Police evidence, documents indicate

Montreal physician Dr. Henry Morgentaler used surgical instruments in a way not recommended by their makers while performing abortions prior to February of this year, evidence gathered by police and documents obtained through a California manufacturer indicate.

According to Rex E. Doherty, executive vice-president of Berkeley Bio-Engineering Inc., Dr. Morgentaler wrote the firm Feb. 13 complaining its newest model polyethylene "Vacurettes," used in early vacuum abortions, collapsed when subjected to negative pressure.

An earlier model, Dr. Morgentaler complained was more durable and could be reused. "The fact that they could be re-used a few times was an advantage to the doctor, even though a disadvantage to you," he added.

Doherty, however, said that "from day one, we have made only disposable Vacurettes, that is Vacurettes which are sold in sterile form for one use only. The package is clearly marked 'cannot be re-used.'

"If Dr. Morgentaler had been re-using our Vacurettes, it was strictly against the specific instructions from the manufacturer, and without the knowledge of the manufacturer," he said.

TRANSMIT DISEASE

Re-use of the Vacurettes, which cost $3.30 each, could result in transmitting diseases to subsequent patients if the instruments were not properly sterilized, according to doctors queried.

Such diseases could include viral hepatitis, tetanus, venereal disease and gaseous gangrene.

Re-sterilizing a polyethylene instrument would be a difficult process, according to manufacturers.

Normally, instruments are sterilized by subjecting them to temperatures of 250 degrees Fahrenheit under 20 pounds steam pressure.

Most polyethylenes cannot withstand temperatures over 176 degrees Fahrenheit. If heated beyond that point, they can discolor and often melt. Even the most recent types cannot withstand more than 248 degrees.

At the factory, they are sterilized through a different process, employing the gas ethylene oxide. According to Berkeley's Doherty, re-sterilization of the Vacurettes also "weakens the walls" of the instrument, making it prone to collapse during operations under vacuum pressure.

Montreal police have confirmed that "a couple of boxes" of used Vacurettes, including several that were discolored or heat damaged, were confiscated earlier this year from Dr. Morgentaler's office.

"I have never heard of a Berkeley Vacurette that collapsed during an abortion providing the Vacurette is a brand new one, never used before and sterilized only once (at the factory)," Doherty said.

Dr. Morgentaler's complaint, he added, "stands alone."

DENY VEHEMENTLY

Contacted last week, Dr. Morgentaler said earlier model Vacurettes "could occasionally be used more than once," but that "whether someone uses a Vacurette once or twice has nothing to do with practising good medicine."

He said he would "deny vehemently" that he is practising bad medicine and said that his procedure was "normal" and "standard." Dr. Morgentaler is not currently performing abortion.

According to medical literature, simply soaking an instrument in a disinfectant or "sterile" solution would not kill all the bacteria present. Heat or gas sterilization would be needed to do so.

A bacteriologist at a local hospital said that re-sterilizing of such instruments, even if successful, could "pose a danger of chemical deterioration of the instrument, which could itself cause toxic effects" in a patient.

"Whenever the package says it should not be re-used, I think the directions should be carefully followed," the doctor added.

According to Doherty, the reason why disposable plastic instruments are being manufactured now is "because of the malpractice suits being brought against hospitals for using non-sterile instruments."

According to Dr. Augustin Roy, president of the Quebec Medical Professionals Board which regulates medical ethics in the province, "proper sterilization is elementary before any operation."