Can't do it alone 

Susan Cahill lost everything when her clinic was vandalized. Now western Montana risks losing one of its only abortion providers.

Susan Cahill sweeps a small pile of broken glass and two Band-Aids from the floor of her former treatment room into a dustpan. The room is otherwise empty. Gone are the ultrasound machine and the electric suction machine once used to perform abortions.

"It was smashed," Cahill says of the suction machine.

Also absent are the cabinets and the exam tables and the antibiotics and syringes. On the one-month anniversary of the night that Zachary Klundt allegedly destroyed the place, little remains of Cahill's All Families Healthcare.

"We lost everything," she says.

Moving men carry a small white refrigerator into a truck parked outside, then return for a large plastic bin full of forceps and speculums. The equipment will remain in storage until Cahill decides whether to use them again. Following the break-in and the calculated dismantling of her professional equipment and personal items, Cahill, 64, has yet to decide if she'll ever return to the Flathead Valley practice she's built up over the course of her career.

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Prosecutors say the 24-year-old Klundt broke into All Families Healthcare late on March 3 or early the next morning and proceeded to douse the office with iodine and, as if to ensure that nothing could ever be used again, spray a fire extinguisher that left a yellow coat of powder everywhere. Most horrifyingly for Cahill, the perpetrator used what appeared to be a claw hammer to gouge faces out of family photos.

This was no random attack, Cahill says. This was personal. As she takes stock of the empty office weeks after the incident, she still sounds shaken. "It's hard for me to be in here for very long," she says.

Cahill is a physician's assistant who for 37 years has practiced medicine in the Flathead Valley, curing sore throats and stomachaches, performing Pap smears and delivering babies. She believes that it's her work providing abortions that made her a targetand it wouldn't be the first time.

Cahill has weathered a lot of abuse from the anti-abortion contingent in this small conservative community of 20,000 people. She's been called a "baby killer" in the comment sections of local news websites, and been compared to Stalin and Hitler. In 1994, a pro-life extremist firebombed her Kalispell office. But Cahill says the past several months have been the most difficult of her career.

In February, she was evicted from the Meridian Road office she worked in for more than six years after the executive director of the local pro-life crisis pregnancy center, Hope Ministries, purchased the building. Hope's director, Michelle Reimer, discussed the transaction in a written statement released to Democracy Now after the sale. "We made a stand for the prolife position in a legal, peaceful and non-confrontational way," Reimer said, "purchasing the building in order to advance the cause of life."

click to enlarge Susan Cahill says she’s not sure if she’ll reopen her medical clinic after an early March attack destroyed her Kalispell office. - PHOTO BY CATHRINE L. WALTERS
  • photo by Cathrine L. Walters
  • Susan Cahill says she’s not sure if she’ll reopen her medical clinic after an early March attack destroyed her Kalispell office.

Cahill believes the attack on her new office also aimed "to advance the cause of life." She had only moved in three weeks before Klundt allegedly broke in. Zachary is the son of Twyla Klundt, a longtime Hope Ministries board member who resigned from her post the day after Zachary was arrested. Cahill says it doesn't take much sleuthing to connect the dots.

"I think, in a way, that Zachary did something that his parents should be proud of him," Cahill says. "I think his parents believe that, too."

Since Cahill's practice was destroyed, there's been an outpouring of support from members of the pro-choice community. They say the attack constitutes a loss not only to Cahill, but to women throughout the region. There are no abortion providers in Idaho, Cahill says, nor any on the Blackfeet Reservation. She says her patients drove from as far away as Sandpoint, Idaho—more than 350 miles roundtrip—to terminate pregnancies.

With Cahill's practice closed, women from Browning seeking an abortion will have to travel some 200 miles to Blue Mountain Clinic in Missoula. The absence of local care prompted the Daily Beast to dub a 1,200-mile stretch of the northwest—from Idaho, across Montana east to the Dakotas, and south into Wyoming—an "abortion desert."

"I wander around and I look at all these young girls and I think, 'Where are they going to go?'" Cahill says. "Or, 'How are they going to get there?'"

The battle between pro-life and pro-choice supporters is nothing new. Legal and legislative debates garner most of the regular headlines, such as when Texas state Sen. Wendy Davis staged an 11-hour filibuster last year to protect abortion rights. But pro-choice advocates say the destruction of Cahill's office highlights a far more terrifying trend of increased violence and intimidation.

"It's an awful thing for me to admit, that these tactics really are working," says NARAL Pro-Choice Montana Executive Director Maggie Moran.

Since 1993, pro-life extremists have killed eight clinic staffers and volunteers. Forty-one abortion facilities were bombed between 1977 and 2009, and 175 set on fire. According to data compiled by NARAL, clinics reported more than 600 bomb threats during that same period.

"We know how to fight anti-choice legislation," Moran says. "But fighting this intimidation and violence is a whole other ball game."

Cahill knew the picketers were coming March 5. The anti-choice group, 40 Days for Life, announced it would protest in front of her new office on First Avenue East in Kalispell that day. The contractor Cahill hired to install an alarm system was slated to finish March 4.

click to enlarge Susan Cahill takes stock of her office in early March, shortly after Zachary Klundt allegedly destroyed the place. - PHOTO COURTESY OF NICOLAS HUDAK
  • photo courtesy of Nicolas Hudak
  • Susan Cahill takes stock of her office in early March, shortly after Zachary Klundt allegedly destroyed the place.

At first, Cahill thought it was bad luck the alarm wasn't ready when the break-in happened. Hindsight, however, along with the knowledge that Klundt was carrying a fully loaded handgun with a spare magazine in his holster when he was arrested, provides a different perspective.

"I thought, 'You know what? I think that it was damn good luck,'" she says, considering what would've happened if the alarm had thwarted his effort. "He would have destroyed me."

Cahill shares her thoughts while sipping tea and sitting on a cream-colored leather couch inside her Kalispell residence. She's spending more time at home lately. For the past four decades, she woke up most days at 6 a.m., drank coffee, read the news and then went to work. She still gets up early. But rather than treating patients, she's left to contemplate the fact that her practice is gone.

"That is a death to me," she says.

Cahill misses the work and the interaction with patients, but she also sounds like someone still coming to grips with a violation of her professional space and the systematic destruction of so many personal items. She mentions the art on the walls and how she specifically selected a wall paint to match. She wonders if, in the rush to push past the fear, anger and sadness stirred by the attack, she and her volunteer helpers, including patients and friends, rashly threw away keepsakes that could have been preserved.

"There was so much destruction and so much bad feeling in there," she says. "You just want to try and get rid of it."

Among the pieces she'll miss most is a painting by Norman Rockwell titled "Golden Rule," which features dozens of portraits of people of different ethnicities and reads, "Do unto others as you would have them do unto you." Cahill purchased the piece with her former business partner, Dr. James Armstrong, while attending a National Abortion Federation conference in Philadelphia. Because it was out being framed in 1994, when her old office was firebombed, it survived that attack. This time it didn't.

The losses hit Cahill harder now. She says she contemplated retirement after being evicted from her Meridian Road office earlier this year. The thought of starting over again was daunting, especially because Cahill knew from experience how tough it would be to find a new location. It had taken her two months to find the Meridian Road office. She says Flathead building owners aren't exactly eager to rent to a well-known abortion provider who draws picketers carrying graphic signs, or worse.

But as Cahill considered the decision, she realized she wasn't ready to retire. Plus, the prospect of leaving women for hundreds of miles without access to abortion kept her up at night.

In recent years, Cahill terminated roughly 230 pregnancies annually. She also offered free services to women who couldn't afford health care and solicited community donations to help pay for gas and hotels for patients traveling long distances.

For all of the controversy surrounding her practice, Cahill provided one of the most common medical procedures in this country. According to the Centers for Disease Control and Prevention, half of all pregnancies are unplanned. In 2011, health care professionals administered 1.06 million abortions. Even with an overall decline in the number of abortions performed between 1980 and 2011a decrease health care experts attribute largely to increasing access to contraception—current data indicates that one in three women will terminate a pregnancy before the age of 45.

Even with ongoing demand for the procedure, fewer professionals offer it. Between 1996 and 2011, the number of abortion providers in the United States declined from 2,042 to 1,720, according to data compiled by the Guttmacher Institute, a nonprofit committed to advancing reproductive health and abortion rights. Bloomberg news reported that between 2011 and 2013 an additional 73 clinics across the country closed.

In Montana, the drop in providers has been even more extreme. According to Guttmacher, there were 23 abortion providers in the state in 1978. There are roughly five today. Most women go to clinics to terminate pregnancies, rather than to independent physicians or hospitals. In Montana, only three clinics now offer surgical abortion: Blue Mountain Clinic and Planned Parenthood in Billings and Helena.

Cahill understands the situation, but she's still not sure about her future. She's committed to taking the summer off as she considers whether or not to open another clinic. As Montana loses providers, Cahill says she's simply unwilling to serve any longer as a high-profile holdout with a target on her back.

"I can't do this alone anymore," she says. "I just can't. I won't do it alone anymore."

Cahill's former colleague and partner, Dr. James Armstrong, remembers when abortion was illegal. He says he can't forget the women he treated while attending New York Medical College in the 1950s who attempted to terminate their own pregnancies.

"They could get a heavy piece of wire," Armstrong recalls. "And they'd, examining themselves, try to put the wire in the opening of the cervix and poke around with it until they interrupted the pregnancy enough that the woman would go ahead and miscarry."

click to enlarge Cahill says the vandal gouged faces out of her family photos. - PHOTO COURTESY OF NICOLAS HUDAK
  • photo courtesy of Nicolas Hudak
  • Cahill says the vandal gouged faces out of her family photos.

Armstrong is now 84 and hard of hearing, but he's still able to rattle off abortion statistics with ease. Referencing data compiled by the Guttmacher Institute, he notes that history proves women will always find ways to terminate unwanted pregnancies, regardless of legal prohibitions.

Before the U.S. Supreme Court legalized abortion in 1973, women received—or performed on themselves—between 200,000 and 1.2 million abortions annually, according to the Guttmacher Institute. While it's tough to discern how many of those women got sick or died from the procedure, smaller snapshots provide some insight. In 1962, for instance, Harlem Hospital Center in New York admitted nearly 1,600 women for abortion-related ailments, such as infection, hemorrhage and damage to the uterus or reproductive organs. In 1968, the University of Southern California Los Angeles County Medical Center reported admitting 701 women sick from abortion-related sepsis.

"The numbers of women having complications from illegal abortion, sometimes self-induced trauma and things like that," Armstrong says, "was really epidemic mass proportions."

It was with that backdrop that the U.S. Supreme Court in 1973 legalized abortion. The lawsuit before the court was filed under a pseudonym of Jane Roe on behalf of a 22-year-old Texas woman named Norma McCorvey, who was pregnant with her third child. She argued, in the lawsuit filed against Dallas County District Attorney Henry Wade, that Texas' law banning the procedure unless the mother's life was in jeopardy violated constitutional assurances to privacy.

The court agreed with McCorvey. In one of the most controversial cases ever decided by the court, justices agreed that assurances to privacy entitle women to make their own reproductive choices. In the majority opinion written by Justice Harry Blackmun, the court noted further that, while some argue life begins at conception, that belief is not universal. Judaism, for instance, holds that the first breath marks life's beginning. Christian theology, meanwhile, held that a male fetus can be considered alive 40 days after conception. That number was 80 days for a female. Prior to the 19th century, before a fetus showed signs of movement, it was, as Blackmun noted, "regarded as part of the mother, and its destruction, therefore, was not homicide."

By the time of the Roe v. Wade decision, Armstrong had moved to Kalispell and opened a medical practice. Because of his experience treating women who had received botched abortions, he felt compelled to offer the procedure.

click to enlarge One month after the attack, Cahill finished moving out of her office. “It’s hard for me to be in here very long,” she said. - PHOTO BY CATHRINE L. WALTERS
  • photo by Cathrine L. Walters
  • One month after the attack, Cahill finished moving out of her office. “It’s hard for me to be in here very long,” she said.

Armstrong's practice thrived in the 1970s, prompting him to seek additional assistance to meet demand. The timing was good for Cahill, who was looking to move west after graduation from the State University of New York at Stony Brook's physician assistant program. Once in Montana, she found that she had a lot in common with Armstrong. They shared Long Island upbringings, New York City medical school educations and, as they would learn in the years to come, the fortitude to withstand legal and extralegal attacks.

Cahill recalls waking up at about 3 in the morning on Oct. 11, 1994, to the sound of her neighbor, the local fire chief, pulling out of his driveway. Three hours later, Armstrong called Cahill to deliver the news: Their clinic had been firebombed.

The attack resulted in $200,000 worth of damage and prompted Armstrong to invest an additional $50,000 in security upgrades, including a fire and bulletproof door and a thick Plexiglass window between the reception area and the clinic's office.

The perpetrator, Richard Andrews, also admitted to torching six other abortion facilities in Montana, Idaho, Wyoming and California, including Blue Mountain Clinic. In February 1998, Andrews, who was the former leader of a group called the Christian Coalition for Public Policy, pleaded guilty in federal court to eight counts of arson. (He torched one clinic twice). A judge sentenced him to 81 months in prison.

"For some reason," Cahill says, "I thought that would be the end of it."

That wasn't the end of it. In the 1990s, the pro-life movement began morphing into a powerful political force. Cahill was threatened with arrest in 1995 after state lawmakers, at the urging of the Montana Right to Life Association, passed a bill making it illegal for physician assistants to perform abortion. Because Cahill was the only PA in the state at the time providing the procedure, the legislation became known as "the Cahill law."

Cahill, along with Armstrong and three other plaintiffs, including Blue Mountain Clinic, fought the legislation all the way to the Montana Supreme Court and the U.S. Supreme Court. Two years later, they won.

As the Right to Life Association lobbied to shut down Armstrong and Cahill's clinic through legislative action, anti-choice extremists across the country took a more deadly approach. In 1993, David Gunn became the first abortion clinic staffer assassinated. Michael F. Griffin reportedly yelled, "Don't kill any more babies," as he shot Gunn in the back as the doctor walked through an anti-abortion protest at Pensacola Women's Medical Services in Florida.

In 1994, the director of an anti-abortion group called Defensive Action used a 12-gauge shotgun to kill 69-year-old abortion provider John Britton and his 74-year-old clinic escort, James Barrett, outside a Pensacola, Fla., reproductive health clinic. Barrett's 68-year-old wife, June, was also wounded. When law enforcement arrested the shooter, Rev. Paul Hill, he said, "I know one thing, no innocent babies are going to be killed in that clinic today."

Between 1994 and 2009, pro-life activists killed two clinic receptionists in Brookline, Mass., a security guard in Birmingham, Ala., and a gynecologist in Amherst, N.Y. The last provider to die, physician George Tiller, was killed while attending church in Wichita, Kan. Tiller had survived two earlier assassination attempts, including a 1993 shooting and a pipe bomb explosion seven years earlier.

Cahill says the deaths illustrate the dangers of the pro-life movement's rhetoric and how it's interpreted by extremists. Language that prioritizes a fetus over a woman is inherently damaging.

"When you slowly insinuate that people who provide abortion services are murderers," Cahill says, "you are setting the stage for somebody like Zachary Klundt to do damage."

Twyla Klundt says since her son's arrest, she stopped reading the newspaper. Even with the blackout, it's tough to avoid the coverage. National publications including Democracy Now, the Daily Beast, and the Associated Press reported on the crime, quoting Cahill and reproductive rights advocates who have publicly decried the attack as a hate crime.

click to enlarge Missoula’s Blue Mountain Clinic is one of only three clinics in the state that still offer abortions. Protesters regularly picket outside the facility. - PHOTO BY CHAD HARDER
  • photo by Chad Harder
  • Missoula’s Blue Mountain Clinic is one of only three clinics in the state that still offer abortions. Protesters regularly picket outside the facility.

"I find it so interesting that it has turned into this whole political thing," Twyla Klundt says.

On March 27, Zachary Klundt pleaded not guilty in Flathead District Court to burglary, criminal mischief and theft, charges directly related to the vandalism of Cahill's clinic. Prosecutors also charged him with attempted burglary for allegedly breaking into a nearby bail bonds office. He faces 60 years in prison.

Twyla Klundt says her son has been unjustly characterized and there's more to the story than what's been reported. Her attorney advised her not to speak with the press, but she wants to set the record straight.

Klundt says her son is struggling with chemical dependency and, on March 4, he "wasn't in a good place. ...We're hoping to get him the help that he needs, and get him healthy."

Zachary wasn't raised in an environment of intolerance or hate, she says. And she certainly doesn't condone the destruction of Cahill's office. "I feel terribly," Klundt says. "I want Susan to be well."

In 2013, Samantha Campbell was earning a bachelor's degree in biochemistry at the University of Montana and contemplating medical school. When she met Cahill, she envisioned for herself a career as a physician's assistant.

The 27-year-old Campbell shadowed Cahill for four months, studying the PA's bedside manner and the thoroughness with which she went about her work. She respected Cahill's expertise and sense of community responsibility. Despite enjoying the job itself, Campbell had a tough time going to work some days. The judgmental stares of pro-life picketers in front of Cahill's office left Campbell feeling uncomfortable.

Cahill had been searching for someone to take over her practice after she eventually retired. In Campbell, she saw someone she could groom, someone who would continue to care for patients and provide safe access to reproductive care. But even before the latest attack, Campbell worried she couldn't take the pressure.

"I didn't think I was up for the challenge, because (Cahill) gets so much abuse from people in the community," Campbell says. "It takes a very special person to want to do that, especially here in Kalispell."

Cahill's not the only one facing the challenge of finding a willing successor. As an older generation of doctors and physician assistants reach retirement—those who remember the pre-Roe years—young health care providers aren't filling the void.

"They're not stepping up to the plate," Cahill says, "and I understand that."

Medical schools once taught abortion as part of their integrated curriculum, but that's changed. According to the American Congress of Obstetricians and Gynecologists, only one-third of American medical schools in 2005 provided a formal lecture on abortion. Although 45 percent of schools offer clinical training in abortion care, students frequently opt out. Reproductive rights advocates predict if the trend continues, and abortion becomes even less accessible, women will revert to tactics used in the years before Roe v. Wade.

click to enlarge Zachary Klundt is being charged with burglary, criminal mischief and theft for allegedly destroying Cahill’s All Families Healthcare office. He faces 60 years in prison. - PHOTO COURTESY OF YOU TUBE
  • photo courtesy of You Tube
  • Zachary Klundt is being charged with burglary, criminal mischief and theft for allegedly destroying Cahill’s All Families Healthcare office. He faces 60 years in prison.

"It's a huge fear of ours," says Moran of NARAL Pro-Choice Montana. "We know that this is what's going to happen, because history has already told us that when you limit access to abortion, women are going to take it into their own hands."

If more providers offered the procedure, Campbell believes it would be tougher for pro-life activists to target just one. And while she's worried about future abortion access, she's not willing to carry the torch alone.

"I wish I could be the one to say, 'Well, I'm going to make a change,'" Campbell says. "But I don't know that I want that to be my life."

In the wake of the attack, Cahill says she's received significant support from reproductive rights advocates. The Montana Human Rights Network and its affiliate Love Lives Here held an online fundraiser that raised more than $75,000 to cover Cahill's financial losses.

The reaction from local health care professionals has been less encouraging. Cahill says she's troubled by the fact that none took a public stand against the break-in. Back in 1994, after Cahill and Armstrong's office was firebombed, local community members, including members of the health care community, took out a full-page ad in the Daily Inter Lake condemning the arson. This time, Cahill says, her professional peers remained largely silent.

"People need to be up in arms," she says. "This cannot happen to a colleague of ours in the community. It's wrong. And they're too chicken shit, frankly."

Cahill's voice cracks when she says, again, that she can't continue fighting the extremists and rhetoric alone. If she decides to retire now it would constitute a devastating end to her long career. But her family is worried. They don't want her to be hurt any more than she already has.

"I have to honor that," Cahill says. "I told my son that I will not be a martyr."

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