Corbett demands probe of failure to regulate abortion clinics in Pennsylvania

Hundreds or thousands of live, viable babies have been slaughtered over three decades in a Pennsylvania clinic, and now the two agencies that supposedly regulate medical facilities claim they didn’t know that their jurisdictions covered abortion clinics.  Governor Tom Corbett has demanded answers within a week as to how Pennsylvania’s Departments of Health and State could have allowed Kermit Gosnell’s charnel house to continue its operations.  His predecessor, Ed Rendell, declared himself “flabbergasted” to hear the excuses from the two bureaucracies:

Gov. Tom Corbett said Friday that he gave the Health Department and the secretary of State a one-week deadline to report to him on what happened in the bungled oversight of a squalid abortion clinic that a Philadelphia prosecutor described as a “house of horrors,” where babies born alive were killed with scissors.

Corbett told the Tribune-Review that he asked for a “detailed report” about how to prevent such a tragedy.

“You can imagine from my role coming as attorney general that we’re going to find out exactly what happened on this side,” said Corbett, the former state attorney general and one-time U.S. attorney in Pittsburgh, who was sworn in as governor Tuesday.

Former Gov. Ed Rendell said yesterday that he was “flabbergasted” to learn last year that the state Health Department did not believe its authority extended to abortion clinics. …

“I was flabbergasted to learn that the Department of Health did not think their authority to protect public health extended to clinics offering abortion services,” Rendell, a former Philadelphia mayor and district attorney, said in a statement. ” … I immediately directed them to inspect these facilities. It was simply preposterous that the department took this position, ever.”

Not only should Rendell be “flabbergasted,” everyone should be skeptical in the extreme about this excuse.  It’s not as if the DoH and the DoS in Pennsylvania never bothered to look into Gosnell’s abbatoir.  The grand jury report is damning on these counts.  DoH officials admitted to the grand jury that they knew full well their mandate covered abortion clinics, and indeed that authority is expressly written into the law:

Pennsylvania’s Abortion Control Act charges DOH with regulating and overseeing the performance of abortions and the facilities where abortions are performed “so as to protect the health and safety of women having abortions and of premature babies aborted alive.” 18 Pa.C.S. §3207(a). Abortion facilities require the department’s approval to begin operating.

The DoH didn’t bother to do inspections between 1980 and 1989, but in the latter year found plenty of cause for concern:

By 1989, Gosnell, who is not board-certified as either an obstetrician or a gynecologist, was the only doctor at the facility. The DOH site reviewers also noted that there were no nurses working at the clinic. Blood work was no longer sent out to an independent lab, but was done, supposedly, by “medical assistants.” And in 7 of the 30 patient files reviewed, there was no lab work recorded. The evaluators noted several violations of Pennsylvania abortion regulations, including: no board-certified doctor on staff or contracted as a consultant; no nurses overseeing the recovery of patients; no transfer agreement with a hospital for emergency care; and no lab work recorded in several files. Even so, based on mere promises to improve documentation and filing, and to hire nurses, the DOH site reviewers recommended approval of Gosnell’s clinic for another 12 months.

It took almost three years for DoH to reinspect the facility, however — and they found that little had changed:

Two and a half years later, in March 1992, when DOH representatives next inspected the clinic, there were still no nurses to monitor patient recovery. Evaluators Janice Staloski and Sara Telencio noted that Gosnell was still the only doctor (a Dr. Martin Weisberg was listed as a consultant); that the facility employed no nurses; and that medical assistants were doing lab work. They did indicate there was adequate access for stretchers and wheelchairs, though it is not clear how they reached this conclusion: The facility is multi-leveled and has no elevator.

There is nothing to suggest that these evaluators reviewed any patient files. Gosnell reported performing 62 second-trimester abortions in the previous year, yet the DOH inspectors left blank the section in their report on anesthesia, including who is permitted to give it, what their qualifications are, and the type of anesthesia they are permitted to administer. Also left blank was a section titled “Post-Operative Care,” which addresses the legal requirement that the recovery room be monitored at all times by a registered nurse or a licensed practical nurse under the supervision of a physician – the same regulation that the clinic was cited for violating three years earlier. Nevertheless, the evaluators inexplicably concluded on March 12, 1992, that there were “no deficiencies,” and DOH approved Gosnell’s clinic to continue to perform abortions.

The next inspection was conducted on April 8, 1993, by DOH evaluators Susan Mitchell and Georgette Freed-Wolf. This was also the last site review – until February 2010, when an inspection occurred because law enforcement executed search warrants for illegal drug activity. In the 1993 review, Gosnell was the only doctor listed on staff, but “Dr. Weisberg” was still described as a consultant. Four years after Gosnell had promised to hire nurses to oversee the recovery room, there was still none. Lab work was still being performed by unspecified “medical assistants,” whose qualifications the
evaluators apparently did not question, since that section of the review was left blank. For the third time, inspectors found the access for stretchers and wheelchairs adequate, even though the facility’s layout had become even more convoluted and the building still did not have an elevator.

The DoH knew that their mandate included abortion centers; they just decided not to bother inspecting Gosnell or doing anything about the obvious deficiencies.  They willfully turned a blind eye until 1993, and then simply stopped bothering to check on Gosnell at all.

Nor was DoH alone in this pattern of willful obtuseness.  The grand jury detailed a number of instances in which the Department of State ignored ongoing atrocities in Gosnell’s operation, where prosecutors clearly knew they had the power to press charges and declined to do so — or even investigate the numerous allegations of malpractice and fraud:

Attorneys for Pennsylvania’s Department of State disregarded notices that numerous patients of Gosnell were hospitalized – infected, with fetal remains still inside them; and with perforated uteruses, cervixes, and bowels. Incredibly, in 2004, Department of State attorneys closed – without investigation – a case reported to the Board involving the death of 22-year-old Semika Shaw.

Between 2002 and 2009, Board of Medicine attorneys reviewed five cases involving malpractice and other complaints against Gosnell. (The Grand Jury also received records of three older complaints – from 1983, 1990, and 1992 – one of which resulted in a reprimand.) None of the assigned attorneys, or their supervisors, suggested that the Board take action against the deviant doctor. In fact, despite serious allegations, three of the cases were closed without any investigation. The other two were investigated and then closed – without any action being taken.

The grand jury also noted that prosecutors declined to press charges in the death of Semika Shaw in 2002 after being notified by Gosnell’s insurer of a malpractice settlement, as required by law.  They conducted no investigation beyond regurgitating the summary sent to them by the insurer, and yet the same prosecutors knew of at least one other complaint against Gosnell that contained many of the same allegations Pennsylvania now brings in its indictment against Gosnell and his staff.  Indeed, the prosecutors dismissed that complaint on the very same day they dismissed the Semika Shaw case:

What makes these prosecutors’ inaction even more astonishing is that they did know more than the bare facts included in the Board attorney’s evaluation of the case. On the same day in 2004 that they decided not to do anything about Semika Shaw’s death, these same two prosecutors also closed the investigation into the complaint brought to the Department of State more than two years earlier by Marcella Stanley Choung. That was the complaint that had alerted the Board of Medicine – eight years before Karnamaya Mongar died – to almost all of the same violations revealed by this Grand Jury’s investigation.

In December 2001, Marcella Stanley Choung had filed a detailed, written complaint with the Pennsylvania Department of State. Although she wanted to remain anonymous, she provided her name and her phone number, and participated in a follow-up interview on March 4, 2002. She informed the department investigator that Gosnell  was using unlicensed workers (including herself) to give IV anesthesia to patients when he was not at the clinic; that his facility was filthy; that two sick, flea-infested cats roamed freely in the procedure rooms, vomiting throughout; that Gosnell ate in the procedure rooms; that the autoclave used to sterilize instruments was broken; that he reused single-use curettes; that there were no licensed nurses at the facility when IV anesthesia was administered; that Gosnell allowed one patient to use her cousin’s insurance card to pay for an abortion; that Gosnell performed abortions on “underage children” against their will if their mothers asked him to; and that he performed other abortions without consent forms.

Choung told the Department of State investigator that she thought a second trimester patient had died at a hospital after Gosnell performed an abortion on her. And she said that she had seen patient files in which he prescribed 90 Percocet tablets (a narcotic combining oxycodone and acetaminophen) for a patient one week and then, again, 90 more tablets the next week. She gave very detailed information about the files, what she saw, and when. She provided the name of at least one patient, and suggested that the investigator look at her file. Choung wrote that any of the other clinic workers – except one named Jonathan – would be willing to confirm her information.

But the investigator with the Department of State did not question any of the other unlicensed workers. And the Board of Medicine did not use its subpoena power to obtain files to substantiate Choung’s complaint. No one even asked to see the facility or its files. The investigation consisted of three interviews – one with Gosnell; one by telephone with another doctor, Dr. Warren Taylor, who said he performed abortions at the clinic in 2001; and one with a pharmacist two blocks from the clinic on Lancaster Avenue.

Gosnell told easily-checkable lies in his interview with prosecutors:

Gosnell, according to the investigator’s report, did not directly contradict many of Choung’s allegations, but made excuses instead. He also told outright lies that could easily have been disproved. He said the clinic was licensed as a surgical facility – which it was not and is not. This fact could have been confirmed by a simple call to the Department of Health, or by an internet search. Gosnell claimed that he did not use Schedule II controlled substances for anesthesia, even though he did.

Gosnell asserted that he always administered the anesthesia, something any of the clinic workers would have refuted. He acknowledged that he let his patients choose their own anesthesia from mixes entitled “heavy,” “twilight sleep,” and “custom sleep” – names that should have been a tip-off that someone at the clinic was heavily sedating patients. Gosnell declined to provide a written response to Choung’s allegations.

Still, no one at the Department of State probed further to see if one of Choung’s most serious contentions – that unlicensed employees were administering the anesthesia with no medical professional present – was true. The investigator did not request to see any files. His notes indicate that he “visited the area of Women’s Medical Society,” but there is no indication that he asked to go in. He conducted his interview of Gosnell at a regional office in King of Prussia rather than at the doctor’s office where he could have confirmed many of Choung’s allegations first hand.

In this case, the investigaor did recommend further action in 2002.  That came in 2004 – when prosecutors dismissed the complaint on the same day they dismissed the Shaw case.

The argument by both departments that they didn’t think their jurisdiction extended to abortion clinics is a bald-faced lie.  They knew full well that they had the authority to conduct investigations and to prosecute violations.  They just didn’t want to do it.  As the grand jury concluded, the neglect by both DoH and DoS for “abortion patients’ safety and of Pennsylvania laws is clearly not inadvertent: It is by design.”

Gosnell and his staff of ghouls face criminal prosecution for their crimes.  Corbett and his team should pursue charges against public officials for gross dereliction of duty — and start checking to see how many more Gosnells are operating charnel houses in the Keystone State with impunity because of it.