clinic and laws curtailing abortion, but he did allow himself to speak in generalities. “As a rule, any law restricting abortion is almost automatically going to make abortion more dangerous for women,” he says.
And more dangerous for the doctors who perform them. Hern has watched colleagues die — George Tiller, who was shot in his Kansas church in 2009, was a friend — and he has endured plenty of threats of his own. Two years ago, not long after Tiller’s death, a man from Spokane, Wash., called Hern’s Boulder, Colo., office to warn that two men were on their way to harm his family. Donald Hertz, who made the threat, was recently sentenced to five years of probation for threatening Hern’s family. (More on Time.com: The Grass-Roots Abortion War).
When abortion is restricted, Hern notes, only the well-off have access to the procedure. In his eyes, it ends up being not so much about whether abortion is permitted but about who can pay to have one.
At least one woman died after undergoing treatment at Gosnell’s clinic. Karnamaya Mongar, 41, isn’t here to say whether she would have gone elsewhere if she could have. But what seems pretty clear is that she didn’t have too many choices.
“You can have a safe abortion if you can afford it,” says Hern. “You can get good medical care if you can afford it. If you can’t, you die.”