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There is no good aspect to the story of Kermit Gosnell and the women he brutalized at the Women's Medical Society in Philadelphia.

The one I've been focusing on lately is the failure of state and local regulators to intervene upon hearing complaints about Gosnell, and about the general absence of any clinic inspections from 1995 on.  Here's what the disturbing grand jury report says:

[Janice Staloski of the PA Dept of Health] blamed the decision to abandon supposedly annual inspections of abortion clinics on DOH lawyers, who, she said, changed their legal opinions and advice to suit the policy preferences of different governors. Under Governor Robert Casey, she said, the department inspected abortion facilities annually. Yet, when Governor Tom Ridge came in, the attorneys interpreted the same regulations that had permitted annual  inspections for years to no longer authorize those inspections. Then, only complaint-driven inspections supposedly were authorized. Staloski said that DOH’s policy during Governor Ridge’s administration was motivated by a desire not to be “putting a barrier up to women” seeking abortions.  

[PA Dept of Health senior legal counsel Kenneth] Brody confirmed some of what Staloski told the Grand Jury. He 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, as Brody 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.”  

Brody testified that he did not consider the “access issue” a legal one. The Abortion Control Act, he told the Grand Jurors, charges DOH with protecting the health and safety of women having abortions and premature infants aborted alive. To carry out this responsibility, he said, DOH should regularly inspect the facilities.

The grand jury details how this official indifference manifested, and I warn you that this blockquote gets graphic:

During the next 16 plus years – as Gosnell collected fetuses’ feet in jars in his office and allowed medical waste to pile up in the basement; as he replaced his few licensed medical assistants with untrained workers and a high school student; as his outdated equipment rusted and broke and he routinely reused instruments designed for single-use; as he allowed unqualified staff to administer anesthesia and to deal with babies born before he arrived at work for the day; and as he caused the deaths of at least two patients while continuing to perform illegal third-trimester abortions and to kill babies outside their mothers’ wombs – DOH never conducted another on-site inspection at the Lancaster Avenue facility.

Staloski, who does not face criminal charges, has now spoken with The Philadelphia Inquirer, and it just gets worse:

When Staloski inspected Gosnell's facility in 1992, it was still state policy to conduct annual inspections of abortion clinics.

Soon the Health Department - to satisfy former Gov. Tom Ridge, an abortion-rights supporter - changed its policy. Under the new, unwritten protocol, annual visits were eliminated, but a complaint could prompt an inspection.

By 2002, Staloski had been named head of the Home Health division, which oversees abortion clinics and is part of the bureau she ultimately led. She received a call from an attorney representing the family of Semika Shaw, 22, who died after an abortion at Gosnell's clinic. The attorney later secured a $900,000 settlement for Shaw's family.

Staloski told the attorney there were no other complaints against Gosnell. But the grand jury report said the department record showed at least one, reported in 1996 from an attorney whose client suffered a perforated uterus.

Within weeks, a second call came in. Another lawyer was suing Gosnell.

The clinic hadn't seen an inspector in nine years, and Staloski did not send one.

She enforced a "do-nothing policy," the grand jury report said, and she did so "presumably with the knowledge and blessing of her bosses."

Ugh:

One section [of the grand jury report] lists seven attorneys at the Department of State, which is charged with licensing doctors through the Board of Medicine, who knew of problems at the clinic and did nothing.

Among them was Juan Ruiz. According to the report, he closed a 2009 complaint against Gosnell from a woman who suffered a perforated uterus without reviewing it, saying it was a single incident that showed "simple negligence." He never consulted a national malpractice database that included cases from five women who successfully sued Gosnell for a similar injury, the grand jury found.

The report also criticized the many doctors who treated Gosnell's clients for complications from botched abortions but never alerted health officials, despite a state requirement to do so.

And part of why Gosnell was able to evade scrutiny for so long is he chose his victims well. The women who were most likely to speak up and be heard by people in power were the only ones who got anything close to normal medical treatment.  Employee Tina Baldwin -- herself a defendant, and untrained in the administration of anesthesia she was tasked to deliver to patients -- explained to the grand jury:

A: It was – he sometimes he used to – okay. 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. And one day I said something to him and he was like, that’s the way of the world. Huh? And he brushed it off and that was it.

Tina Baldwin 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. Mrs. Mongar, she said, would have been treated “no different from the rest of the Africans and Asians."

This is what happens when abortion is moved to the back alleys, or treated as shameful.  This is what happens when government fails to hear the complaints of the disempowered and voiceless.  If this were happening in the suburbs, it never would have been allowed to get this far.

Originally posted to Adam B on Tue Feb 01, 2011 at 11:22 AM PST.

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