Gosnell’s+Illegal+Practice

toc 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: Gosnell's illegal practice:


 * he employed unlicensed, untrained workers
 * facility was "grossly inadequate and unsanitary"
 * he allowed and even required his employees to practice medicine without him even in the building
 * his untrained employees gave doses of drugs (including controlled substances such as Valium and Demerol) to abortion patients, sometimes high and repeated doses, without the doctor's supervision
 * he "killed live, viable, moving, breathing, crying babies."
 * he performed abortions well past the legal limit
 * he performed abortions the same day as the "counseling" even though state law required at least a 24-hour wait
 * he presented two unlicensed workers as doctors, and these people "saw, diagnosed and treated patients when Gosnell was not at the clinic."

This page is taken verbatim from the Philadelphia Grand Jury's Report. To distinguish it from my own writing, I am using a different font.

=Section III: Gosnell’s Illegal Practice =

Gosnell’s “medical practice” was not set up to treat or help patients. His aim was not to give women control over their bodies and their lives. He was not serving his community. Gosnell ran a criminal enterprise, motivated by greed.

 Some 40,000 abortions are performed across the Commonwealth each year. Abortion is normally one of the simplest and safest medical procedures. But not in Gosnell’s clinic. Employing unlicensed, untrained workers in a facility that was grossly inadequate and unsanitary, his operation made a pretext of providing health care. In the absence of any regulatory oversight, Gosnell recklessly cut corners, allowed patients to choose their medication based on ability to pay, and provided abysmal care – all to maximize his profit.

 We estimate that Gosnell took in as much as $10,000 to $15,000 a night, mostly in cash, for a few hours of work performing abortions. And this amount does not include the money he made as one of the top Oxycontin prescribers in the state. The Women’s Medical Society stands as a monument to an absolute disdain for the health and safety of women, and in many cases of babies who were born alive in this filthy clinic.

== - The deaths of women and of countless viable babies were a direct and foreseeable consequence of the reckless and illegal manner in which Gosnell operated his clinic. ==

 Employees at the Women’s Medical Society who testified before the Grand Jury were not surprised when a lethal overdose of drugs killed one of Gosnell’s patients in November 2009. They had seen many close calls and at least one other patient’s death caused by Gosnell’s careless and criminal practices. They knew that Gosnell chose unlicensed, untrained, and unsupervised workers to anesthetize his abortion patients, and that the drugs, in accordance with his office procedure, were administered in the doctor’s absence.

 None of Gosnell’s employees were licensed or properly trained. Gosnell’s staff warned him that two of his employees, Lynda Williams and Sherry West, were not only unlicensed and unqualified, but sloppy and unconcerned as well. They presented an obvious danger to the clinic’s patients, whom they routinely over-medicated and failed to monitor.

 But while Williams and West were perhaps slightly more careless than other workers, their actions were consistent with the corner-cutting practice that Gosnell had operated for decades. Every aspect of that practice reflected an utter disregard for the health and safety of his patients, a cruel lack of respect for their dignity, and an arrogant belief that he could forever get away with the slovenly and careless treatment of the women who came to his clinic. The only thing Gosnell seemed to care about was the cash he raked in from his illegal operation.

 The fact that the doctor staffed his facility with unlicensed and indifferent workers, and then let them practice medicine unsupervised, was only one factor that made his clinic such a dangerous place for its patients. Dirty facilities; unsanitary instruments; an absence of functioning monitoring and resuscitation equipment; the use of cheap, but dangerous, drugs; illegal procedures; and inadequate emergency access for when things inevitably went wrong, all put patients at grave risk – every day.

 When two of Gosnell’s staff members sought abortions, they knew better than to go to him. They went to other clinics, where they marveled that physicians actually counseled patients, the facilities appeared sanitary, and a doctor was in the room when they were medicated.

 Mrs. Mongar was just one of many patients victimized by Gosnell’s depravity. There were scores more. At least one other mother died following an abortion in which Gosnell punctured her uterus and then sent her home. He left an arm and a leg of a partially aborted fetus in the womb of another woman, and then told her he did not need to see her when she became sick days later, having developed a temperature of 106 degrees. He perforated bowels, cervixes, and uteruses. He left women sterile.

 He also killed live, viable, moving, breathing, crying babies. He killed them by cutting their spinal cords after their mothers had delivered them after receiving excessive amounts of medication designed to induce active labor. This report documents multiple murders of viable babies. The evidence makes a compelling case that many others were also murdered.

 Gosnell and his employees performed abortions long after the legal limit. The doctor’s unorthodox methods, especially with late second-trimester and third-trimester pregnancies, virtually mandated the premature delivery of live babies – whose spinal cords he would then routinely slit. These practices persisted for many years without interruption by any regulatory body.

 The pain, suffering, and death that he and his employees perpetrated were not the result of accidentally botched procedures. It was Gosnell’s standard business practice, to slay viable babies. The women who died, or whose health he recklessly endangered or irreparably harmed, were simply collateral damage for the doctor’s corrupt and criminal enterprise.

 - Gosnell set up his practice so that, in his absence, excessively medicated patients went into labor and often delivered live babies.
<span style="font-family: 'Courier New',Courier,monospace;"> Latosha Lewis, who worked for Gosnell for over eight years, explained to the Grand Jury how the doctor ran the clinic. According to Lewis and other staff members who testified, the office was actually split into two practices – the abortion clinic, which was mostly on the first floor, and a family practice on the second floor. (Witnesses testified that the family practice had devolved in the last several years into mainly a “pain management” practice.) The office opened at approximately 10:00 a.m., with family practice patients coming only in the evenings. Abortion patients arrived throughout the day. Gosnell, who was the only licensed doctor, did not usually arrive to see patients or perform procedures until after 8:00 p.m.

<span style="font-family: 'Courier New',Courier,monospace;"> Abortions were generally scheduled four days a week – on Mondays, Tuesdays, Thursdays, and Saturdays. Gosnell did not see patients on Wednesdays, but some were seen by his unlicensed staff. According to his staff, the doctor and his wife, Pearl, performed extremely late-term procedures on Sundays. First-trimester abortions at the Women’s Medical Society were generally one-day procedures and were performed all four days. Second-trimester abortions were performed usually over a two-day period. Questionable late-term and suspected third-trimester procedures took three days.

<span style="font-family: 'Courier New',Courier,monospace;"> When Latosha Lewis began work at the clinic in 2000, the practice would perform approximately 20 first-trimester and 5 or 6 second-trimester abortions every procedure night. By 2009, however, the practice’s first-trimester abortions had dropped off significantly. Lewis explained that Gosnell had a bad reputation in the Philadelphia community, and local referral agencies would not recommend his clinic to women seeking abortions. This assertion was confirmed by representatives of Philadelphia community organizations that provide referrals and information on sexual health services.

<span style="font-family: 'Courier New',Courier,monospace;"> As a result, Gosnell began to rely much more on referrals from other areas where abortions as late as 24 weeks are unavailable. More and more of his patients came from out of state and were late second-trimester patients. Many of them were well beyond 24 weeks. Gosnell was known as a doctor who would perform abortions at any stage, without regard for legal limits. His patients came from several states, including Delaware, Maryland, Virginia, and North Carolina, as well as from Pennsylvania cities outside the Philadelphia area, such as Allentown. He also had many late-term Philadelphia patients because most other local clinics would not perform procedures past 20 weeks.

<span style="font-family: 'Courier New',Courier,monospace;"> While there was no doctor on the premises during the day, the clinic’s unlicensed assistants saw abortion patients beginning at about 10:00 a.m. Women could walk in for ultrasounds and for what the clinic staff called “pre-exams.” During the pre-exam, which cost $125, one of the clinic’s workers would ask the patient about her past medical history, allergies, and last menstrual period. The staff member would also draw blood, take the woman’s blood pressure, and perform an ultrasound to determine the age of the fetus – even though none of the staff was properly trained to do ultrasounds. The clinic worker would have the patient sign the facility’s consent form (rarely if ever reviewing it with the client), and then schedule the procedure.

<span style="font-family: 'Courier New',Courier,monospace;"> Lewis testified that when she first went to work for Gosnell, he usually complied with at least part of a Pennsylvania law that requires doctors to wait 24 hours after counseling patients before performing an abortion. She said that Gosnell might wait a day after the patient’s initial pre-exam, even if he did not provide the counseling. By 2008, as the number of women and girls seeking first-trimester abortions from Gosnell shrank, the doctor disregarded the law to attract more patients. Lewis said that a lot of times patients would not return after their first visit to the clinic. The doctor had his staff offer procedures the same day that patients walked in the door – as long as the patient paid in full, typically in cash.

<span style="font-family: 'Courier New',Courier,monospace;"> If first-trimester patients wanted to proceed right away, the doctor would complete the abortion that night using a five-minute suction procedure with an instrument called a curette. Two patients present in the facility during the February 2010 raid told a state Department of Health surveyor, “that it was the only clinic in town that you call the day of and get an appointment and have the procedure done that day.”

<span style="font-family: 'Courier New',Courier,monospace;"> Second-trimester procedures were more complicated because the woman’s cervix had to be dilated sufficiently to extract the fetus. If the woman was between 15 and 24 weeks pregnant, a worker would usually schedule her to come back on a Monday or a Friday night for the first step of a two- or three-day procedure. If, however, the pregnancy was 24 weeks or more – and the patient had her money ready – dilation would often begin that night.

<span style="font-family: 'Courier New',Courier,monospace;"> The dilation procedure involved placing synthetic or seaweed rods called laminaria into the woman’s cervix. The rods would expand as they absorbed moisture and would slowly push the cervix open. Although Gosnell usually performed this delicate procedure himself, it was not uncommon for him to have unlicensed employees pry open the patient’s vagina with a speculum and insert the laminaria. After the laminaria were placed, the patient would be sent home with pain medicine and [|Cytotec] to soften the cervix. Patients would be instructed to return the next day to complete the abortion or to have laminaria replaced if the fetus was really large. Sometimes, if a patient had come from out of state, the doctor would allow the woman to sleep in the facility. No personnel stayed with these patients; they were left alone and unsupervised in the clinic.

<span style="font-family: 'Courier New',Courier,monospace;"> Inserting laminaria is a standard procedure followed by doctors who perform second-trimester abortions. Thereafter, Gosnell’s procedure was not only grossly out of compliance with accepted medical standards, it was ghoulish, dangerous, and criminal.

<span style="font-family: 'Courier New',Courier,monospace;"> Patients returned to the clinic the next day (if they hadn’t spent the night). The person at the front desk, usually the unlicensed and untrained longtime employee Tina Baldwin, would start medicating the patients by giving them more Cytotec to induce labor and temazapan (Restoril) to make them sleepy. The doctor did not arrive before 8:00 pm or later, despite the fact that patients frequently began arriving at noon.

<span style="font-family: 'Courier New',Courier,monospace;"> For hours after they came to the clinic, patients were left naked from the waist down (the clinic provided no robes, only blankets that were washed once a week). Women sat in bloodstained lounge chairs in the “recovery room” while unlicensed, unsupervised workers gave them large doses of various drugs.

<span style="font-family: 'Courier New',Courier,monospace;"> Cytotec was administered hourly, or whenever the staff got around to it. Pills of either 100 mg. strength or 200 mg. – the workers were unclear what they were giving – were administered both buccally, that is, by placing them in the patient’s cheek or lip, or vaginally. These frequent doses of Cytotec made the women’s uteruses contract and cramp, throwing them into active labor and causing severe pain. Kareema Cross, a coworker of Lewis’s, testified that as the patients got “bigger and bigger” over the years, the workers would give more and more Cytotec.

<span style="font-family: 'Courier New',Courier,monospace;"> To make the patients “comfortable” – and keep them quiet – the clinic’s unlicensed and untrained workers used butterfly needles for IV access and injected several different strong, sedative drugs into the women and girls in order to, as Latosha Lewis and Kareema Cross put it, “knock them out.”

<span style="font-family: 'Courier New',Courier,monospace;"> All afternoon and evening, as patients woke and complained of pain, workers would continue to medicate them with injections of sedatives. Between doses, the staff would leave patients largely untended. This would go on until the doctor arrived, some six or more hours after the patient did, or until the woman delivered.

<span style="font-family: 'Courier New',Courier,monospace;"> Very often, the patient delivered without Gosnell being present. Lewis testified that one or two babies fell out of patients each night. They dropped out on lounge chairs, on the floor, and often in the toilet. If the doctor was not there, it was not unusual for no one to tend to the mother or the baby. In fact, several of the clinic’s workers refused to deal with the expelled babies or the placenta. So, after delivering babies, women and girls would have to just sit and wait – sometimes on a toilet for hours – for Gosnell to arrive.

Lewis acknowledged that she would not do anything but wait with the women: >> A lot of times this happened when [Gosnell] wasn’t there. If. . . a baby was about to come out, I would take the woman to the bathroom, they would sit on the toilet and basically the baby would fall out and it would be in the toilet and I would be rubbing her back and trying to calm her down for two, three, four hours until Dr. Gosnell comes. She would not move.

<span style="font-family: 'Courier New',Courier,monospace;"> James Johnson, who supposedly cleaned the clinic and bagged its infectious waste, confirmed Lewis’s account. He testified that sometimes patients “miscarried or whatever it was” into the toilet and clogged it. He described how he had to lift the toilet so that someone else – he said it was too disgusting for him – could get the fetuses out of the pipes.

<span style="font-family: 'Courier New',Courier,monospace;"> Amazingly, these premature deliveries – what Gosnell called “precipitations” – were routine. The doctor’s customary practice called for intense and painful labor, accompanied by heavy doses of potent drugs, all while he was absent from the clinic. Lewis said Gosnell told her that he preferred it when women precipitated, often before he got to the clinic, because it made his job easier. A surgical procedure to remove fetuses, Lewis explained, could take half an hour. Whereas there was little to do – just suctioning the placenta – when babies were already expelled. In addition, by avoiding surgical abortions, Gosnell was less likely to perforate the women’s uteruses with surgical instruments – something he had done, and been sued for, many times.

<span style="font-family: 'Courier New',Courier,monospace;"> If fetuses had not precipitated, Gosnell would often have his staff physically push them out of their mothers by pressing on the mothers’ abdomens.

<span style="font-family: 'Courier New',Courier,monospace;"> According to a board-certified gynecologist and obstetrician who testified as a medical expert, Gosnell’s labor-induction method of performing second-trimester abortions – as opposed to a standard surgical procedure – entails significant risks, including hemorrhage and debilitating pain that leaves patients unable to care for themselves. The pain suffered by women in full labor requires careful supervision and appropriate sedation. Thus, according to the expert, labor induction should be performed only in a hospital setting, where medical professionals can monitor the women throughout their labor. Gosnell had neither the staff nor the facility to perform this type of abortion safely. He did it routinely anyway.

<span style="font-family: 'Courier New',Courier,monospace;"> - Gosnell staffed his abortion clinic with unlicensed and unqualified workers.
<span style="font-family: 'Courier New',Courier,monospace;">Gosnell deliberately hired unqualified staff because he could pay them low wages, often in cash. Most of Gosnell’s employees who worked with patients had little or no remotely relevant training or education. Nor did they have any certifications or licenses to treat patients. Yet they did so regularly, and without supervision – in violation of Pennsylvania’s medical practice standards and the law.

<span style="font-family: 'Courier New',Courier,monospace;"> Tina Baldwin testified that certification did not matter to Gosnell. He told his workers that there was a “grandfather clause where if you – since he’s a doctor and he taught you, you could be automatically whatever it is he taught you to be. You could be certified because he taught you to do that.”

<span style="font-family: 'Courier New',Courier,monospace;"> Gosnell had several employees who lasted just a short time at his clinic, but the following were his principal employees after 2000:

<span style="font-family: 'Courier New',Courier,monospace;">Latosha Lewis worked at the clinic for approximately eight years, beginning in 2000 and ending on February 18, 2010. ....

<span style="font-family: 'Courier New',Courier,monospace;">Tina Baldwin worked at the clinic for nine years, beginning in February 2001 and continuing until the practice closed in February 2010. ...

<span style="font-family: 'Courier New',Courier,monospace;">Kareema Cross worked at the clinic for four and a half years, beginning in August 2005, as another uncertified “medical assistant.” ....

<span style="font-family: 'Courier New',Courier,monospace;">Ashley Baldwin was a 15-year-old high school sophomore when she started working at Gosnell’s clinic in 2006. ....

<span style="font-family: 'Courier New',Courier,monospace;">Sherry West was hired by Gosnell in October 2008. She had known Gosnell as a patient for 35 years. ....

<span style="font-family: 'Courier New',Courier,monospace;">Lynda Williams was hired to work full-time in 2008. ....

<span style="font-family: 'Courier New',Courier,monospace;">Elizabeth (Liz) Hampton is Gosnell’s sister-in-law, his wife’s sister. ....

<span style="font-family: 'Courier New',Courier,monospace;">Adrienne Moton knew Gosnell through his niece and spent time with his family. ....

<span style="font-family: 'Courier New',Courier,monospace;">Randy Hutchins was the only licensed medical provider, other than Gosnell, to work with any regularity at the clinic in the last several years. ....

<span style="font-family: 'Courier New',Courier,monospace;">Maddline Joe worked for 17 years as the receptionist at Women’s Medical Society....

<span style="font-family: 'Courier New',Courier,monospace;"> Anna Keith was Gosnell’s aunt. She was the office manager until she retired in 2007.

<span style="font-family: 'Courier New',Courier,monospace;">Jennifer Leach is a 28-year-old woman who had a time card as if she were an employee of the clinic. ....

<span style="font-family: 'Courier New',Courier,monospace;">Pearl Gosnell, the doctor’s third wife, also helped out in the office. ....

<span style="font-family: 'Courier New',Courier,monospace;">Kermit Gosnell himself was not qualified. ....

==<span style="font-family: 'Courier New',Courier,monospace;"> - Gosnell presented two of his unlicensed workers as doctors in his practice, and allowed them to treat, diagnose, and prescribe medicine for patients. ==

<span style="font-family: 'Courier New',Courier,monospace;">Gosnell hired unlicensed medical school graduates Steve Massof and Eileen O’Neill to practice as doctors at his clinic. They were presented to patients and staff as “Dr. Steve” and “Dr. O’Neill, ” and Massof was listed on a sign inside the office door as “Dr. Steve Massof, Medical Intern.” Both saw, diagnosed, and treated patients when Gosnell was not at the clinic. And both prescribed medicine to patients who never saw Gosnell – even though their prescriptions bore Gosnell’s signature. (Massof admitted writing on pre-signed prescription pads; O’Neill insisted that Gosnell signed the prescriptions after she wrote them.)