Mm, Mm Good

Howard's statement was full of disturbing details. When Howard and his partner visited the clinic, Rajanna's white coat appeared rumpled and stained, and his hands looked dirty, Howard wrote. Howard's partner, Mansaw, later told Howard that he had seen dried blood on the floor of the surgery room, which was covered in old plaid carpet, and that the room looked "nasty."

"The clinic was filthy. It was disgusting. It was repulsive," Howard tells the Pitch. "To think that there was invasive surgery going on in that clinic was not a comforting thought. It might remind you of a clinic you'd run into in a Third World country."

Then, Attorney General Kline got involved. He made a presentation before the House Federal and State Affairs Committee, saying that the conditions at Rajanna's clinic proved that a licensing law was needed. He called Rajanna's business a "back-alley" clinic. "This is a place where no woman, no person, should have to undergo a medical procedure," Kline said.

Some legislators seized on the fetus-eating allegation.

"His own staff said that he cannibalized human tissue," Mast tells the Pitch. "I have very little doubt in my mind that he did this. I had heard that they do this type of thing in China, but we in America are not ready for this. Why else would he keep them in the freezer?"

But even the tales of fetus eating and Howard's affidavit weren't enough to boost the bill's chances. With the Board of Healing Arts promising to wrap up the Rajanna matter soon, Mast's bill died in committee.

Until about five years ago, Krishna Rajanna performed abortions at Aid for Women, a Central Avenue clinic that sits in a free-standing white building with a manicured lawn and a large, neatly lettered sign that reads "Central Family Medicine."

For years, Eugene Frye, who is in his fifties and owns a small construction business, spent his Saturday mornings outside the clinic with a small group of protesters, holding "Abortion Is Murder" signs with graphic images of mutilated fetuses and shouting to women on their way into the clinic.

"He's very vocal," says Sherman Zaremski, the physician who now runs the clinic. Zaremski, who worked with Rajanna before he left, says Rajanna departed after a falling-out with the clinic's then-owner, Malcolm Knarr. The dispute culminated in a lawsuit in which Rajanna accused Knarr of withholding $4,000 of salary. Rajanna left and opened his own clinic just a few blocks away.

"He is a good surgeon, technically speaking," Zaremski says of Rajanna. "I don't know that there was ever a question about his competence as a physician." Zaremski says he's skeptical about Garcia's charges. Zaremski says it's not unusual to store fetuses in a freezer. "We store a sample of the fetus in the freezer anytime somebody thinks they might prosecute for rape. Not in a Styrofoam cup, but they're sealed, marked and labeled. It's a matter of police chain of evidence," Zaremski says.

But Zaremski tells the Pitch he was not surprised that Rajanna had been disciplined. He says he stopped by Rajanna's clinic one afternoon a few years ago, just to be friendly, and noticed that the procedure room was carpeted -- making it difficult to clean and nearly impossible to sterilize. "No, it didn't surprise me. I saw it myself," Zaremski says.

Jennifer Mulich, one of Rajanna's former clinic employees, downplays the dirty conditions. "The place ain't nothing fancy," she tells the Pitch. "It's 10th and Central, for God's sakes."

Mulich, who is out of a job now that the clinic is closed, says a lot of poor women were upset when the clinic shut its doors. At $290 for an abortion -- and a sale price of $250 on Wednesdays -- Rajanna was one of the least costly abortion providers in town. "This is going to sound terrible, but we had a lot of repeat customers," she says.

Mulich defends Rajanna, saying that the fetus-eating allegations are simply untrue. She says some employees -- including Garcia -- fabricated stories about Rajanna because they disliked him. "She just made up a bunch of stuff," Mulich says of Garcia.

When the Pitch spoke to Howard and pressed him for details of his interview with Garcia, he acknowledged that Garcia had never said she actually saw Rajanna eat a fetus. She told Howard that she had seen him eat something from a container that resembled the ones she'd seen him store fetuses in and concluded that he'd eaten fetal tissue.

"She leaned over and whispered to one of the other girls, and they both concurred that's what it was," Howard says.

At first, Rajanna denied repeated requests for an interview. His attorney, Robert Manske, complained that it was unfair for Rajanna to have to prove he didn't do something.

Finally, Rajanna granted a telephone interview. Sounding emotionally shaken by the controversy, he explained that there was a very simple reason why he never ate fetal tissue.

He's a vegetarian.

"I was raised very strictly," Rajanna tells the Pitch. "My mother would commit suicide before she'd even think of touching a meat product." Though he says he has become more lax with his diet since he moved from southern India to the United States in the 1970s, meat still makes him squeamish. And he says he'd never consume a fetus. "This is outrageous," Rajanna says.

Telling a police officer that Rajanna ate fetuses, the doctor says, was Garcia's way of getting revenge on him for reporting that he suspected his employees of theft and for firing her.

Rajanna says the police came to investigate the missing $1,000 but immediately sided with the employees. Rajanna admits he kept aborted fetuses in Styrofoam containers in his refrigerator's freezer, but he says he did it to keep them from rotting before they could be picked up by his biohazard disposal service. He adds that the vegetables and rice he eats from plastic containers, which he brings from home, are nothing like the Styrofoam containers in the freezer. "My food is in my own plastic containers. I make it at home and take it there," Rajanna says.

The doctor chalks up the allegations to an anti-abortion conspiracy. "That police officer was a pro-lifer's dream," he says. "Now all of them have gotten together on this."

In February 2005, a full year after Frye's initial complaint, the Board of Healing Arts took action against Rajanna. Citing numerous problems with the cleanliness of his clinic, the board fined him $1,000 and made him promise to clean the place up, get certified in advanced cardiac life support and submit to two unannounced follow-up inspections.

It wasn't the first time the board had disciplined him. In 2000, Rajanna was fined $1,000 for improperly dispensing prescription medications. A year later, he was fined another $1,000 for failing to provide Rh factor testing to patients. (When performing abortions, doctors must provide all women who have an Rh negative blood type with a drug to help them avoid serious complications with future pregnancies.)

On March 22 and 24 of this year, Board of Healing Arts investigator Peter Massey conducted surprise inspections of Rajanna's clinic and found that conditions had actually worsened. On the second visit, he snapped a photo of a dead mouse on the clinic floor.

The next day, the board issued an emergency order and temporarily suspended Rajanna's medical license. A hearing was scheduled for March 31.

Meanwhile, the latest debate on abortion-clinic licensing was raging in the Kansas Legislature, and Rajanna's clinic was at the center of it.

Mast again sponsored a licensing bill, this one called the Women's Health Protection Act. At the beginning of the session, the Board of Healing Arts still hadn't taken action against Rajanna, and this time, legislators had obtained the photographs taken by Garcia.

"The evidence over these past few years has just been so compelling that anyone in their right mind can't avoid it," Mast tells the Pitch. "This kind of thing would never be accepted in any other medical clinic or even in a restaurant without being closed down."

The 2005 bill called for the state to set standards for abortion clinics, including requirements for dressing rooms for staff and patients, separate counseling rooms, supervised and staffed recovery rooms, secure medical-record storage areas, and ultrasound equipment in clinics that perform abortions on women who are 12 or more weeks pregnant.

"One of the problems with the bill is that it's so prescriptive," says state Rep. Nancy Kirk, who opposed the bill. "Most of us who have been here awhile know it's not good for legislators to try to play medical doctors. The statutes should be broad in nature, guidelines that drive the rules and regulations." Kirk says she would back legislation that, instead of singling out abortion clinics, requires licensing and inspections for all doctors' offices and clinics -- such as those run by podiatrists, dermatologists and even dentists -- where doctors perform surgery using anesthesia.

"What a number of us were opposed to was singling out one procedure. We're trying to get this out of the abortion battleground," Kirk says.

Jana Mackey, a lobbyist for the Kansas chapter of the National Organization for Women, says the detailed requirements in the bill and the burden of paying high annual licensing fees to cover the cost to the state of implementing the bill -- estimated at $291,188, according to a fiscal note drafted by state legislators this year -- would cause major hardship for clinics.

Of the seven abortion clinics remaining in Kansas (down from 26 clinics in the late 1970s, a few years after the Roe v. Wade decision), only the two largest clinics -- Comprehensive Health in Overland Park and George Tiller's Women's Health Care Services in Wichita -- would survive a licensing law, Mackey says. Even the clinics that survived, she adds, would have to pass on the costs to patients, many of whom would have to travel farther to get abortions.

According to the National Abortion Rights Action League, Kansas is one of the worst states for abortion access. In a rating system from A to F, the group gives Kansas a D minus based on the state's laws and the political leanings of its Legislature and attorney general.

Zaremski says provisions of the bill -- such as requirements that clinic hallways be wide enough to accommodate a gurney and that a room be used only for counseling, along with an estimated $49,000 a year licensing fee -- would be difficult for small providers to meet. "The bill wouldn't do anything except put people out of business," Zaremski says.

But the Rajanna photos, along with the January 2003 death of a 19-year-old Texas woman after an abortion at Tiller's Wichita clinic, gave the bill's proponents ammunition.

"I think the photos were used as a major part of a fear campaign -- they were really used for shock value," Mackey says.

When Kansans for Life distributed the photos depicting the inside of Rajanna's clinic, even the bill's opponents admitted they looked bad. "Nobody supports or condones the conditions that were in that clinic," Kirk tells the Pitch. The pictures left pro-choice lawmakers on the defensive and allowed anti-abortion activists to portray the issue as one of women's health.

State Sen. Roger Reitz, a medical doctor who voted against previous versions of the bill, says the photos of Rajanna's clinic changed his mind on the clinic-licensing issue. Reitz remembers the moment a colleague tapped him on the shoulder during a break and slid the color photos toward him. "I was aghast. I had thought better of my colleagues," Reitz says. "It was simply unacceptable."

The photos swayed other moderate legislators as well, and for a while this spring, the bill looked as though it might finally succeed with enough support to override an expected veto.

The bill would come to a vote on March 31, the same day Rajanna was scheduled for his hearing at the Board of Healing Arts.

At the hearing, the board's disciplinary counsel, Stacy Cook, presented evidence against Rajanna to the hearing's presiding officer, board member and doctor Nancy Welsch.

Investigator Massey testified that on his first surprise visit to the clinic, on a Tuesday morning, it was dirty and the doctor was not there. Staff members told Massey they couldn't reach Rajanna because his cell phone had been stolen and he didn't have a home phone.

Massey testified that he looked around anyway and saw a number of problems: The floors needed vacuuming, there were soiled surgical drapes in the office that had been folded and stacked instead of thrown away, the toilet was dirty and streaked, two plastic bags full of trash sat on the office floor, old paper towels sat in the soap dishes, and there were large gaps along the baseboards in the procedure room left by the removal of carpet. In the recovery room, there was an old living-room couch with a standard bed pillow and blanket on it. The lids were off the biohazard containers, leaving bloody waste exposed. In the refrigerator, predrawn syringes of medication were unlabeled, with only a handwritten initial of the drug on the cup containing the syringes.

Two days later, Massey arrived on a Thursday morning and found the dead rodent. When Rajanna arrived and Massey told him about the mouse, Massey testified, "He somewhat exclaimed that it was working, that his rodent pest control was working." Rajanna explained that he had put out rat poison in the clinic. When Massey asked Rajanna why the clinic was so dirty, "He told me that he had explained to 'his girls' that this needed to be cleaned, but they had failed to clean," Massey testified.

At the hearing, Rajanna called two clinic employees to testify. "Personally to me the office was never really dirty," employee Lori Jakes stated. During cross-examination by Cook, she admitted that she had been hired to clean the office but had quickly been called on to assist during abortions. The staff had so many duties, Jakes said, that they sometimes didn't have time to check on patients in the recovery room.

In his closing statement, Rajanna admitted that his clinic had "some deficiencies" but complained that the board had not made requirements clear to him. "It was very difficult to pinpoint how to make it 100 percent compliant," Rajanna said. "I may have one opinion of an item, and the board's investigator may have a different opinion of the same item."

During Rajanna's statement, an attorney for the board, Mark Stafford, interrupted to warn the doctor not to rely on the board to help him comply. "You need to seek the appropriate legal or professional advice," Stafford told him.

Cook said, "This case is unique in that multiple times this board has instructed Dr. Rajanna on the deficiencies of his clinic. The board doesn't have the resources to visit each doctor's office once a month to make sure they're cleaning." She added that Rajanna should hire professional pest control and cleaning companies and, as a practicing physician, should know how to properly dispose of medical waste. She said Rajanna was violating state law regarding labeling medications, which requires that labels include the drug's name, the name of its manufacturer, its lot number, its strength and quantity, and its expiration date.

After the hearing, Welsch ordered that Rajanna's license remain suspended for 30 days to give the board a chance to review his case. Following another postponement in April, the board revoked Rajanna's license this past weekend.

During the Board of Healing Arts proceedings against Rajanna, no mention was made of the allegations that the doctor had eaten fetuses. When the Pitch asked why, Buening said the board had been unable to substantiate the charges in interviews with 17 witnesses. "Anybody who it was alleged had any information in regard to the situation was contacted," Buening says. "Any allegations that were made, we pursued. The charges we were left with were only the ones we felt we could prove."

The same day of Rajanna's hearing, the Kansas House of Representatives passed the abortion-clinic-licensing bill by what supporters called a "veto-proof" margin of 88 to 34. The state Senate had already approved the bill by more than a two-thirds margin with a vote of 27 to 12. If no legislators changed their votes, it looked like a veto could be overridden.

Two weeks later, on April 15, Gov. Sebelius vetoed the bill, as she had said she would. "Once again in 2005, the Legislature has chosen pure politics over good policy, has rejected uniform standards for all procedures, and has instead chosen to regulate only one procedure -- abortion," Sebelius said in a statement she released that day.

On April 28, legislators in the House tried to override the veto but failed by two votes. "We were a little worried, but in the end the vote came out exactly as we expected it to," Mackey says.

If the Rajanna investigation had helped boost the bill's chances, his disciplining, some say, helped sink it.

Kansans for Life's Ostrowski accuses the board of politically motivated timing. It was no accident, she says, that the Board of Healing Arts finally suspended Rajanna's license the same day the Legislature voted on the licensing bill.

But Stafford, the board's attorney, dismisses the connection. "Politics, I don't think that had anything to do with it," he says. "The board meets only six times a year, and they can only take final actions at those times. It came up as the result of a completed investigation, and I think there was just a lot of coincidence there."

The investigation took a long time, Buening says, because the board's seven investigators are stretched thin, with about 700 cases open at any one time. (Not all open cases require full investigations, however.) He says the board is considering revising its procedures in order to complete urgent investigations faster.

"I think in hindsight now it's, Gosh, I wish we would have gotten that done a little faster than what we did," Buening says.

Rajanna has moved out of the building on Central Avenue and does not plan to go back. He hired an attorney in May, and he can appeal his license revocation to the district court. He says he is a good surgeon and has had a very low rate of complications. "If there's any way we can make them understand the truth, it's what I want to do," Rajanna says.

Rajanna says he was offering a service to the community by providing abortions at a lower price than other area clinics. "We were helping the women in the community. The hugs that I get is enough reward," he says.