Sunday, April 14, 2013

Kermit Gosnell, Murdered Newborns, and the Media (p. 2)

Kermit Gosnell, Murdered Newborns, and the Media
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Failure of Government Oversight



The the grand jury report is long, but I recommend reading at least the first thirteen pages to get a sense of how horrible this was. Here’s an excerpt:
This case is about a doctor who killed babies and endangered women. What we mean is that he regularly and illegally delivered live, viable, babies in the third trimester of pregnancy – and then murdered these newborns by severing their spinal cords with scissors. The medical practice by which he carried out this business was a filthy fraud in which he overdosed his patients with dangerous drugs, spread venereal disease among them with infected instruments, perforated their wombs and bowels – and, on at least two occasions, caused their deaths. Over the years, many people came to know that something was going on here. But no one put a stop to it….Over the years, there were hundreds of “snippings.” Sometimes, if Gosnell was unavailable, the “snipping” was done by one of his fake doctors, or even by one of the administrative staff. But all the employees of the Women’s Medical Society knew. Everyone there acted as if it wasn’t murder at all.
The murdered babies, racist medical practice, and the endangered women are enough to make this newsworthy, but one of the disturbing facets of this case was how government oversight agencies had a “see no evil” approach to this extraordinarily shoddy abortion clinic. From the report:
Pennsylvania is not a third-world country. There were several oversight agencies that stumbled upon and should have shut down Kermit Gosnell long ago. But none of them did, not even after Karnamaya Mongar’s death. In the end, Gosnell was only caught by accident, when police raided his offices to seize evidence of his illegal prescription selling. Once law enforcement agents went in, they couldn’t help noticing the disgusting conditions, the dazed patients, the discarded fetuses. That is why the complete regulatory collapse that occurred here is so inexcusable. It should have taken only one look.
One line of defense is the Pennsylvania Department of Health, which is supposed to audit medical facilities like Gosnell’s to ensure they provide safe health care and follow the rules. The department gave the OK to open the clinic in 1979, but didn’t conduct another site review until ten years later, where Gosnell got a pass when he promised to correct the violations the department found. There were site views in 1992 and 1993 reporting violations but the department didn’t ensure the violations were corrected. Quoting from the report:
But at least the department had been doing something up to that point, however ineffectual. After 1993, even that pro forma effort came to an end. Not because of administrative ennui, although there had been plenty. Instead, the Pennsylvania Department of Health abruptly decided, for political reasons, to stop inspecting abortion clinics at all. The politics in question were not anti-abortion, but pro. 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. Better to leave clinics to do as they pleased, even though, as Gosnell proved, that meant both women and babies would pay.
So pro-choice politics played an unfortunate role in stopping the inspection of abortion clinics, which I frankly find astounding. The pro-choice ideal of legal and safe abortions would be meaningless without the government making an effort to keep women safe; and in that regard inspecting clinics and ensuring violations are corrected are commonsense safeguards. The idea that such protections would put up a barrier to women is tragically misguided; removing these protections put up a barrier to these women getting safe abortions. I thus find it disastrously ironic that pro-choice politics played a role in government agencies turning a blind eye the problems of the clinic.

But the failure of the department gets worse:
The only exception to this live-and-let-die policy was supposed to be for complaints dumped directly on the department’s doorstep. Those, at least, would be investigated. Except that there were complaints about Gosnell, repeatedly. Several different attorneys, representing women injured by Gosnell, contacted the department. A doctor from Children’s Hospital of Philadelphia hand-delivered a complaint, advising the department that numerous patients he had referred for abortions came back from Gosnell with the same venereal disease. The medical examiner of Delaware County informed the department that Gosnell had performed an illegal abortion on a 14-year-old girl carrying a 30-week-old baby. And the department received official notice that a woman named Karnamaya Mongar had died at Gosnell’s hands.

Yet not one of these alarm bells – not even Mrs. Mongar’s death – prompted the department to look at Gosnell or the Women’s Medical Society. Only after the raid occurred, and the story hit the press, did the department choose to act. Suddenly there were no administrative, legal, or policy barriers; within weeks an order was issued to close the clinic. And as this grand jury investigation widened, department officials “lawyered up,” hiring a high-priced law firm to represent them at taxpayer expense. Had they spent as much effort on inspection as they did on attorneys, none of this would have happened to begin with.
From Section VI of the report:
We discovered that Pennsylvania’s Department of Health has deliberately chosen not to enforce laws that should afford patients at abortion clinics the same safeguards and assurances of quality health care as patients of other medical service providers. Even nail salons in Pennsylvania are monitored more closely for client safety.
....
Indeed, the department has shown an utter disregard both for the safety of women who seek treatment at abortion clinics and for the health of fetuses after they have become viable. State health officials have also shown a disregard for the laws the department is supposed to enforce. Most appalling of all, the Department of Health’s neglect of abortion patients’ safety and of Pennsylvania laws is clearly not inadvertent: It is by design. [emphasis theirs]
You read that right, by design. The report gives evidence for this and goes on about the details in how the Pennsylvania’s Department of Health failed to do its job, but for space I won’t mention all the details here. While Pennsylvania’s Department of Health’s willful neglect of patient safety is awful enough, it gets even worse. Gosnell still might have been caught sooner had other government agencies not also dropped the ball. The report talks about how the Pennsylvania Department of State in many ways had “more damning information than anyone else” and likewise failed. From section VI of the report:
Yet even a 22-year-old woman’s death did not warrant an investigation, according to the Board of Medicine. It is curious, therefore, that the only complaint against Gosnell that did lead to any kind of disciplinary action by the Board involved a non-certified physician’s assistant who treated a child for pink eye in 1990. As it happens, the child’s grandmother, the complainant, worked for the Bureau of Professional and Occupational Affairs....We are concerned, however, about the patients whose doctors do not end up in the news – doctors who may be unethical, reckless, or unprofessional every day with impunity. We want to know that the Department of State is protecting the public from dangerous doctors even if they do not happen to treat someone with a connection to the department, and even if they do not end up in the news. We do not have that confidence after this investigation.
There are other troubling details about the Department of State’s failure that justify the grand jury’s aforementioned lack of confidence, but for space I’ll omit them. Another failure is the Philadelphia Department of Public Health. From section VI:
An employee of the Philadelphia Department of Public Health alerted her bosses – twice – that things were seriously wrong at Gosnell’s clinic. The last time she did so was one month before Karnamaya Mongar died. Records produced by the city department reveal that employees in at least two different divisions within the department missed red flags that should have led to investigation and action.
Again, for space I’ll skip the details. Another organization should have done better is the National Abortion Federation (NAF) which “upholds the strictest health and legal standards for its members.” The NAF inspected the clinic after Gosnell applied for membership.
Gosnell, bizarrely, applied for admission [to the federation] shortly after Karnamaya Mongar’s death. Despite his various efforts to fool her, the evaluator from NAF readily noted that records were not properly kept, that risks were not explained, that patients were not monitored, that equipment was not available, that anesthesia was misused. It was the worst abortion clinic she had ever inspected. Of course, she rejected Gosnell’s application. She just never told anyone in authority about all the horrible, dangerous things she had seen.

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.
And in section VI:
Had state and local officials performed their duties properly, Gosnell’s clinic would have been shut down decades ago. Gosnell would have lost the medical license that he used to inflict irreparable harm on women; to illegally abort viable, late-term fetuses; and to kill innumerable babies outside the womb.
The horribleness of the crimes and the massive government oversight failure seems to make this story quite newsworthy indeed. So why the failure of the press here?

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