When Dr. James Armstrong was still interning as a doctor in New York state during the early 1960s, he would see as many as 20 women a day suffering the consequences of illegal abortions.
He remembers one particular incident in which unsympathetic police trying to find out where an illegal abortion had been performed interrogated a woman just hours before she died.
Armstrong vowed that he would perform abortions if they were ever made legal. And so when the Supreme Court’s Roe v. Wade decision accomplished just that in January 1973, Armstrong’s family practice in Kalispell was ready to offer the procedure by November. Since that time, it has remained the only provider of abortion services in Flathead County.
After 32 years, Armstrong, now 76, has decided to retire on New Year’s Day. Armstrong’s retirement will break up a duo that has worked together since 1977 to provide safe and legal abortion in the Flathead, despite legal battles, legislation, and a firebombing, but with the help of Planned Parenthood, the practice he started will continue to operate.
Armstrong hired Susan Cahill as his physician assistant in 1977, when demand for abortions began to make it difficult for him to offer other services at his family practice. Cahill had studied to be a physician assistant in New York state, where learning to perform abortions was part of her course of study. She notes that by the late 1970s, nurses had to opt out of the procedure to avoid it. Now, she says, it’s difficult to find schools that teach physician assistants to perform abortions at all.
During the early years of legal abortion, Armstrong says there was little controversy about his work in the Flathead.
“At that time the entire country was practically in favor of abortion,” he says. “People were generally aware of the problems with illegal abortions.”
A few of his patients changed doctors because they did not believe in abortion, but “it was done decently.”
Attitudes began to change around the time Ronald Reagan was elected president, Armstrong says. It seemed to him that anti-abortion sentiment began to gain traction nationwide, just as the Flathead Valley began to grow in population.
In the early 1980s, Armstrong’s Kalispell practice drew its first picketers. The leaders of these pickets, Armstrong says, came from outside the valley.
Although the pickets brought attention to Armstrong’s practice, it wasn’t until the 1990s that access to abortion in the Flathead was actually threatened.
In 1992, a group called Flathead Pro-Life complained to the Montana Attorney General’s office that Armstrong was performing abortions illegally by providing them outside of a hospital during the second trimester, and that Cahill, as a physician assistant, could not legally provide abortions. The complaints eventually led to a criminal investigation.
Armstrong and Cahill fought back by filing a lawsuit against the Montana Attorney General, reaching an agreement in November 1993, by which U.S. District Court Chief Judge Paul Hatfield upheld their right to perform abortions.
But that was just the beginning of their problems.
Cahill remembers waking up at 3 a.m. on Oct. 11, 1994, to the sound of her neighbor, a fire fighter, leaving his driveway. A few hours later, when she was getting ready for work, her phone rang. It was a co-worker, saying she had just heard on the radio that the office had been fire bombed.
Cahill got dressed and ran to the office, which was less than a mile from her house.
The front of the building, she says, “was completely charred.” Someone had thrown a fire bomb through its front window, into the waiting room.
Damage to the building totaled $200,000, and it had to be closed for five months. But, apparently unfazed, Cahill and Armstrong were back up and running within two weeks, reopening their practice in a rented space until their offices could be repaired.
A little more than a year after the bombing, legal questions resurfaced when Republican state Rep. Susan Smith of Kalispell introduced a bill in the Legislature calling for a ban on physician assistants performing abortions. The law, which passed, became known as the “Susan Cahill Law” because Cahill was the only physician assistant performing abortions in the state.
Cahill and Armstrong again filed suit against the state. For the next four years, as their case worked its way through the legal system, Cahill’s ability to perform legal abortions would change, sometimes from day to day. Ultimately, in 1999, the Montana Supreme Court sided with Cahill, affirming a woman’s private right to choose her health-care provider.
Cahill took a short detour out of the Flathead in 2001, leaving to work as clinical director of reproduction at the University of Rochester, in New York, but promptly returned when Dr. Armstrong decided to go into semi-retirement, limiting his ability to meet the Flathead’s abortion demand.
For some time, Cahill says, Armstrong had been encouraging her to start a practice where he could work part-time, but Cahill says it wasn’t until after her work in Rochester that she felt ready to make that leap. When she returned to the Flathead in 2003, she started Choice Family Health Care in Kalispell with Armstrong as her part-time physician.
Still, Armstrong wanted eventually to retire completely, but since Cahill would not be able to perform abortions legally without a physician supervising her, he stayed on until an exit strategy could be devised.
That strategy took the form of Planned Parenthood when the nationwide organization acquired Cahill’s practice. Armstrong was finally able to announce his retirement, passing his torch to a new physician, Dr. Jules Marsh, when Planned Parenthood took over in September. Besides providing the money to pay a physician, the national nonprofit reproductive health organization also processes the clinic’s insurance information, takes care of its property and malpractice insurance, and, Cahill says, provides quality birth control options.
Planned Parenthood also continued operations as a full family practice, making it the only Planned Parenthood in the state to do so.
“Planned Parenthood may bring some picketers,” or other unwanted attention, Cahill says, but she feels it was the only way she could continue to provide the service for which she and Armstrong had fought so long.