Gruesome testimony renews debate over abortion

• Doctor%27s abortion clinic described by prosecutors as a house of horrors
• Abortion foes say mainstream news media haven%27t covered trial adequately
• Doctor%27s attorney says his client is victim of prosecutorial lynching

PHILADELPHIA — One clinic worker testified that she saw aborted fetuses moving, breathing and, once, "screeching." Another described a 2-foot-long fetus that "didn't have eyes or a mouth, but it was like … making this noise. … It sounded like a little alien."

A third witness recalled how, as ordered, she used surgical scissors to snip the spine of an aborted fetus she'd found in a toilet, its arm still moving. "I did it once, and I didn't do it again," she said. "…it gave me the creeps."

The creeps are an occupational hazard for jurors in the murder trial of Kermit Gosnell, accused of running a clinic where seven babies were allegedly killed after botched abortions and an adult patient was given a fatal overdose of Demerol.

Abortion opponents hope that the horrifying crimes attributed to this one defendant can shift the balance of power in an abortion debate that's been deadlocked for decades.

The most recent Gallup poll reflects no marked change from those taken decades ago: 52% of Americans say abortion should be legal in some circumstances; 28% say legal in all circumstances; 18% say it should be illegal in all circumstances. It's an issue that hasn't been resolved and hasn't gone away — "a constant agitating of the American soul," in the words of columnist Peggy Noonan.

In the Gosnell trial, "the debate suddenly has a visual argument," says Marjorie Dannenfelser, president of the Susan B. Anthony List, a group that supports anti-abortion political candidates. "You look at pictures, and you think, 'That's a baby.' "

One photo, taken by a clinic worker and shown at the trial, showed a fetus whose gestational age was estimated by the medical examiner at 28 weeks at the time of the abortion. When it was placed in a pan, its body curled up in the fetal position. Gosnell, former staffer Kareema Cross testified, joked, "The baby's big enough that it could walk to the store."

The prosecution rested Thursday. The defense, which begins this week, will try to show that there were no live births at the clinic — that the fetuses were aborted in utero — and that the adult patient died of unforeseen complications. It's unclear whether Gosnell will take the stand.

Abortion opponents, such as USA TODAY opinion contributor Kirsten Powers, complained about what they said was insufficient coverage by established news organizations. (There has since been an increase in trial coverage.) Abortion rights advocates respond that the gruesome case suggests a need for wider access to abortion, not less. They say the trial depicts abortion not as it is, but as it was before the procedure was legalized by the Supreme Court in 1973 in Roe v. Wade, and as it will be again if Roe is reversed.

"I've never heard of this anywhere else," says Eric Ferrero of Planned Parenthood, which provides reproduction-related health services, including abortions. "There aren't Gosnells operating all over the country. This case is as unusual as it is unspeakable."

How can he be sure? asks Anna Higgins of the Family Research Council, an anti-abortion group. "We don't have regular inspections in most states. … Is there infanticide?"

ABORTION RESTRICTIONS EXPAND

The trial coincides with a campaign by abortion opponents, who were frustrated by the issue's relative obscurity in the 2012 presidential election, to restrict abortion on the state level.

Planned Parenthood says that this year, 300 bills designed to restrict abortion access have been proposed in 42 states. This comes after a record 135 abortion restrictions passed by state legislatures over the previous two years, according to the Guttmacher Institute, a research group that supports abortion rights.

Despite Democratic gains in the national elections, Republicans control the governorship and legislatures in 23 states. That helps explain why, in recent months, North Dakota, Alabama, Kansas and Virginia have approved stringent abortion restrictions.

Kansas legislators approved a bill that says life begins at fertilization and would prevent abortion providers from claiming tax breaks and prohibit abortions based on sex selection. North Dakota banned abortions as soon as a fetal heartbeat is detected, which can be as early as six weeks.

In Arkansas, where Republican legislators overrode a veto by Democratic Gov. Mike Beebe, abortions have been restricted after the 11th week.

Some new rules and regulations have been justified as necessary to protect the health of pregnant women and unborn children. Alabama and Mississippi, for example, have required doctors who do abortions to have admitting privileges at a local hospital; Virginia has required abortion clinics doing surgery to comply with standards for outpatient surgery centers.

Abortion rights advocates, such as Planned Parenthood, say some of these measures are designed primarily to drive up clinics' costs and put them out of business.

Will the Gosnell case accelerate this trend?

Ferrero of Planned Parenthood says more state laws wouldn't have stopped Gosnell; Pennsylvania had ones that were not enforced. Ilyse Hogue, president of NARAL Pro-Choice America, says many of the new and proposed state laws will drive out legitimate abortion providers: "The more restrictions we impose, the more we keep monsters like Gosnell in business."

Her point may be illustrated by the story of Karnamaya Mongar, who was 41 and 16 weeks pregnant when she came to Gosnell's clinic in 2009.

Mongar had reasons for ending the pregnancy. She was poor, spoke no English, and, after spending 20 years in a Nepalese refugee camp, had been in the USA for less than a year. She already had three children; with a fourth, there was no way she could hold a job. "She said, 'We're just getting started here,' " her daughter, Yashoda Gurung, testified last week in the trial.

Abortion is legal up to 24 weeks (the first two-thirds) of pregnancy in many states, but Mongar found that actually getting one can be difficult.

A clinic near her home in Woodbridge, Va., said it did not perform abortions after 14 weeks. That clinic directed her to one in Fredericksburg, Va., which also refused her and suggested a clinic in Washington, which in turn referred her to Gosnell's in west Philadelphia.

She arrived Nov. 19, had the abortion and went into a coma after an unlicensed staffer gave her a dose of Demerol, apparently without knowing her weight; the clinic scale was broken, according to trial witnesses. She died the next day at a hospital.

A relative of Mongar's, Damber Ghalley, testified that when he approached Gosnell to complain, "he said, 'I didn't do anything wrong. I'll be able to answer any question anywhere.'"

The Gosnell case — U.S. Rep Chris Smith, R-N.J., calls it "the trial of the century" — has injected emotion into a debate that couldn't seem to get any more emotional.

Lydia Saad of the Gallup Organization, who has followed public opinion on abortion for decades, is skeptical it will have a lasting effect.

"These things tend to fade, like the reaction to the abortion clinic bombings in the past," Saad says. "This is just one extreme case. I think it will be hard to base too much on it."

'HOUSE OF HORRORS'

Gosnell's clinic was in a three-story brick building at 3801 Lancaster Ave. in west Philadelphia. It was named, without irony, the Women's Medical Society. District Attorney Seth Williams has called it "a house of horrors," and his office's case was presented over five weeks in Courtroom 304 of the courthouse across from City Hall.

Witnesses described an institution where employees, many with personal or financial problems that left them few options, were paid meager wages off the books to perform tasks for which they were unlicensed and untrained, such as taking ultrasounds, administering anesthetics and other prescription drugs orally or intravenously, and assisting in abortions.

In an apparent attempt to standardize staffers' tasks, Gosnell had them administer uniform dosages of painkilling medication and other drugs, according to one who testified, Latosha Lewis. Some patients, given inappropriately high doses of labor-inducing drugs, abruptly aborted and expelled their fetuses in toilets or on floors.

Testimony from Lewis and others indicated that Gosnell performed many illegal third-trimester abortions but always noted in the patient file the same at-the-legal-limit gestation period — 24.5 weeks.

Clinic workers described equipment that was filthy, broken or outmoded. Plastic instruments were reused. Fetal remains were stored in freezer bags, water jugs and pet food containers. Floors were stained with everything from patients' dried blood to feces from cats that wandered freely. When members of a grand jury visited the premises, they wore hazmat suits.

In February 2010, a state-federal task force — on Gosnell's trail for alleged prescription drug sales, not abortions — raided the clinic. It had been 17 years since a state health inspection. "Over the years, many people came to know that something was going on," said Williams, the DA, "but no one put a stop to it."

Why not? A grand jury report offered this explanation: "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."

Jack McMahon, Gosnell's lawyer, says his African-American client is the victim of a "prosecutorial lynching" and argues that he treated women even if they couldn't pay up front or in full. "This black man," he said in his opening statement last month, was charged "because of who he is, and where he works."

COURTROOM 304

At 72, Gosnell is tall, freckled, graying and balding. Last week, he sat calmly in court, suit coat buttoned, a copy of the textbook Knight's Forensic Pathology at hand. He whispered in the ear of his lawyer and took notes on a yellow legal pad.

Occasionally, he gazed out benignly at those in the courtroom, including reporters. His stately demeanor offered no hint that he could face the death penalty. His appearance — dark suit, light blue shirt, perfectly knotted floral print tie — seemed the antithesis of the chaotic, rundown clinic described by witnesses, and his demeanor betrayed no hint that he faced seven charges of first-degree murder (the babies) and one of third-degree murder (Mongar).

His photo sat atop a crime family-style organizational chart on the wall in front of the courtroom. Clinic staffers' photos were arrayed in rows beneath his, like so many mob capos and soldiers.

In the well of the court, the prosecution had assembled equipment from his clinic, including a defibrillator that didn't work and a recovery chair whose side was streaked with blood.

Prosecutor Edward Cameron noted that the clinic's files often were stained with bodily fluids. As he passed around a patient file folder, he urged a court clerk to put on gloves before handling it. "It has some sort of dried red substance on it," Cameron warned. "It stinks."

Contributing: The Associated Press