This post originally appeared in a slightly different form at Leaven for the Loaf.
In a jail cell somewhere, Kermit Gosnell is serving a life sentence for the premeditated murder of three children in Philadelphia. He was also convicted of manslaughter in a woman’s death.
He was “Doctor” Gosnell during his 2013 trial. I’m pretty sure his medical license was suspended somewhere along the way. Gosnell, an OB/GYN, committed late-term abortions in circumstances that left a trail of dead and injured women. Sometimes, children survived his attempts to abort them. He snipped the necks of some of those stubborn survivors to ensure their demise.
Have the people who have come of age in the past decade learned about him? Do those of us who read coverage of his trial remember him? I want to make sure the answer is yes.
His crimes were discovered accidentally, as law enforcement came calling at his clinic on another matter altogether. We can read about this in the grand jury report that led to his trial – a report that should interest anyone concerned about women’s health and human rights.
“We find common ground in exposing what happened here”
The grand jury summarized the background of what became the Gosnell case.
On February 18, 2010, the Federal Bureau of Investigation and detectives from the Philadelphia District Attorney’s Office executed search warrants at the Women’s Medical Society, a clinic operated by Dr. Kermit Barron Gosnell at 3801-05 Lancaster Avenue in Philadelphia. The federal Drug Enforcement Administration (DEA), the Philadelphia Police Department, and the District Attorney’s Dangerous Drug-Offender Unit had been investigating Gosnell and his clinic for months, based on reports of illegal prescription drug activity.
During the drug-trafficking investigation, District Attorney’s Detective James Wood learned from one of the clinic employees that a woman had died in November 2009, following an abortion procedure. Detective Wood discovered other disturbing details about Gosnell’s medical practice. The premises were dirty and unsanitary. Gosnell routinely relied on unlicensed and untrained staff to treat patients, conduct medical tests, and administer medications without supervision. Even more alarmingly, Gosnell instructed unlicensed workers to sedate patients with dangerous drugs in his absence.
Based on this information, Detective Wood believed that further investigation of the woman’s death the previous November was warranted. The detective searched for a police report on the incident, but finding none, he went to the Philadelphia Medical Examiner’s Office to try to identify the woman and to find out more about her death. Detective Wood learned that the dead woman was Karnamaya Mongar, and that her toxicology report revealed an extremely high level of Demerol, a drug Gosnell used at the clinic to anesthetize patients.
In light of this suspicious death and the other significant health and medical concerns, DEA Agent Stephen Dougherty invited personnel from the Pennsylvania Department of State (which regulates doctors and the practice of medicine) and the Pennsylvania Department of Health (which regulates health care facilities) to accompany law enforcement officers on the February 18 raid. No one from these agencies had visited the clinic in more than 15 years, even after the Department of Health had been informed of Mrs. Mongar’s death months earlier.
The search team waited outside until Gosnell finally arrived at the clinic, at about 8:30 p.m. When the team members entered the clinic, they were appalled, describing it to the Grand Jury as “filthy,” “deplorable,” “disgusting,” “very unsanitary, very outdated, horrendous,” and “by far, the worst” that these experienced investigators had ever encountered.
There was blood on the floor. A stench of urine filled the air. A flea-infested cat was wandering through the facility, and there were cat feces on the stairs. Semi-conscious women scheduled for abortions were moaning in the waiting room or the recovery room, where they sat on dirty recliners covered with blood-stained blankets.
All the women had been sedated by unlicensed staff – long before Gosnell arrived at the clinic – and staff members could not accurately state what medications or dosages they had administered to the waiting patients. Many of the medications in inventory were past their expiration dates.
Investigators found the clinic grossly unsuitable as a surgical facility. The two surgical procedure rooms were filthy and unsanitary – Agent Dougherty described them as resembling “a bad gas station restroom.” Instruments were not sterile. Equipment was rusty and outdated. Oxygen equipment was covered with dust, and had not been inspected. The same corroded suction tubing used for abortions was the only tubing available for oral airways if assistance for breathing was needed. There was no functioning resuscitation or even monitoring equipment, except for a single blood pressure cuff in the recovery room.
Ambulances were summoned to pick up the waiting patients, but (just as on the night Mrs. Mongar died three months earlier), no one, not even Gosnell, knew where the keys were to open the emergency exit. Emergency personnel had to use bolt cutters to remove the lock. They discovered they could not maneuver stretchers through the building’s narrow hallways to reach the patients (just as emergency personnel had been obstructed from reaching Mrs. Mongar).
The search team discovered fetal remains haphazardly stored throughout the clinic – in bags, milk jugs, orange juice cartons, and even in cat-food containers. Some fetal remains were in a refrigerator, others were frozen. Gosnell admitted to Detective Wood that at least 10 to 20 percent of the fetuses were probably older than 24 weeks in gestation – even though Pennsylvania law prohibits abortions after 24 weeks. In some instances, surgical incisions had been made at the base of the fetal skulls.
The investigators found a row of jars containing just the severed feet of fetuses. In the basement, they discovered medical waste piled high. The intact 19-week fetus delivered by Mrs. Mongar three months earlier was in a freezer. In all, the remains of 45 fetuses were recovered at the clinic that evening and turned over to the Philadelphia medical examiner, who confirmed that at least two of them, and probably three, had been viable.
…Had state and local officials performed their duties properly, Gosnell’s clinic would have been shut down decades ago. Gosnell would have lost the medical license that he used to inflict irreparable harm on women; to illegally abort viable, late-term fetuses; and to kill innumerable babies outside the womb….Let us say right up front that we realize this case will be used by those on both sides of the abortion debate. We ourselves cover a spectrum of personal beliefs about the morality of abortion. For us as a criminal grand jury, however, the case is not about that controversy; it is about disregard of the law and disdain for the lives and health of mothers and infants. We find common ground in exposing what happened here, and in recommending measures to prevent anything like this from ever happening again.
Report of the Grand Jury, Court of Common Pleas, First Judicial District of Pennsylvania, Criminal Trials Division, Misc. No. 0009901-2008, https://www.supremecourt.gov/opinions/URLs_Cited/OT2015/15-274/15-274-1.pdf
Politicians and regulators fell short
As Gosnell’s clinic was operating, there was a law in Pennsylvania about inspecting abortion facilities on a regular basis. The law was unenforced as a matter of state policy. In 1993, Republican Governor Tom Ridge ordered inspections halted, lest they prove a “barrier” to women seeking abortions.
Even in the days when inspections happened, they were infrequent. More from the grand jury: “The [Pennsylvania] Department [of Health] had contact with the Women’s Medical Society [Gosnell’s facility] dating back to 1979, when it first issued approval to open an abortion clinic. It did not conduct another site review until 1989, ten years later. Numerous violations were already apparent, but Gosnell got a pass when he promised to fix them. Site reviews in 1992 and 1993 also noted various violations, but again failed to ensure they were corrected.”
Deflecting blame
As the Gosnell trial attracted national attention, NARAL – that’s National Abortion Rights Action League – used its blog in an effort at damage control.
From NARAL: “We may never know why Gosnell preyed on women and put their lives at risk. But what we do know is why women would turn to someone like him instead of a reputable provider elsewhere: anti-choice politics have put safe, affordable, legal abortion care out of reach for many women….The horrific conditions in Gosnell’s clinic are an example of what happens to women and our basic dignity when abortion isn’t available through safe and legal providers. It is why we fight every day.”
NARAL failed to mention a few things, like the fact that Gosnell was on trial for killing a woman, not just children. NARAL didn’t mention the trial at all, actually.
In fact, Gosnell was operating legally. As far as the state of Pennsylvania was concerned, he was operating reputably and safely. Inspections had been suspended by the governor, so no one was in a position to say a facility was “unsafe.”
Women going to him for abortions weren’t likely to know that a woman under his care named Semika Shaw died in 2002, since her death didn’t prompt a state investigation. What happens when “legal” abortion providers undermine women’s basic dignity? Gosnell showed us an answer: they are called to account only when something accidental brings their actions to light.
Human dignity, or housekeeping?
If only Gosnell hadn’t been such a ghoul about keeping babies’ corpses and body parts, he would very likely have escaped prosecution on the premeditated-murder charges. If the only evidence of the murder of children had been testimony by Gosnell’s staff, his attorneys would have had a field day impeaching those witnesses. The attorneys tried that anyway, even with the sickening physical evidence.
Gosnell’s crimes did not consist principally in the filth of his office. If he had kept a clean place, the snipped babies would still be dead. We’d just be less likely to know about them. A tidy facility wouldn’t have helped Karnamaya Mongar survive a drug overdose. Declaring Gosnell an “outlier” among abortion providers means nothing if it is only an admonition to maintain good housekeeping.
I shudder even ten years later at the thought of how many mothers were maltreated by Gosnell’s poorly-trained or untrained staff. We’ll never know. Most – not all – survived. Thank God for a staffer who testified against Gosnell at his trial, and in so doing threw some light on the women who didn’t think they were risking death when they walked into the office.
More from the grand jury: “Gosnell set up his practice to rely entirely on the untrained actions of his unqualified employees. They administered drugs to induce labor, often causing rapid and painful dilation and contractions. But Gosnell did not like it when women screamed or moaned in his clinic, so the staff was under instruction to sedate them into stupor.”
Lessons learned?
The Gosnell grand jury ended its lengthy report with some recommendations, one of which could apply in any state: license surgical abortion facilities as ambulatory surgical facilities. This would not address complications from now-ubiquitous pill-induced abortion, but it would provide a measure of protection for women resorting to surgical abortion.
From the grand jury: “There is no justification for denying abortion patients the protections available to every other patient of an ambulatory surgical facility, and no reason to exempt abortion clinics from meeting these standards.“
Is there such a law or regulation in your own state? If not, why not?
And what happens to aborted children? There’s no way to make their deaths anything other than horrible. Had Gosnell been more concerned with neatness, he would have treated them as medical waste. They’d have been out of sight and presumably out of mind. But their deaths would have been just as certain. What about the children determined to have been born alive, whose lives were snipped away? Every state should require ordinary care for abortion survivors – but not every state does, even a decade after Gosnell’s convictions.
Surely we can do better, for women and for children.
Several years after Gosnell’s conviction, I was at an event to hear Ann McElhinney and Phelim McAllen, authors of Gosnell: the Untold Story of America’s Most Prolific Serial Killer (HatTip Books, 2017). McElhinny said this: “I never trusted or liked pro-life activists. Even at college I thought them too earnest and too religious. Fast forward to April 2013 and Kermit Gosnell’s trial in Philadelphia, when everything changed….[The] images shown in the courtroom were not from activists, they were from police detectives and medical examiners and workers…What they said and the pictures they showed me changed me. I am not the same person I was.”
I am not the same person I was: a fitting response, even today, to what came to light during a trial a decade ago.
Ellen Kolb 