Wednesday, January 18, 2023

Anesthesia at Kermit Gosnell's Clinic

Kermit Gosnell
I've started watching a YouTube channel about anesthesia, and needless to say it brings up jarring contrasts between properly administered anesthesia and what I've seen done in abortion clinics. The most jarring, of course, is Kermit Gosnell and his Women's Medical Society. Their slipshod practices in sedating patients led to the death of 41-year-old Bhutanese refugee Karnamaya Mongar in 2009.

Looking through the Grand Jury Report, let's look over this specific aspect of the House of Horrors at 3801 Lancaster Avenue, Philadelphia.

"Despite his efforts to fool her, the evaluator from NAF readily noted that records were not properly kept, that risks were not explained, that patients were not monitored, that equipment was not available, that anesthesia was misused."

The people administering anesthesia at Gosnell's clinic:

  • Latosha Lewis. She worked for about eight years at the clinic between 2000 and the day of the raid, taking one year off to work for another facility and two maternity leaves. She had completed an 8-month program at Thompson Institute, a vocational training institution, but received no certification or license. She was not rained to perform ultrasounds, administer medication, or deliver babies though she did all of these tasks at the clinic. Among her other duties, she administered intravenous anesthesia and attended to patients in recovery. Except for the times she was actively assisting Gosnell, she performed these duties while he was off-site. 

  • Tina Baldwin
    Tina Baldwin.
     She worked continuously at the clinic from February of 2001 until the February 2010 raid. She had also attended the Thompson Institute but was not certified as a medical assistant until 2009, whereupon she started looking for another job. She performed the same duties as Latosha Lewis until she was moved to the front desk in 2005. She admitted that she knew that she was not supposed to administer IV medications but did so anyway.

  • Kareema Cross. She worked at the clinic from August of 2005 until the raid and performed the same duties as Lewis and Tina Baldwin. The Grand Jury Report mentions no formal training for her.

  • Ashley Baldwin. Ashley was a 15-year-old high school sophomore when her mother, Tina Baldwin, recruited her to start working at the clinic part-time in 2006. She performed the same tasks as the other employees mentioned so far.

  • Sherry West
    Sherry West.
     She was hired in October of 2008 and had no training and performed the same tasks as the other employees, including administering anesthesia. She assisted in sedating Karnamaya Mongar.

  • Marcella Stanley Choung. She said that her training consisted of Gosnell describing what he typically did and reading a chart he had posted in a cabinet. "She was so uncomfortable medicating patients, she said, that she 'didn't sleep at night.' She knew that if she made even a small error, 'I can kill this lady, and I'm not jail material.' One night in 2002, when she found herself alone with 15 patients, she refused Gosnell's directives to medicate them. She made an excuse, went to her car, and drove away, never to return. Choung immediately filed a complaint with the Department of State, but the Department never acted on it."

  • Pearl Gosnell
    Pearl Gosnell.
     Gosnell's wife, she was a licensed cosmetologist. She claimed to have attended Lyon's Technical Institute to obtain certification to take temperatures and blood pressure. She was Gosnell's sole assistant on Sundays, when he performed the abortions that were so late in the pregnancy that he dared not do them in front of other staff. 

  • Lynda Williams. She knew Gosnell from Atlantic Women's Medical Services, the National Abortion Federation clinic where Gosnell worked on Wednesdays, starting late abortions that would be finished at his clinic. She also had no formal training and performed the same tasks as the other employees. Other staff said that Williams would give patients repeated doses of Cytotec to induce labor, which would cause more pain, whereupon Williams would administer more drugs. She was the one who administered the Demerol, promethazine, and diazepam resulting in Karnamaya Mongar's death, even though Randy Hutchins, whom the Grand Jury Report refers to as a "licensed medical provider," was present at the facility. Lynda Williams  continued to perform her tasks between Karnamaya's death and the raid.
Anesthesia routine at Gosnell's clinic:

Anesthesia "cheat sheet" created by 16-year-old Ashley Baldwin
"Drugs were administered without regard to a patient's weight, medical condition, potential risk factors, or any other relevant factors that physicians need to weigh in determining appropriate medications. Gosnell ordered his untrained and inexperienced staff to administer drugs to patients, even when they protested, as 16-year-old Ashley Baldwin did, that they were not qualified." Patient began to arrive at the facility at noon and were anesthetized prior to Gosnell's arrival, typically at 8 pm. "Gosnell disliked it when workers disturbed him by calling for medication advice. .... According to Lewis, 'You had to rely on your own. If you felt like they were in pain and you wanted to administer medication, you would just administer the medication yourself.'"

Other staff indicated that Williams and West improvised their own drug cocktails. "Other staff members repeatedly reported this dangerous practice to Gosnell, yet he continued to give Williams responsibility for drugging his second-trimester patients. Cross warned Gosnell in 2008 that Williams gave too much medication, but 'Gosnell didn't care what she did.' Cross would tell Williams that she was giving too much medication; Williams would respond, 'Well, that is what Dr. Gosnell told me to give.'"

First-trimester patients were offered a list of different types of sedation and their prices and chose the sedation they wanted. Ashley Baldwin had created a "cheat sheet" of the cocktails offered:
  1. Local (10 mg. nalbuphine and 12.5 mg promethazine)
  2. Heavy (50 mg. Demerol, 12.5 mg. promethazine, and 5 mg. diazepam)
  3. Twilight (75 mg. Demerol, 12.5 mg. promethazine, and 7.5 mg diazepam)
  4. Custom (75 mg Demerol, 12.5 mg. promethazine, and 10 mg. diazepam) 
Latosha Lewis told the Grand Jury that this was how patients were presented their anesthesia choices:
You can pick which anesthesia you want to receive, whether you want to be up, half asleep, if you wanted to be knocked out, and it's additional to your procedure, but local anesthesia is included in the smaller cases and custom anesthesia, which is the highest, to be put to sleep in the bigger cases.
"Anesthesia for Surgery" form from Women's Medical Society
The "Anesthesia for Surgery" form presented the options and suggested:
It will probably be best to pay the extra money and be more comfortable if some of the following conditions are true for you.
  1. The decision to have the procedure is a difficult decision.
  2. Medication is usually necessary for your menstrual cramps.
  3. Your decision has been forced by your parents or partner.
  4. Your family members or friends 'Don't like pain."
The descriptions given to patients were as follows (with prices added by me in parentheses):
Most women who choose CUSTOM SLEEP ($150) want to feel ABSOLUTELY NO CRAMPS OR PAIN during their procedure. A needle with an anticlotting medication is inserted prior to the procedure and sedation is repeatedly administered until the patient is comfortable throughout the procedure.
Most women who choose TWILIGHT SLEEP ($90) want to feel VERY FEW OR VERY SLIGHT CRAMPS during their procedure.
Most women who choose HEAVY SEDATION ($50) want to feel SLIGHT TO MODERATE CRAMPS during their procedure. 

Staff testified that when patients arrived they'd be given Cytotec (to induce labor) and Restoril (to calm their nerves) at the front desk, then taken to the "recovery room" where they'd be undressed from the waist down and covered with a blanket. Once an IV was in place they'd be given "twilight" (75 mg. Demerol, 12.5 mg. promethazine, and 7.5 mg diazepam) "to put them to sleep and make them comfortable." Patients typically would wake up three or four times throughout the day and she'd be given more drugs to keep her under throughout the day. Women might remain in this casually sedated state for 8 or 9 hours, in labor, until they either expelled their babies or Gosnell arrived to perform abortions on them. If Gosnell performed a procedure, he would give the woman even more medication. 

Staff would also sedate women into unconsciousness at Gosnell's insistence if they would "get out of hand."

Staff typically did not document when they administered medications, and sometimes another employee would come along and give a patient another dose. 

No monitoring equipment was used, and typically the only time staff came into the room was to set up a new patient or to check every hour or so to see if anybody was moaning and if she was, to administer more drugs.

Monitoring and resuscitation equipment:

The clinic had one defibrillator (to shock the heart to try to restore a heartbeat), one EKG machine (to monitor the heart), and one pulse oximeter (to monitor pulse and oxygen saturation). They had all been broken for years as of the February, 2010 raid. There was only one blood pressure cuff in the clinic. The only equipment available to suction an airway was the suction machine used for abortions. There was no crash cart of medications in the procedure or recovery room. 

Karnamaya Mongar

Karnamaya Mongar
This Bhutanese refugee, who spoke no English, came to the clinic on November 19, 2009 for the final step of her two-day abortion procedure. She was 19 weeks pregnant. She was less than 5 feet tall and weighed only 110 pounds. Karnamaya's daughter, Yashoda Garung, was allowed to stay in the room by her mother's recliner. 

Between 3:30 and 8:00 pm, staff administered five or six doses of Cytotec to stimulate labor. No monitoring equipment was in use because, as already noted, the clinic had only broken monitoring equipment unless you count the blood pressure cuff that nobody ever used. Yashoda noted that staff injected drugs into her mother's IV several times. 

At 8:00, staff told Yashoda that Gosnell would be arriving soon to do her mother's abortion so she had to go out to the waiting room. Yashoda tried to wake her mother before she left but staff told her not to because the medication was supposed to keep her asleep.

Staff said that Karnamaya was moaning in pain as they took her to the procedure room and put her on the table. Williams administered the "custom" does of medications (75 mg. Demerol, 12.5 mg promethazine, and 10 mg. diazepam) to stop her from moving and moaning. Once she became still and quiet, Williams left the room. Karnamaya was heavily sedated and completely unsupervised until Gosnell arrived 10 or 15 minutes later to perform the abortion.

Women's Medical Society
With all the conflicting testimony it's unclear when Williams realized that Karnamaya wasn't breathing. Sherry West said that Williams came out of the procedure room yelling for help. West found Gosnell performing what looked like CPR. Eileen O'Neill, who had trained as a doctor but was not licensed, worked in another part of the clinic. Williams summoned her from her office. O'Neill said that though Karnamaya seemed to already be dead when she arrived in the procedure room, she took over CPR because Gosnell wasn't performing it properly. Gosnell went to the third floor to get the disused crash cart. O'Neill tried to use the defibrillator but it didn't work. Meanwhile Gosnell went through the medications on the crash cart and expressed happiness that the medications weren't expired. However, he didn't use any of them to try to revive Karnamaya. 

O'Neill testified that she wanted to administer Narcan to revive the patient but that Gosnell told her not to because it wouldn't work on Demerol -- which is not true. 

O'Neill came away with the impression that the reason Gosnell had fetched the crash cart was to stage the room for when paramedics arrived, since the law required that there be a crash cart on hand if patients were sedated. Gosnell also put the dead woman's feet in the stirrups to make it appear that she had been in the middle of the abortion procedure when she'd stopped breathing. 

Meanwhile Ashley Baldwin arrived in the room. Gosnell told her to plug in the pulse oximeter to make it look as if there had been at least some monitoring equipment in place. 

Only after the scene was staged -- after 11 pm -- did anybody call 911. Medics arrived to find that Karnamaya's IV had been removed and Gosnell just standing there, not doing anything to attend to his patient. Nobody told them about the massive amounts of drugs administered to the tiny woman. The medics worked to resuscitate Karnamaya -- restoring faint cardiac function. However, it took more than 15 minutes to get her out of the clinic and into the ambulance because of the narrow, cluttered, twisting hallways and the fact that the emergency door was gated and padlocked and nobody could find the key.

Karnamaya was admitted to the intensive care unit, but she had no neurological function. She was kept on life support until her family members could come to the hospital to say goodbye to her the following day.


To my knowledge, in spite of their appalling practices, somehow Gosnell and his staff only managed to dope the one woman to death. However, the Grand Jury Report also notes that Gosnell's staff would put barely conscious patients in wheelchairs and shove them out the door to their companions' cars. It's entirely possible -- if not likely -- that one or more of those women died after leaving the premises and their deaths were not properly investigated or were actively covered up. Since Gosnell also ran a pill mill, it's entirely possible that some of his patients were known addicts whose deaths would be attributed to accidental overdoses of recreational drugs. 

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