Abortion clinics are not licensed, inspected or regulated by the state in New Hampshire, but Rep. Kathleen Souza, a longtime Republican right-to-life activist, is writing legislation to mandate such oversight in the wake of the Philadelphia abortion doctor scandal.
Some abortion rights advocates say they do not oppose state oversight as long as abortion providers are not singled out to make it harder for women to obtain safe, legal abortions.
They are concerned, though, about being painted with the same brush as Dr. Kermit Gosnell, described as a "monster" by the man who successfully prosecuted him for murdering three babies who survived illegal late-term abortions and the 2009 drug overdose death of an abortion patient.
"Nobody has oversight," Souza said, adding: "Right-to-life people have been trying to put in legislation for 20 years to require abortion clinic licensing and clinic inspections."
It is impossible to know how many abortions are performed in the state, Souza said, or to even know how many clinics or physician offices are performing them.
"We would see ambulances leaving (Planned Parenthood) on Pennacook Street" and not be able to find out what happened, Souza said, because abortion clinics are exempt from licensure by law because they are deemed to be physician offices, which Souza believes is a deliberately misleading designation.
Jane Munson, former medical director of the Concord Feminist Health Center, where abortions are performed, said she wouldn't oppose state oversight.
"This really highlights the need for legitimate abortion providers that adhere to standards and have a safe environment, which we do. There is no way anything even remotely like (Gosnell) could happen here," Munson said.
She worries that new laws and regulations could force legitimate abortion providers to close, requiring women to resort to illegitimate providers like Gosnell.
"There were abortion providers in Pennsylvania who complained to the state agency," Munson said. "They knew and they were getting feedback about what wvas going on. The complaints were not followed up on. It's really on the state."
When asked whether she would oppose state licensing and inspecting, Munson said: "No, absolutely not. We have nothing to hide, and we know the quality of our services."
She would oppose, however, new regulations aimed solely at restricting access to safe abortions.
"That's the latest tactic of anti-abortion groups," Munson said. "This man (Gosnell) is an outlier. He is a criminal. He is not representative of abortion providers in New Hampshire and legitimate abortion providers nationwide."
Munson said the Concord facility and Planned Parenthood do not perform abortions past 15 weeks and six days of pregnancy, though there is no prohibition in New Hampshire against performing abortions anytime during pregnancy.
"It's not remotely approaching getting into the possibility of being born alive," Munson said.
Kris Neilsen, communications director for the state Department of Health and Human Services, explained in an email that abortion clinics like Planned Parenthood and the Concord Feminist Health Center are exempt from state licensing and inspection requirements because they are considered physician offices.
Twenty-three health care providers such as hospitals, hospices, nursing homes, and dialysis centers are licensed by the state, but not abortion clinics.
"In New Hampshire, there is no such thing as an abortion clinic - the majority of abortions are done in doctors offices ... and doctors' offices are exempt from licensure under RSA 151:2 II," Neilsen said.
"Because they are exempt, we have no jurisdiction over them, and neither does anyone else."
Michael Tierney, an attorney who represents New Hampshire Right To Life, scoffed at the Neilsen's statement regarding no abortion clinics in New Hampshire.
"I wish that were the case," Tierney said. "There are several abortion clinics, but no recognition of abortion clinics as a separate entity in New Hampshire statutes."
The state could have some very limited oversight of the clinics because they dispense drugs and accept state and federal dollars, but chooses not to do so, he said.
"The state is not making sure that these are safe and reliable medical providers," Tierney said. "The state should absolutely not be sending New Hampshire and federal tax dollars to support them both in terms of Medicaid and in terms of Title X family planning money.
Gosnell's trial detailed gruesome incidents of killing babies who survived late-term abortions by snipping their spinal cords and filthy, unsafe conditions in his practice. The case has reignited controversy on an emotional subject with deeply held opinions on both sides.
Two U.S. congressional committees cited the Gosnell case in recent letters to officials in every state, including New Hampshire, seeking details on how they regulate abortion clinics and prosecute abortion-related crimes.
The House Committee on Energy and Commerce asked the top health commissioner in every state whether abortion clinics are regulated, seeking detailed answers by May 28.
"Pennsylvania's Department of Health has deliberately chosen not to enforce laws that should afford patients at abortion clinics the same safeguards and assurance of quality healthcare as patients of other medical service providers," said the letter signed by committee Chairman U.S. Rep. Fred Upton, R-Mich., and five other lawmakers.
A similar letter by the House Committee on the Judiciary was mailed May 7 to every state attorney general seeking information about criminal prosecutions.
"Do prosecutors in your state treat the deliberate killing of newborns, including those newborns who were delivered alive in the process, as a criminal offense?" asked the committee, chaired by U.S. Rep. Bob Goodlatte, R-Va.
State officials said they either hadn't received the letter or needed more time to study it before commenting.
Laura Thibault, interim executive director of NARAL-NH, said she is familiar with the congressional letters. "It's an example of extreme anti-choice members of Congress who are using current events to push their agenda," Thibault said.
"What we can all agree on is that Dr. Gosnell was horrific ... what this has pointed to in the pro-choice community is that it is more important than ever to have safe, legal, accessible, affordable reproductive health care," Thibault said.
Jennifer Frizzell, senior policy adviser at Planned Parenthood New Hampshire, emailed a statement to the Sunday News.
"Kermit Gosnell ran a criminal enterprise, not a health care facility, and the jury in Philadelphia has punished him for his appalling crimes. The verdict is just and will ensure that no woman is ever victimized by Gosnell again."
She said at Planned Parenthood, the medical standards and guidelines are informed by "the most trusted medical knowledge and professional organizations, including the CDC, the FDA, and the American College of Obstetrics and Gynecology.
"All health care providers should be regulated to ensure high standards of care - but patient health and safety should not be politicized," Frizzell said.
Holli Senior, spokesman for the Pennsylvania Department of Health, said before Gosnell's crimes were discovered, abortion clinics were in a category of their own and inspected on a "complaint basis," though there was a failure to inspect Gosnell's practice even after complaints.
The law has been tightened to require that abortion facilities meet the same standards as ambulatory surgical care facilities, with annual inspections if abortions are performed while the patient is semi-conscious or unconscious under anesthesia. Annual inspections are also required even if local anesthesia is used, she said.
Julie Laughner runs a prayer vigil outside Planned Parenthood in Manchester every second Saturday of the month, and other groups pray regularly there on Thursdays.
"I'm aware that (clinics) are not inspected by the state," Laughner said. "There are very few laws relative to clinics. I would love to see them regulated, licensed and inspected."
Without information that state oversight would provide, Rep. Souza said, it is impossible to know whether there are any unscrupulous abortion providers operating in the state.
"We hope it's not happening here, but have no way of knowing," Souza said. "Look at how flagrant it was in Philadelphia."