I am Pro-Choice

I read a new story that made my stomach turn. A man by the name of Kermit Gosnell  operated a clinic called the Women’s Medical Society in an impoverished region of Philadelphia. It was at his clinic that the horrors of illegal and unregulated abortion can be seen. The brief AP news report is sickening enough; reading the case presentment and grand jury report are much more detailed and grizzly and I did read both, page after disgusting page.

This not a story about the horrors of abortion.

This is a story about how in one of the richest countries in the world we turn our backs on the poor. This is a story about what happens when people do not have access to safe affordable healthcare. This is what happens when violations can go ignored, where people can slip through a system designed to protect them.

This is a very graphic post and may be triggering to some people. It is the epitome of horror. There is no other word to describe what happened.

We’re in America and yet there are people who do not and cannot receive adequate medical care. Aside from the sheer cost, the spectrum of medical services available in low income neighborhoods are often quite sparse. Far too few people will open up a practice in neighborhoods with high crime rates either because they feel unsafe or because these clinics are rarely able to remain open and profitable. Without health insurance to rely on many people simply cannot afford to access anything better. There are many storefront medical practices in the places we call, “the wrong side of the tracks.” They usually look pretty questionable from the outside and those who venture inside will also notice more than a few health code violations and slippery ethics. Sometimes they are dentists, sometimes they are pediatricians, sometimes they are just general practice clinics. Women’s health services and abortion providers are even more scarce. The hurdles to open a clinic are steep. Some of these hurdles are deliberately designed to make it so difficult to open a clinic or obtain services. Abortion providers must also content with protesters who harass, threaten, and intimidate clinic staff and clients. It is not unusual for family planning clinics to have metal detectors and armed private guards for the safety of everyone inside the buildings.

Abortion is still technically legal in the United States. This does not mean that all people have access to abortion. It is in many cases de facto illegal. A lack of resources does not reduce the need for these services and unscrupulous people are more than willing to take the opportunity to profit. It’s amazing how much money you can make off of people when they have no other option.

Here’s the description of Kermit Gosnell’s clinic from the December 2010 raid:

The clinic reeked of animal urine, courtesy of the cats that were allowed to roam (and defecate) freely.  Furniture and blankets were stained with blood.  Instruments were not properly sterilized.  Disposable medical supplies were not disposed of; they were reused, over and over again.  Medical equipment – such as the defibrillator, the EKG, the pulse oximeter, the blood pressure cuff – was generally broken; even when it worked, it wasn’t used.  The emergency exit was padlocked shut.  And scattered throughout, in cabinets, in the basement, in a freezer, in jars and bags and plastic jugs, were fetal remains. (Grand Jury Report; page 2.)

If you’re looking for any more damning evidence that Kermit Gosnell was not in business to provide healthcare to people, there is also this charming bit of information:

The people who ran this sham medical practice included no doctors other than Gosnell himself, and not even a single nurse.  Two of his employees had been to medical school, but neither of them were licensed physicians.  They just pretended to be.  Everyone called them “Doctor,” even though they, and Gosnell, knew they weren’t.  Among the rest of the staff, there was no one with any medical licensing or relevant certification at all.  But that didn’t stop them from making diagnoses, performing procedures, administering drugs.  Because the real business of the “Women’s Medical Society” was not health; it was profit.  There were two primary parts to the operation.  By day it was a prescription mill; by night an abortion mill.  A constant stream of “patients” came through during business hours and, for the proper payment, left with scripts for Oxycontin and other controlled substances, for themselves and their friends.  Gosnell didn’t see these “patients”; he didn’t even show up at the office during the day.  He just left behind blank, pre-signed prescription pads, and had his unskilled, unauthorized workers take care of the rest.  The fake prescriptions brought in hundreds of thousands of dollars a year.  But this drug-selling operation is the subject of separate investigation by federal authorities.

With abortion, as with prescriptions, Gosnell’s approach was simple: keep volume high, expenses low – and break the law.  That was his competitive edge. (GJR; pgs 2-3.)

The conditions of Kermit Gosnell’s clinic were dangerous to women. So dangerous, in fact, that a woman did die of Demerol overdose administered by an untrained and unlicensed employee of the clinic. She was an immigrant from Nepal who had been in America for just a few months after arriving here from a refugee camp. As she is deceased, she cannot speak for herself. Her family required Nepali translators to testify in court as they spoke little or no English at all. It is doubtful that this woman did give truly informed consent. In fact despite the fact that many, many, many files that should have been in the clinic were missing (employees stated that he stored some of the more ‘controversial’ files at home), those that were seized were often incomplete, contained fraudulent information, or lacked a signed consent form for the procedures.

The grand jury report also explicitly cites pro-choice politics as one of the reasons that these conditions persisted for more than 15 years at least. Perhaps this argument might (might) hold water except that there had been numerous complaints and lawsuits about his practice. In fact, even the report of the death of Karnamaya Mongar after a routine abortion had not been investigated at all. This son-of-a-bitch got caught when his clinic was raided for drug charges from his prescription narcotic mill. If it had not been for an investigation into controlled substances, these violations and deaths would have gone unnoticed. City Department of Health officials have lawyered up about their complete lack of response to any of the formal complaints, 46 lawsuits, or the very suspicious death that had been reported to them. It wasn’t just the City Department of Health that failed, it was also the State Department as well. They too had received numerous formal complaints and requests for an investigation.

Almost a decade ago, a former employee of Gosnell presented the Board of Medicine with a complaint that laid out the whole scope of his operation: the unclean, unsterile conditions; the unlicensed workers; the unsupervised sedation; the underage abortion patients; even the over-prescribing of pain pills with high resale value on the street.  The department assigned an investigator, whose investigation consisted primarily of an offsite interview with Gosnell.  The investigator never inspected the facility, questioned other employees, or reviewed any records.  Department attorneys chose to accept this incomplete investigation, and dismissed the complaint as unconfirmed. (GJR; pgs 10-11)

Here are some stunning examples of the complaints lodged against Kermit Gosnell:

One woman, for example, was left lying in place for hours after Gosnell tore her cervix and colon while trying, unsuccessfully, to extract the fetus.  Relatives who came to pick her up were refused entry into the building; they had to threaten to call the police.  They eventually found her inside, bleeding and incoherent, and transported her to the hospital, where doctors had to remove almost half a foot of her intestines.

On another occasion, Gosnell simply sent a patient home, after keeping her mother waiting for hours, without telling either of them that she still had fetal parts inside her.  Gosnell insisted she was fine, even after signs of serious infection set in over the next several days.  By the time her mother got her to the emergency room, she was unconscious and near death.

A nineteen-year-old girl was held for several hours after Gosnell punctured her uterus.  As a result of the delay, she fell into shock from blood loss, and had to undergo a hysterectomy.

One patient went into convulsions during an abortion, fell off the procedure table, and hit her head on the floor.  Gosnell wouldn’t call an ambulance, and wouldn’t let the woman’s companion leave the building so that he could call an ambulance. (GJR; pg 6.)

Not all of Gosnell’s patients were treated in such a manner. “Only in one class of cases did Gosnell exercise any real care with these dangerous sedatives.  On those rare occasions when the patient was a white woman from the suburbs, Gosnell insisted that he be consulted at every step.  When an employee asked him why, he said it was ‘the way of the world.’” (GJR, pg 7.)

A further indication of the state’s prejudice against abortion care can be found in another report that was in the hand’s of the State Department.

“A woman, years before Karnamaya Mongar [the victim of the Demerol overdose]…died of sepsis after Gosnell perforated her uterus.  The woman was 22 years old.  A civil suit against Gosnell was settled for almost a million dollars, and the insurance company forwarded the information to the department.  That report should have been all the confirmation needed for the complaint from the former employee that was already in the department’s possession.  Instead, the department attorneys dismissed this complaint too.  They concluded that death was just an “inherent” risk, not something that should jeopardize a doctor’s medical license.” (GJR; pg 11.)

There had been numerous lawsuits against Gosnell from women whose internal organs had been punctured. The State Department never investigated these claims and they never checked the national litigation database. They concluded that there had been no pattern of wrong doing. The Grand Jury Report does note that there is a bit of a pattern here. Not one of these lawsuits or complaints had any media coverage whatsoever and the victims were all people of color from low income backgrounds.

The Grand Jury Report actually goes on for many more pages describing just how much knowledge the city, county, and state had about Kermit Gosnell. In fact, multiple city DPH workers who visited his clinic to pickup blood samples for testing observed fetal remains in the employee food refrigerator and the 30 jars containing the severed feet of fetuses scattered throughout the clinic. These employees did file formal reports of these observations. Everything had been ignored. “The agency’s head lawyer, chief counsel Christine Dutton, defended the department’s indifference: “People die,” she said.” (GJR; pg 15.)

Kermit Gosnell not only took advantage of his patients, he exploited his employees whenever possible. The 15 year old high school student he hired to perform administrative tasks and assist in patient care was forced to work 50 hour weeks (GJR; pgs 14-15.) He pay rate was low, when he actually paid his workers. He often required that they work “volunteer shifts” at the clinic where only their gas fare was compensated. One employee stated in the case presentment, “For 15 hours a week, sometimes he give me 200 every couple of weeks and sometimes 200 a month. Sometimes 400 every two months.” Gosnell paid in cash. (Presentment; pg 48.)

Here is a description of the raid on Kermit Gosnell’s clinic and home:

There was blood on the floor. A stench of urine filled the air. A flea-infested cat was wandering through the facility, and there were cat feces on the stairs. Semi-conscious women scheduled for abortions were moaning in the waiting room or the recovery room, where they sat on dirty recliners covered with blood-stained blankets.

All the women had been sedated by unlicensed staff – long before Gosnell arrived at the clinic – and staff members could not accurately state what medications or dosages they had administered to the waiting patients. Many of the medications in inventory were past their expiration dates.

Investigators found the clinic grossly unsuitable as a surgical facility. The two surgical procedure rooms were filthy and unsanitary – Agent Dougherty described them as resembling “a bad gas station restroom.” Instruments were not sterile. Equipment was rusty and outdated. Oxygen equipment was covered with dust, and had not been inspected. The same corroded suction tubing used for abortions was the only tubing available for oral airways if assistance for breathing was needed. There was no functioning resuscitation or even monitoring equipment, except for a single blood pressure cuff in the recovery room.

Ambulances were summoned to pick up the waiting patients, but (just as on the night Mrs. Mongar died three months earlier), no one, not even Gosnell, knew where the keys were to open the emergency exit. Emergency personnel had to use bolt cutters to remove the lock. They discovered they could not maneuver stretchers through the building’s narrow hallways to reach the patients (just as emergency personnel had been obstructed from reaching Mrs. Mongar).

The search team discovered fetal remains haphazardly stored throughout the clinic – in bags, milk jugs, orange juice cartons, and even in cat-food containers. Some fetal remains were in a refrigerator, others were frozen. Gosnell admitted to Detective Wood that at least 10 to 20 percent of the fetuses were probably older than 24 weeks in gestation – even though Pennsylvania law prohibits abortions after 24 weeks. In some instances, surgical incisions had been made at the base of the fetal skulls.

The investigators found a row of jars containing just the severed feet of fetuses. In the basement, they discovered medical waste piled high. The intact 19-week fetus delivered by Mrs. Mongar three months earlier was in a freezer. In all, the remains of 45 fetuses were recovered at the clinic that evening and turned over to the Philadelphia medical examiner, who confirmed that at least two of them, and probably three, had been viable.

A simultaneous search of Gosnell’s house found patient files that he had taken from the clinic. In a filing cabinet in his 12-year-old daughter’s closet, they found $240,000 in cash and a gun. (GJR; pgs 20-22.)

This is the work of a sociopath who was continuously allowed to carry on with his practice. Investigator’s have estimated that Gosnell was making roughly $10,000-$15,000 each night (mostly in cash) from abortion services alone. This number does not include what he made as, “top Oxycontin prescribers in the state.” (GJR; pg 23.)

I realize that I have essentially just been rehashing this report. It is reprehensible that the city, the county, and the state all allowed this to continue. Every time we push a family planning clinic out of a neighborhood, we could be allowing someone like Kermit Gosnell to move-in. Every time we make cuts to sponsored healthcare, we could be allowing someone like Kermit Gosnell to move-in. This is why we need to make drastic changes to health care. This is why we need to fight to keep abortion safe and legal. We can’t allow something like this to happen ever again and what saddens me so much is that there are undoubtedly more stories like this one out there. There are more reports and complaints lost in the system. A horror show like this does not exist in a vacuum.