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In Response: The Kermit Gosnell Abortion Clinic Case

January 21, 2011

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:

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26 Comments leave one →
  1. June 27, 2011 8:06 am

    Reading about this case changed my stated position from pro-life to pro-choice. My actual beliefs didn’t change at all, but reading the new story about the Gosnell ‘clinic’ did change my stated position.

    I realized that as long as providers live in fear of being shut down for political reasons, regular inspections won’t happen. If the right to an abortion isn’t 100% secure, then providers are right to fear that inspections could turn political instead of a stated professional standardization for high quality health care.

    This controversy hurts women. It hurts babies all grown up, who should count exactly as much (if not more) than unborn, undeveloped babies. If pro-lifers are pro-human, why can they not see that?

    They played on my compassion and ignorance for years. I truly thought pro-lifers were sensible, like me, and expected that everything would settle down once partial-birth abortion was outlawed. I feel so foolish now. Instead, they are just gathering more speed and apparently, money.

    I hope the other women supporting the “pro-life” movement wake up and understand it’s not about life, it’s about money and power and manipulating people of good will to hand over more money and power. If it were truly about life, it would also be about free prenatal care, subsidized daycare, government paid maternity leave for new parents, etc. It’s not pro-parenthood; it’s anti-woman. (That includes all those babies who are female too.)

    • Jennifer Caminiti permalink
      November 11, 2011 2:07 pm

      So, let me get this straight: it’s acceptable to kill your baby as long as you, the so-called “mother,” are treated well, right?!!! No matter what you want to think, a baby is just as much a person as you are, from the moment of conception to the moment they die–regardless of when that happens. Why is it that when you WANTED the baby inside you, you called it a baby; however, when you got pregnant and did’t want it, suddenly, it wasn’t a baby anymore?!!! Oh, I know–IT WAS AN INCONVENIENCE!!! THAT’S WHAT IT’S REALLY ALL ABOUT, ISN’T IT???!

    • Sarah permalink
      February 5, 2012 12:13 am

      Dear Shadowlife,

      Anyone who has respect for human life has respect for all human life, regardless of the person’s age, sex, health, socio-economic status, etc. The atrocities committed by Gosnell and his employees are a direct result of the mindset that says, “There are circumstances when one person can legally determine when another person’s life may be taken away.” If all life is not sacred, no life is sacred.

      The fact is, pro-lifers care as much about adult humans as they do about humans still within the womb. With just a bit of research, you will find a multitude of pro-life organizations in this country that provide practical support (housing, food, clothing, employment, etc) as well as emotional support (pre AND post abortion counseling, etc) for women who are struggling with the choice to give life to their child, usually due to economic or social stress. The fact is that most women who choose abortion suffer tremendous pain afterwards, physical as well as emotional and psychological. Too often, those who are pro-choice, in an effort to make this choice seem normal and okay, neglect to truly care for the women in the aftereffects. It’s just another surgery of an unwanted blob of tissue, after all. How many women have their tonsils or appendix taken out and need months/years of counseling afterwards? By recognizing the life in the womb, those who support the pro-life cause know that what the woman has chosen is not just any surgery. Many, many women who have had an abortion suffer tremendous guilt, depression, and post-traumatic stress disorder. Pro-life organizations embrace these women and give them the help they need to heal. I’m not saying there aren’t pro-choice groups who offer this as well, but to believe that pro-lifers only care about the unborn is false. If they did, there would be no practical, emotional, or psychological support given to the women, when there very often is.

      Moreover, if there is anyone who is simply in the abortion debate for power and money it is not the pro-life movement. Who in the pro-life movement makes money when a child is born to his parents, or given up in adoption? Abortionists, as well as the organizations that support them, such as Planned Parenthood, make millions and even billions through abortion. There are many well-intentioned pro-choice advocates out there, but we cannot be so naive to believe that PP and other abortion providers are not in the business of making money. If their objective was to truly help women, and that help created an environment in which no women would want nor “need” an abortion, they would be working towards the goal of going out of business. PP vehemently opposes abstinence education programs. Why? If the goal of pro-choice groups such as PP was really about educating and empowering women, stopping the spread of STDs, etc, why wouldn’t they at least include abstinence education as part and parcel of their program? B/c abortion providers do not make money if no one gets pregnant. I do not know a single pro-lifer who will gain a single dime by the birth of someone else’s child, but there are plenty of pro-choice providers that make a living off the ending of others’ lives.

      Pro-lifers do not want unsafe conditions for women who choose abortion. Pro-lifers do not want women to choose abortion. Period. Not because they gain anything by it, but because they know that abortion hurts every family member involved, from the infant to the parents to the extended family. And, as a result, it hurts the larger society. The vast number of abortions, as per the language of pro-choicers, are just that: a matter of choice. No woman should ever have to be forced into a back alley abortion operation, because virtually no woman MUST have an abortion. Any woman who needs to remove the embryo/fetus/baby to save her life, and these circumstances are extremely rare (i.e. ectopic pregnancy), can certainly receive that care from an obgyn.

      The case of Gosnell has nothing to do with illegal abortion. Abortion is legal. It is an extremely tragic example of how a lack of respect for unborn life quickly deteriorates into lack of respect for life, period. Why honor a woman’s (or man’s) right to anything if we do not even have the right to live? A society is only as strong as its weakest members. Who is more vulnerable than a child in her mother’s womb?

      • kitty permalink
        April 12, 2013 12:33 pm

        Planned Parenthood is a non-profit, not a business. Have you ever been to a PP clinic? They offer a sliding scale of payment in which wealthier patients or those with insurance subsidize the costs of poor, uninsured patients. No one is getting rich off providing PP services, which are mostly related to sexual health and birth control, not abortion.

        PP is opposed to abstinence-only sex education because refusing to provide information about safe sex and pregnancy prevention does NOT prevent teenagers (or anyone else) from having sex. No one will deny abstinence is a valid way to prevent STDs and pregnancy. It’s just not the only way, and there’s no excuse for withholding information about sexual health from people who need it.

        This nightmare clinic didn’t come into being because abortion is legal. The kinds of abortions Gosnell was providing were criminal –after fetal viability, performed incorrectly, incompetently and in unsanitary conditions. Inducing a live birth and killing the infant afterward is very much illegal.

        Very few doctors will perform a late-term abortion without a very compelling reason — most are in cases where a child is wanted but the mother’s life is threatened by the birth, or the fetus will not be not viable due to birth defect and continuing pregnancy is pointless and harmful. Gosnell was operating far outside the norm for abortion providers.

      • krupke permalink
        April 12, 2013 5:20 pm

        “With just a bit of research, you will find a multitude of pro-life organizations in this country that provide practical support (housing, food, clothing, employment, etc) ”

        Would you mind providing a list? Also, how long do they offer these services? For the entire life of the child and mother? Do they provide care at least until the child reaches age 18? If the mother doesn’t want the child can they guarantee adoption?

      • April 12, 2013 6:26 pm

        1, I can provide you links to the pregnancy help resources if you actually are interested. There are more prolife centers offering practical help than there are abortion facilities. Most of them provide support through the pregnancy and until the child is about age 2, though many provide mentoring programs that give the mother a support person she can rely on for as long as she wants. Remember, they focus on building relationships rather than just taking the money, processing the patient, and sending her on her way to cope the rest of her life all by herself.

        Most pregnancy resource centers also provide access to abortion aftercare, including treatment for complications.

        Most importantly if you’re interested in real *choice* and not just in abortion, they provide access to free assistance to women who change their minds and want to reverse an abortion in process. The most common sort of help is for abortions after about 16 weeks, which are multi-day procedures involving insertion of laminaria (expanding seaweed sticks) to dilate the cervix prior to the abortion. Doctors working with the pregnancy centers can check to see if the fetus is still alive and if so remove the laminaria and provide treatment to stabilize the pregnancy. The woman is provided with care as any other client of the pregnancy center. Recently some doctors have developed a method to halt RU-486 abortions that have not yet reached the point of no return.

        If the abortion facilities really are providing the choice the woman thinks is best, they’d not have so many patients changing their minds that there are actually treatment protocols for reversing the process, would they? They especially would not take the approach of using a digoxin injection prior to inserting laminaria in order to make sure the baby is dead and the mother can’t change her mind.

        2. Asking if pregnancy help centers provide help until age 18 is an indication that you’re not being serious. Do abortion clinics provide aftercare to the woman for the rest of her life? Do they assist with adoptions if the abortion leaves her unable to bear children? Do they care for her already-born children if she is left incapacitated, like Shelby Moran was?

        3. Since there’s a long waiting list for infant adoptions, including infants with disabilities, OF COURSE there’s a guarantee of an adoption placement if the mother chooses to make such a placement. She is given choices of open adoption or closed adoption, a chance to actually choose the family, and a choice to either provide a gift and letter to be given to the child at a later point, or the opportunity to maintain contact.

      • April 12, 2013 7:33 pm

        Let’s not pretend crisis pregnancy centers are anything other than what they are – organizations determined to convince women not to have abortions for ideological reasons. The providers at abortion clinics are actually trained to discuss with women whether they are sure of their choices, and to encourage them to make their own choices. CPCs exist to convince women of a specific choice, and often use scientifically inaccurate and misleading information to do so.
        Here’s a study of the misinformation presented by North Carolina CPCs: http://www.ncbi.nlm.nih.gov/pubmed/22770790
        Here’s a 2006 House Oversight report on misleading info presented by CPCs: http://www.chsourcebook.com/articles/waxman2.pdf
        And of course NARAL is pro-abortion-rights, but they found similar deceptions in Ohio: http://www.prochoiceohio.org/what-is-choice/cpc/reporttext.shtml
        Here’s a documentary in which CPC coercion/untruths can be watched: http://www.hbo.com/documentaries/12th-and-delaware/index.html
        Here’s an example of a judge ruling against their deceptive advertising practices: http://thinkprogress.org/health/2012/10/05/970581/san-francisco-judge-crisis-pregnancy-centers/

        So maybe your own experience is different, or you actually believe the lies about mental health, breast cancer, etc. (all of which are scientifically unsupported). But on the whole CPCs are there to convince women to make the choice they want them to make, not to support women in making the best decisions for their own lives, or even to be honest with them about medical evidence.

        Further, let’s not pretend that pregnancy and adoption are equivalent options or decision points. A pregnant woman can choose to be pregnant or not pregnant; a woman who has given birth can choose to keep or surrender a child. Continuing a pregnancy requires a woman to make her body available for the use of another person for a significant period of time, taking into consideration her own medical, financial, dis/ability, and other circumstances. This is a significant use of her own body which is not remedied by adoption.

        Finally, Dr. Gosnell is *not* representative of the vast majority of abortion providers in the United States; pregnancy carries a higher risk of death for the woman in this country than does abortion. This is attributable primarily to the fact that abortion complications and deaths plummeted when abortion became legal and could come out of the shadows. Women will always have abortions – the question is whether they have to go to questionable providers like Gosnell in an illegal/heavily restricted landscape, or whether they can continue in the relative safety of legal abortion.

      • April 12, 2013 9:45 pm

        1. Gosnell was hardly an outlier. He was starting illegal third trimester abortions in a National Abortion Federation member clinic in Delaware and finishing them at his “house of horrors” in Philly. Funny how folks are so busy worring about whether a woman might be annoyed or pestered by prolifers but look the other way (as did the authorities in PA) when women are actively and outright endangered or killed by prochoicers. Remind me again of your priorities?

        2. Abortion deaths had been falling rapidly for decades before legalization, thanks to antibiotics, blood banks, improved medical care, etc. Funny how your pet cause gets credit for other people’s hard work.

    • krupke permalink
      April 12, 2013 5:15 pm

      “If it were truly about life, it would also be about free prenatal care, subsidized daycare, government paid maternity leave for new parents, etc. ”

      Exactly.

      • April 12, 2013 6:32 pm

        How does siding with the people who knew how bad Gosnell was and opted to turn a blind eye make any sense?

        Since it does NOT, I don’t believe that you’ve changed sides. I think you’re just claiming that for effect. NOBODY who isn’t already deeply in the pro abortion movement could for a moment blame Gosnell’s crimes on anybody but Gosnell and pro-abortion fanatics.

      • April 12, 2013 7:12 pm

        The people who “knew how bad Gosnell was and opted to turn a blind eye” are effectively the state officials who neglected to do proper inspections or follow-up, *not* individuals who hold pro-choice views in general but who were not exposed to and had no control over discipline of Gosnell. You’re correct that Gosnell is to blame for his own actions; that it’s attributable to “pro-abortion fanatics” writ large is a convenient but inaccurate fantasy. If anything, the type of “care” Gosnell provided is *much* more typical of what women experience when abortion becomes illegal or deeply restricted.

      • April 12, 2013 9:50 pm

        You can argue that the prochoice people in Pennsylvania who knew about Gosnell but looked the other way were renegades and outlierr. But how do you explain that National Abortion Federation clinic in Delaware that actually hired him? Women who did their homework and turned to NAF for supposedly safe abortion care would get referred to a NAF member that would collect Gosnell’s fee for him and then turn women over to his care. He was starting illegal 3rd tri abortions at that National Abortion Federation member clinic then finishing them at his Philly “House of Horrors.” This includes the abortion of Baby Boy A.

        Are you asserting that NAF is run by renegade fringe abortion fanatics that aren’t part of the mainstream of responsible abortion care in America?

  2. Kevin permalink
    December 3, 2011 2:16 am

    Hi Rachael, you write, “I am fortunate enough to have been born in the post-Roe era in which abortions, while not always accessible, are legal.”
    You are certainly right in writing that. Being born in the post-Roe era isn’t a given any more since many seem to insist on an artificial distinction between a baby pre-birth and a baby post-birth.

    • December 3, 2011 10:32 am

      Kevin, if you’re interested in more than just a drive-by anti-abortion comment, you’re welcome to read any of my many posts that would explain why I disagree with you.

      • Kevin permalink
        December 4, 2011 5:46 am

        Hi Rachel,

        Thanks for posting. I’m most certainly interested in more than a drive-by comment but the thought I raised is worth exploring since this case has so vividly illustrated it. The opportunity to discuss this important issue is much appreciated.

  3. josiah permalink
    March 30, 2012 2:13 am

    i just read the 281 page pdf case file and this is quite an intense case

  4. Kevin permalink
    April 12, 2013 10:05 pm

    The published words of someone are reflective of what they believe – particularly when it has been thoroughly reviewed and printed in an era where printing wasn’t as cheap as it is now. The below is insightful:

    “..the most urgent problem to- day is how to limit and discourage the over-fertility of the mentally and physically defective. Possibly drastic and Spartan methods may be forced upon American society if it continues complacently to encourage the chance and chaotic breeding that has resulted from our stupid, cruel sentimentalism.”

    “There is every indication that feeble-mindedness in its protean forms is on the increase, that it has leaped the barriers, and that there is truly, as some of the scientific eugenists have pointed out, a feeble-minded peril to future generations–unless the feeble-minded are prevented from reproducing their kind. To meet this emergency is the immediate and peremptory duty of every State and of all communities.”

    Those are the thoughts of a lady called Margaret Sanger. The organisation she founded is Planned Parenthood.

    The above are excerpts from her book, “The Pivot of Civilisation”.
    See for yourself: http://www.gutenberg.org/files/1689/1689-h/1689-h.htm

    • April 13, 2013 10:01 am

      Sanger was obviously problematic in certain ways, but I find this the most apt response, mentioned in this previous post (http://womenshealthnews.wordpress.com/2010/02/14/those-billboards-in-atlanta-on-black-women-and-abortion/): “Thomas Jefferson and many of the other signers of the U.S. Constitution owned slaves and didn’t believe that Black people were intelligent beings — should we Americans scrap the current Constitution and jot up another one, then?”

      • Kevin permalink
        April 14, 2013 8:48 pm

        Thanks for the reply Rachel,
        We’re in agreement that Sanger’s and Jefferson’s views are in your words, problematic. The reason why they are problematic is that they chose not to value human beings, which is the same issue with regards to understanding abortion.

  5. Kevin permalink
    May 14, 2013 7:08 pm

    FYI – an update on this story:
    Kermit Gosnell has been charged with 3 counts of 1st degree murder, 1 of involuntary manslaughter and racketeering (amongst other charges, see http://www.guardian.co.uk/world/2013/may/13/kermit-gosnell-found-guilty-murder)

    Interesting summary of this case can be found here: http://3801lancaster.com/
    Important points and the times where they appear in the video:

    Body parts in jars – 03:06-03:38; 03:53-03:56
    …and this is the story of one of the babies’ mother: http://3801lancaster.com/more-stories-from-3801/ (top video)

    On the procedure Gosnell called “snipping”, Philadelphia Assistant District Attorney said, “And when we use the word snip, it is a scissors taking a boney part of a vertebra and cutting it. This is a very, very painful thing. And some of these babies do not die immediately. And they describe their bodies twitching and lifeless.” 07:05-08:21

    A loss of choice with one woman recounting being forced to have her abortion – 08:22-08:52

    Continual lack of investigation by the Department of Health of problems at the clinic – 15:03-16:23

    Philadelphia District Attorney (Paraphrased): There is more oversight of women’s hair and nail salons than abortion clinics. – 16:23-16:50

    A woman being told that there are no possible consequences for future fertility with abortions – 17:27-18:59

    Abortion as a Civil rights issue – 12:58-14:48

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