I observed the narrow boundary between life and death when the spirit left my father from his bed in an army hospital last winter. One moment he was with us; the next he was gone. For those few moments, life and death merged. For a short while, each resembled the other. This amorphous condition lasts beyond the collapse of respiration, the stilling of the heart, or the shutdown of the brain. Lifelike qualities persist, as if a flame were being slowly extinguished. When the fire is out, the transition is complete. That is when the ancients say the spirit leaves the body. That is when my dad died.
The best guess from the medical statistics division of the California Department of Health Services is that about 20,000 abortions are performed each year in San Diego County. The last year for which the department is able to provide a specific figure is 1985, when health officials reported 19,160. That number was adopted by the state from research done by the nonprofit Alan Guttmacher Institute of New York City, a former affiliate of the Planned Parenthood Federation of America.
The Guttmacher Institute performs a nationwide abortion-statistics survey every two years, with state-by-state breakdowns. According to research assistant Jennifer Van Vort, the institute relies on its contacts with Planned Parenthood affiliates across the country, as well as with such organizations as the National Abortion Rights Action League, to collect accurate information.
Providers of abortion services may be quizzed by letter up to four times, with follow-up telephone calls for the most recalcitrant. “These places are very busy,” says Van Vort of abortion providers. “But if they refuse to provide information, we check with a nearby clinic. Their competitors know what they are doing.” Van Vort says the institute’s last survey, conducted in 1986 for the years 1984 and 1985, had a ninety-four-percent response rate.
“Some places just refuse [to provide the requested information] flat out,” she says. For that reason, in addition to the institute’s ties to Planned Parenthood and other pro-abortion groups, foes of abortion claim the Guttmacher Institute underreports the number of abortions. But state officials say the group’s figures are the most reliable available. “If anything, it is probably a conservative figure,” says Charles Wolcott, a research analyst with the state division of medical statistics.
One reason Wolcott finds the Guttmacher figures reliable is that they have showed a steady trend since the reports began in 1973. “It goes up every year, though not as fast lately,” he says. “In 1977, the abortion rate [in California] was 41.2 per 1000 women. In 1985 it was 48.2 per 1000.”
Nonetheless, the state health services department, which is required by law to issue an abortion statistics report to the state legislature every two years, notes the likelihood that the figures may be off. “Because of incomplete reporting from hospitals and clinics and the absence of reports from physicians, the department’s abortion survey may not be representative of the total number of California abortions,” explains the department’s 1988 report to the legislature. But if the state abortion figures are even close, the number of abortions performed in San Diego County each year exceeds by several thousand the number of recorded deaths (16,512) and is almost half the total of recorded live births (42,516).
My father survived for many days from sheer will, refusing to surrender to the cancer that was spreading from one vital organ to another. Despite the great pain and indignity of his disease, he stubbornly defied the laws of biology. His physicians were perplexed by this. They were unable to offer any reliable prognosis, other than to note that it was a fight he was destined to lose. Each of my father’s last breaths were acts of defiance by which he affirmed life, demonstrating that given a choice, life does not yield easily to death.
Thirty minutes had not passed following my father’s death before his physicians requested permission to perform an autopsy. They wanted to perform this postmortem examination not because there was any mystery regarding the cause of death, but rather in the interest of medical knowledge. It always proves instructive, they said, to examine “the disease process.” Although inexplicably reluctant, I had no insurmountable objections. My view was not, however, shared by the rest of my family. “No! Nooo! No!” wailed my oldest brother upon hearing the request. “They are going to cut him up. They want to cut him up.” My mother, more subdued but also full of painful emotion, whispered her objection. “I don’t think that is really necessary,” she said.
“Unlike other animal bodies, the human body is human, that is, it participates in the dignity of the human person. Even after death the human cadaver reminds us that once there was present in our midst a human person, a being like ourselves, sharing our dignity and value. For this reason, civilized people have always been outraged at the desecration of the dead.”
— Encyclopedia of Bioethics.
“Either at common law or under statute, or both, it is an offense to treat a dead body indecently, or to fail to bury it, or to dispose of it indecently, or to sell it, or to interfere with the right of burial, or to mutilate it, or, under certain conditions, to disinter it.”
— Corpus Juris Secundum
My brother’s mournful refusal to allow an unnecessary autopsy on my father was not merely an unreasoned expression of anguish by a man consumed by grief. His was one in a chorus of millions of voices through the ages affirming a primordial human instinct. It is a moral intuition expressed repeatedly in the taboos, rituals, and laws of our culture. Desecration of the human symbol, even in war, evokes outrage among the civilized — lampshades of human skin, ears collected from the heads of battlefield corpses, severed genitals sewn into the mouths of dead enemies. These are the deeds of bloodthirsty madmen. They turn our stomachs and insult our most basic sensibilities.
American law recognizes our responsibility toward the dead “as in the nature of a sacred trust.” Our courts have extended even to the parts of a dismembered body the right to respectful treatment and decent burial. And although abortion has been legal in the United States for fifteen years, legislatures across the country continue to reflect great moral ambivalence on the subject by acknowledging there is something human about a dead fetus.
According to Peter Lehman, chief of the appellate section with the San Diego County district attorney’s office, California law specifically addresses the question of fetal remains. “A recognizable dead human fetus” under twenty-weeks’ gestation, regardless of any other provision of law, must be either buried or incinerated, says Lehman.
Disposition of fetuses over twenty-weeks’ gestation depends on the circumstances of death. Local mortuaries and crematories report that they sometimes are asked to inter or cremate the older fetuses, which under law must have a death certificate. In some instances, the mothers of late-term fetuses that are aborted or stillborn ask that they be baptized, then buried. But if a late-term abortion is performed at a clinic, hospital, or physician’s office under provisions of the state’s Therapeutic Abortion Act, the remains often are treated like those of younger fetuses.
California law also attempts to protect the dignity of fetal remains — and the sensibilities of the public — by proscribing certain methods of disposal. It is illegal to dispose of fetal remains “in a public or private dump, refuse, or disposal site or place open to public view,’’ regardless of the age of the fetus at the time of death.
In a discussion of cadavers and fetuses, the Encyclopedia of Biomedical Ethics makes note of the regard in which fetal remains still are held, despite changing social attitudes about abortion itself: “Although abortion practices are widely accepted by public and legal institutions, as well as by private persons, there is a commonly accepted principle that respect is due the human fetus.”
Regard for fetal remains is so high in some jurisdictions that the law requires they be treated in the same way that any other human remains are treated. “We operate in forty-four states and three Canadian provinces,” says a spokesman for BFI Medical Waste Systems, a national leader in the disposal of medical and surgical by-products. “Some states specifically prohibit disposing of fetal remains anywhere but a mortuary or crematorium.”
Respect for aborted fetuses is not, however, a universal sentiment. Pro-abortion advocates regard attempts to require special treatment for fetuses as a Trojan horse planted in the legislature by anti-abortion activists. The hidden agenda, say those who oppose legal restrictions on a woman’s choice regarding abortion, is the ultimate recriminalization of abortion.
Abortion advocates see any move to compel “special” treatment of dead fetuses as an attack on women’s rights. “The so-called Right to Life movement that tries to tell women what they can or cannot do with their own bodies wants to give special attention to this tissue in order to support their view that abortion is murder,” explains one clinic insider who asked not to be identified. “That is wrong. A woman has a right to dispose of it without guilt. Women don’t enter into abortion lightly. There are already enough personal anxieties that go into that decision. I don’t think you should impose another burden on women over what they do with fetal tissues.”
Between the time a fetus is removed from the uterus during an abortion and picked up for final disposal, California law requires that it be treated as infectious waste. Like other infectious waste, the remains must be discarded into double red plastic bags labeled “Biohazard.” The red bags are then tied to prevent leakage and transferred to larger containers. The larger containers vary in size from fifty-five-gallon drums to small cartons. Whatever their dimensions, the law requires that these containers be leakproof and have tight-fitting lids. The waste may be stored legally in such containers for up to four days in temperatures above freezing, for up to ninety days in temperatures below freezing.
Stored fetuses, as with the other infectious waste, must be kept in a restricted area designed to keep them removed from the elements, insects, and rodents. The storage area may not be easily accessible, and warning signs reading “Caution — Infectious Waste Storage Area — Unauthorized Persons Keep Out” must be posted, both in English and Spanish. All infectious waste must be stored separately from other garbage. Some properly equipped medical facilities are allowed under law to dispose of their own infectious waste on-site. Most, however, contract with a licensed disposer of infectious waste, who periodically stops by to collect the containers.
Even some of the best hospitals and medical clinics in the county, however, are routinely cited by inspectors from the Hazardous Materials Management Division of the San Diego County Department of Health Services for failing to comply with the strict requirements of the law regarding segregation, storage, and disposal of infectious waste.
In March of 1987, Sharp Memorial Hospital was cited for failure to use identifying red bags for infectious waste and for inadequate labeling of infectious waste containers. Sharp-Cabrillo Hospital was cited in June 1986 for using infectious waste containers that were neither leakproof nor equipped with tight-fitting lids. In January of 1985, Hillside Hospital was cited for failure to keep infectious waste separate from other waste and for inadequate labeling of infectious waste containers.
Inspectors cited the Womancare Clinic in June 1986 for exceeding the legally permitted limits on storage time for infectious waste. During an October 1987 reinspection at Womancare, a violation was recorded for improper labeling of infectious waste containers. At the UCSD Medical Center, which has a highly regarded infectious waste program according to some experts, inspectors found in February 1986 that infectious waste containers were not properly protected from weather, insects, and rodents. UCSD Medical Center was also cited at the time for failure to double-bag infectious waste and for failure to securely tie its bags. When re-inspected in June of 1987, UCSD Medical Center was again cited, this time for inadequate labeling of infectious waste containers and for not using tight-fitting lids on the containers.
Military hospitals have similar problems. The U.S. Navy Hospital at Camp Pendleton was gigged for six violations in April of 1986, including failure to double-red-bag infectious waste, failure to separate it and store it separately from other waste, failure to use tight-fitting lids, and inadequate labeling of infectious waste containers.
Among private practices, the IGO Fertility Institute of San Diego was cited in May of 1987 for failure to have an infectious waste master plan available or a current disposal agreement with a licensed disposal facility available for inspection, as well as for having infectious waste containers that were not properly lidded or labeled.
When inspected in July of 1986, the Uptown Medical Group and Fifth Avenue Medical Group, which share the same address, were cited for improper labeling of pathological waste. In October of 1987, when re-inspected, the practices were cited for failure to double-bag infectious waste and for failure to have a current disposal agreement with a licensed contractor available.
During the past several weeks, a friend and I conducted our own spot checks of trash containers at randomly selected medical clinics and laboratories. On June 24, we retrieved from an open trash container behind a medical clinic on Fourth Avenue three heavily packed red plastic bags clearly marked “Caution — Infectious Waste — Biohazard.” One of the bags was torn and leaking some of its contents. Among the items discovered in the bags were blood-stained gauze, glass tubing, small glass syringes with metal end pieces, used surgical gloves, dental prosthetic molds, x-ray folders, and a calendar of patient appointments.
The same night, we found, in the open trash containers behind a multistory medical office building on Balboa Avenue, used surgical gowns, and several pairs of used, stained surgical gloves. We also inspected trash containers behind a closed but unlocked gate to the rear of a medical clinic on El Cajon Boulevard in La Mesa. We observed numerous beige plastic bags filled with what appeared to be human secreta and excreta wrapped in disposable diapers. Several of the bags were covered with maggots.
On July 3, we explored the contents of a trash bin behind a medical and diagnostic laboratory complex on Flintkote Street in Sorrento Valley and found several beige plastic bags filled with various used laboratory glass devices, including blood-stained glass cylinders and many pipettes, several of which protruded through the plastic. We retrieved from the site about three pounds of foul, sulfur-smelling ash residue wrapped inside five plastic bags.
Former Marine jet pilot Jeff Garvin manages the local operations of BFI Medical Waste Systems from a sparse, modern office in an industrial building at 7737 Formula Place, a few blocks off Miramar Road. BFI Medical Waste Systems is a subsidiary of Browning-Ferris Industries, a billion-dollar, multi-national waste disposal company based in Houston. Browning-Ferris acquired its San Diego County holdings in January of 1986, buying out the previous owner, W. D. Bingham Co. of Orange County.
Today BFI Medical Waste Systems is the only state-licensed firm in the county legally permitted to dispose of infectious waste. It employs fifteen people and operates a fleet of five trucks to serve between 250 and 300 clients in the San Diego area. Garvin says county records are “pretty accurate” in their estimation that the company disposes of about 1430 tons of infectious waste a year, including the annual incineration of 127 tons of “pathological waste” — human tissues and anatomical remains — and “chemotherapy trace,” the residual chemicals used in the treatment of cancer.
BFI Medical Waste Systems is innocuously situated next door to Skyline Business Forms West in a large industrial park. Across the street are Ingram Paper Company and Full Sail Produce. A large, garage-style, aluminum door is set off by three different signs warning “Restricted Area.” Four white trucks are parked in front, each marked with the BFI logo. One bears Nevada license plates. On the far left are stacks and stacks of empty plastic or fiber-glass containers labeled “infectious waste.” A red warning sign graces the front of the building: “These premises may contain chemicals known to the State of California to cause cancer.” To the far right, a small smokestack on the roof rises from the interior of the building.
Most of the space inside is taken up by the actual processing of waste. With production-line efficiency, two goggled young men wearing thick plastic gloves wheel large barrels of infectious waste onto a raised platform equipped with a row of metal wheels. The contents of the barrels are emptied into one of two huge silver-colored vats, or autoclaves. A foul-smelling steam rises from the autoclaves, which cook the waste at 325 degrees for thirty-five minutes, like giant pressure cookers. Once sterilized — the process kills all pathogens — the waste material is removed from the autoclaves and sent down another wheeled, raised conveyer to a compacter, where it is compressed for eventual burial at a landfill.
The stench is much worse in the small room where BFI maintains a large gas-fired incinerator. The smell gets into your nostrils and clings. It is a cross between formaldehyde and wet animal fur. It is a deathly odor. The furnace is not in operation on this particular day. Garvin says the incinerator is capable of burning a hundred pounds of waste an hour but that the Air Pollution Control District, to whom BFI pays annual fees of around $5000, will allow the incinerator to operate only three days a week. Several red and yellow barrels stand nearby, ready for the next firing of the furnace. Outside the door of the incinerator room stacks of outdated pharmaceuticals await incineration. As one worker struggles with an infectious waste container nearly as big as he, I ask Garvin, “Isn’t that kind of dangerous?” He replies, “Not really. We tell them when they come to work here, ‘You just don’t tip one over — ever.’ ”
The tons of infectious waste that arrive at BFI’s San Diego headquarters come in three basic kinds of containers, color-coded by BFI so workers will know what to do with them. Red barrels marked “incinerate only” are supposed to contain dead lab animals, human tissues and parts, and laboratory specimens. Yellow barrels, also marked “incinerate only,” are supposed to contain equipment with traces of chemotherapeutic agents used to treat cancer. Beige or off-white containers are supposed to carry other infectious waste, such as discarded surgical gloves, medical tubing, disposable probes, and contaminated paper and plastic equipment. The contents of the off-white barrels are sterilized, compacted, and buried in the Miramar landfill.
But whether BFI’s customers are adhering to the color code is a mystery to the company. When workers receive the containers, they process them based on their color. No one looks inside. “We have no control over what [BFI clients] put in [the containers],” says Garvin.
In addition to the BFI incinerator, the San Diego County Air Pollution Control District licenses eleven other incinerators in the county specifically for the disposal of pathological waste, which is defined as “biomedical waste which includes human or animal body parts, surgical specimens, blood and excreta.” Among the licensed pathological waste incinerators in San Diego County are one animal hospital, two pet cemeteries, and one convalescent hospital. But most the most active incinerators are at hospitals and universities. The Air Pollution Control District reports that it licenses pathological waste incinerators at Grossmont District Hospital, Mesa Vista Hospital, two on the UCSD campus, one at the UCSD Hospital/School of Medicine, one at the U.S. Navy Hospital, Camp Pendleton, and one at the Kaiser Foundation Hospital.
“One difference between cremation and incineration is that we burn one body at a time.”
— Spokeswoman for the Neptune Society
“The practice of cremation has been revived in civilized communities in comparatively recent times.... The practice has become general, and crematories are now so common in many of the larger cities of the United States that the courts may take judicial notice of the usual method of operation: the corpse is placed in a crucible, entirely closed except the necessary vents for the escape of gases, and there subjected to intense heat, whereby, in a few hours, it is entirely consumed.”
— American Jurisprudence.
State law requires certain pathological waste be destroyed “by incineration in a controlled-air, multi-chambered incinerator which provides complete combustion of the waste to carbonized or mineralized ash.”
At BFI, says Garvin, he tries to identify containers earmarked for incineration that may contain human fetal remains; the company, he maintains, prefers to cremate, instead of incinerate them. “That’s not a legal requirement,” says Garvin. “It’s just an aesthetic thing.” When he locates what he believes to be fetal remains, he explains, he refrigerates them in an eight-foot-by-twenty-foot cooler for shipment three times a week to Vernon, in south-central Los Angeles, where he presumes company officials cremate them. “I don’t really know exactly what happens to them [Sometimes they are shipped out of state.”
In order to accomplish his task of sorting fetuses from the rest of the infectious waste, Garvin says he employs a system that even he acknowledges is far from foolproof. His system basically involves noting whether red barrels come from abortion clinics, based on an identifying bar code. If they do, he says, he assumes they contain fetal remains, and into the cooler they go.
BFI corporate officials agree that Garvin is correct when he notes that his firm has a special solicitude toward fetal remains, but they say he is wrong if he believes the fetuses he ships to Vernon are cremated. The company does not operate a special crematorium or maintain a contract with any crematorium for disposal of fetuses. “We have an incinerator in San Diego, but not everything is incinerated there,” explains Bob Spurgin, vice president of BFI Medical Waste Systems. “Because of its capacity, waste is sometimes transferred to Vernon, where it is accumulated for disposal in a BFI-owned incinerator.”
In fact, according to Spurgin, BFI subsidiaries are not even supposed to accept fetal remains. He cites a company policy issued in March that covers the topic. “We at BFI Medical Waste Systems believe that fetuses from abortions and human appendages should be destroyed by the services rendered at a crematorium, whenever possible,” reads the text in its entirety. Spurgin says it may be true that BFI is incinerating fetal remains, but that is not because it wants to. “We do not solicit that part of the market,” he claims. “It is our corporate policy not to knowingly handle it. But what a hospital chooses to put in a container we have no control over. All of us universally feel that human fetal remains are human remains, and those remains are best handled the same way that any other human remains would be.”
Ending up in an incinerator with dead lab animals and liver biopsies is hardly “the same way that any other human remains would be handled.” But, insists BFI, preferring to place blame on its clients, rather than itself, if aborted fetuses are being burned by BFI, it is only because its customers are placing them in the wastestream without BFI’s knowledge or consent. Garvin sees himself caught between two constituencies that cannot be placated, regardless of what BFI does. He explains, “The generators say, ‘Just burn it. Treat it like regular path! But the other side says, ‘It’s special. Treat it different.’ ”
What worries Garvin even more, he says, is that a lot of infectious waste is being illegally disposed of. The company estimates there are around 8000 generators of infectious waste in San Diego County, but fewer than 300 of them are BFI customers. State law requires any producer of more than 220 pounds of infectious waste per month to follow strict regulations for disposal, which almost always means using BFI. Some producers of infectious waste that generate far less quantity must also follow the regulations. Among these are any state-licensed hospitals, skilled nursing homes, community clinics, free clinics, surgical clinics, and dialysis clinics. Garvin believes that fetal remains — as well as other infectious wastes — are routinely disposed of illegally by penny-pinching physicians more concerned about the next Mercedes payment than the public health. “Some of these doctors are not interested in spending any amount of money,” he says. “They just say, ‘I’ll take care of it.’ The question is, what are they throwing in the trash? No one knows.”
”A human fetus was found yesterday morning in the sewage filtration tank at the city ’s Pump Station One on East Harbor Drive. The coroner’s office will conduct tests to estimate the age of the fetus, which appeared to be in its amniotic sac. Under the law, Deputy Coroner George Dickason said, if it is determined to be at least 20 weeks old, the case will be investigated further. If not, he said, the case will be dropped.”
— San Diego Union February 18, 1987
County Coroner David Stark says the incidence of discovery of fetal remains in the sewer system ebbs and flows, but has mostly ebbed in recent years. Nonetheless, he says, fetuses are discovered in sewage grates at least once a year. The age of the fetus is the key to how the Coroner’s Office handles such discoveries. “They are not really considered coroner’s cases if the fetus is under twenty-one weeks gestation,” he says. “That fetus is just considered a pathology specimen and we don’t make a case on them. These little fetuses that have been found in the screen at the sewage plant are usually very, very small — only a couple of months at most, just barely recognizable.”
There have been very rare instances in which late-term fetuses have been discovered, according to Stark. “One of the last ones I remember was in a Dumpster at an apartment. Homicide got involved and, in that case, we identified the person as being twenty weeks or more.”
Unlike other areas of the state, there have been no large-scale discoveries of improperly disposed fetuses in San Diego County. In fact, a spokesman for the district attorney’s office says there has never been a prosecution in San Diego County for the illegal disposal of fetal remains. In February of 1982, however, 16,433 dead fetuses were discovered stored in twenty-foot steel boxes inside a metal shipping container repossessed from a Woodland Hills pathologist. Investigators later determined that among the fetuses were 193 that were older than twenty weeks. Antiabortion activists sought permission to bury the late-term remains but were thwarted by an injunction obtained by the American Civil Liberties Union on behalf of the Feminist Women’s Health Center. Opponents of burial argued that state intervention in the matter violated the Constitutional principle of separation of church and state.
“A woman has a right to abort a fetus,” says the health clinic worker who asked not to be identified. “It is no different than a woman having a right to an appendectomy. A fetus is not a baby, and women don’t owe it any more reverence than they do their appendix. I agree, tissue has to be disposed of properly. But a fetus is just tissue. It is not a baby.”