Kermit Gosnell’s Horror Show


This article orginally appeared in the February 14, 2011 edition of The Nation and can also be found on The Nation’s web site.

See all our coverage of the Kermit Gosnell case here.

Blood-spattered floors. Cat feces. Broken equipment. A 15-year-old giving anesthesia. Two women dead, countless more maimed and injured. Third-trimester fetuses delivered alive whose spines were then severed by the doctor. This was the Women’s Medical Society in West Philadelphia. This is what illegal abortion looks like.

That’s right. Illegal abortion. A great deal has been written about Dr. Kermit Gosnell and the shocking conditions and practices at his facility, which was closed last March after a drug raid, and is back in the news because a grand jury has indicted him and nine employees for murder in the deaths of one woman and seven infants. There have been many calls for further restrictions on abortion, much revulsion expressed at post-viability abortions, much blame cast on prochoicers for supposedly doing nothing to stop him. But it has not been pointed out often enough that what Dr. Gosnell was doing was illegal in Pennsylvania. It is not legal to perform abortions after twenty-four weeks. It is not legal to slit the necks of born-alive fetuses at any age, much less at thirty weeks or even more. It is not legal for untrained, unlicensed employees to perform medical procedures.

Now prochoicers are being blamed for this rogue operator. The grand jury report suggests that Tom Ridge, Republican governor from 1995 to 2001, discontinued inspections because prochoicers claimed they were too burdensome. The ones I talked to were skeptical. “We never lobbied against inspection,” Carol Tracy of the Women’s Law Project, which represents clinics in Pennsylvania, told me by phone. She pointed out that under Ridge’s Democratic predecessor, Bob Casey, who was famously opposed to legal abortion, Gosnell’s clinic was inspected three times, and each time serious problems were found. Nothing was done. Perhaps it’s relevant that Gosnell’s patients were poor, many of them immigrants—like 41-year-old Karnamaya Mongar from Nepal, with whose murder Gosnell has been charged—who may not even have known that safe and legal abortion is available here.

On Slate, William Saletan agreed with the grand jury’s criticism of the National Abortion Federation, which rejected Gosnell’s 2009 application for membership, for failing to alert state authorities to the terrible conditions at his facility. In her organization’s defense, NAF head Vicki Saporta says, “What we saw didn’t meet our standards, but they’d cleaned the place up and hired an RN for our visit. We only saw first-trimester procedures.” Others did alert authorities about problems at the facility, though. A doctor from the Children’s Hospital hand-delivered a complaint to the Health Department after numerous patients returned from Gosnell’s facility with venereal disease from unsterilized instruments. The department never responded. As the grand jury report noted, the department was also alerted by the medical examiner of Delaware County that Gosnell had performed an illegal abortion on a 14-year-old who was thirty weeks pregnant. And the department was informed of Mongar’s death at Gosnell’s hands. Brenda Green, executive director of CHOICE, a nonprofit that connects the underinsured and uninsured with health services, told me it tried to report complaints from clients, but the department wouldn’t accept them from a third party. Instead, the patients had to fill out a daunting five-page form, available only in English, that required them to reveal their identities upfront and be available to testify in Harrisburg. Even with CHOICE staffers there to help, only two women agreed to fill out the form, and both decided not to submit it. The Department of State and the Philadelphia Public Health Department also had ample warning of dire conditions and took no action.

It might seem odd that Pennsylvania, where antichoice legislators have laden abortion with restrictions, should have been so uninterested in the Women’s Medical Society. But actually it makes perfect sense. As Carol Tracy put it, “The problem here was that Pennsylvania has always focused on eliminating abortion, not on abortion as healthcare.” In fact, as she points out, the Pennsylvania Abortion Control Act, the primary vehicle for regulating abortion, is part of the criminal code. “Since abortion isn’t seen as medical care, they didn’t have the appropriate locus for oversight.”

What fueled Gosnell’s business were the very restrictions the legislature was so keen on passing—parental notification, waiting periods, biased counseling and, most important, a ban on state funding for abortion for low-income women. Would women have gone to the Women’s Medical Society if Pennsylvania paid for abortion with Medicaid funds? Would they have had late procedures if they could have afforded earlier ones? Maybe some underage girls went to him to avoid the parental notification rules that supposedly protected them. Only women who felt they had no better alternative would have accepted such dangerous, degrading and frightening treatment. In a way, that’s the saddest part—that women didn’t feel they could turn around and leave.

Will Pennsylvania learn anything from this experience? No, says Brenda Green. As I write, the state legislature has fast-tracked a bill that will ban any insurance plan that covers abortion from insurance exchanges set up under healthcare reform. That means more women forced to pay for abortion out of pocket—and more customers for unscrupulous providers. “That Gosnell was able to get away with his horrific practice does not prove new regulations are needed,” says Susan Schewel, executive director of the Women’s Medical Fund, which helps low-income women pay for their abortions. “It shows we need to enforce the laws we have.”

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  • rebellious-grrl

    Thank you Katha, great article!!!!

  • progo35

    Lobbying against regulating abortion clinics as medical/surgical facilities is something RH does all the time:

    http://www.rhrealitycheck.org/blog/2007/09/17/new-missouri-law-on-hold

    http://www.rhrealitycheck.org/blog/2008/05/06/trapping-abortion-providers

  • ahunt

    One more time Progo…when the intent of the law has absolutely nothing to do with health and safety, and everything to do with slut-shaming deterrence, then yes, pro-choicers object to the law.

     

    Give me any other medical surgery where the law mandates one must be given 24 hours to “think” about the procedure.

  • genevieve-dusquesne

    …no, in both of those cases the writers are objecting to new proposed laws which treat abortion clinics unfairly or as though they were different from other buildings, including other medical facilities such as plastic surgery clinics.  The only proposed law that makes sense is the one about door and hall widths.  And new clinics should comply, just as they should with other laws such as the Americans with Disabilities Act.  They have every ability to do so, they don’t have a structure yet.  Older buildings, however, are typically exempt from these rules, as it says in the article. And it is a good idea to get older clinics to comply–however, if the government wants to do this for the sake of patient safety, they should pay for a sizeable portion of the renovations themselves.  Of course, then the politicians suggesting these laws would probably find negative campaign ads excoriating them for supporting abortion, and we can’t have that

    The other TRAP laws, however, are silly:

    “Take South Carolina where the law requires six air changes per hour in the recovery room and mandates that there be no grass or weeds near clinics or medical offices where pregnancies are terminated. Arizona requires MDs performing abortions to do gonorrhea and Chlamydia tests on every patient, a practice, providers say, that usurps a physician’s ability to judge what measures are necessary. It also drives abortion fees up by $30-$40 per procedure.”

    STD testing is good, but for the monogamous married woman whose test came back negative the last time, should it be necessary?  Changing the air is time-consuming and unnecessary, and the grass and weeds rule seems designated for games of gotcha. 

    Inspections are also good, but not to the point of disrupting patient trust.

    And as for this…

    “‘The new standards of care require our doctors to be certified by a disinterested physician saying that he or she is qualified to perform abortions,’ Ayers says. ‘These are already licensed MDs who have to find someone to stick his or her neck out and do this unnecessary paperwork once a year.'”

    …if you have a board-certified OBGYN, what’s the point of the yearly rigamarole?  Right.  Because most of these rules have nothing to do with safety and everything to do with making life harder for providers and patients.

    So no, we want abortion clinics treated like medical facilities–just the way other medical facilities are.  What we don’t want is unnecessary measures intended to put clinics out of business.

  • genevieve-dusquesne

    “Gosnell’s clinic was inspected three times, and each time serious problems were found. Nothing was done. Perhaps it’s relevant that Gosnell’s patients were poor, many of them immigrants—like 41-year-old Karnamaya Mongar from Nepal, with whose murder Gosnell has been charged—who may not even have known that safe and legal abortion is available here.”

    I think this is a good point.  Not only were they poor or immigrants, but they were often also women of color.  And four of the patients who Gosnell hurt the most–Mrs. Mongar, Dana Haynes (who had fetal parts left inside of her and later needed serious emergency care at a hospital), Davida Johnson (who wound up with a lifelong STI and suffered four subsequent miscarriages) and another woman given the pseudonym of Alice, who had a seizure at Gosnell’s clinic because of medications given to her which she should not have taken–were all people who are often ignored, judged, or ostracized by society.  Karnamaya Mongar spoke no English.  Haynes had had previous abortions.  Johnson was a single mother unintentionally pregnant for the second time.  Alice was a former heroin addict and at that time a patient at a nearby methadone clinic.

    Non-English-speakers, women who have more than one abortion, women who have multiple unintended pregnancies, and drug addicts do not get much sympathy in our culture.  These were the majority of the people being hurt by Gosnell, and the state of Pennsylvania turned a blind eye.

  • the-abortioneers

    Well, female sterilization, actually, depending on your state and insurance status. (Some states in the South require Medicaid-funded women to wait as long as a month after their request; this was based in very justified concerns about the coercive and covert sterilization of poor, uneducated, black, Native American, and mentally disabled women up until the 1970s — unfortunately though, now we have women who want tubal ligation and are deterred by red tape and long waits or are even wrongly denied it…) Not to take away from your point, though, that the state inappropriately questions women’s reproductive decision-making; after all, the sterilization waiting period does NOT apply for vasectomy! 

  • the-abortioneers

    Katha, thanks so much for this post. The statements about the “pro-choice attitude” supposedly deterring inspections have made no sense to me (seeing that pro-choice people are more, not less, likely to favor quality of care in abortion!). And it’s been frustrating that the individuals and organizations who tried to bring the situation into the light were first stonewalled by the regulatory bodies, and now blamed for supposedly doing nothing.

     

    As we keep saying — when you’re against abortion care, you can’t be in favor of quality abortion care, and thus your regulatory attempts will always fail to improve abortion care. (It’s so obvious when it’s said like that.) Your quote from Carol Tracy says it perfectly, though: “The problem here was that Pennsylvania has always focused on eliminating abortion, not on abortion as healthcare…Since abortion isn’t seen as medical care, they didn’t have the appropriate locus for oversight.”

     

    Thanks again for clarifying the real issues at stake like you do.

     

    -placenta sandwich