Learning the Right Lessons From the Philadelphia Abortion Clinic Disaster


Editor’s note: This article, being republished in April 2013, was originally published by RH Reality Check in 2011 when the details about illegal abortions performed by Dr. Kermit Gosnell first became clear.

This article is cross-posted with permission from Beacon Broadside.

See all our coverage of the Kermit Gosnell case here.

Reading the Grand Jury report on Women’s Medical Society in Philadelphia, the now-closed abortion clinic ran by Dr. Kermit Gosnell, is stomach turning. This was truly a chamber of horrors: a filthy facility, with blood stained blankets and furniture, unsterilized instruments, and cat feces left unattended. Most seriously, there was a jaw dropping disregard of both the law and prevailing standards of medical care. Untrained personnel undertook complex medical procedures, such as the administration of anesthesia, and the doctor in question repeatedly performed illegal (post-viability) abortions, by a unique and ghastly method of delivering live babies and then severing their spinal cord. Two women have died at this facility and numerous others have been injured. What remains baffling is how long this clinic was allowed to operate, in spite of numerous complaints made over the years to city and state agencies, and numerous malpractice suits against Dr. Gosnell. Indeed, it was only because authorities raided the clinic due to suspicion of lax practices involving prescription drugs that the conditions facing abortion patients came to law enforcement’s attention.

As information about this clinic spread, many have understandably compared Women’s Medical Society to the notorious “back alley” facilities of the pre-Roe era, when unscrupulous and often unskilled persons (some trained physicians, some not) provided abortions to desperate women, in substandard conditions. This is an apt comparison. But Gosnell’s clinic should not only be understood as a strange throwback to the past. Women’s Medical Society represents to me an extreme version of what I have termed “rogue clinics,” facilities that today prey on women, disproportionately women of color and often immigrants, in low income communities.

In my recent book, Dispatches from the Abortion Wars, I wrote:

“that such clinics can flourish until the inevitable disaster occurs…is a ‘perfect storm’ caused by the marginalization of abortion care from mainstream medicine, the lack of universal health care in the United States, and the particular difficulties facing undocumented immigrants in obtaining health care.”

All these factors helped explain why women came to Gosnell’s clinic, in spite of its location in Philadelphia, a city with several reputable abortion facilities. Among the saddest things I have read in the wake of this disaster is the account of a Philadelphia social worker, pointing out that the community health center which serves the same low- income neighborhood in which the Gosnell clinic was located is considered to be one of the city’s best facilities. But as a recipient of federal funding, of course this center could not offer abortion care.

So why did Gosnell’s patients not go to a better, i.e. safer, abortion clinic, for example, the Planned Parenthood in downtown Philadelphia, no more than a few miles from Women’s Medical Society? One very poignant answer to this comes from a statement that one of Gosnell’s patients made to the Associated Press. The woman had initially gone to this Planned Parenthood for a scheduled abortion, but “the picketers out there, they scared me half to death.”

Another reason women came to Gosnell’s clinic is that he undercut everyone else’s prices. As numerous abortion clinic managers have told me over the years, for very poor women—who are way over-represented among abortion patients—differences of even five or ten dollars can be the deciding factor of where to go. The price list at Women’s Medical Society, listed in the Grand jury report, shows that in 2005, a first trimester procedure was $330.00, while the average price nationally then was about one hundred dollars higher. For a 23-24 week procedure, Gosnell charged $1625.00, while the relatively few other facilities in the Northeast offering such abortions would have charged at least one thousand more.

Still another reason drawing women to this clinic was that it became widely known that Gosnell was willing to flout the law and perform post-viability (i.e. post-24 week) abortions even in cases where women did not meet the very strict legal guidelines of a life-threatening or serious illness or were carrying a fetus with a lethal anomaly. In a horribly unfair vicious cycle, the poorest women often take time to raise the funds for an abortion, and then find themselves past the cutoff for procedures available early on–and facing a higher cost for an abortion. When women in these situations realize that they neither have the funds to pay for a later procedure, and/or can’t find a reputable provider that will perform their procedures after 24 weeks, they end up at places like Women’s Medical Society.

Predictably, in response to the story of Dr. Gosnell’s clinic, the antiabortion movement has been calling for additional massive oversight of all clinics, and claiming that all abortion providers resemble this outlier. But the overwhelming majority of abortion-providing facilities in the U.S. are not rogue clinics and legal abortion has achieved a remarkable safety record, the aberration of Gosnell-like providers notwithstanding. According to the Guttmacher Institute, the death rate from abortion performed in the first eight weeks of pregnancy is one in one million. The right lesson to be drawn from this tragic story is that there will be more unnecessary deaths among the most vulnerable women in our society until affordable and accessible abortion is made part of mainstream medicine.

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  • purplemistydez

    Great article.  The ones who will be paying the cost of all these abortion restrictions will be minority, poor women.  If Roe is made illegal clincs like Dr. Gosnell will pop up more often.  They want a quick buck off of women’s desperation.

  • progo35

    Frances Kissling pointed out that there is no evidence to indicate that most late term procedures are done to address maternal health concerns and even less to support the idea that only fatal fetal anomalies are “corrected” via abortion. (Down Syndrome, anyone?) She also pointed out the fallacy of asserting that a woman who cannot afford a first trimester procedure suddenly managed to come up with three times that amount of money months later.

  • billfalls

    …for your thoughtful explanation of how restrictions on access to abortion care can force women to seek substandard medical services.

     

    According to the Open Letter from NAF on January 21 http://prochoice.org/news/releases/20110121.html, the grand jury found that NAF’s Clinical Policy Guidelines, one of the standards followed by reputable abortion providers, “are, in many ways, more protective of women’s safety than are the state’s [Pennsylvania] regulations.” The additional restrictions proposed by antiabortion groups are unnecessary: the clinic in question reportedly was already in violation of both Pennsylvania law and medical standards.

  • julie-watkins

    included a link.

    But the reasons for abortion, as judged by outsiders, is irrelevant to the point that unless (attempting to) give birth should be a gift not an obligation — unless you believe it’s ok to treat women & poor people as 2nd class by definition.

  • the-abortioneers

    Ha! Yeah, and Frances Kissling also has ignored many questions from very experienced abortion clinic staff, fund managers, AND researchers about why she is skeptical of what is very clear to most of us who have done this work. For example, women often don’t realize til it’s nearly too late that they’re going to have to sell their furniture or go back to their abusive ex in order to get the financial means to afford their abortion. If you want to call that “suddenly managing” to have the money, then whatever, but you clearly haven’t worked on these cases.

     

    We respect and appreciate lots of things Frances says and does, but this is not one of them. She brought up money problems as an example of “things we say without much evidence,” but it was a really terrible example. If you had done your research instead of latch on to one thing a pro-choice person said that you want to exploit, you’d know this was an unsubstantiated claim on HER part.

  • the-abortioneers

    (Incidentally, she’s right that the jury is still out on fetal anomalies and health concerns, both because the cases are so rare and unevenly-reported that lots of counting is needed [1% of procedures are done past 20 weeks] AND because no one [including Frances] has been clear on exatly what number of weeks we are supposedly discussing — people who say “most procedures done at 20 weeks are for maternal or fetal health problems” are wrong, but I’d venture to say that if you made the claim about procedures done after 24 weeks you’d be right. Yet despite all this — here is the salient thing — your bringing up the maternal/fetal health claim in this discussion is a total red herring. Women who do qualify under this provision probably were not a large proportion of Gosnell’s patients, and no one has claimed so here!)

  • jivinj

    What remains baffling is how long this clinic was allowed to operate, in spite of numerous complaints made over the years to city and state agencies, and numerous malpractice suits against Dr. Gosnell.

     

    It only remains baffling to pro-choicers who either haven’t read or have chosen to ignore the Grand Jury Report which clearly notes that pro-choice politicians were worried that inspecting clinics might put up a barrier to abortions. 

     

    But at least the department had been doing something up to that point, however ineffectual. After 1993, even that pro forma effort came to an end. Not because of administrative ennui, although there had been plenty. Instead, the Pennsylvania Department of Health abruptly decided, for political reasons, to stop inspecting abortion clinics at all. The politics in question were not anti-abortion, but pro. With the change of administration from Governor Casey to Governor Ridge, officials concluded that inspections would be “putting a barrier up to women” seeking abortions.

  • the-abortioneers

    Nope, we read it, and have previously commented on that same excerpt. That actually seems like a lame cover on the part of lax regulators — and is logically absurd. (No pro-choice person wants women to be injured and killed because they sought abortions. In fact, many people are pro-choice because they’re aware that women risking injury and death is part of the status quo for most times and places in which abortion is illegal. If there were actually a pro-abortion-rights attitude in Pennsylvania government, they’d have been employing experts who actually care about improving the quality of abortion care.)

  • jodi-jacobson

    has been widely debated and is in good part not based on the available evidence.

    Just like with anything else, just because “so and so” says so doesn’t make something true or false.

  • nonsense-nonsense

    You do realize that abortion is legal in Philadephia? You do realize that clinics like Gosnell operate because of less regulation, not more regulation?

  • invalid-0

    Nobody’s saying that pro-choicers intended for clinics like this to have their reign, but it’s unfortunately the logical ending point of opposing clinic regulations under the banner of ‘access’.  The report of the grand jury cannot simply be disregarded as poppycock.  

    Naturally, I imagine you’ll disagree.  Many pro-choicers see pro-abortion-rights and pro-woman as inseparable when really they’re not.  The fact, instead, is that sometimes a law requiring abortions to be provided by a licensed physician is a good thing.  Sometimes a law requiring parental notification where a minor seeks an abortion can be a good thing.  Sometimes a crisis pregnancy center has more to offer a woman than an abortion clinic does.

    And look, if abortion didn’t kill a living human being, I would likewise admit that in many situations, pro-choicers are the ones offering the better service for the woman.  Many actually do have their best interests in mind (but, of course, ignore the child’s).  The problem occurs when pro-choice, or pro-woman really does become pro-abortion.  (Which it can; you have to admit.)

  • ldan

    There’s a difference between regulation and enforcement. Gosnell operated due to lax enforcement, not lack of regulations. His clinic did not meet the existing regulations and should have been shut down. More regulations would have had zero effect with nobody enforcing them.

     

    However, his being used as a rallying cry to create stricter regulations–which have historically been aimed at creating rules that were not necessary for safety but were onerous enough to shut down clinics that otherwise have fine records–is just capitalizing on tragedy to create a world with less and less access.

  • julie-watkins

    Many pro-choicers see pro-abortion-rights and pro-woman as inseparable when really they’re not.

    If your world-view is elitist, for the status quo, anti-woman, pro-capitalism, anti-poor and/or believe it’s immoral to say an unfair situation is “unfair” rather than submit —  it’s very easy to separate these two.

    I don’t.

    [Re: regulation: there's a difference between appropriate standards (that weren't enforced in Gosnell's situation) and TRAP regulations that don't increase safety, that have a political/restricting access purpose rather than health reason.]

  • jayn

    First off, what good is more regulation when the EXISTING ones (that Gosnell was already in violation of) aren’t being enforced?

     

    Secondly, pro-choicers want women to have access to SAFE abortions, which–guess what?–means things like inspections and enforcement, making sure that the place is clean and that medical procedures are being performed by actual medical personnel.  So we’re fine with regulations that improve the safety of the procedure.  The ones we take issue with are the ones that make abortion more difficult to attain, like waiting periods.  It will not be safer for a woman to have the procedure done tomorrow than today, but it does add to the trouble she has to go through.

  • the-abortioneers

    I’m not sure, but maybe you misread my sentence: “part of the status quo for most times and places in which abortion is illegal” wasn’t to imply that Gosnells only exist in countries where abortion is illegal; simply that they (and worse) tend to be the horrifying NORM in those countries, instead of the horrifying EXCEPTION as in this country.

     

    Criminalizing abortion is unlikely to lead to less injury and death, and in most cases has gone hand-in-hand with more injury and death. This is one common reason that pro-choice people are pro-choice, and that’s why I said the regulators’ attempt to shift blame on pro-choice attitudes was illogical.

  • ldan

    I have yet to see pro-woman + pro-choice become pro-abortion. The latter would be actually pushing for abortion in some fashion (frankly, anti-contraception seems rather pro-abortion to me). I have yet to really see this other than very isolated individuals who were pretty much anti-people. I could see a radical environmental stance that might go pro-abortion, but that wouldn’t come from a pro-woman ideology.

     

    Nor would I consider someone who is pro-abortion to be pro-woman. Those who try to force women to have abortions are no more pro-woman than those who force them to give birth.

     

    Are there people who actually do mean well working at CPC’s? I’m not sure. If CPCs primarily existed to give pregnant women who did not want abortions the support and care to raise their children, I’d be more inclined to believe that a decent percentage of those working there actually wanted the best outcome for the women who came to them.

     

    But the constant reports of CPCs seem to indicate that they see their primary business as halting abortions, and don’t mind using deception to do so. This tends to make me doubt that there are many people who actually have the best interests of the women who come there in mind. 

  • the-abortioneers

    Sure, I’m pro-abortion — in the same way I’m pro-insulin, pro-defibrillator, pro-dialysis, pro-penicillin. If you need it, you should be able to have it, and how easy or difficult it is to obtain shouldn’t depend on whether someone else likes it or not.

     

    I don’t just want legal abortion, I want excellent abortion. Your care should not only be legal but also as safe as can possibly be, not only affordable but provided by caring people who make you feel important.

     

    One unfortunate thing about people who are politically anti-abortion is that they can never be in favor of improving care. That’s how you know that their regulatory attempts are going to fail. And that’s why you need to employ people who care about quality abortion care in regulation and enforcement.

  • ldan

    OK, now there’s a definition of pro-abortion I’d go with.

  • arekushieru

    Sure, I’m pro-abortion — in the same way I’m pro-insulin, pro-defibrillator, pro-dialysis, pro-penicillin. If you need it, you should be able to have it, and how easy or difficult it is to obtain shouldn’t depend on whether someone else likes it or not.

    But that’s like saying that someone can be anti-abortion, at the same time they are ProChoice, because they are anti-surgical risk.  That, to me, just creates a lot more (referring to situations *other* than antis automatic assumption that ProAbortion = convincing women to have abortions, here) confusion and complexity that I don’t think the Pro-Choice side needs.

  • rebellious-grrl

    opps, I think I posted this in the wrong place. My bad.

  • rebellious-grrl

    Ok maybe not. I was trying to respond to “JivinJ”

     

    I think this has more to do with the politics of poverty than the politics of abortion.

     

    Have you read the entire 281 page report? Thoroughly? I’ve skimmed the report. If the blame is placed on the decision of inspecting abortion facilities being politicly influenced by the governor’s politics, and there were “pro-life” and “pro-choice” governors during the lifetime of the clinic, how does that make sense? I think it has more to do with the politics of poverty than with abortion.

     

     

    From, “Kermit Gosnell’s Horror Show” (just posted here)
    http://www.rhrealitycheck.org/blog/2011/01/31/kermit-gosnells-horror-show
     
    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.

    (Bold emphasis mine)

  • the-abortioneers

    I get what you’re saying. And I don’t personally care one way or another whether you call me pro-choice or some other thing that also accurately reflects my stance. But I don’t know anyone who is “pro-abortion” in the way that anti-abortion people describe. It’s just a straw man. So in a sense, it’s only confusing because antis tell tales. 

     

    Not actually suggesting we relabel everyone and cause confusion. Just that I’m sick of hearing “some people go beyond pro-choice and become pro-abortion.” Who? To the extent that there are “pro-abortion” folks out there (some abusive partners or parents who don’t allow the pregnant women in their lives a choice), their approach never was pro-choice to begin with. Obviously. 

  • arekushieru

    I’m not sure if you were aware, because I didn’t separate them very well, but I was making two separate points.  Not just the referral to the way antis like to ‘label’ us.  My first point was about not really being anti-abortion but anti-surgical risk.  Just as it isn’t really about ProAbortion so much as being Pro-Health Care. 

    Either way, I do agree it’s probably a moot point.  Just thought I’d put my two cents in.  But, thanks for the conversation!

  • arekushieru

    Abortion doesn’t kill a living human being.  It doesn’t kill, and it doesn’t involve a human being. 

    Killing = cause of death.  The reason removal of artificial life support is not determined to be ‘killing’ is because legal/medical expert opinion agrees there is no intent in the removal, itself, for it to be listed as the cause of death.  Much the same as when one removes biological life support in the case of abortion. 

    Human being = person, something not ONE of you has been able to define in such a way that it exCLUDES cells, tumours, parasitic twins, fetus in fetu, sperm, eggs, hydatid molar pregnancies, etc… yet include fetuses. 

    No child involved, either.  The best interests of a child is to raise it in a home where it is unwanted or was forced to be relinquished to or a home where it will be stigmatized or treated differently?  Wow, never knew you anti-choicers would admit that you don’t really care about exISting children.

    Sometimes a law requiring parental notification where a minor seeks to continue a pregnancy can be a good thing.  Sometimes an abortion clinic has more to offer a woman than a crisis pregnancy center does.  /snerk

    These are the kinds of regulations that would become the norm if abortion was made illegal and women were forced to access care later than they normally would and the kinds of regulations that would force women to access services at clinics such as Gosnell’s.

     

  • invalid-0

    With the change of administration from Governor Casey to Governor Ridge, officials concluded that inspections would be “putting a barrier up to women” seeking abortions.

    -Grand Jury Report

    Right there.  That is when protecting ‘choice’ becomes more about protecting abortion than protecting women.  Don’t tell me they’re inseparable, because they’re certainly not.  And unfortunately for the women who could only afford this type of clinic, it was more important for Gosnell’s clinic to perform the abortion than to care for the woman.

  • saltyc

    You take one line out of the grand jury report and pretend this was the result of pro-choice considerations, it wasn’t. If you or these allegedly pro-choice officials (in one of the most virulently anti-choice states in the Union) gave even a half a shit about women who can’t afford an abortion you’d support public funding for abortion, so that women don’t end up in these disastrous situations. There’s a reason Gosnell operated in Pennsylvania: no public funding for abortion. Pennsylvania is one of the worst, most backwards states when it comes to reproductive rights, so pretending that state officials didn’t bother to inspect because they’re pro-choicers is the height of stupidity. No pro-choicer favors no inspection for this one procedure, on the contrary, we want it to be treated like any other routine medical procedure and the patients of course need protection. Routine inspections don’t put any barriers up for women, but lack of funding does.

    We pro-choicers care about women, arex, I have more concern about women I don’t know in my pinky-nail than you ever had in three lifetimes. What a smarmy jackal you are, arex.

  • the-abortioneers

    I’ve commented multiple times on this post about how I think that was a nonsensical attempt on the regulatory agencies’ part to deflect blame and attention from themselves. (After all, a “pro-choice climate” can’t be interrogated, indicted or fired.) I don’t want to reiterate the same points, so you can (a) scroll up and read them yourself, and (b) read more about how that claim doesn’t fit with the facts of the situation at Katha Pollitt’s article here http://www.rhrealitycheck.org/blog/2011/01/31/kermit-gosnells-horror-show