Friday, November 20, 2015

Karnamaya Mongar: A Referral to a House of Death

Just When Life Seemed Safe 

Headshot of a middle-aged Bhutanese woman with her hair pulled back and a faint smile on her face
Karnamaya Mongar
At the age of 41, Karnamaya Mongar had survived nearly 20 years in a refugee camp in Nepal. What she was unable to survive was a visit to an American abortion clinic.

Karnamaya, her husband, Ash, their three children and one grandchild arrived in the United States on July 19, 2009 as part of a resettlement program. 
Karnamaya was more than 18 weeks pregnant when went to a clinic in Virginia for an abortion. But the Virginia clinic, and another in Washington, D.C., did not do abortions that late in the pregnancy. One of the clinics referred Karnamaya to Kermit Gosnell's Women’s Medical Society in Philadelphia because Gosnell had a reputation for performing abortions regardless of gestational age.

Karnamaya went with her daughter to the Gosnell's clinic on November 18, 2009. That afternoon,
Latosha Lewis, who had completed a medical assistant course but had never been certified, conducted the clinic’s version of a “pre-examination,” which was so scanty it didn't even involve weighing the patient. Falsified informed consent forms were added to Karnamaya's file.  

After the "pre-examination" was done and the paperwork was completed, Randy Hutchins, a part-time physician’s assistant who worked without State Board of Medicine approval, inserted laminaria to dilate Karnamaya’s cervix and administered Cytotec to soften it. Hen then told Karnamaya to return the next day to complete the abortion.

Drugged Up

Kermit Gosnell's Philadelphia
"house of horrors" where
Karnamaya Mongar was drugged to
death by unqualified staff.
Karnamaya arrived at the clinic on November 19 around 2:30 p.m., accompanied by her daughter and her daughter's mother-in-law. At the front desk, Tina Baldwin gave Karnamaya her initial medication – Cytotec to soften the cervix and to cause contractions; and Restoril, a drug that causes drowsiness.  After giving Karnamaya the medicine, Baldwin told her to wait in the recovery area until the doctor arrived to perform the abortion.

Lynda Williams and Sherry West, who were without any medical-related qualifications medicated Karnamaya in the “recovery room” while she waited for Gosnell.

Karnamaya's daughter, Yashoda Gurung, told the Grand Jury that she waited with her mother in the recovery room for several hours. During that time, between 3:30 and 8:00 p.m., her mother was given five or six doses of oral medicine and repeated injections into an IV line in her hand.  As usual at Gosnell's clinic, no equipment was available to ensure proper monitoring of vital signs.



A handwritten, hand-colored chart of names for anesthesia concoctions and the amount of each drug to go in each
Anesthesia chart drawn up by 15-year-old
Gosnell employee Ashley Baldwin
Yashoda did not know what drugs her mother was given, but typically employees gave repeated injections of the concoction of sedative drugs that Gosnell referred to as a “twilight” dose. Each of these “twilight” doses, repeated a number of times at the discretion of the unlicensed workers, consisted of 75 milligrams of Demerol, 12.5 milligrams of promethazine, and 7.5 milligrams of diazepam.

The standard practice was for Gosnell's untrained staff to give repeated doses of sedative and pain-killing drugs to the patients, without regard to a woman's size or weight, whenever it was deemed necessary by the untrained staff. For example, if the woman started moaning, she was presumed to be in pain, and would be given another dose of drugs. Karnamaya, at only 4'11" in height and 110 lb. in weight, would have been endangered by a dose appropriate for an average-sized women, much less by the massive doses administered at Women's Medical Society.

A little before 8:00 p.m., West and Williams sent Karnamaya's daughter to another waiting area. She was left there, with no idea what was happening to her mother until the ambulance arrived after 11 p.m.


Williams helped Karnamaye into the procedure room, put her on the table, and drugged her again, this time with the clinic's "custom" dose of 75 mg. of Demerol, 12.5 mg. of promethazine, and 10 mg. of diazepam. The heavily drugged patient was then left, unattended and with no monitoring equipment, alone in the procedure room.

Cardiac Arrest

Kermit Gosnell mugshot
Kermit Gosnell mugshot
Sherry West told detectives that, some time after sedating Karnamaya, Williams came out of the procedure room, yelling for help. West said that when she later entered the procedure room, Gosnell was there trying to perform CPR on Karnamaya. Lynda Williams summoned Eileen O’Neill , an unlicensed medical school graduate who worked at the clinic, from her second-floor office.

O'Neill told the Grand Jury that she thought Karnamaya was already dead by the time she got to the procedure room, but she took over administering CPR because Gosnell wasn't doing it correctly. Gosnell, meanwhile, left to retrieve the clinic’s only “crash cart” (the emergency kit to treat a cardiac arrest) from the third floor. After returning with the kit, however, Gosnell did not use any of the drugs in it to try to save Karnamaya's life. Instead he just looked through them and seemed pleased that they were up to date. He seemed purely interested in keeping outsiders from finding out that the crash cart had been nowhere near the procedure room while patients were being sedated.

O’Neill testified that Gosnell told her not to administer Narcan, a drug that could have reversed the effects of the Demerol. She said that Gosnell told her it would not work on Demerol. O’Neill also said that she tried to use the defibrillator to revive Karnamaya, but that the paddles did not work.

Emergency Services

One of Gosnell's filthy
procedure rooms
It was after 11 p.m. – long after O’Neill had decided that Karnamaya was dead and returned to her office – that Lynda Williams finally asked Ashley Baldwin to call 911. Ashley then went into the procedure room and found Gosnell alone with his dead patient. He told Ashley to turn in the pulse oximeter, which they should have been using all along to monitor Karnamaya's pulse and blood oxygen. This surprised Ashley, since Gosnell knew that the pulse oximeter had been broken for months.

Emergency personnel arrived at 11:13. They found Karnamaya lifeless in the procedure room and Gosnell just standing there, not doing anything. The paramedics immediately intubated Karnamaya to give her oxygen, and started an intravenous line to administer emergency medications, since for some reason clinic staff had removed the IV line they'd been using all day to drug their patient. They also failed to tell the paramedics about the drugs they had administered.

The medics were able to restore weak heart activity. But getting Karnamaya to the ambulance was
 needlessly and dangerously time-consuming because the emergency exit was locked. Gosnell sent Ashley to the front desk to look for the key, but she could not find it. Ashley told the grand jury that a firefighter needed to cut the lock, but “It took him [20 minutes]… because the locks is old.” Karnamaya's daughter and friend ran outside, crying, and witnessed this. After cutting the locks, responders had to waste even more time struggling to maneuver through the cramped hallways that could not accommodate a stretcher.

When the ambulance arrived at the hospital shortly after midnight, Karnamaya had no heartbeat, no blood pressure, and was not breathing. After  aggressive resuscitation efforts, doctors were able to restore a weak heartbeat. Karnamaya was then sent to the Intensive Care Unit, where she remained on life support until family members could make the trip from Virginia to say good-bye. She was pronounced dead at 6:15 p.m. on November 20. She had died of a massive overdose of Demerol.

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