In Response: The Kermit Gosnell Abortion Clinic Case

Dr. Kermit Gosnell was a Philadelphia abortion provider, and has been charged with several counts of murder after one patient died and several infants born alive were allegedly murdered. The grand jury documents [PDF] related to this case describe horrors encountered by patients who were ostensibly in the care of Dr. Gosnell. Let me be perfectly clear: it is an abomination when women cannot receive safe, legal abortion services. What happened at Kermit Gosnell’s “clinic” is unacceptable at any time, in any place.

I also believe that this horrific story is not a case study in why abortion should be further restricted.

The situations described in news reports are a violation of the women who trusted Dr. Gosnell and his staff to provide safe, good quality, abortion procedures. It will unfortunately give ammunition to those who attempt to pass regulations to further regulate abortion clinics. Some of the inevitable proposed rules may not be necessary, and may be intended primarily to make abortion providers go out of business rather than to actually make abortion safer for women, but they’re sure as hell going to be easier to sell to legislatures and the public by whispering “Gosnell.”

In that sense, actions and conditions such as those alleged about Dr. Gosnell’s clinic harm all women who seek safe, legal abortions (estimated as about 1/3 of us over our lifetimes), and all people who support the rights of women to make this personal choice in a safe environment with properly trained medical professionals. The harms inflicted on the women who received “care” at the clinic are of course worst of all.

There have been a number of pro-choice posts written on how this situation highlights the need for access to safe, legal abortion, and I will list some of those at the bottom of the post for further reading. I want to highlight two things:

1) I believe the atrocious conditions at Kermit Gosnell’s clinic would not have been allowed to continue if more privileged women had been affected by them.
The grand jury document describes more appalling conditions than can be easily imagined: dirty and damaged equipment, failure to dispose of medical waste and fetal remains, fraud in which untrained personnel acted as “doctors,” appalling misuse of anesthesia, neglect of patients, poor performance of the procedures, failure to appropriately respond to complications, allowing cats to roam the clinic and defecate freely throughout it, and possible infant murder.

Each of these things is appalling on its own, as is the failure of public health authorities to follow up on complaints about the clinic.

Adding insult and injustice to (literal) injury, the grand jury documents describe explicit differences in the treatment of women depending on their race, with women of color singled out for worse treatment. The following passage describes testimony about Gosnell’s allowing untrained personnel to administer anesthesia without supervision or talking to the patient:

Like if a girl – the black population was – African population was big here. So he didn’t mind you medicating your African American girls, your Indian girl, but if you had a white girl from the suburbs, oh, you better not medicate her. You better wait until he go in and talk to her first.

The same individual who made these statements “also testified that white patients often did not have to wait in the same dirty rooms as black and Asian clients. Instead, Gosnell would escort them up the back steps to the only clean office – Dr. O’Neill’s – and he would turn on the TV for them.”

That is not okay. It is never okay. This explicit singling out of women of color for poorer treatment is an abomination. Many of the women were receiving late term abortions which could perhaps have been unnecessary if the women had economic access to a quality clinic earlier in their pregnancies when most abortions take place. Some of them may have had concerns about their immigration status, the stigma of abortion, limited knowledge of the healthcare and legal systems, or other issues which may have legitimately prevented them from reporting their treatment. Kermit Gosnell likely knew that these women had few alternatives, and – I can only imagine – therefore assumed that these disenfranchised women did not have access to the kind of privilege and resources it takes to go elsewhere or to raise a fuss about how they were treated at his clinic.

Some women *did* make complaints, though, as did a physician who performed follow-up care for some of Gosnell’s patients and noticed that several of them were coming in infected with “trichomoniasis, a sexually transmitted parasite, that they did not have before the abortions.” Even after complaints such as these, no inspection was performed and nobody at the state level bothered to intervene.

I believe that if such abuses were going on in an abortion clinic frequented primarily by privileged white or higher income women, the state would not have neglected to perform inspections or intervene for so long. The grand jury report expressed a similar sentiment:

Bureaucratic inertia is not exactly news. We understand that. But we think this was something more. We think the reason no one acted is because the women in question were poor and of color, because the victims were infants without identities, and because the subject was the political football of abortion.

The case highlights an injustice that deserves much more attention, especially as we anticipate political maneuvers to roll back both health coverage and abortion access. While Gosnell’s actions are deplorable, attention must be paid to systemic inequalities and racism that allow and perpetuate such abuses. As an author at the grio writes:

We can’t allow the sensationalistic images from Gosnell’s case to distract us from the underlying issues that might otherwise be highlighted by this case; namely, the realities of women’s and children’s health care in poor, urban, and minority-populated areas of the United States, and basic things we can do as a community to improve these realities…That we live in an environment in which such an obviously shady practice could thrive for so long is simply unacceptable.

2) As I read through the descriptions, I can’t help thinking: this is what an underground, illegal abortion clinic looks like.

I am fortunate enough to have been born in the post-Roe era in which abortions, while not always accessible, are legal. I’ve never personally experienced the fear and danger of the so-called “back alley” abortion provider, and have only heard stories of the fear and tragedy of those times. Reading the Grand Jury report on Kermit Gosnell’s clinic reminds me of everything I’ve ever heard or read about pre-Roe America, when women with few options were forced to choose substandard abortion providers and were expected to silently suffer the consequences of their maltreatment.

From the grand jury report:

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.

These stories, of neglect, infection, poorly performed procedures and lack of follow up. They’re appalling, and they sound just like what I’ve always heard from older women about the pre-Roe era. While we celebrate the anniversary of Roe tomorrow, we must remember that Roe didn’t make abortion safe and accessible for everyone, even in America.

Women – all women, all the time, every where – deserve better.

Further reading, will be updated as I find things to pass along:

• Victims say abortion doctor scarred them for life
• Doctor Who Performed Illegal Abortions Indicted for Murder – Amie Newman at RHRC
• Why the Pa. Abortion Doc’s Case Is About Poverty, Not Roe v. Wade – Belinda Luscombe at Time Healthland
• Roundup: Everyone Deserves Safe Medical Care – Rachel Larris at RHRC
• What Makes Abortion Dangerous – Pema Levy at the American Prospect blog, Tapped

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