Mm, Mm Good

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.