Kermit Gosnell's Pro-Choice Enablers (Is This What an Industry That Self-Regulates Looks Like?)

The ultimate non-partisan body – a criminal grand jury – has supplied us with the graphic, 261-page horror story of Kermit Gosnell, M.D., who stands accused of butchering seven babies – yes, after they were born alive -- and fatally doping a refugee from Nepal with Demerol in a clinic that smelled of cat urine, where the furniture was stained with blood and the doctor kept a collection of severed baby feet. As often as possible, the report says, Gosnell induced labor for women so pregnant that, as he joked on one occasion, the baby was so big he could "walk me to the bus stop." Then, hundreds of times over the years, he slit their little necks, according to the grand jury report:

[He] regularly and illegally delivered live, viable, babies in the third trimester of pregnancy – and then murdered these newborns by severing their spinal cords with scissors. The medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths. Over the years, many people came to know that something was going on here. But no one put a stop to it.

And the kicker? This nightmare facility had not been inspected in 17 years – other than by someone from the National Abortion Federation, whom he actually invited there. For whatever reason, Gosnell applied for NAF membership two days after the death of the 41-year-old Nepalese woman, Karnamaya Mongar. Even on a day when the place had been scrubbed and spiffed up for the visit, the NAF investigator found it disgusting and rejected Gosnell's application for membership. But despite noting many outright illegalities, including a padlocked emergency exit in a part of the clinic where women were left alone overnight, the grand jury report notes that the NAF inspector did not report any of these violations to authorities:

So too with the National Abortion Federation. NAF is an association of abortion providers that upholds the strictest health and legal standards for its members. Gosnell, bizarrely, applied for admission shortly after Karnamaya Mongar's death. Despite his various efforts to fool her, the evaluator from NAF readily noted that records were not properly kept, that risks were not explained, that patients were not monitored, that equipment was not available, that anesthesia was misused. It was the worst abortion clinic she had ever inspected. Of course, she rejected Gosnell's application. She just never told anyone in authority about all the horrible, dangerous things she had seen.

The report says outright that the lack of oversight after pro-life Democrat Bob Casey left the Pennsylvania governor's office in 1993 was overtly political. When pro-choice Republican Tom Ridge took over for Casey, the report says,

...[t]he 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. Even nail salons in Pennsylvania are monitored more closely for client safety. Without regular inspections, providers like Gosnell continue to operate; unlawful and dangerous third-trimester abortions go undetected; and many women, especially poor women, suffer.

This is where those of you who are pro-choice may well want to cross your arms over your chest, but the kind of regulation that if enforced might have prevented this atrocity is in all cases seen as an infringement by abortion rights advocates, and thus is strenuously opposed. In Evansville, Indiana, for instance, the pro-choice community was outraged in 2008 after county commissioners passed an ordinance requiring abortion clinic doctors to have hospital admitting privileges. As an Evansville Courier editorial decrying the ordinance put it, "Abortion rights groups see it as an attempt to harass abortion providers and to limit women's access to legal abortions.'' But wouldn't such a requirement also provide a degree of protection to women – particularly the poor, immigrant population Gosnell preyed upon? Not surprisingly, Gosnell had no such hospital admitting privileges, though he was well known to local hospital doctors who, the report says, regularly had to clean up after him, and treat patients like the 19-year-old who had to have a hysterectomy after Gosnell punctured her uterus.

Abortion-rights activists call such regulations "TRAP laws" – short for Targeted Regulation of Abortion Providers; these laws attempt to regulate abortion clinics at the same level of other outpatient surgical centers, for instance by requiring that hallways be wide enough to get a gurney through if something goes wrong. What difference could that possibly make? Well, it took Emergency Medical Service workers 20 minutes to get Karnamaya Mongar out of Gosnell's clinic and into an ambulance because the hallways were blocked and the emergency exit padlocked. (Here, Tarina Keene, the executive director of NARAL Pro-Choice Virginia, registers the standard complaint that such regulation is too costly and is "really just designed to shut these places down. It has nothing to do with medical care.")

Only, on the day of the annual marches marking the 38^th anniversary of Roe v. Wade, I want to ask my pro-choice friends whether opposing all regulation is in fact in the best interest of the women I know you care about. Wherever you stand on this issue – and I am a liberal Catholic who is not pro-choice – we agree that what Gosnell is accused of doing exceeds all bounds of decency. But without regulation and enforcement, how can we be sure there aren't other Gosnells out there?

Other kinds of free-standing ambulatory clinics are inspected periodically by state health departments, but abortion clinics are not, says Mary Spaulding Balch, of National Right to Life, who tracks legislation and regulations in all 50 states. And, again quoting from the grand jury report, here is what the lack of enforcement of regulations already on the books looks like:

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.

Shortly thereafter the department received an even more disturbing report – about a woman, years before Karnamaya Mongar, who 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 of State. 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.

The same thing happened at least twice more: The department received complaints about lawsuits against Gosnell, but dismissed them as meaningless. A department attorney said there was no "pattern of conduct." He never bothered to check a national litigation database, which would have shown that Gosnell had paid out damages to at least five different women whose internal organs he had punctured during abortions."

Though we're constantly told that there are only a handful of brave doctors performing late-term abortions, an '06 survey by the pro-choice Guttmacher Institute in New York found that about 1.5 percent of the 1.2 million abortions performed annually – in other words, about 18,000 abortions a year -- are performed at 21 weeks or later. Nearly a quarter of providers, according to Guttmacher, offer abortions after 20 weeks, and slightly more than 1 in 10 will perform an abortion after 24 weeks. That translates to 140 known providers doing truly late-term procedures. But as the National Right to Life's Douglas Johnson asks, "Do you suppose this guy in Philadelphia was dutifully filling out the Guttmacher reports and turning them in?"

I'm well aware that the counter-argument is that if late-term abortions in particular were more readily accessible and less stigmatized, there would be fewer Gosnells in this world. But how stigmatized was he, pocketing $1.8 million a year while allegedly maiming women and killing their living, breathing children with no apparent fear of detection from officials who according to the grand jury feared that inspections would pose obstacles to choice?

Though I've never heard of any case this grisly, Johnson says it's "not all that isolated a case, but usually they're just local news stories.'' Last year, the license of New Jersey abortion doctor Stephen Brigham was pulled after authorities learned he was routinely starting illegal late-term abortions in New Jersey then transporting the women to Maryland to finish the job. And how was he discovered? Again, by accident. According to a recent story by The Associated Press, "Brigham's practices first caught the attention of Maryland regulators after a patient was hospitalized with a ruptured uterus and small intestine.''

This story reports on the owners of several shoddy Florida clinics, including the one in Hialeah where in 2006, an 18-year-old who was 23 weeks pregnant gave birth to a child whose body was discovered, according to the police, after someone reported hearing crying coming from a trash can. Officers who searched the clinic said they finally found the body where it had been moved -- in a biohazard bag stashed on the clinic's roof.

And a case that made the news 20 years ago now involved New York's Abu Hayat, whom the tabloids dubbed "The Butcher of Avenue A." As it happened, I knew Hayat by sight – and talk about the banality of evil -- because he lived in my building, where I frequently wound up sharing a lap lane with him in the pool.

In each of these well-known cases, many more victims came forward after some particularly gruesome event brought these doctors' methods to light; how many more like them go undetected?

In 2002, a piece of legislation called the "Born-Alive Infant Protection Act'' began requiring doctors to treat children born alive during abortions the same way they treat other newborns. Initially, advocates for choice adamantly opposed that legislation, too, as an assault on Roe v. Wade.

But what about assaults on children who, having somehow gotten out of the birth canal alive, we agree are children? And what of the assaults on women, who uniformly deserve sterile conditions and an unlocked emergency exit? How can we know they are treated competently without the regulation and oversight of this, as any other industry? Just like other industries, the abortion industry prefers the self-policing that in the Gosnell case did not prevent tragedy any more than the self-regulation and lax enforcement of the oil industry prevented the BP oil spill.

On Saturday, President Obama affirmed his support for Roe v. Wade by saying that "government should not intrude on private family matters." But it's a hands-off lack of oversight that allowed Kermit Gosnell to do so much damage before he was finally stopped – by accident, by authorities investigating him for over-prescribing OxyContin.

Perhaps Gosnell himself best summed up the underlying problem at his arraignment, where he reportedly seemed confused by the proceedings: "I understand the one count, because a patient died,'' he told the court, "but I didn't understand the seven counts.'' It apparently never occurred to him that the dead infants – one of them photographed in a plastic shoe box, another kept frozen in a gallon of spring water – were people, too.


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