seyma bayram

‘The emotions are on a huge spectrum’: Inside one of Ohio's few remaining abortion clinics

By Seyma Bayram and Doug Livingston

Published in the Akron Beacon Journal, March 24, 2022 (Click HERE to view on news site).

Note: This is one story in a 4-part series. To read the rest of the package, see the links at the end of this story.

Editor's note: The patients observed and interviewed for this article didn't want their real names used because of privacy and safety concerns. 

Jessica fumbled to pry open the small, black titanium lockbox containing abortion pills. The gray-haired doctor who gave her the box — and later the combination to open it — leaned in to watch her on a Zoom call from his Cuyahoga Falls abortion clinic, 85 miles away from Jessica’s hometown of Galion, where there are no abortion clinics nearby.

Jessica was one of Dr. David Burkons’ many patients at the Northeast Ohio Women’s Center the previous day, a Friday morning in early March. The 26-year-old woman, who was six weeks pregnant and already has a 6-year-old son, wasn't physically or mentally ready to raise another child. She had arrived at the clinic that Friday for the required in-person consultation and ultrasound before being sent home with the lockbox. State law requires 24 hours between the consultation and the procedure. 

As one of Ohio’s most prolific abortion doctors, Burkons’ ability to innovate around legislative restrictions has allowed his operations to double capacity while clinics across Ohio are closing. His Cuyahoga Falls clinic is one of six remaining in the state that offers surgical abortions, in addition to medical abortions that use oral medication to end pregnancies. 

The lockboxes are the latest of example of how Burkons has adapted to continue providing abortions amid restrictions that have already caused more than half of the state’s abortion clinics to shut down since 2011. And more challenges will likely come the doctor's way with the potential demise of Roe v. Wade later this year. 

In the spring of 2021, the U.S. Food and Drug Administration approved telemedicine for medical abortions during the COVID-19 pandemic. Though Ohio law permits mail-order prescriptions of other drugs, like temperature-sensitive insulin injections, the state forbids patients from receiving the abortion-inducing pill Mifeprex, which is taken orally, via mail.

As a result, Burkons’ patients had to be at his office for the ultrasound and back again another day to take the pill under his supervision, rendering the telemedicine option ineffective.

The doctor brainstormed alternatives and bounced them off of his attorney Jessie Hill, a constitutional law professor at Case Western Reserve University, who rejected them one by one — on legal grounds — until the lockbox idea came to him in the middle of the night. 

By July 2021, Burkons and his staff had telemedicine abortions up and running. He's since doubled the share of abortions conducted via Zoom, from 12% of all abortions at his facility last year to 24% as of early March.

The telemedicine abortion takes about five minutes, and people often join the calls from inside their cars during breaks from work. Sometimes, his patients opt for the virtual appointment simply because they don’t want to put up with the protesters who yell at them outside of the clinic. 

“It can be like a circus out there,” Burkons said, motioning on a Saturday toward the sidewalk next to the Northeast Ohio Women’s Center, where about a dozen anti-abortion protesters had gathered by 10 a.m, most of them older, white men.

Their shouts and sermons were intermittently drowned out by the sound of kazoos played by clinic escorts, who were discreetly ushering patients in and out of the parking lot and building. 

“They don’t know you, they don’t know your story, but they know what’s good for you,” Burkons said with a sardonic grin.

“If anything, the protesters make the patients more appreciative of us.”

Under close scrutiny

Raised by an OB-GYN father, Burkons, 75, graduated from medical school in 1973, the year that the Supreme Court legalized abortion in the landmark case Roe v. Wade. 

Years later, Burkons continues to see the chipping away at that right from the influential anti-abortion lobby and GOP-controlled state legislatures. Their efforts have set the stage for the U.S. Supreme Court to overturn or gut Roe despite polls showing most Americans favor a person’s right to choose whether to have an abortion. 

Burkons' patients praise him and his staff for their compassion and support, but some in the anti-abortion movement accuse him of murder.

"There’s babies being killed here," said one middle-aged protester outside of the clinic, who would not reveal his name.

From 2019 to 2021, Burkons' practices in Cuyahoga Falls and Shaker Heights recorded a combined 84% increase in abortions, from 1,899 to 3,498. The business is on pace to hit 3,850 abortions in 2022. 

His clients come from all over to the Falls location. Even before implementing telemedicine, 3 out of 5 of Burkons' patients in 2020 were not Summit County residents. 

Burkons opened Northeast Ohio Women’s Center in 2014 in the wake of growing abortion restrictions in the state. The Ohio State Medical Board suspended his license for six months in 2017 on allegations that he signed blank prescriptions. 

At the time of the investigation, Ohio Right to Life President Mike Gonidakis, one of three members of the anti-abortion lobbying group appointed by then-Gov. John Kasich, was the president of the Ohio State Medical Board. Gonidakis is not a physician. 

“I was writing a lot of prescriptions here — and they claimed that they were not properly documented, and they did this big investigation. If you read the paper, they found one prescription that was signed but there was nothing to it. … They claimed there were hundreds. There was one,” Burkons said. 

His attorney advised him to swallow the suspension and move on. Fighting the decision would have cost a lot of money and time, and “they always win.” Under usual circumstances, such a violation would have landed the doctor with a censure, the lawyer said. “But in your case, they threw the book at you,” he told Burkons.

For six months, an undeterred Burkons had somebody else run the clinic. 

Because of how difficult it is for people to access abortions in Ohio, Burkons operates seven days a week, with evening hours. And the septuagenarian does not plan to stop anytime soon.

“I don’t need the money … I had a very successful practice. I can retire anytime I want. But I just figured, the best way to get back at these a******* was to do well, and just keep busy," he told the Beacon Journal.

A group of anti-abortion protesters purchased a parking lot across from Burkons’ Toledo clinic, where patients used to park. In June, four members of Red Rose Rescue, a militant anti-abortion group, entered the Northeast Ohio Women’s Center, staged a prayer and refused to leave. The protesters were found guilty of trespassing.

Since then, volunteer escorts said they receive a list of patients the clinic expects each day.

In a January 2020 report, the FBI recorded a 40% increase in crimes against abortion clinics, including trespassing and obstruction by protesters or violence and threats against staff. 

"Driven in part by the recent rise in state legislative activities related to abortion services and access," the FBI concluded that "(a)ctors motivated by pro-life extremist beliefs have historically and continue to perpetrate the most lethal attacks, and have committed the majority of non-violent criminal violations." 

Since the report, an arson in October 2021 precipitated the closure of Capital Care of Toledo, which Burkons purchased and reopened as the Toledo Women's Center. A New Year's Eve arson destroyed a Planned Parenthood under renovation in Knoxville, Tennessee. In January 2021, on the 48th anniversary of the Roe v. Wade ruling, a man with a white bandanna over his face fired a shotgun into the facility, which was closed at the time.  

'You change lives every day'

Burkons operates despite the danger. 

The door of the recovery room at Burkons' Cuyahoga Falls clinic is covered from floor to ceiling in heartfelt, handwritten letters of appreciation from former patients. 

“You change lives every day,” reads a letter from one 34-year-old white woman who drove two hours from Columbus for a six-week surgical abortion. She had struggled to get an appointment at more local clinics, including the Planned Parenthood in East Columbus.

"Before my (appointment) with you guys, I was terrified," reads a note from another patient. "I thought I would be judged for my decision and believed my life was over. ... The young lady who did my internal ultrasound told me it was okay to cry when she saw me trying to hide my tears and told me I was safe ... Because of you guys, I get to continue my education and keep my dream job."

During surgical abortions, nurses offer tissues to patients or gently dry their tears for them — warm gestures in a sterile, fluorescent-lit surgical room.

"The emotions are on a huge spectrum," said Sherri Grossman, executive director of the clinic, describing the patient experience.

"Some people are just like 'get me not pregnant.' Other people have a lot of emotions attached to that. And wherever someone falls, it's fine. We're going to meet them right there and support them where they are," she said.

Burkons is passionate about supporting people during a critical time in their lives. 

“Nothing I’ve ever done is more satisfying than this. You just come into work, and every patient walks in with a problem and they walk out without that problem," he said, referring to unintended or unwanted pregnancies.

"They still have the problems that brought (them here) — you know, a bad relationship, money. There’s nothing we can do about that. But this we can take care of,” he said.

‘It’s going to be more expensive to pay for another child for the rest of my life’

Latoya Stringer leaned over a woman lying on her back on the black surgical table at the Northeast Ohio Women’s Center. 

“Just squeeze my hand and breathe in,” she said softly to the 25-year-old patient, Michelle, who drove from Columbus to abort her six-week pregnancy.

“That should be the worst of it, honey,” Burkons said, laying down his syringe. “Don’t forget to breathe, we like breathing."

Another minute passed. 

“All done,” Burkons said.

After the procedure, Stringer escorted the young woman to the recovery room, where she sat with a heating pad, overwhelmed with relief.

“I’m just not ready. … I’m trying to get back to school and everything like that. That’s pretty much my reason. I already have a child,” said Michelle, who was on birth control when she accidentally became pregnant. She is a Black mother of an 8-year-old, working full time and dreaming of becoming a licensed aesthetician, perhaps one day opening up her own business in Atlanta. 

Michelle had struggled to get an appointment at the East Columbus Surgical Center before calling and getting a next-day appointment with Burkons.

“Columbus is terrible when it comes to abortions,” she said. “I have a car, but I mean ... it puts a strain. I had to call off work to be able to get rest to get here on time.”

Like 12 other patients interviewed for this article, Michelle expressed concern over legislative attacks on reproductive rights and abortion access.

“I think it’s terrible. … People go through stuff, you know? It’s kind of messed up to try to force somebody to bring a child in when nobody is even prepared for that,” she said.

She views abortion bans as an effort by the government to keep people, particularly marginalized people and communities of color, in cycles of poverty.

“I just feel like the government is just worried about ‘keep having kids, keep having kids’ so we keep relying on them, you know, to be in the system and keep needing food stamps. It’s just messed up,” she said.

Sarah, a single, white 21-year-old mother of a 3-year-old who works full time, traveled an hour from Youngstown to medically abort her eight-week pregnancy. 

“I’m already a single mother and the father … I didn’t think he would be around. I work 12-hour shifts. Even now, it’s hard to take care of one kid, financially and mentally. I didn’t think I was in the right space to handle a second,” she said.

“I do work and get by, but even with a job, it still was hard,” she said, describing the difficulties of gathering the money for her abortion. 

The Hyde Amendment, first passed in 1976, forbids the use of federal funds to pay for abortions, except in rare circumstances, such as incest or rape, so welfare recipients must pay out of pocket for their abortions. Burkons’ clinics offer some financial support through the National Abortion Federation and funds like the Columbus-based Women Have Options, but Sarah was able to get help from her mother. 

“It’s going to be more expensive to pay for another child for the rest of my life,” she said, weighing the $650 cost of the abortion against a lifetime of financial responsibility. 

‘I will find other ways to get rid of it’

Mary Schatzman, a nurse at the Cuyahoga Falls clinic, said abortion restrictions only deepen America's class divide.

“Women with means are always able to find some way. … Women who are really desperate will go to shady kinds of methods,” she said.

Schatzman studied 50 years ago at Baylor University in Texas, where she knew a college classmate who had to go to Mexico for an abortion.

In the course of her decades-long career, including as a women’s health nurse practitioner and a sexual assault nurse examiner, Schatzman said she's noticed people have become less informed on women's health, pregnancy and reproductive issues, largely because of "abstinence-only education." 

“When you look at abortion rights, there are discrepancies across economic, educational, also racial barriers," she said. "What we do here, we try to equalize things. We get patients who get some funding help from National Abortion Federation. We try to make everything as accessible as possible to everybody. But if abortion were to become illegal, the privileged would be less affected than the lesser privileged."

Before scheduling her telemedicine medical abortion with Burkons, Lisa had struggled to book an appointment at a Planned Parenthood location closest to her hometown of Ashtabula. Then, she visited a crisis pregnancy center, where she said a staff member with no medical training tried to pressure her into keeping her pregnancy. 

When Lisa asked the employee to refer her to an abortion doctor, she said they would not help her. The 21-year-old woman is already struggling to take care of her toddler as a single mother while her baby’s father serves a jail sentence.

Lisa knew she wanted to abort her pregnancy, and she knew she needed to do it fast. Her conservative Puerto Rican family would have forced her to keep the child if they found out she was pregnant.

“It’s definitely hard. I have a kid already, so I’m not ready for another one. I just can’t support two kids and myself ... so I just thought this was the best thing for me to do,” she said. “I’ve cried, thinking about me actually giving a kid away.”

Financial support from NAF cut the cost of Lisa’s abortion by about $175. If she had not been able to access a safe and legal abortion through Burkons, she said she would have taken matters into her own hands.

“It was so hard for me to even find the place. I just think they should have something in my town that helps us,” she said. 

“Before I found this place, I'm not going to lie … I physically cannot have this baby, like, I will find other ways to get rid of it, whether it is safe for me or not. There definitely is other ways to get an abortion that is not the right way,” she said.

The long walk to the front door

Outside, protesters come within inches of the clinic's tiny parking lot in Cuyahoga Falls.

Clients are often dropped off in the rear and escorted by volunteers who shield the women from at least the sight of the ruckus with giant rainbow umbrellas. The drivers leave the parking lot to make room for the next arrival.

Wherever they park, often on side streets or in the lots of neighboring businesses, the protesters find them. With brochures tucked in their sleeves, they preach through car windows until the person inside rolls down the window or drives away. 

On a frigid but sunny Monday in late February, Madonna was the first volunteer escort to arrive. She positioned her minivan parallel to the road, blocking all but the space cars needed to access the parking lot, creating a barrier.

"You take advantage of the things you can. And my van is one of the things we have," said Madonna, who withheld her real name in case the protesters, who she fears would do her harm, haven't already figured it out.

A Michigan native, she moved to Ohio in 2012 and started counterprotesting outside the clinic the first Saturday after Donald Trump won the 2016 presidential election. 

On the sidewalk, she spotted the "Queen Stalker" — one of the many nicknames she and the other volunteers have given the protesters as the escorts use humor to cope with the sometimes stressful situation outside. There's also "Lukewarm Steve Austin," a play on the wrestler "Stone Cold" Steve Austin, and "Drill Minister," who they say sounds like a cross between a preacher and a drill sergeant.

In the parking lot next door, Rita Vitale walked from a parked car holding a sign with the silhouette of a woman and a late-term baby in her belly.

"I have a particular disdain for her," said Madonna, "because she's seen what happens to some of these babies. I imagine she's seen it all."

Vitale, a registered nurse in the neonatal intensive care unit of a local hospital, has spent much of her free time in the past 10 years standing with her back to the State Street traffic, trying to persuade women to stop at the front door of the clinic and turn away. She said she's gotten through to some, though Madonna and the other escorts have never seen it.

"I've always understood the real science, that human life begins at conception," Vitale told a Beacon Journal reporter. "And the killing of a human being is never the answer. We can do better. I'm here to tell these women that I'm here to walk alongside them."

Vitale said she's literally willing "to adopt a baby who's on the chopping block today."

"Abortion hurts women in the end. Not only the women, it hurts the man who's involved, or not involved. It kills someone's grandchild. It kills someone's niece or nephew. That's a person inside of them and it doesn't just belong to one person," she said, meaning the mother.

As Vitale disappeared around the corner to check on a driver waiting in an idling car, Madonna thought about a homeless woman addicted to heroin who she helped through the front door of the clinic three years ago.

"What was she supposed to do?" Madonna asked. "Go have that baby, as Rita would say? And have it addicted to heroin?"

Sometimes, she tells protesters who are mothers about a person she knew who was raped.

"Do you remember every time your baby would kick in the womb?" Madonna, who is a mother, would ask the protesting mothers. "Do you remember how much joy that brought you? Well I have a cousin who, when she was younger, was dragged into a stairwell and raped and conceived.

"What if you had something that terrible happen to you, and every time your child moved in your womb, you were raped again? Could you handle that? Imagine all that joy you felt and turn it into terror, and live that the last six months of your pregnancy."

Madonna thinks the story has kept a few protesters from returning. 

‘We're proud of what we do’

Burkons said goodbye to his last Zoom medical abortion patient on a Saturday afternoon. Despite a busy six-hour shift that included six surgical abortions, the grandfather was energetic, thanks in part to an appetite for Diet Coke.

Burkons believes a lack of courage from the medical community and its silence on the violent attacks on abortion providers and reproductive rights have emboldened anti-abortion lobbyists and protesters in recent years. Most medical schools don't train residents in how to perform the procedure, he pointed out, so those who want to learn can train only at clinics like Burkons' Falls facility. 

“If the doctors won’t talk about it and say that we do it, and we’re proud of what we do," Burkons said, "then it makes the patient feel that what they’re doing is somewhat shameful."

People often ask him whether he's concerned about the Supreme Court's pending decision on Roe v. Wade.

"I kind of say ‘no,’ only because there is nothing really I can do about it,” he said.

Instead, Burkons is committed to fighting stigma around abortion and said he wants to normalize a safe medical procedure and the many reasons a person might want an abortion.

The public figures who have come out in support of abortion often tell their stories with the caveat that there was a rape or abusive relationship involved, he said.

Burkons does not doubt that their experiences are true and valid, but he emphasized that for the vast majority of Americans who get abortions, they simply "weren’t planning another child, it was a mistake pregnancy and they analyzed their situation and said ‘this isn’t the right thing for us.'"

“Until people are willing to stand up ... abortion is going to remain in the shadow and patients are going to feel stigmatized," he said.

_______

To read the rest of this 4-part series on abortion restrictions in Ohio, click on the stories below:

• “Who is getting abortions in Ohio? And where are people getting them?,” Akron Beacon Journal (March 24, 2022) (co-reported with Doug Livingston).

• “How each side of the abortion debate is preparing for life after Roe v. Wade in Ohio,” Akron Beacon Journal (March 24, 2022) (co-reported with Doug Livingston).

• “How Catholic Democrats in Akron helped write the conservative playbook to overturn Roe,” Akron Beacon Journal (March 24, 2022) (co-reported with Doug Livingston).