Gosnell left dozens of damaged women in his wake. His reckless treatment left them infected, sterilized, permanently maimed, close to death, and, in at least two cases, dead. Their injuries and deaths resulted directly from Gosnell’s utter disregard for their health and safety. However, if their fate was entirely foreseeable, it was not necessarily the product of specific intent to kill. The same cannot be said of untold numbers of babies – not fetuses in the womb, but live babies, born outside their mothers – whose brief lives ended in Gosnell’s filthy facility.
The doctor, or his employees acting at his direction, deliberately killed them as part of the normal course of business.
Gosnell and his staff severed the spinal cords of viable, moving, breathing babies who were born alive.
Surgical abortions in Pennsylvania, performed up to 24 weeks of gestational age, are legal. Killing living babies outside the womb is not. The neonatologist who testified before the Grand Jury defined “born alive.” According to this expert witness, the federal Born-Alive Infants Protection Act defines a human as “somebody who’s been completely expelled from the mother and has either a heartbeat, pulsating cord, or is moving.”
Pennsylvania’s Abortion Control Act defines “born alive” similarly, but adds breathing and brain wave activity as indicators of life. 18 Pa.C.S. §3203. Gosnell’s staff testified about scores of gruesome killings of such born-alive infants carried out mainly by Gosnell, but also by employees Steve Massof, Lynda Williams, and Adrienne Moton. These killings became so routine that no one could put an exact number on them. They were considered “standard procedure.” Yet some of the slaughtered were so fully formed, so much like babies that should be dressed and taken home, that even clinic employees who were accustomed to the practice were shocked.
Baby Boy A
One such baby was a boy born in July 2008 to 17-year-old we will call “Sue.” …. An ultrasound conducted by Kareema Cross recorded a gestational age of 29.4 weeks. …. Eventually, she gave birth to a large baby boy. Cross estimated that the baby was 18 to 19 inches long. She said he was nearly the size of her own six pound, six ounce, newborn daughter. ….After the baby was expelled, Cross noticed that he was breathing, though not for long. After about 10 to 20 seconds, while the mother was asleep, “the doctor just slit the neck,” said Cross. ….
Baby Boy A was among the more memorable large babies that Gosnell killed, perhaps because of the photographs, or because his teenage mother almost died too. He was not, however, the only one. Ashley Baldwin remembered Gosnell severing the neck of a baby that cried after being born. The baby had “precipitated” when the doctor was not in the clinic. Lynda Williams placed the baby in a basin on the counter where the instruments were washed and called the doctor to come.
Ashley heard the infant cry. She saw the baby move while it was on the counter. She estimated the infant was at least 12 inches long. When Gosnell arrived at the clinic, she recalled, “he snipped the neck, and said there is nothing to worry about, and he suctioned it.”
The Routine
If Gosnell was absent, his employees would kill viable babies. Ashley Baldwin saw Steve Massof slit the necks of babies that moved or breathed “five or ten” times. Massof, repeating what he had been taught by Gosnell, told her that that it was standard procedure to cut the spine in all cases. Ashley testified:
o Q. These larger babies, when Dr. Steve was there, did he ever – was he ever there when any of the larger babies precipitated?
o A. Yes
o Q. Babies that would move?
o A. Yes.
o Q. So, Dr. Steve – what would Dr. Steve do with babies that moved?
o A. The same thing.
o Q. The same thing. And how many time did you see Dr. Steve?
o A. A lot. He told me that “don’t worry about it. They are not living. It is just a reaction.”
Kareema Cross testified that, between 2005 and 2008, she saw Steve Massof sever the spinal cords of at least ten babies who were breathing and about five that were moving.
When Massof left the clinic in 2008, Lynda Williams took over the job of cutting baby’s necks when Gosnell was not there. Cross saw Williams slit the neck of a baby (“Baby C”) who had been moving and breathing for approximately twenty minutes. Gosnell had delivered the baby and put it on a counter while he suctioned the placenta from the mother. Williams called Cross over to look at the baby because it was breathing and moving its arms when Williams pulled on them. After playing with the baby, Williams slit its neck. When asked why Williams had killed the baby, Cross answered:
o Because the baby, I guess, because the baby was moving and breathing. And she see Dr. Gosnell do it so many times, I guess she felt, you know, she can do it. It’s okay
Adrienne Moton also killed at least one baby by cutting its spinal cord. Cross testified that a woman had delivered a large baby into the toilet before Gosnell arrived at work for the night. Cross said that the baby was moving and looked like it was swimming. Moton reached into the toilet, got the baby out and cut its neck. Cross said the baby was between 10 and 15 inches long and had a head the size of a “big pancake.” Gosnell later measured one of the baby’s feet and said that it was 24.5 weeks.
Gosnell’s illegal and unorthodox practices resulted in the birth and then killing of many viable, live babies.
Killing really had to be part of Gosnell’s plan. His method for performing late term abortions was to induce labor and delivery of intact fetuses, and he specialized in patients who were well beyond 24 weeks. Thus, the birth of live, viable babies was a natural and predictable consequence. The subsequent slitting of spinal cords, without any consideration for the babies’ viability, was an integral part of what Gosnell’s employees called his “standard procedure.”
Steve Massof described this “standard procedure.” It required the clinic’s unequipped staff to manage a clinic full of sedated patients who were thrown into full labor, and then to “deal” with whatever precipitated, including live babies – all while the doctor was at home, or jogging, or working at a clinic in Wilmington. In particular, Massof described what Gosnell expected him to do when babies precipitated in the afternoon and evening before the doctor arrived:
o A: As I mentioned earlier, Dr. Gosnell would dilate the cervix to make room for passage of the products. And with the Cytotec, softening the cervix, the outlet of the uterus, well, mother nature would take its course. Every woman is different.
o Q: What would happen?
o A: Well, the fetus would precipitate.
o Q: What do you mean?
o A: Oh, come right out, right out. Just you know, I would be called, somebody would call me and at that point what I would have to do is, I’d have to go and tend to that patient.
o Q: How would you do that? What would you do?
o A: As – well, my first – my first reaction would be is at that point it depended sometimes it happened in the waiting room, sometimes it happened in the bathroom because, you know, a woman would be pushing in the bathroom. Sometimes, you know, it happened everywhere in the clinic.
o So what I would do is, I’d make sure that when – if the fetus precipitated, the cord was cut. Also, a standard procedure, the cervical spine was cut, as well as make sure that there wasn’t bleeding or, in other words, the placenta came down and that’s the way we insured less blood would be lost.
o Q: How often did this happen?
o A: More times than I really care to remember. I would have to say every week it would happen to at least 50 percent of the patients.
o Q: Fifty percent of the time?
o A: Yeah, easy, easy. That – you know, and that is how, you know, and that’s what would happen.
o Q: You said it was standard procedure to cut the – first to cut the umbilical cord?
o A: Yes.
o Q: That’s from the mother or how is that attached?
o A: Well that is from the mother to the fetus.
o Q: And where would it be? Would it still be – the placenta would still be in the mother’s uterus?
o A: Yes.
o Q: Okay.
o A: Yes. And so I would cut the attachment and you know, then the cervical portion of the spine at that point. Those were the larger patients.
o Q: So you said that was standard procedure. What do you mean when you say standard procedure?
o A: Well, that’s – that was his standard procedure.
o Q: When you say his, do you mean Gosnell?
o A: Yes.
o Q: Did he show you how to do that?
o A: Yes, he did.
o Q: When did he show you how to do that?
o A: He showed me how to do that maybe 2004, sometime within a year I started working there, that is what he did during his [second-trimester] procedures.
Tina Baldwin corroborated that this was Gosnell’s standard procedure. She explained that after a fetus was expelled, Gosnell “used to go ahead and do the suction in the back of the neck.” She saw this “hundreds” of times. Gosnell told her that this was “part of the demise.”
The Crime
Gosnell’s technique of aborting pregnancies by inducing labor and delivery, while unnecessarily painful for the women, did not itself constitute a crime. What made his procedure criminal was that he routinely performed these abortions past the 24-week limit prescribed by law. Not only was this a crime in itself, it also meant that he was regularly delivering babies who had a reasonable chance of survival. Except Gosnell would not give them that chance. Pennsylvania law requires physicians to provide customary care for living babies outside the womb. Gosnell chose instead to slit their necks and store their bodies in various household containers, as if they were trash.
Although the Grand Jury learned that there is some difference of opinion as to the earliest point of viability, the experts who appeared before the Grand Jury all agreed that, by 24 weeks, organs are sufficiently developed that prognosis for survival is good. These babies can sometimes breathe on their own, though many require assistance. When a woman delivers at 24 weeks or later in a responsible medical setting, such assistance is provided, and resuscitation of the baby is routine. Indeed, a doctor’s failure to provide assistance constitutes infanticide under Pennsylvania law.
Gosnell’s intent to never resuscitate was obvious from his failure to employ even minimally qualified personnel or to have the equipment necessary to save the lives of newborn infants. The policy he instituted and carried out was not to try to revive live, viable babies. It was to kill them.
Gosnell severed spinal cords and suctioned and crushed skulls after the babies were fully delivered.
At one point in his Grand Jury testimony, Steve Massof tried to suggest that the clinic’s practice of cutting babies’ spinal cords was somehow part of a late-term procedure called intact dilation and extraction (IDX), commonly referred to as “partial birth abortion” and banned under federal law since 2007. In an intact dilation and extraction, which was used most often to abort pregnancies beyond 17 weeks, the fetus was removed from the uterus as a whole. In order for the head to pass through the cervix without damage to the mother, the doctor would collapse the fetal skull by making an incision at the base of the neck and suctioning the contents. This procedure was done while the baby was still inside the mother.
This was not the procedure Gosnell used. Under further questioning, Massof acknowledged that Gosnell and he almost always cut the spinal cords, and sometimes suctioned skulls as well, after the babies were fully expelled by their mothers, when there was clearly no need or medical reason to collapse the skull.
Tina Baldwin’s testimony also made it clear that Gosnell was not cutting spinal cords, crushing babies’ skulls, or suctioning in order to allow the head to pass through the cervix. Even while claiming that Gosnell sometimes suctioned a fetus’s skull in order to get it through the birth canal, her description of his technique belied her claim: She said that he would “crack” the neck after the head was out – when only the baby’s torso was still inside the mother – and then suction the brain matter out. Tina Baldwin tried to explain:
o Q: He was delivering, for lack of a better word …
o A: Yes.
o Q: — a fetus?
o A: Yeah.
o Q: And then he was taking care of the problem after the fact?
o A: Yes.
o Q: Did you see him do this in instances where the fetus had been completely expelled from the mother’s body before he crushed the head?
o A: And then he crushed it.
o Q: and then he crushed it. I mean I guess you just told the members of the jury about episodes where he would leave the shoulders or –
o A: Uh-huh.
o Q: — the shoulders would be out?
o A: The shoulders would be out, yeah
o Q: And he would go work on the neck, you said he would crush the neck and suction the head?
o A: Uh-huh.
o Q: Did you ever see instances where the fetus was completely expelled from its mother’s body?
o A: Oh, yeah, yeah. That’s what we call precipitation.
o Q: What do you mean by that? Tell the members of the jury, what would happen?
o A: That’s when a patient would precipitate. Usually by the Cytotec that was given to the patient and it just made the uterus so flimsy to where the baby just falls and we had a lot of patients that was second-trimester, it would just fall wherever she was at. And it was picked up and it was put in a dish and it just traveled with the mother. And then the person put the mother up on the table, the baby was put inside the – in the dish on the table and the doctor was called to come in.
o Q: And then what would the doctor do when he came in?
o A: Let me think back then. Usually he would check and see, check on the fetus and then I think that’s when he used to go ahead and do the suction in the back of the neck.
o Q: Even though the fetuses had already been removed from their mother?
o A: Yeah, they had already been removed. He would just go ahead and finish it.
o Q: Would he explain to you why he did that?
o A: No.
o Q: Or why that was his practice?
o A: No.
o Q: Did you ever question it?
o A: No.
o Q: Okay, how many times would you say you’ve seen this?
o A: Hundreds. I’ve seen hundreds. . . .
The Brief Switch to Digoxin
Kareema Cross testified that when she first started working at the clinic, in 2005, Gosnell slit the neck of every baby. But he subsequently told the workers that the law changed so that he could not do that anymore. (The law, in fact, never allowed him to cut necks of viable babies after they were fully expelled.) Cross said that Gosnell then tried a few times to use a new procedure: He tried to inject a drug called digoxin into the fetus’s heart while it was in the womb. This was supposed to cause fetal demise in utero. But because Gosnell was not skillful enough to successfully administer digoxin, late-term babies continued to be born alive, and he continued to kill them by slitting their necks. Cross testified:
o So he tried to do the needle in the stomach and that’s what was supposed to have killed the baby before the baby came out, but if it didn’t, he’ll say, oh, well, the law says that I can do it. I can still slit the baby’s neck because it didn’t work. The needle didn’t work.
And according to his staff, the needle never worked. So Gosnell stopped trying and reverted to his old system of killing babies after they were born.
“Snipping”
Gosnell’s staff testified that he constantly tried to explain to them why what he was doing was legal – even though it clearly was not legal. Severing the spinal cord of viable, live babies after they have been delivered is simply murder. To then crush and suction their skulls defies medical explanation. It can only be understood as an attempt to conceal the true and only purpose of the neat scissor incision at the back of the neck: to kill the babies.
The clinic’s employees used the term “snip” to describe the severing of the spinal cord, but this is misleading. Our neonatal expert testified that, because of the bony vertebrae surrounding the spinal cord, it would actually take quite a bit of pressure to cut all the way through the spinal cord and the bone – even at 23 or 24 weeks gestation. At 29 weeks, on babies such as Baby Boy A, the expert said, “it would be really hard.” The baby, we were told, would feel “tremendous pain.”
When we asked our medical experts if there could be any legitimate, medical purpose behind Gosnell’s practice, one said: “it would be the same as putting a pillow over the baby’s face, that the intention would be to kill the baby.” Another likened the practice of severing babies’ spinal cords to pithing frogs in biology class.
Gosnell and his staff regularly cut necks of viable babies after observing signs of life.
Although no one could place an exact number on the instances, Gosnell’s staff testified that killing large, late-term babies who had been observed breathing and moving was a regular occurrence. Massof said that Gosnell cut the spinal cord “100 percent of the time” in second-trimester (and, presumably, third-trimester) procedures, and that he did so after the baby was delivered.
Massof testified that he saw signs of life in some of these babies. He recalled seeing a heartbeat in one baby and observed a “respiratory excursion” (meaning a breath) in another. On other occasions, he observed “pulsation.” Gosnell dismissed these observations as “spontaneous movement.” “That was his answer for if we ever saw anything that was out of the ordinary, it was always a spontaneous movement.”
Latosha Lewis testified that she saw babies precipitate at 23 to 28 weeks. In those cases, Massof or Gosnell:
0 … would cut the back of the neck and insert a curette, which is a plastic tubing … that is used to do a suction. You would insert it in the back of the neck of the baby, so that the brain would come out.
Sometimes, according to Lewis, “he [Gosnell] would just snip the neck.” Lewis saw babies move before Gosnell did this:
o Q. How many times did you see precipitated babies that had been fully expelled from its mother moving before he snipped the neck?
o A. A lot.
* * *
o Q. Can you give us a percentage of the time?
o A. Probably 25 percent of the time.
No steps were ever taken to attend to these babies; “we never even checked to see if [there] was a heartbeat.” Lewis, who had herself given birth twice, recognized that the larger precipitated babies were viable:
o … The bigger cases, you would see more movement or the baby would look a little bit more realer to you.
o Q. What do you mean?
o A. Like the skin would be a lot different. The color of the skin would be a lot different.
The Grand Jurors learned from the neonatology expert that the skin of viable babies does, in fact, appear different from the typically translucent skin of a pre-24-week fetus.
Kareema Cross said she saw Gosnell slit the neck of babies born alive “more than 15 times” : “over 10 times,” when she had seen a baby breathing, and about “five times” when she had seen a baby move. She could tell these babies were breathing because “I just seen a baby’s chest go up and down and it would go real fast, real fast.”
Ashley Baldwin also saw Gosnell slice the neck of moving and breathing babies. When asked how many times Ashley had observed babies being delivered that were moving or breathing or crying and the doctor cut the neck, she answered: “Most of the second tris that were over 20 weeks.” She said this happened probably dozens of times, maybe more. She described at least 10 babies as big enough to buy clothes for, to dress, and to take care of. She told the Grand Jury what happened to them:
o Q. And what happened to those ten babies that came out from their mother, that were big enough that you could put clothes on and take home and take care of, that moved around, what did you see happen to them?
o A. He killed them.
o Q. Who killed them?
o A. Doc.
o Q. How did he kill them?
o A. He cut the back of the neck.
Ashley said Gosnell told her this was “normal.”
Tina Baldwin told the jurors that Gosnell once joked about a baby that was writhing as he cut its neck: “that’s what you call a chicken with its head cut off.”
Although Massof was not as cavalier about what he did, he admitted that there were about 100 instances in which he severed the spinal cord after seeing a breath or some sign of life:
o Q. … of those 100 how many were larger than 24 weeks?
o A. That I couldn’t tell you for sure. I would have to think that they would all be because they were all able – after a certain period in weeks, you know, there’s – they would have to be capable. I mean premature births are quite common.
When investigators raided the clinic in February 2010, they sent the fetuses they discovered to the Philadelphia medical examiner’s office. The medical examiner concluded that two of them – aborted at 26 and 28 weeks – were viable, and another, aborted at 22 weeks, was possibly viable. The 28-week fetus, a male (Baby Boy B) had a surgical incision on the back of the neck, which penetrated the first and second vertebrae. The 22-week fetus, female, had a similar incision.
We believe, given the manner in which Gosnell operated, that he killed the vast majority of babies that he aborted after 24 weeks. We cannot, however, recommend murder charges for all of these cases. In order to constitute murder, the act must involve a baby who was born alive. Because files were falsified or removed from the facility and possibly destroyed, we cannot substantiate all of the individual cases in which charges might otherwise have resulted.
While the evidence before the Grand Jury supports only a limited number of murder charges, it is without challenge that Kermit Gosnell, under the pretext of providing medical care, routinely killed viable babies and irreparably damaged women. At least two of his patients, he also killed.
Above: Example of a slit neck – Baby Boy B
