Dr. Gosnell was a little befuddled at his arraignment on January 20. Indicted for eight murders, the Philadelphia abortionist told the court that he understood the first count, a charge of third-degree murder for the death of a woman on whom he had operated. He didn’t understand, however, the seven other counts—the first-degree charges for the deaths of seven babies delivered alive and then killed in his clinic.

No, “clinic” is too antiseptic a word for what the 69-year-old doctor ran for over three decades in a small brick building on the corner of 38th and Lancaster in Philadelphia. A grand jury, led by district attorney R. Seth Williams, began investigating Kermit Gosnell’s abortion practice when a drug raid last February (the man ran a profitable side business in dodgy painkiller prescriptions) revealed conditions almost beyond belief.

“Pennsylvania is not a third-world country,” the grand jury felt compelled to insist in its brutal 261-page report, and it’s a bad sign when you have to preface your description of an American medical office with those words. But this was a story of rooms sticky with the remains of old placenta and fetuses, reeking of urine and feces from the cats that wandered freely through the building, echoing with the screams of women forced into labor and then abandoned for hours. “Furniture and blankets were stained with blood,” the grand jury wrote.

Instruments were not properly sterilized. Disposable medical supplies .  .  . were reused, over and over again. Medical equipment .  .  . was generally broken; even when it worked, it wasn’t used. The emergency exit was padlocked shut. And scattered throughout, in cabinets, in the basement, in a freezer, in jars and bags and plastic jugs, were fetal remains. It was a baby charnel house.

Pennsylvania may not be a third-world country, but its abortion mills—like those in most other states—really are reminiscent of one: free and independent entities, uniquely exempt from supervision and regulation, carved out from the rest of medicine. Every other kind of doctor is weighed down by record-keeping and inspection requirements. Abortionists alone are free. “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,” the Gosnell grand jury explained. “Even nail salons in Pennsylvania are monitored more closely for client safety.”

The reason, of course, is what such medical practices involve. Ever since the Supreme Court issued its Roe v. Wade decision in 1973, ending states’ power to outlaw abortion and making it instead an individual right, abortion has distorted American law and snarled American politics. Why should it be any surprise that it has soiled American medicine as well? People like Dr. Gosnell are allowed to exist by the pro-abortion lobbying groups that insist ordinary medical supervision will lead to a curtailing of access to abortion in this country.

As it happens, they’re right. Partly that’s because laws concerning medical licensing genuinely do offer a chance for pro-life state legislatures to hurt the abortion business by burdening its practitioners with extensive paperwork and expensive equipment. The activists at NARAL and Planned Parenthood are not exactly wrong to worry about what they call TRAP laws (Targeted Regulation of Abortion Providers). And yet, there’s a more serious reason that medical supervision threatens the abortion license in this country. It’s what ordinary medical regulation and supervision would reveal: the fact that the abortion business is the gutter of American medicine.

Make no mistake: Abortion genuinely is a business in the United States, and a big one. The grand jury estimated that Gosnell was bringing in nearly $1.8 million a year, mostly in cash, by performing ordinary (or “just a little illegal”) first- and second-trimester abortions with his untrained staff every Monday, Tuesday, and Thursday night. No one knows how much more he made from the operations he apparently performed most Sundays: the abortions so late in the third trimester that he allowed only his wife to help with them. Add what he made by writing prescriptions for narcotics—he was one of the top three Oxycontin prescribers in the state—and the man was running his own little mint on the streets of Philadelphia.

In a powerful recent account of Gosnell’s house of horrors, Politics Daily editor Melinda Henneberger found herself surprised when she began adding up the abortion stories so grisly that they had managed to break through into the news over the last 20 years. New York’s Abu Hayat, for instance: “The Butcher of Avenue A,” who killed a 17-year-old girl in a botched abortion and then denied ever having her as a patient. Or the Florida clinic that delivered a baby at 23 weeks and threw it out, alive, in a nearby garbage can. Or New Jersey’s Stephen Brigham, who was operating on women in a van, driving them from state to state in the midst of their abortions to skirt laws against late-term procedures.

And now we have Kermit Gosnell, our third-worlder, our poster child for the deadly meeting of shady business and political activism. Gosnell managed to destroy enough records that he was indicted for only the seven cases of infanticide for which sufficient evidence remained. But those cases are enough to sicken anyone. The baby he delivered alive at seven and a half months, for instance—then snipped its spinal cord, packed it in a shoe box, and joked that it was so big it could “walk me to the bus stop.” And the 28-week-old baby whose corpse was discovered in the clinic packed in a frozen water bottle. And the baby who lived for more than 20 minutes before an assistant finally came in and cut the spinal cord “just the way,” the grand jury was told, “she had seen Gosnell do it so many times.”

This was a man who, in hundreds of cases over more than three decades, performed abortions by delivering live babies and then severing their spines with scissors. He routinely overdosed his patients with pain-killers and labor-inducers, used instruments infected with venereal diseases, and killed at least two of the pregnant women on whom he worked by perforating their wombs and bowels.

Many people knew what was going on at his Philadelphia clinic; several filed complaints with state and local agencies. But nothing was done, and at the time of his arrest, he hadn’t been visited by a medical examiner for 17 years. As the grand jury noted, with the change of governors in Pennsylvania in 1995—when the pro-abortion Tom Ridge replaced the pro-life Bob Casey—“the Pennsylvania Department of Health abruptly decided, for political reasons, to stop inspecting abortion clinics at all,” as “officials concluded that inspections would be ‘putting a barrier up to women’ seeking abortions.”

Who could wonder why Kermit Gosnell was confused at his arraignment? No one had stopped him before. No one in more than 30 years had questioned him. No one had ever given him a signal that he might be prosecuted for performing abortions by inducing overmedicated third-trimester labor and then chopping through the spinal cord of the living result. No one had ever dared call his abortion business murder.

No one, in fact, had ever told him he wasn’t the absolute ruler of his own little third-world country.

Joseph Bottum is a contributing editor to THE WEEKLY STANDARD.

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