PHILADELPHIA — There was no shortage of red flags about what was allegedly going on in the three-story brick building on a bustling stretch of Lancaster Avenue in West Philadelphia.
A routine inspection of Dr. Kermit Gosnell's abortion clinic had turned up problems as early as 1989, according to official reports. More recently, hospital workers and attorneys had repeatedly contacted state health officials with disturbing reports about women who had contracted the same venereal disease after visiting the clinic; a 14-year-old girl who had had an illegal abortion at 30 weeks of pregnancy; and a 41-year-old Virginia woman who had died after an abortion.
But it wasn't until 2010, when authorities raided the clinic over its distribution of painkillers, that authorities uncovered evidence that led to Gosnell's capital murder trial, which started in March. Gosnell faces seven first-degree murder charges resulting from the deaths of babies whose spinal cords he allegedly severed after they were born alive. He is also charged with third-degree murder in the death of the Virginia woman, Karnamaya Mongar.
The prosecution rested Thursday after weeks of testimony from former employees who reported seeing babies moving and breathing after they were delivered. Gosnell or other workers would then cut their necks, the witnesses said. Jurors also heard about the allegedly unsanitary conditions from Mongar's relatives.
Gosnell's attorney has said that no live births took place and that Mongar suffered from respiratory problems. Gosnell could face the death penalty if convicted.
The case has captivated and repulsed a nation where back-alley abortion clinics have become a rarity since 1973, when the Supreme Court legalized abortion. The catalogue of horrors delineated by prosecutors has raised questions about whether there is adequate inspection and regulation of the 1,800 facilities nationwide that provide abortions.
The rules governing abortion clinics vary widely by state and invariably become tangled in the issue's incendiary politics, with supporters of abortion rights often complaining they are too onerous and abortion foes calling for ever-stricter guidelines.
Abortion rights advocates note that Pennsylvania has strict laws governing abortion clinics but that they were not enforced. They say that Gosnell's case is rare and that abortions are among the safest of medical procedures.
But abortion foes say the case has been a wake-up call about the lack of oversight and the potential for abuse in abortion facilities.
Pennsylvania Gov. Tom Corbett, a Republican, has called the lack of oversight by state officials "despicable." He fired or suspended some workers for negligence, and others have resigned. Corbett also announced that abortion clinics throughout the state would be subject to annual inspections, as well as periodic unannounced visits.
Activists on both sides of the issue say the conditions inside Gosnell's clinic were the worst they've seen. He is accused of a litany of atrocities at the Women's Medical Society, including his "snipping" technique, in which he allegedly severed the spines of babies who had been born during abortion procedures. Fetal remains apparently were stored in jugs and bags, and authorities described the clinic as filthy.
The grand jury that indicted Gosnell excoriated several oversight agencies for failing to crack down on his clinic. In the grand jurors' 2011 report, they called the failure a "complete regulatory collapse."
The report details how the Pennsylvania Department of Health issued approval for Gosnell to open the clinic in 1979. The next site review came a decade later, and while numerous violations were already apparent, "Gosnell got a pass when he promised to fix them," the report states.
Nearly a decade before his arrest, the report states, a former employee presented the Pennsylvania Board of Medicine with a complaint "that laid out the whole scope of his operation," from unsterile conditions to underage patients to over-prescribing of pain pills.
Soon after, the department received another report about a woman who died of sepsis after Gosnell perforated her uterus.
"Bureaucratic inertia is not exactly news. We understand that. But we think this was something more," the grand jury wrote. "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."