Karnamaya+Mongar

I am using the  Grand Jury Report on the crimes of Philadelphia abortionist Kermit Gosnell as the basis of this Wiki. I will add material to support my contention that though Gosnell is beyond the pale, this is mainly in the way he combined and refined aspects of the ghoulish and callous disregard for humanity often seen in abortionists. He was hardly a pioneer.

In order to distinguish between my own writings, and those of the Grand Jury, I will use a different font that makes the Grand Jury Report appear to be typed.

**Summary:** Mrs. Mongar was a Nepalese refugee who sought an abortion from the Women's Medical Society; she spoke no English; was only 4'11" in height and weighed only 110 lb. The standard practice at the clinic was for the untrained staff to give repeated doses of sedative and pain-killing drugs to women having abortions, without regard to the person's size or weight, whenever it was deemed necessary by the untrained staff (for example, if the woman started moaning, she was presumed to be in pain, and given another dose of drugs), and without any monitoring equipment (such as blood pressure monitors or oxygen monitors; and often without even a staff member in the room to make sure the patient was still breathing). After it became obvious that Mrs. Mongar was having problems, Gosnell and his staff did not make adequate efforts to resuscitate her; when emergency services were finally called, they wasted valuable time with a locked emergency exit and narrow hallways that could not accommodate a stretcher. Gosnell did not tell the emergency personnel that Mrs. Mongar had received large doses of Demerol; and the chart was edited to hide how much Demerol she received. A blood test done 18 hours later showed that she had received so much Demerol that the peak concentration was literally "off the chart"; and although the doctor could not determine the exact dosage(s) given her, the concentration was so high that it proved that Gosnell (and the chart) could not be telling the truth.

See Appendix D for Karnamaya Mongar's chart

=Section V: The Death Of Karnamaya Mongar =

 Karnamaya Mongar died because Gosnell’s unlicensed employees excessively drugged her.
 On November 19, 2009, 41-year-old Karnamaya Mongar suffered a fatal drug overdose during an abortion procedure at the Women’s Medical Society in West Philadelphia. Along with her husband, Ash, the mother of three and grandmother of one had arrived in the United States only four months before, after spending nearly 20 years in a refugee camp in Nepal. She and her family had been among the thousands expelled from their homeland of Bhutan following pro-democracy protests. They came to the United States on July 19, 2009, as part of a humanitarian resettlement program. Her husband had just found a job in a chicken factory in Virginia where they lived. Mrs. Mongar spoke no English.

 Mr. and Mrs. Mongar

 When Mrs. Mongar was more than 18 weeks pregnant, she asked a family friend, Damber Ghalley, to take her to a clinic in Virginia to terminate her pregnancy. But the Virginia clinic, and another in Washington, D.C., would not do the second-trimester procedure. She was referred to the Women’s Medical Society because Gosnell had a reputation for performing abortions regardless of gestational age.

 Mr. Ghalley drove Mrs. Mongar and her daughter to the Women’s Medical Society on November 18, 2009, and waited for them in the car. That afternoon, Latosha Lewis conducted the clinic’s version of a “pre-examination.” She performed an ultrasound, which showed that Mrs. Mongar was 19 weeks pregnant, and drew blood, purportedly for lab work. No one counseled the patient, as is required by Pennsylvania’s Abortion Control Act, or recorded her weight. (The next day it was recorded as 110 pounds.) Gosnell did not even meet her, although he had pre-signed a form entitled “24 Hour Counseling Certificate” that falsely certified he had counseled her – a fraud that was his customary practice.

 Mrs. Mongar’s initials, perhaps written by someone else, appear on a form entitled “Consent to Office Procedure Administration of Anesthesia and Rendering of Other Medical Services.” This form purported to authorize Gosnell or “whomever he may designate as his assistant” to perform a therapeutic abortion. Unspecified anesthesia was to be administered “by or under the direction of one of the staff members.” The form included a waiver of “any claim that my consent is not informed consent.” This consent form and waiver were supposedly initialed by the non-English-speaking patient. Her daughter, who also spoke almost no English, was asked to sign as a witness.

 After the pre-exam and the signing of forms, Randy Hutchins, the part-time physician’s assistant who worked without State Board of Medicine approval, inserted laminaria to dilate Mrs. Mongar’s cervix and administered Cytotec. Hutchins instructed Mrs. Mongar to return the next day to complete the abortion procedure.

 Mrs. Mongar arrived at the clinic on November 19 around 2:30 p.m., accompanied by her daughter and her mother-in-law. (Damber Ghalley, who drove them, again waited in the car.) At the front desk, Tina Baldwin gave the patient her initial medication – a 200 mg. pill of Cytotec (misoprostol) to soften the cervix and to cause contractions; and a 45 mg. pill of Restoril (temazapan), a drug that causes drowsiness. Mrs. Mongar was then instructed to wait in the recovery area until the doctor arrived to perform the abortion.

Lynda Williams and Sherry West, by all accounts the least competent and most careless of Gosnell’s unlicensed and unqualified crew, were supposed to medicate and attend to Mrs. Mongar in the “recovery room,” where she awaited her procedure. Gosnell assigned Williams this duty even though Kareema Cross had warned him, at least a year earlier, that Williams did not know what she was doing and that she routinely overmedicated patients. Randy Hutchins also spoke to Gosnell about Williams anesthetizing patients in Gosnell’s absence. Gosnell assured him that “Williams was a trained professional and that it was not a problem.”

 Mrs. Mongar’s daughter, Yashoda Gurung, clearly believed Williams was a trained medical professional – she referred to the unlicensed and unskilled worker as a “doctor” when she testified. Ms. Gurung told the Grand Jury, through an interpreter, that she was permitted to wait with her mother in the recovery room for several hours. Mrs. Gurung testified that, between 3:30 and 8:00 p.m., her mother was given five or six doses of oral medicine – pills that were placed between her mother’s lip and cheek, which is consistent with how the clinic administered Cytotec orally.

 Mrs. Gurung also saw her mother receive additional medication by injection through an IV line they inserted in Mrs. Mongar’s hand. This was consistent with Gosnell’s standard practice, which was to keep the second-trimester patients asleep while the Cytotec induced cramping and labor, in the hope that the women would deliver their babies without a surgical procedure. Also consistent with standard practice at the clinic, no equipment was available to ensure proper monitoring of Mrs. Mongar’s vital signs.

 Mrs. Gurung did not know what drugs were being given throughout the afternoon and evening, but typically the doctor’s employees gave repeated injections of the concoction of sedative drugs that Gosnell referred to as a “twilight” dose. Each of these “twilight” doses, repeated a number of times at the discretion of the unlicensed workers, consisted of 75 milligrams of Demerol (meperidine); 12.5 milligrams of promethazine (Phenergan); and 7.5 milligrams of diazepam (Valium).

Lynda Williams admitted to detectives that she had administered IV sedation to Mrs. Mongar in the recovery room when the doctor was not on site. But she claimed that the amount she gave was significantly less than what others said was standard – Williams said she gave only 10 mg. of Demerol and 12.5 mg. of promethazine, a dosage she called a “local.” (The chart describing the clinic’s anesthesia options, however, describes the “local” dose as 10 mg. of a different drug, nalbuphine, and 12.5 mg. of promethazine.) [See Appendix A.]

 A little before 8:00 p.m., West and Williams told Mrs. Gurung that she would have to leave the recovery room. Gosnell was not yet at the clinic, but they told her that he would be arriving at about 8:00 p.m. Mrs. Gurung tried to wake her mother before she left the recovery room, but was unsuccessful. West and Williams told her not to rouse her mother because the medicine was supposed to keep her asleep. Mrs. Gurung was sent to another waiting room, away from her mother. She heard nothing else about her mother’s condition until after an ambulance arrived after 11:00 p.m. to take her lifeless mother to the hospital.

<span style="font-family: 'Courier New',Courier,monospace;"> Repeated injections of strong narcotics, administered in accordance with Gosnell’s standard procedures, killed Mrs. Mongar.
<span style="font-family: 'Courier New',Courier,monospace;">Sherry West and Lynda Williams provided several contradictory and unreliable versions of what took place in the three hours between when they sent Mrs. Mongar’s daughter away from her mother and when the ambulance was called. (Both women chose not to testify before the Grand Jury but made statements to the federal authorities.) What is clear, however, is that they administered a combination of dangerous, sedative drugs, and they did so under Gosnell’s standard instructions and with his carte blanche approval – but without the doctor’s personal supervision or presence in the facility. Indeed, Gosnell had never met the 4’ 11”, 110 lb., Asian woman before allowing his unlicensed staff to administer the narcotics that put Mrs. Mongar into a deep sleep.

<span style="font-family: 'Courier New',Courier,monospace;"> It is also clear that more than three hours passed from the time Mrs. Gurung was unable to rouse her mother and was told to leave the recovery room until the ambulance arrived at the clinic. Ashley Baldwin testified that just before Mrs. Mongar was taken into the procedure room, she was awake again and groaning in pain. Ashley called Williams, and Williams escorted Mrs. Mongar into the procedure room, put her on the table, and placed her feet in stirrups.

<span style="font-family: 'Courier New',Courier,monospace;"> Ashley said she expected that Mrs. Mongar would continue to be medicated until she precipitated. According to her testimony, she could tell that Williams did in fact sedate Mrs. Mongar after placing her onto the procedure table. The patient, who had been groaning in pain and moving around, suddenly became completely still and silent. Yet Mrs. Mongar was left alone. Williams, according to Ashley, sat outside the procedure room, even though no machines were monitoring the heavily sedated patient.

<span style="font-family: 'Courier New',Courier,monospace;"> Williams acknowledged that, after she took Mrs. Mongar to the procedure room, she gave the patient more sedating medication – this time the clinic’s “custom” dose. The “custom” dose, as described on the clinic’s anesthesia chart, consists of 75 mg. of Demerol, 12.5 mg. of promethazine, and 10 mg. of diazepam. [See Appendix A.]

<span style="font-family: 'Courier New',Courier,monospace;"> West told the FBI that, before Williams anesthetized Mrs. Mongar in the procedure room, she and Williams telephoned Gosnell, who had yet not arrived at the clinic. According to Williams’s statement, Gosnell instructed her to “med her up,” meaning to medicate the patient and get her ready for the procedure. Williams said that Gosnell came down (she claimed that he was upstairs when she called him) to do the procedure about 10 to 15 minutes later.

<span style="font-family: 'Courier New',Courier,monospace;"> Dr. Andrew Herlich, the Chairman of the Anesthesia Department at the University of Pittsburgh Medical Center, testified that even a single “custom” dose was a “very, very heavy dose” that would constitute deep sedation or even general anesthesia. He explained that the promethazine, although helpful in treating nausea, can have a multiplier effect on Demerol. Together with 10 mg. of diazepam, the drugs constituted a “very potent sedative.”

<span style="font-family: 'Courier New',Courier,monospace;"> Dr. Timothy Rohrig, the Director of the Sedgwick County (Kansas) Regional Forensic Science Center, testified as an expert in forensic toxicology. Dr Rohrig’s testimony substantiated that Mrs. Mongar received either multiple (more than two) doses of 75 mg. Demerol or one extremely large dose. Still, Dr. Herlich was incredulous when asked, hypothetically, about the effects of two “custom” doses (each containing 75 mg. Demerol, along with smaller doses of promethazine and diazepam). The anesthesiologist could not conceive why a doctor would ever give two doses. Dr. Herlich opined that if average-sized adults, with no particular sensitivities to the drugs, were given two “custom” doses within four hours, “most would stop breathing.” Mrs. Mongar was 4’11’’ and 110 pounds – significantly smaller than average. And she did in fact stop breathing.

<span style="font-family: 'Courier New',Courier,monospace;"> Assistant Medical Examiner Dr. Gary Collins determined that Mrs. Mongar died as a result of an overdose of Demerol. He also confirmed Dr. Herlich’s testimony that the combination of diazepam and Demerol “work[ed] together to make her respiration or respiratory depression even worse.”

<span style="font-family: 'Courier New',Courier,monospace;"> The medical examiner’s toxicology report showed that, approximately 18 hours after the paramedics were summoned (after which no further Demerol was given), Mrs. Mongar still had a Demerol concentration of over 700 mcg/L (micrograms per liter) in her blood. When the toxicology expert attempted to draw a chart to illustrate the corresponding concentration level at the time the medication was administered, he literally pointed off the chart, saying: “The peak concentration is going to be off the scale way up here.”

<span style="font-family: 'Courier New',Courier,monospace;"> Dr. Herlich was appalled not only by the dangerous mixtures of drugs administered, but also by the clinic’s procedures. He explained that it is absolutely essential for a doctor who is ordering anesthesia to meet with the patient beforehand. Different patients, he noted, react differently to the drugs, depending on factors such as height, weight, age, medical history, pregnancy, and race. (Mrs. Mongar’s small stature, her ethnicity, and her pregnancy were all factors indicating that she could be more sensitive to anesthesia than average adults.) He stated that it was “incredible to” him that a doctor would have staff administer sedation when he was not on-site and had not seen and consulted with the patients.

<span style="font-family: 'Courier New',Courier,monospace;"> Dr. Herlich also emphasized that anytime sedation is injected intravenously – and especially when it is deep sedation, as was administered to Mrs. Mongar – the patient needs to be monitored. The standards of professional care require, at a minimum, that an anesthesiologist monitor blood pressure, heart rate, heart rhythm, oxygen in the blood, and breathing. No physician should proceed with a second-trimester abortion, Dr. Herlich said, without all of the appropriate monitors – including an electrocardiogram to monitor heart rhythm and a pulse oximeter to monitor the oxygen saturation of a patient’s blood. Performing such procedures without monitors, the anesthesiologist testified, “is offensive to me as a physician.”

<span style="font-family: 'Courier New',Courier,monospace;"> Dr. Herlich explained that drugs injected intravenously, as Lynda Williams did to Mrs. Mongar, can reach the heart in 9 seconds and the brain in 16 to 18 seconds. It is crucial, therefore, not only to monitor constantly, but also to administer the medications slowly, a little at a time, and to watch carefully to see how the patient reacts. It was beyond reckless for Gosnell to entrust this delicate and dangerous medical procedure to Williams or any of his other unlicensed, untrained, and unsupervised employees – particularly with no monitoring equipment and no doctor on-site to step in if there was trouble.

<span style="font-family: 'Courier New',Courier,monospace;"> The reckless practices that killed Mrs. Mongar were even more irresponsible and dangerous because of the drugs involved. Dr. Herlich testified that Demerol has been out of favor for 10 to 15 years because it has serious side effects and because there are better, safer drugs to use during procedures. Demerol is made more dangerous by mixing it with diazepam, he said, and its potency is multiplied by promethazine. One of the safer drug options the anesthesiologist mentioned is Nalbuphine, a drug that Gosnell sometimes used in his so-called “local” concoctions. But Eileen O’Neill testified that Gosnell would substitute Demerol because it was “very cheap versus the Nalbuphine.” Massof also told the Grand Jury that Demerol “was easier to obtain at a better price.”

<span style="font-family: 'Courier New',Courier,monospace;"> The expert testimony substantiated that it was hazardous to have the untrained employees administering even the promethazine. Promethazine, Dr. Herlich testified, has a “black box warning” attached to it, meaning that it has “a side effect that is so terrible that you better be cautious about using it.” The side effect is that if the drug escapes the vein while being administered intravenously, it can cause tissue necrosis, a condition that looks like a burn or a crater.

<span style="font-family: 'Courier New',Courier,monospace;"> In light of the testimony of Dr. Herlich and other experts, it is no surprise that the combination of callously reckless and illegal procedures, unlicensed and unsupervised employees, and outrageously excessive sedation at Gosnell’s clinic proved lethal to Mrs. Mongar.

<span style="font-family: 'Courier New',Courier,monospace;">Gosnell and his staff made inadequate efforts to resuscitate Mrs. Mongar.
<span style="font-family: 'Courier New',Courier,monospace;">Sherry West told detectives that, some time after Williams had sedated Mrs. Mongar, Williams came out of the procedure room, yelling that “she needed help.” Liz Hampton testified that she was in the room next to the procedure room when Williams emerged and said that she was having a problem. Although Hampton could not remember if Gosnell was in the procedure room when Williams came out, West said that when she subsequently entered the procedure room, Gosnell was there performing what she thought was CPR on Mrs. Mongar. Eileen O’Neill eventually came in to assist Gosnell, according to West.

<span style="font-family: 'Courier New',Courier,monospace;"> O’Neill testified that Lynda Williams summoned her from her second-floor office. The unlicensed “doctor” told the Grand Jury that she thought Mrs. Mongar was already dead by the time she got to the procedure room. Nevertheless, she took over administering CPR to the lifeless body because, she said, Gosnell was not doing the CPR correctly. Gosnell, meanwhile, left to retrieve the clinic’s only “crash cart” from the third floor. A crash cart is usually a set of drawers or shelves that contains the tools and drugs needed to treat a person in or near cardiac arrest.

<span style="font-family: 'Courier New',Courier,monospace;"> After returning several minutes later with the medicine case, however, Gosnell did not use any of the drugs in it to try to save Mrs. Mongar’s life. O’Neill said that she tried to use the defibrillator “paddles” to revive Mrs. Mongar, but that they did not work. Still no one called 911.

<span style="font-family: 'Courier New',Courier,monospace;"> Even though an overdose was immediately suspected as the cause of Mrs. Mongar’s cardiac arrest, O’Neill testified that Gosnell instructed her not to administer Narcan, a drug that could have reversed the effects of the Demerol. She said that Gosnell told her it would not work on Demerol – which is not true according to the toxicology expert who appeared before the Grand Jury. O’Neill testified that Gosnell took the time to look through the case of medicines and that he was “thrilled” to find it was up-to-date. This is puzzling, since he seemed to have no intent of actually using the drugs to try to save Mrs. Mongar.

<span style="font-family: 'Courier New',Courier,monospace;">Gosnell and his staff attempted to cover up the cause of Mrs. Mongar’s death before paramedics arrived.
<span style="font-family: 'Courier New',Courier,monospace;"> Gosnell’s odd behavior – retrieving the clinic’s case of emergency medicines from the third floor, appearing thrilled that the case supposedly was up to date, and then making no effort to use the supplies to resuscitate his patient – can only be explained as a cover-up: He simply wanted to have a “crash cart” on hand when the paramedics were finally summoned. Gosnell clearly knew it was a violation of the law – as well as of the standards of the medical profession – to sedate a patient without having resuscitation drugs and equipment ready for use.

<span style="font-family: 'Courier New',Courier,monospace;"> In fact, when the ambulance was finally called, the paramedics noted that the patient had no IV access for administering life-saving drugs. Someone had evidently taken out the IV access that had been used that afternoon and evening to administer sedatives. No one told the paramedics that Mrs. Mongar had been given heavy doses of Demerol before her heart stopped. There is no other explanation than that Gosnell was trying to hide from the paramedics the cause of Mrs. Mongar’s cardiac arrest. The effect of this deception was to further delay potentially effective efforts to save the patient’s life.

<span style="font-family: 'Courier New',Courier,monospace;"> It is also odd that Gosnell placed Karnamaya Mongar’s feet in the stirrups of the procedure table before the paramedics arrived. Eileen O’Neill and Ashley Baldwin both testified that they remembered clearly that the patient’s legs were dangling off the table when they saw her lifeless body before the paramedics were called. Yet, when the paramedics arrived, her feet were in the stirrups, as if she had just undergone the abortion procedure.

<span style="font-family: 'Courier New',Courier,monospace;"> Ashley Baldwin also testified that, after she called 911, she went back into the procedure room where Gosnell was with Mrs. Mongar. O’Neill was back upstairs by then, and Ashley never even knew she had been in the room for nearly 10 minutes performing CPR and discussing the crash cart with Gosnell. It was only then, a good 10 minutes after O’Neill thought Mrs. Mongar was dead, that Gosnell asked Ashley to plug in the pulse oximeter – the machine that, had it worked, should have been used to monitor Mrs. Mongar’s blood oxygen level during the procedure. This action by Gosnell was, again, entirely for appearances – an effort to prevent the paramedics from noticing that the monitor was unplugged. Ashley said that Gosnell knew the machine was broken and had been for months. He had said he would get it fixed, but he never did. She said it shocked her when she tried to plug it in the night Mrs. Mongar died.


 * <span style="font-family: 'Courier New',Courier,monospace;"> Emergency personnel, who were called far too late, found Mrs. Mongar without a pulse when they arrived. **

<span style="font-family: 'Courier New',Courier,monospace;"> It was after 11 p.m. – long after O’Neill, at least, had decided Mrs. Mongar was dead – that Lynda Williams finally asked Ashley Baldwin to call 911. Emergency personnel responded to the “code blue,” indicating cardiac arrest, within two minutes of receiving the call, arriving at the clinic at 11:13. They found Mrs. Mongar in the procedure room, lifeless. She had no pulse and was not breathing. Paramedics reported that Gosnell was just standing there, not doing anything. The paramedics immediately intubated Mrs. Mongar to give her oxygen, and started an intravenous line to administer emergency medications to stimulate her heart. They hooked up the patient to a heart monitor, confirmed that her heart was not beating, and began CPR. They were surprised that, in a medical clinic, basic steps had not already been taken before their arrival. After twice administering medication – epinephrine and atropine – to stimulate Mrs. Mongar’s heart, the paramedics also used a defibrillator that they had brought to the scene, and were able to restore weak heart activity.

<span style="font-family: 'Courier New',Courier,monospace;"> Mrs. Mongar’s slim chances of survival were seriously hampered because it was exceedingly difficult for responders to get her to the waiting ambulance. The emergency exit was locked. Gosnell sent Ashley to the front desk to look for the key, but she could not find it. Ashley told us that a firefighter needed to cut the lock, but “It took him awhile … because the locks is old.” She testified that it took “twenty minutes, probably trying to get the locks unlocked.” Mrs. Gurung and her mother-in-law ran outside, crying. Mr. Ghalley and Mrs. Gurung, frightened, watched the firefighters struggling to get the door open, while Karnamaya Mongar lay motionless. After cutting the locks, responders had to waste precious more minutes trying to maneuver through the narrow cramped hallways that could not accommodate a stretcher.

<span style="font-family: 'Courier New',Courier,monospace;"> Once the EMTs finally succeeded in getting Mrs. Mongar into the ambulance, they continued to administer medication and use the defibrillator. Sherry West went to the hospital with Mr. Ghalley and the family, in Ghalley’s car. According to the family, West gave directions, but there was no real conversation. West told them that Mrs. Mongar was unconscious, but not to worry.

<span style="font-family: 'Courier New',Courier,monospace;"> When the ambulance arrived at the Hospital of the University of Pennsylvania shortly after midnight, Mrs. Mongar was in extremely critical condition. She had no heartbeat, no blood pressure, and was not breathing. After 45 minutes to an hour of aggressive resuscitation efforts, doctors were able to restore a weak heartbeat.

<span style="font-family: 'Courier New',Courier,monospace;"> Mrs. Mongar was sent to the Intensive Care Unit in extremely critical and unstable condition. She never regained consciousness and had no neurological function. One doctor explained to us that, while many of the body’s organs can be resuscitated 15 or 30 minutes after the heart stops pumping, the brain will shut down after about 10 minutes (the amount of time that Gosnell wasted retrieving the crash cart that he did not use and talking with O’Neill before calling 911). The doctor testified that, even though medical personnel were able to restore a weak heartbeat at the hospital, Mrs. Mongar was, by most people’s definition, “dead” at the abortion clinic.

<span style="font-family: 'Courier New',Courier,monospace;"> Mrs. Mongar remained on life support until family members could make the trip from Virginia to say good-bye. As a result of the cardiac arrest, she had stopped breathing and suffered acute anoxic encephalopathy – brain damage due to a lack of oxygen. She was pronounced dead at 6:15 p.m. on November 20, 2009. The medical examiner concluded that the acute anoxic encephalopathy resulted from the cardiac arrest, which itself had been caused “because somebody gave her a Demerol overdose.”

<span style="font-family: 'Courier New',Courier,monospace;"> While the family was waiting at the hospital, Gosnell came to the hospital to pick up West. Mr. Ghalley, waiting outside, saw him and asked Gosnell to explain what had happened. Gosnell repeatedly told Ghalley that he hadn’t done any thing wrong, that he hadn’t made a mistake. Gosnell, according to Ghalley, said the victim’s heart stopped beating, but “don’t blame me.”

<span style="font-family: 'Courier New',Courier,monospace;"> Gosnell and his staff tried to cover up what drugs were administered, who administered them, when, and how.
<span style="font-family: 'Courier New',Courier,monospace;">The evidence indicates that Sherry West made false entries on Mrs. Mongar’s file before handing it over to the Hospital of the University of Pennsylvania. Ashley Baldwin testified that the paramedics asked for Mrs. Mongar’s file so they could take it with them to the hospital. Instead of giving it to them, Ashley said, West grabbed the chart and took it herself to the hospital. By the time the file was turned in to the hospital doctors, it had notations about medications that Ashley said had not previously been there [See Appendix D]. The notations were totally inconsistent with all of the other evidence – from Lynda Williams, from Mrs. Gurung, and even from Gosnell – and grossly understated the amount of medication that was given.

<span style="font-family: 'Courier New',Courier,monospace;"> Williams, West, and Gosnell all contradicted themselves and each other about how much medication Mrs. Mongar received, who gave it to her, when, and even how. The file notations indicated that Mrs. Mongar received 10 mg. Demerol, 0.6 cc (cubic centimeters) promethazine, and 1 cc. diazepam at 8:14 p.m., followed by another dose of 10 mg. Demerol, 0.6 cc promethazine, and 2 cc diazepam at 10:45 p.m. An entry made by West in the clinic logbook, however, indicated that Mrs. Mongar was given a much larger dose: 75 mg. Demerol, 12.5 mg. promethazine, and 10 mg. diazepam.

<span style="font-family: 'Courier New',Courier,monospace;"> Lynda Williams was interviewed by law enforcement on the night of the February 2010 raid. At first, she told her interviewers that she did not put IVs in patients, that Gosnell administered the medication, and that she thought he gave a “heavy” dose (50 mg. Demerol, 12.5 mg. promethazine, and 5mg. diazepam). When pressed to tell the truth, Williams changed her story, admitting that she had administered the anesthesia. She insisted, however, that she had called Gosnell before administering 10 mg. Demerol and 12.5 mg. promethazine at 6:00 p.m., and an additional “custom” dose (75 mg. Demerol, 12.5 mg. promethazine, and 10 mg. diazepam) when the “local anesthesia” wore off. She said that she injected these medications into the patient’s arm.

<span style="font-family: 'Courier New',Courier,monospace;"> Dr. Herlich, the University of Pittsburgh Medical Center anesthesiologist, testified that the first dose of Demerol described by Williams made no sense – that there is no such thing as a 10 mg. dose of Demerol. He further explained that a 10 mg. dose of Demerol, if it existed, “would be barely noticeable in terms of pain control” in the average adult. The dosage Williams claimed had been administered would not, in any case, have had the effect witnessed by Mrs. Mongar’s daughter. She said that her mother had been in a lot of pain in the recovery room before the procedure, but that the medicine administered intravenously by Williams and West put her mother “to sleep.”

<span style="font-family: 'Courier New',Courier,monospace;"> It is notable that Williams’s story was different from the one given by Gosnell when he was interviewed by Detective James Wood, the FBI, and the DEA on the night of the raid. According to Detective Woods’s notes, Gosnell first told his interviewers that medication was given by “one of his nurses or by a medical assistant, he wasn’t sure who …” – even though no nurses were employed in the clinic. He then said that during the “evening,” before the procedure, “one of the nursing staff” administered an unspecified dose of Demerol and diazepam (not promethazine) intramuscularly (meaning an injection into a muscle rather than a vein – which would be intravenous). He said that he then administered a dose of Demerol intravenously when he did the abortion procedure.

<span style="font-family: 'Courier New',Courier,monospace;"> He also told the DEA that he had performed a “successful and uneventful. . . suction and curette procedure” – even though Mrs. Mongar’s 19-week-old fetus was found in the clinic’s freezer completely intact.

<span style="font-family: 'Courier New',Courier,monospace;"> Gosnell’s statements to law enforcement contradicted what he had earlier reported to the Department of Health shortly after Mrs. Mongar’s death. On November 26, 2009, Gosnell wrote a letter to health department officials advising them of his patient’s death.

<span style="font-family: 'Courier New',Courier,monospace;"> At that time, he reported that Mrs. Mongar had been given two doses of sedation intravenously, each containing 50 mg. of Demerol and 5 mg. of diazepam. He did not say who had administered this mix of drugs, which he called “customary.” All the evidence is to the contrary: This combination of drugs was nowhere listed on the clinic’s medication chart, and every other staff member stated that the final dose given to every second trimester patient was 75 mg. Demerol, 12.5 mg. promethazine, and 10 mg. diazepam.

<span style="font-family: 'Courier New',Courier,monospace;">Kareema Cross explained to the Grand Jury why it was significant that Williams, as opposed to the doctor, had given Mrs. Mongar the lethal drugs. Cross said that Williams had confided in her that Gosnell was willing to say that he had administered the drugs. Cross testified that “Dr. Gosnell told her that she’s not going to be in trouble. He’s going to say that he gave the patient the medication.” Asked why this mattered, Cross said:

>> <span style="font-family: 'Courier New',Courier,monospace;"> A. Because she’s not certified, none of us are certified to do it. >>> <span style="font-family: 'Courier New',Courier,monospace;">* * * >> <span style="font-family: 'Courier New',Courier,monospace;">Q. But if he gave the medicine, was it your understanding that no one would get in any trouble because he’s a doctor? >> <span style="font-family: 'Courier New',Courier,monospace;"> A. Right. >> <span style="font-family: 'Courier New',Courier,monospace;"> Q. And it would just be malpractice; is that right? >> <span style="font-family: 'Courier New',Courier,monospace;"> A. Yes >> <span style="font-family: 'Courier New',Courier,monospace;"> Q. And not criminal; is that right? >> <span style="font-family: 'Courier New',Courier,monospace;"> A. Yes. >> <span style="font-family: 'Courier New',Courier,monospace;"> Q. Is that how it was told to you? >> <span style="font-family: 'Courier New',Courier,monospace;"> A. Yes. >> <span style="font-family: 'Courier New',Courier,monospace;"> Q. Is that how Lynda [Williams] explained it to you? >> <span style="font-family: 'Courier New',Courier,monospace;"> A. Yes.

<span style="font-family: 'Courier New',Courier,monospace;"> In fact, according to Cross, Gosnell rarely gave medication; he almost always left this task to his untrained and uncertified workers.

<span style="font-family: 'Courier New',Courier,monospace;"> The toxicology expert’s testimony flatly contradicted these self-serving statements. Dr. Rohrig, the toxicology expert, explained to the Grand Jury that all of Gosnell’s, Williams’s, and West’s shifting accounts of the drugs given to Mrs. Mongar were inconsistent with the levels of medications found in Mrs. Mongar’s blood post mortem. Those levels were consistent, however, with what Kareema Cross said was the clinic’s standard practice – to give multiple doses of 75 mg. Demerol, along with promethazine and diazepam, throughout the afternoon and evening before the procedure.

<span style="font-family: 'Courier New',Courier,monospace;"> The expert explained that Demerol has a “half-life” of about three hours, meaning that it takes about that long for the concentration of the drug in the body to be reduced by half. It then takes another three hours for the remaining concentration to be reduced by 50 percent, and this pattern continues until all of the drug has dissipated. Demerol is thus “fairly quickly removed from the body.” At least 18 hours after the drugs were administered, Mrs. Mongar still had a Demerol concentration of 750 micrograms per liter in her blood.

<span style="font-family: 'Courier New',Courier,monospace;"> While Dr. Rohrig was unable to determine precisely how much Demerol Mrs. Mongar had been given, he testified that, based on the high concentration still in her blood, it was far more than Gosnell, Williams, and West claimed. The expert explained that if Mrs. Mongar had been given 100 mg. of Demerol (as Gosnell told the Department of Health), the peak drug concentration would have been about 300 micrograms per liter. Mrs. Mongar’s level – over 700 micrograms a day later – was totally inconsistent with Gosnell’s, Williams’s, and West’s stories. “You just can’t have that high concentration 18 hours later… That’s enough [time] to cause the normal therapeutic doses to go to zero.” Mrs. Mongar had to have been given multiple 75-mg. doses of Demerol, or the doses she was given had to have contained well over 75 mg. of Demerol.

<span style="font-family: 'Courier New',Courier,monospace;"> What Gosnell and others reported to the hospital, to the Health Department, and to law enforcement about the amount of medication they gave to Mrs. Mongar was demonstrably false.

<span style="font-family: 'Courier New',Courier,monospace;"> Predictably, Gosnell and his staff also tried to avoid responsibility by blaming the victim. The day after Mrs. Mongar died, West said to Ashley Baldwin that one of the family members had told her that Mrs. Mongar “took some pills, because she was trying to get rid of it at home.” Similarly, Liz Hampton in her testimony before the Grand Jury claimed that she had had a discussion with Mrs. Mongar’s “husband and two daughters” upstairs at the clinic. Hampton insisted, under oath, that they had said to her: “we told her not to take the drugs.” But the only family members to enter the clinic were Mrs. Mongar’s daughter and the daughter’s mother-in-law, and neither of them spoke English.

<span style="font-family: 'Courier New',Courier,monospace;"> Mrs. Mongar’s husband was in Virginia and Mr. Ghalley was waiting outside in the car. Mrs. Mongar’s daughter flatly denied that anyone in her group ever said any such thing. Her mother, she testified with the help of a translator, had taken nothing other than the medication given to her at the clinic the night before.

<span style="font-family: 'Courier New',Courier,monospace;"> Ashley Baldwin testified that she did not believe West and Hampton’s claims, because it seemed odd to be hearing about them only after the patient had to be transported to the hospital. In any event, expert testimony established that Mrs. Mongar died from an overdose of Demerol, the drug administered in Gosnell’s clinic, and not some mystery pill.