Kermit Gosnell and abortion clinic regulation: Did pro-choice politics protect him?

How the politics of abortion protects bad clinics.
Feb. 16 2011 5:34 PM

What Happened to the Women

A grand jury says Kermit Gosnell mistreated and killed abortion patients. Why did nobody stop him?

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Kermit Gosnell. Click image to expand.
Kermit Gosnell
William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

On Feb. 18, 2010, detectives and FBI agents raided the Philadelphia office of Dr. Kermit Gosnell. They had been led there by an investigation of illegal drug sales. What they found was, presumably, the worst licensed abortion clinic in the United States: dirty surgical instruments, blood on the floor, cat excrement on the stairs, a stench of urine in the air, and operating facilities one agent compared to a bad gas station restroom. Fetal remains were in milk jugs and cat-food containers. Last month, in its reconstruction of the scene, a grand jury reported:

"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."
Report of the Grand Jury of Philadelphia.

The grand jury's report, citing forensic evidence and testimony from clinic employees, accuses Gosnell of routinely delivering viable babies and severing their spinal cords. But it also details ill treatment of women. According to the report, Gosnell used unlicensed workers to administer anesthesia, failed to obtain patients' informed consent, gave them expired drugs; endangered their health with poor sanitation and broken equipment, and caused the deaths of at least two women.

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Yesterday, Pennsylvania Gov. Tom Corbett fired several state officials faulted by the grand jury for failing to intervene in the case. Corbett ordered two agencies to tighten their procedures for inspecting and investigating abortion clinics. Meanwhile, Pennsylvania lawmakers have begun hearings into the scandal. They want to know how the abuses described in the report went unprosecuted for decades. And they want to make sure it never happens again. Ahead looms a statewide, and possibly nationwide, debate over the regulation of abortion clinics: How do we balance freedom of choice, consumer protection, and the role of government?

The Pennsylvania Department of Health inspected Gosnell's clinic when it opened in 1979. The department was supposed to check back within a year, but there's no clear record of another inspection until a decade later. Nor is there any evidence that the evaluators, when they returned, examined Gosnell's patient files, his sanitation, his emergency equipment, his use of anesthesia, his compliance with rules of post-operative care, or the qualifications of employees who did his lab work.

From 1993 on, Gosnell went completely uninspected. The grand jury says the health department "decided, for political reasons, to stop inspecting abortion clinics at all. … 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." Casey was pro-life; Ridge was pro-choice. The department's senior counsel, in his testimony before the grand jury,

"described a meeting of high-level government officials in 1999 at which a decision was made not to accept a recommendation to reinstitute regular inspections of abortion clinics. The reasoning, [the witness] recalled, was: "there was a concern that if they did routine inspections, that they may find a lot of these facilities didn't meet [the standards for getting patients out by stretcher or wheelchair in an emergency], and then there would be less abortion facilities, less access to women to have an abortion.""

In 2009, a health department official learned that a patient had died at Gosnell's clinic. But she didn't send out an investigator—which was her usual practice when a patient died—because the implicated facility was an abortion clinic. She took the case to her boss but, according to her testimony, never received authorization to pursue it.

The other agency that could have stopped Gosnell was Pennsylvania's Department of State, which included the state Board of Medicine. According to the grand jury, the department ignored complaints about Gosnell for years. The complaints involved unlicensed administration of anesthesia; sexually transmitted infections (apparently spread by the clinic itself); perforated uteruses, cervixes, and bowels; hospitalizations of infected patients; and family members prevented from summoning emergency aid. The consequences allegedly included a hysterectomy and a patient's death.

Why didn't the Department of State pursue Gosnell? The department's representative, in his testimony, cited the agency's lack of law-enforcement powers. The grand jury rejects this excuse but notes that the Board of Medicine, absurdly, has less inspection authority than the board that supervises cosmetologists. The grand jury also blames the two departments' inaction on their failure to "share information or coordinate." The Department of Health referred complaints and queries about Gosnell to the Department of State. The Department of State, in turn, sought—and failed—to dump a crucial complaint about Gosnell onto the Department of Health.

Two years ago, Gosnell applied for membership in the National Abortion Federation, a private network of clinics committed to patient safety. NAF examined his facility and flunked him for numerous reasons: Unqualified assistants were administering anesthesia, nobody was monitoring sedated patients, medications weren't recorded, and women weren't informed of the risks of drugs and procedures. The grand jury applauds NAF's high standards but wonders "why an evaluator from NAF, whose stated mission is to ensure safe, legal, and acceptable abortion care, and to promote health and justice for women, did not report Gosnell to authorities."

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