PHILADELPHIA — A doctor on the stand Thursday in the murder trial of a Philadelphia abortion provider called it "reprehensible" that he would let patients pick, as prosecutors allege, among "local," "heavy," "twilight," or "custom" anesthesia based on how much they could pay.
Prosecutors say Dr. Kermit Gosnell's untrained staff offered patients these choices and Gosnell did little to monitor patients afterward, failing to use blood pressure cuffs, oxygen machines, a pulse monitor or other standard surgical equipment.
"All bets are off (without monitoring)," said Dr. Andrew Herlich, an anesthesiologist and a professor at the University of Pittsburgh School of Medicine.
Gosnell is charged in the drug overdose death of a 41-year-old patient and the deaths of seven babies allegedly born alive at his West Philadelphia clinic. The death-penalty trial began Monday and is expected to last about two months. He has pleaded not guilty.
The woman, a recent immigrant, weighed only about 100 pounds and did not speak English. Hand-scrawled clinic notes show she received two heavy doses of sedatives and narcotics during a 2009 abortion, despite signs of respiratory distress after the first dose. She was later pronounced dead at a hospital.
Herlich testified that the amount of drugs given to Karnamaya Mongar – at least as suggested by the nearly illegible clinic note – would likely put her in a coma. He said the procedure also should have been stopped to address her breathing problems. Continuing with the surgery and giving her more drugs "is not what we would do under any circumstances," Herlich said.
Gosnell, 72, allegedly used the cheaper, outmoded drugs on patients, who paid anywhere from a few hundred dollars cash for a one-day, first-trimester abortion to nearly $3,000 for a three-day late-stage procedure.
Authorities found $250,000 in cash under a mattress when they raided his home in 2010, although they believe he also made significant sums through a separate "pill mill" at his street-corner clinic, where they say a steady stream of people sought painkiller prescriptions.
On cross-examination, Herlich acknowledged that Mongar apparently did not disclose any pulmonary problems to Gosnell's staff, although they turned up in her autopsy. But he said most of her problems could only have been diagnosed after her death.
Large sections of Mongar's medical questionnaire had been left blank. She had come to the clinic with an adult daughter who spoke little to no English herself.
Herlich also acknowledged that other patients had gotten the same drug cocktail from Gosnell and survived.
"But that doesn't mean they're the same person, with the same reactions," he said.
In graphic testimony this week, the jury heard from a former employee who admitted killing 10 babies and a woman hospitalized after a botched abortion when she was 17. Prosecutors allege the woman was about 30 weeks pregnant – well beyond the 24-week legal limit – and that her baby was born alive.
McMahon argues that all seven babies died in the womb during the abortion process.
Mongar, a native of Bhutan, spent 20 years in refugee camps before arriving in the U.S. four months before her death. Her husband, who worked on a chicken farm in western Virginia, and three children have filed a wrongful-death suit against Gosnell, the city of Philadelphia and others.
"I have personally been devastated and demoralized by this catastrophic event," Gosnell wrote state health officials after the patient's death. "Our staff, in addition, has been severely affected."
Prosecutors say city and state health officials failed to inspect Gosnell's clinic for nearly a decade before an unrelated 2010 federal drug raid turned up chaotic, foul-smelling and even macabre conditions.
FBI Agent Jason Huff testified that agents found fetal bodies stored beside staff lunches in a refrigerator; jars containing the tiny feet of aborted fetuses; and rubber, disposable medical tubing waiting to be rinsed and reused.
Gosnell still faces federal drug distribution charges stemming from the FBI raid. He has pleaded not guilty in that case. The murder trial resumes Monday.