A choice alternative 

Celebrating 25 years of health and heartache at Blue Mountain Clinic

Upon arriving at Blue Mountain Clinic, the first thing you notice is the fence. Austere and imposing, it surrounds the clinic and parking lot, seemingly out of place in Missoula, giving the facility the distinct feel of, say, an embassy in a blighted neighborhood of some developing country. The security cameras mounted atop the building do nothing to alleviate this impression. But as you enter the clinic (after being buzzed in by the receptionist), your perception immediately changes. Warm pastel colors, plants and handmade decorations tastefully adorn the waiting area. Children play with a collection of toys in the corner. A young couple awaits an appointment, holding hands and talking quietly.

It’s a typical day at Blue Mountain Clinic, Missoula’s one-of-a-kind, non-profit and non-corporate family practice health care center. First opened in 1977 as the Blue Mountain Women’s Clinic, the present-day Blue Mountain Clinic–re-christened, rebuilt, and reshaped—celebrate its 25th anniversary this week. The clinic’s quarter century of continued existence and evolution, along with the passion and dedication of its staff and supporters, in the face of adversity that has at times turned violent, are indeed a cause for celebration.

For people, not for profit
For longtime patient Nancy McCourt, choosing the Blue Mountain Clinic for health care has been easy for her and her family. “I go to Blue Mountain Clinic because of the top quality health care, the bedside manner of the staff, and the philosophy that comes through in the care,” says McCourt, who first became a patient here in the early 1980s. She made the mistake of taking for granted the clinic’s nurturing environment and compassionate staff, until she sought health care while living in Portland in the late ’80s. “I realized after my experience in Portland that not all clinics are like the Blue Mountain Clinic,” she says.

Later, when McCourt sought pediatric care for her young daughter, she initially took the girl to a specialist. “He saw my daughter for less than five minutes. There was no personal connection, and I just wasn’t happy with that,” she says. Her experience at Blue Mountain Clinic was notably different. And especially with pediatric care, accessibility is a key factor. “For a parent, it’s great,” she says. “You can make an appointment and come in the same day, which is important with a child.”

For its staff and supporters, the most exciting facet of Blue Mountain Clinic’s evolution over 25 years has been its transformation from a women’s reproductive health clinic to an integrated clinic offering a full range of family practice services. In layman’s terms, this means that the clinic offers comprehensive health care for everyone: men, women, and children. To officially recognize this change, Blue Mountain Clinic dropped the word “Women’s” from its name in 1991.

“It has been somewhat difficult to overturn our image as a women’s clinic,” says Laura Marx, a family nurse practitioner at the clinic. “But we have definitely been seeing more and more men over the last several years, as our image changes. And I think having a male provider [Family Practice Physician Dr. Eric Ravitz] on staff helps as well.”

Marx feels that what sets the clinic apart is its model of care-giving. “We give [patients] so much attention…we’re easy with them. They come in and we take time with them, visit with them, it’s not just a five minute, 10 minute visit. People who come here regularly become part of the Blue Mountain Clinic family… for better or for worse,” she laughs. “I guess that’s the best way to put it.”

Blue Mountain Clinic is unique in western Montana in that it is integrated, meaning that it offers not only Western medicine, but also complementary and alternative health care. Staff practitioners include specialists in a diverse range of treatment options, including acupuncture, Chinese herbal medicine, counseling, and massage therapy, all working together under one roof. The beauty of this integrated approach to medical care lies in its underlying philosophy, which views Western medicine and alternative medicine as complementary, rather than competitive.

Patient empowerment is another cornerstone of Blue Mountain Clinic’s philosophy. The clinic’s health care providers strongly encourage patients to educate themselves and take an active role in making informed choices about their own treatment. “We encourage and allow people to make treatment decisions for themselves, whether it’s Western medicine or other alternatives,” says Marx. “That’s the ultimate pro-choice issue.”

The clinic strives to make high-quality health care accessible to everyone, an emphasis that is reflected in its status as a nonprofit organization. “There’s a proud sense of identity around the fact that we’re not a corporate health care facility,” says Raquel Castellanos Miller, Blue Mountain Clinic’s executive director. “We’re about providing access to women’s reproductive health services, but we’re also about providing access to health care, period. It’s a huge need.”

In fact, only about 40 percent of the clinic’s 3,500 patients have health insurance. The rest are either Medicaid or Medicare patients—or are uninsured. The clinic treats as many of these patients as possible, even though they typically become a major financial write-off. The clinic ’s Fair Care program, implemented last year, offers services to uninsured patients at a 20 percent discount, a practice that is virtually unheard of in the field of medical care. The clinic has also developed a working relationship with Missoula Youth Homes, and provides pediatric care to children who are in foster care.

A fiery history
In the wake of the Supreme Court’s 1973 decision on Roe v. Wade, which affirmed a woman’s constitutional right to choose abortion, a women’s health collective that had been meeting in Missoula decided to address the need for abortion services, which were as yet unavailable in Montana. After taking a series of steps toward establishing women’s access to abortion (including a successful challenge that struck down Montana’s state law against abortion), a group of 10 to 12 “founding mothers” began discussing the concept of a clinic in Missoula. From the very beginning, recalls founding mother Judy Smith, the vision for the clinic was that it would be consumer- rather than doctor-driven. The clinic’s fundamental goal would be to inform and empower women to make their own reproductive health care decisions. To this end, the clinic was staffed and operated entirely by community women, and doctors’ services were contracted.

The clinic’s services were clearly needed and appreciated. From the beginning, there was a steady stream of patients, and the facility’s staff and range of services expanded gradually throughout the 1980s. By the late ’80s, however, harassment of abortion providers and disturbances at clinics nationwide were also becoming increasingly frequent and militant. In Missoula, picketers began appearing regularly outside the Blue Mountain Clinic, and at times the entrance was blockaded. Specially trained escort volunteers began maintaining a presence at the clinic, which at the time was located on Kensington Avenue.

On the night of March 29, 1993, however, no one was present to witness the vicious crime that took place. That night at around 1 a.m., an arsonist snuck onto the premises and firebombed the clinic. The perpetrator, a Washington man, was ultimately caught, convicted and imprisoned. The facility was a near-total loss. Miraculously, all of the patients’ records, though damaged in metal file cabinets, survived the fire.

The community’s response was both immediate and compelling. “It was absolutely incredible,” says Cherrie Garcelon, the clinic’s business manager, who was shocked awake by an early morning phone call informing her of the awful news. Rallies took place in front of the gutted building, and the clinic received letters of sympathy and support from around the world. As donations began pouring in, it quickly became obvious that the question wasn’t if Blue Mountain Clinic would be rebuilt, but when.

Two and a half years and $700,000 worth of donations later, that question was answered. In September of 1995, the clinic moved into its new home, designed with state-of-the-art security features and built from the ground up. The new facility was just what the doctor ordered: roomy, comfortable and pleasant.

Thus far, disturbances at the clinic ’s new location have been minimal, and no further violence has occurred. But Castellanos Miller’s reflections on having to work in a secured building, in a post-Sept. 11 world, give her pause for thought.

“I think, coming up on the anniversary of 9/11…abortion providers and clinics have to live with that fear every day,” she says. “Every day we have to come in and be aware, and on heightened security alert when we come to work. And now our country’s feeling that, of course, but that’s something that has been a reality for abortion providers for a long time.”

A steady erosion of access

Nearly 30 years after the Roe v. Wade decision, the issue of abortion remains contentious and deeply divisive throughout the United States. Although abortion remains legal in all 50 states, the anti-abortion movement has grown increasingly sophisticated in utilizing new means to make it more difficult for women to obtain abortions. A recent survey found that 84 percent of all U.S. counties have no identifiable abortion provider. In non-metropolitan areas, that figure rises to 94 percent. In Montana, where schools are not mandated to teach sexuality education, 89 percent of all counties have no abortion provider. This means that many women must travel long distances to reach the nearest abortion provider.

“We see people from all over the state—people drive here for five or six hours to access reproductive health services,” says Castellanos Miller. “And we have a lot of folks that come here from Idaho, from Wyoming, and from Canada. It’s a matter of access.”

Around the country, anti-abortion activists and organizations have worked on a state-by-state basis to curtail that access by passing laws and influencing public policy in order to create barriers to abortion. Examples include mandatory waiting periods and parental notification laws, mandatory counseling laws (requiring clinic personnel to lead patients through state-prescribed “scripts,” which critics argue violate the right of free speech), elimination or redirection of funding used for family planning or health education programs, and recently, efforts to elevate the legal status of the fetus to that of a person.

Violence directed against abortion providers, something the staff at Blue Mountain Clinic has experienced firsthand, has had a detrimental effect on access as well. Since 1994 in the United States and Canada, a doctor, a clinic escort and three clinic employees have been murdered, and several others have been shot and wounded. The violence has included bombings, arson, vandalism, burglary, blockades, threats and harassment. Not surprisingly, this has contributed to a decline in the number of abortion providers, while fewer and fewer medical schools now teach the procedure as part of their standard curricula.

“Here in Montana, we’ve lost 66 percent of our [abortion] providers in the last 10 years. We had twelve providers in 1992. In 2002, we have four,” says Castellanos Miller. “And Montana is mirroring a trend that’s happening all over the country.”

The anti-abortion movement recently acquired a high-level ally in George W. Bush, whose administration has waged war on women’s reproductive rights worldwide. In an unprecedented move, the Bush administration last month cut all U.S. funding to the United Nations Population Fund, which for 30 years has provided voluntary reproductive health care and family planning services to the world’s poorest citizens. Ironically, these services do not even include abortion, and in fact the United Nations Family Planning Agency estimates that Bush’s action, by reducing the availability of birth control in the developing world, will result in more than one 1 million additional abortions from more than 3 million more unintended pregnancies.

Here in the United States, women’s reproductive rights advocates see a similar dynamic unfolding. “Since Bush, all the money that’s coming down for health education is abstinence-only,” says Castellanos Miller. “I think we’re going to see significant increases in unwanted pregnancies and sexually transmitted diseases over the next five or 10 years because of this.

“Abortion rights aren’t just in a vacuum,” she adds. “What gets to me about limiting access to comprehensive sex education and contraceptives is that the right [wing] doesn’t turn around and say, ‘Let’s support all these poor children.’ Instead, they cut and gut social support programs for the working poor. I just don’t get it.”

The next 25 years
According to Castellanos Miller, the integration of reproductive health care and family practice is a natural, desirable, and ultimately essential development. “We’re providing abortion services within the context of a full family practice,” she says. “I think that this is one of the most exciting things that we do because it breaks ground and says, ‘You know what? This is part of being a human being.’ We are sexual beings, and we have to deal with our sexuality, and that includes looking at unwanted pregnancies. Every family practice physician really should be looking at abortion services because you cannot be practicing family practice medicine in this country and not see someone come in during the course of your practice with an unwanted pregnancy. You will always see that.”

Physician Assistant Mindy Opper, who has practiced at the Blue Mountain Clinic on and off since 1980, agrees.

“Part of the long term goal of the clinic’s philosophy is to stop stigmatizing abortion, and recognize that it’s part of family practice,” she says. “Family practice includes all sorts of care, including reproductive care. There are very few clinics, offices, etc. around the country that integrate abortion throughout their daily services…but it’s not a separate issue. It’s part of a woman’s life.”

Just how serious is the threat to women’s reproductive rights? It’s a difficult question to answer, but among pro-choice advocates and organizations there is now a great deal of concern, given the current political climate in Montana and the United States. Longtime activist Judy Smith foresees a range of scenarios that could unfold.

“The Supreme Court could let the legality of abortion go back to a state’s rights level,” she says, which wouldn’t necessarily overturn Roe v. Wade, but which could worsen the patchwork of availability in different states. Or, the anti-abortion movement could continue to push for added restrictions, to the point that providing abortions, while still technically legal, would become a practical impossibility. One thing, says Smith, is certain. “Women aren’t willing to give up their right to choose. But [undermining access to abortion] forces them back into a situation where it’s dangerous.”

Laura Marx shares Smith’s concerns, but remains optimistic. “Most of the young women, the women in their 20s right now, have grown up with the ability to have an abortion. They’ve never had to fight for it,” she says. “And there is a fear with the women who fought for it that there would be no one to pick up the torch if Roe v. Wade was turned around. But I feel that if that happened, those women would pick up that torch.”

Whatever changes may be in store for Blue Mountain Clinic over the next 25 years, Missoulians can expect one thing to stay the same: the clinic’s emphasis on top-notch, individualized medical care that puts patient empowerment and choice first, and that occurs within the context of a community in which all members are interrelated. As Nancy McCourt says of the clinic’s staff, “When we cross paths in the community, they stop and talk. It’s the reason I live in Missoula, and it’s the reason I go to Blue Mountain Clinic.”
Blue Mountain Clinic’s 25th anniversary celebration, featuring drinks, hors d’oeuvres, and a panel of guest speakers, takes place on Thursday, Sept. 5 from 4–7 p.m. at the clinic, 610 N. California. For details, call 721-1646.

Fire on the mountain

Tallying the devastating price of anti-abortion terrorism

When the Blue Mountain Clinic was firebombed in 1993, it was hardly the first abortion clinic in the nation to be targeted for such an attack. When it reopened in 1998, it looked more like a high-security prison than a place of healing. A spiked security fence, bulletproof glass, surveillance cameras and a security door all contribute to the safety of the clinic’s patients and employees.

According to the National Abortion and Reproductive Rights Action League (NARAL) since Roe v. Wade there have been more than 59,000 acts of violence aimed at clinics that offer abortion and reproductive health services. These include seven murders, 17 murder attempts, 41 bombings, 165 arsons, and 557 anthrax threats. Below are some examples of why Blue Mountain’s security measures are necessary to ensure the safety of its patients and staff.

• On April 14, 2001, an arsonist threw a container filled with an accelerant through the front entrance of the Ft. Lauderdale Women’s Clinic, igniting a blaze.

• On Dec. 1, 2001, an unknown person fired at least 25 bullets into a suburban Kansas City, Kan. abortion clinic. The shots were fired after 2 a.m. from outside the clinic.

• In September of 2000, the Rev. John Earl, a Catholic priest, smashed his car into the sole abortion clinic in Rockford, Ill. and then proceeded to attack the clinic with an ax. He was convicted of property damage and faces 30 months of probation and nearly $8,000 in fines and restitution.

• In March of 1999, a bomb exploded at western North Carolina’s only abortion facility. Although the bomb caused minimal damage, police say it would have severely damaged the clinic had it fully detonated.

• On Jan. 29, 1998, a bomb exploded in front of the New Woman All Women Health Care clinic in Birmingham, Ala. The bomb killed the clinic’s security guard, Robert Sanderson, and badly injured nurse Emily Lyons, leaving her nearly blind. Eric Robert Randolph was charged with these crimes and is wanted for questioning in another Atlanta area abortion clinic bombing.

• On Dec. 30, 1994, John C. Salvi opened fire with a rifle in two clinics in Brookline, Mass. and then traveled to Norfolk, Va., where he was arrested after allegedly firing 23 shots into another clinic. Two clinic receptionists, Shannon Lowney and Lee Ann Nichols, were killed. Five others were injured in the attacks.

• On July 29, 1994, Dr. John B. Britton and his clinic escort James H. Barrett were shot and killed with a 12-gauge shotgun outside of a reproductive health clinic in Pensacola, Fla. Reverend Paul Hill, a well-known abortion protester, was convicted of the murders in the fall of that year.

• On March 10, 1993, Dr. David Gunn was murdered during an anti-abortion protest at a Pensacola clinic. During the summer of 1992, “wanted” posters featuring Gunn’s photograph, home telephone number and schedule were distributed by Operation Rescue, an anti-abortion group.

by Brian Alterowitz

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