By now you’ve probably noticed our subtitle for Medical Miscreants – Hic sunt Dracones – “There Be Dragons here” a phrase once found on ancient world maps to denote unknown, spooky places. We find the quote highly appropriate, because our entire purpose here, you see, is to shine a bright light into dark places. And as you are about to learn, there are simply no spookier places on earth than the nooks & crannies of health care.
For decades, the Pennsylvania State Board of Medicine ignored the nasty rumors they were hearing about a spine-chilling brick building located at the corner of 38th street and Lancaster, in West Philadelphia. No business in the entire state was more inappropriately named than this place – the Women’s Medical Society. And we now know that at least some members of the health department knew it.
Because the Women’s Medical Society had been in business for nearly 40 years, state health officials had more than enough time to shut the place down and save lives. For reasons that are readily found in court documents, they chose not to. Which meant that a medical monster named Doctor Kermit Gosnell was free to walk the halls, operating a true House of Horrors for fun and profit, at the expense of thousands of poor pregnant women, who – in most cases – believed they had no place else to go. Gosnell was – after all – a licensed doctor who had even grown up in their neighborhood. Everybody knew who he was. His clinic could be found on the internet, fully certified and legal. The ugly rumors couldn’t possibly be true, could they?
Well, they were true, and proof was obvious to anybody who walked through the doors. The Women’s Medical Society reeked of animal waste, for starters, because numerous cats roamed the hallways, urinating, pooping, in the corners. Patients sat on office furniture and slumped beneath blankets streaked with blood. Used surgical items were stacked everywhere; hazardous waste was neither cleaned up nor disposed of; non-sterilized tools were reused, over and over again. Lifesaving medical equipment was broken. Emergency exits were padlocked shut.
And scattered throughout the entire building in cupboards, on shelves, in the basement, in a freezer, in jars and bags and plastic jugs, were the body parts of hundreds of aborted fetuses.
Doctor Kermit Gosnell’s House of Horrors. Sound like a Halloween movie?
The shadow people operating this dungeon involved no other physician than Gosnell himself, and he hired not a single trained nurse. Two of his employees had some medical training, but neither of them had graduated from any recognized program. They pretended to be doctors, and – like patients everywhere – these women had no way of knowing the truth. Not a single staff member had relevant training.
That didn’t stop them from making diagnoses, performing surgical procedures, administering drugs and writing prescriptions.
By now it should be obvious the real business of the Women’s Medical Society had nothing to do with health care – it had to do with making as much cash as possible. And the dollars flowed from two reliable sources: By day? The “clinic” was a prescription drug-pushing house. At night, when Gosnell arrived, it became an abortion mill. The clinic thrived because a constant stream of “patients” came through during business hours and, for cash on demand, left with prescriptions for narcotics. These drugs were then sold for profit on the streets. Gosnell never saw these “patients” because he didn’t work during the day. He provided blank, already-signed prescription pads. His unskilled, unauthorized staff did the rest. These assembly line prescriptions brought in millions.
But it was at night, when Gosnell arrived, that the cash truly accumulated, because that’s when America’s most prolific illegal abortion factory went into high gear.
As with drug-pushing, Gosnell’s approach to abortions was basic: high volume, low expenses – and perform atrocities no other doctor around would do. That’s what he called his competitive edge.
Like most states, Pennsylvania permits regulated abortion. Clinics must, for example, provide counseling about the nature of the procedure. Minors must have parental or court consent. All women must wait 24 hours from their first visit to the facility, in order to fully consider their decision. Gosnell’s compliance with such requirements was non-existent. His clinic catered to women who could not get abortions elsewhere. Generally, physicians do not perform second-trimester abortions, from approximately the 20th week of pregnancy. And late-term abortions after the 24th week are totally illegal. For Kermit Gosnell, they were an opportunity. Because the bigger the baby, the more he charged.
Now, state law requires a measurement of fetal age, usually determined by an ultrasound. But ultrasound records would leave documentary proof that abortions at this clinic were illegal. So Gosnell did not allow professional sonographers to do the exams. His solution was to train the staff how to document fake measurements. How is this done? By tilting the ultrasound probe at an angle, one can make the photo look considerably smaller – and therefore legal to destroy – than it really is.
Of course, late-term abortions posed other challenges. Larger babies are hard to get out. Gosnell’s approach, whenever possible, was to force full labor by administering the extremely dangerous drug known as oxytocin. The women would check in during the day, pay cash, and take labor-inducing drugs. Gosnell wouldn’t appear until evening, often around 10:00 p.m., and only then deal with the women who were ready to deliver. By that time, nearly half had already given birth.
Their procedure was, in reality, patient labor without staff labor. The final obstacle was obvious: when you perform late-term “abortions” by inducing labor, you get babies. Living, breathing, squirming babies. By 24 weeks, most premature babies will survive if they receive appropriate medical care. But that was not what the Women’s Medical Society was about.
Gosnell had a simple solution for the unwanted babies they delivered each day: he killed them. Of course when teaching his staff how to end these little lives, he didn’t call it killing. He called it “ensuring fetal demise.”
And the way they ensured fetal demise was by sticking scissors into the back of the baby’s neck and cutting the spinal cord. At the spooky brick building at 38th and Lancaster, they simply called it “snipping.”
And over the years, countless thousands of “snippings” occurred. Sometimes, if Gosnell was unavailable, the “snipping” was done by one of his fake doctors, or even by the office staff. Among the staff, it wasn’t murder at all.
And in the pluperfect Catch-22 world called medicine, very few criminal acts can be prosecuted, because a criminal doctor learns early on to not keep files.
Among the relatively few cases that could be specifically documented, one was Baby Boy A. His 17-year-old mother was almost 30 weeks pregnant – seven and a half months – when labor was induced. An employee estimated his birth weight as approaching six pounds. He was breathing and moving just fine when lab-coat lunatic Gosnell severed his spine with scissors and plopped the little body into a plastic box for disposal. According to staff testimony, the doctor joked that this baby was so big, “he could walk me to the bus stop.”
Gosnell made little effort to hide his illegal abortion procedures. But there were some that even he was afraid to perform in front of others. These abortions were scheduled for Sundays, a day when the clinic was closed and the only person allowed to assist with these special cases was his wife. The files for these cases were destroyed by Gosnell before his trial started.
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Now, Pennsylvania is not a third-world country. Their taxes fund more than a few oversight agencies, any one of which should have shut down medical maniac Kermit Gosnell long ago. But none of them did. The reality is, Gosnell was only caught by accident, when police raided his offices to seize evidence of his illegal drug operation. It was those early investigators who observed the disgusting conditions, the dazed patients, the discarded fetuses. Which is why the entire regulatory collapse is so inexcusable. It should have taken only one look.
The first line of defense was the Pennsylvania Department of Health. Their job is to audit hospitals and outpatient facilities, to ensure rules are followed and safe care provided. The department did not conduct site review until 1989, ten years after it opened. Numerous violations were documented, but Gosnell got a pass when he promised to fix them. Site reviews in 1992 & 1993 also noted violations, but again, no follow-up.
Complaints about Gosnell were endless. More than a few attorneys, representing women injured by Gosnell, contacted the department of health. A Children’s Hospital physician hand-delivered a complaint, advising the department that numerous patients he had referred for abortions came back from Gosnell with the same venereal disease. The medical examiner of Delaware County informed the state that Gosnell had performed an illegal abortion on a 14-year-old girl carrying a 30-week-old baby. And the department received official notice that a woman named Karnamaya Mongar had died at Gosnell’s hands.
Yet not one of these alarm bells – not even Mrs. Mongar’s death – prompted health authorities to visit the Women’s Medical Society. Only after the raid occurred, and the story hit the news, did the state choose to act. Suddenly an order was issued to
close the clinic. And as this grand jury investigation widened, department officials “lawyered up,” hiring a high-priced law firm to represent them at taxpayer expense. Had they invested the same effort on inspection as they did on attorneys, none of this would have happened at all.
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