Just days after Marie Smith got an abortion at a West Philadelphia clinic, her stomach swelled and she began vomiting.
Her mother, Johnnie Mae Smith, took her to a hospital where doctors rushed the unconscious 20-year-old into surgery to remove numerous fetal parts that were left inside her body during the procedure, causing a potentially fatal infection.
The doctor who performed the abortion, Kermit Gosnell, turned up at the hospital with his checkbook, aiming to settle immediately, the mother said.
Instead, Johnnie Mae Smith chased him away, vowing to sue. Later, her daughter got just $3,000 -- after lawyer fees -- from a $5,000 settlement.
Gosnell, by contrast, took in at least $1.8 million a year from his corner-store medical practice at the Women's Medical Society, which prosecutors who charged him with eight counts of murder last week called his drug mill by day and abortion mill by night.
"His entire practice showed nothing but a callous disdain for the lives of his patients," Philadelphia prosecutors wrote in a nearly 300-page grand jury report released Wednesday. "His contempt for laws designed to protect patients' safety resulted in the death of Karnamaya Mongar."
The grand jury had scathing criticism for Pennsylvania state health and medical regulators who had numerous opportunities to shut down Gosnell but ignored complaint after complaint about filthy conditions and illegal operations.
Gosnell, 69, was charged with killing seven babies born alive and with the death of Mongar, a 41-year-old refugee who prosecutors say died in 2009 after a botched abortion at the clinic. Unlicensed staff members gave her far too much anesthesia for her 4-foot-11, 110-pound body hours before Gosnell arrived for his evening slate of abortions, a grand jury charged.
Mongar had fled Bhutan and had survived nearly 20 years in refugee camps in nearby Nepal, even after cholera took the life of a 4-year-old daughter. She and her family had made it to the United States just four months earlier to pursue "all that America has to offer," said lawyer Bernard W. Smalley, who filed a medical malpractice lawsuit against Gosnell last week.
"She was the matriarch of their family and now she's no longer there. Her [three] children will all have to be raised without her," Smalley told the Associated Press. "At the end of the day, this man has deprived her of her life."
Another clinic in Virginia, where Mongar lived, had referred her to Gosnell's clinic because it did not do second-trimester abortions. Although Gosnell did not advertise, pregnant women throughout the mid-Atlantic learned through word of mouth about his Women's Medical Society in the city's impoverished Mantua section. Abortions are legal in Pennsylvania until 24 weeks, although many clinics won't do them past 20 weeks, or sometimes 12 weeks, unless the mother's health is in danger.
Gosnell routinely performed illegal third-trimester abortions, when babies are viable and the procedure is far more dangerous, authorities charged. One 17-year-old who was 30 weeks pregnant nearly died in 2008 after he tried to perform an abortion on her at 30 weeks, they said. The girl's great-aunt had paid $2,500 in cash for the late-term procedure, they said.
Another girl, 14, went into labor and delivered a stillborn 29-week-old baby at a hospital after being dilated at Gosnell's clinic and then sent home, authorities said. She was supposed to return for the abortion later that Sunday, a day when Gosnell's unlicensed wife sometimes performed abortions, authorities said.
Gosnell was certified in family practice but had never finished an obstetrics/gynecology residency. In the words of Joanne Pescatore, a lead city prosecutor on the case, "He does not know how to do an abortion."
Gosnell perforated uteruses, bowels and cervixes of countless patients, the grand jury report charged. He left fetal parts inside them, ignored postoperative pain and bleeding and passed venereal diseases from one patient to the next through bloody and dirty instruments, the report said.