West Philadelphia abortion doctor Kermit Gosnell routinely delivered live babies in the third trimester of pregnancy, then murdered them by "sticking scissors into the back of the baby's neck and cutting the spinal cord," according to the Philadelphia District Attorney.
One newborn who weighed almost six pounds was so big "the doctor joked . . . this baby 'could walk me to the bus stop.'"
Those are among the jaw-dropping details - complete with photographs - in a 260-page Grand Jury report released Wednesday that charges Gosnell, 69, with the murder of a patient and seven live infants.
The report culminates a massive, year-long investigation of Gosnell and his Lancaster Avene clinic, which was shut down after a raid last February.
But the report is sure to be just the beginning of finger-pointing and soul-searching as city and state health officials, legislators, and those on both sides of the bitter abortion debate seek to understand how the clinic operated for 32 years, apparently with little oversight.
"The inaction of public agencies is exposed," DA Seth Williams said Wednesday at a press conference.
In addition to Gosnell, his wife, Pearl, and eight employees - none of whom had medical credentials - were arrested Wednesday morning. Four of the workers are also facing murder charges.
Williams said the prosecution is not about the morality of abortion.
"I am aware that abortion is a hot-button topic," he said. "But as district attorney, my job is to carry out the law. A doctor who knowingly and systematically mistreats female patients, to the point that one of them dies in his so-called care, commits murder under the law."
Philadelphia lawyer William Brennan, who represented Gosnell before Wednesday's arrest, said he hadn't read the report, and hasn't been formally retained as Gosnell's attorney.
"I would say simply that it's important to remember that Dr. Gosnell is presumed to be innocent," Brennan said.
The investigation began last February, after federal and state drug agents and Philadelphia police raided the clinic at 3801 Lancaster Ave. on suspicion that Gosnell was illegally dispensing narcotic painkillers. (The federal drug-trafficking investigation is ongoing.)
What they found, according to the report, was "filthy, deplorable, and disgusting": Blood on the floor. The stench of urine. Cat feces on the stairs. Semi-conscious women moaning in the waiting or revovery rooms, covered with blood-stained blankets. Broken equipment. Blocked or locked exits.
The investigators also learned that, in November 2009, an abortion patient had died.
Gosnell is now charged with 3rd degree murder of that woman, Karnamaya Mongar, 41, who had travelled from Woodbridge, Va., for an abortion. A native of the nation of Bhutan who had arrived in the U.S. only five months earlier, Mongar was 19 weeks of pregnancy. She developed a fatal heart arrythmia after being overdosed with anesthetics by an unlicensed caregiver, the report says.
The grand jury also alleges that Gosnell and his staff delayed in calling 911, attempted to deceive paramedics when they arrived - and then took couldn't find the key for the emergency exit lock, which responders finally cut open.
That February raid was the beginning, Williams said, of ever more shocking discoveries that revealed Gosnell had been flouting Pennsylvania's abortion law - and other laws - for many years.
Gosnell, who graduated from Jefferson Medical College in 1966, received Pennsylvania Department of Health approval to do abortions at his clinic in 1979, after an on-site inspection.
Even before then, in 1972, he made headlines for using an experimental abortion-inducing device on 15 women, nine of whom developed serious complications.
From the start, he was well-known for being willing do abortions beyond 12 weeks - the limit set by most clinics - and for treating poor and minority women.
Pennsylvania, which has one of the nation's most restrictive abortion laws, requires that the woman be counselled about the risks and wait 24 hours before the procedure.
The state also requires that fetal tissue from abortions after 20 weeks be sent to a pathologist for review.
Abortions after 24 weeks - when the fetus can usually survive outside the womb - are outlawed unless the doctor determines, and reports to authorities, that the abortion "is necessary to preserve maternal life or health."
If the chosen abortion method might enable a live birth, the law says a second physician must be "in the same room" and provide medical care to the newborn.
Gosnell not only flouted these requirements, he falsified ultrasound and state reports to cover his post-24 week abortions.
"Gosnell's approach, whenever possible, was to force full labor and delivery of premature infants on ill-informed women," the report says. "When you perform late-term 'abortions' by inducing labor, you get babies. Live, breathing, squirming babies. . . . Gosnell had a simple solution: he killed them. . . . by sticking scissors into the back of the baby's neck and cutting the spinal cord."
Williams said the grand jury heard testimony that Gosnell performed what he called "snippings" hundreds of times, but most cannot be prosecuted because the evidence is gone.
Still, investigators found fetal bodies and body parts in garbage bags, plastic bozes and bottles at the clinic.
One of the seven cases of infanticide that have been documented is "Baby boy A" - the one about whom Gosnell made the bus stop joke, according to report.
"His 17-year-old mother was almost 30 weeks pregnant - seven and a half months - when labor was induced," the report says.
Contact staff writer Marie McCullough at 215-854-2720 or firstname.lastname@example.org. Follow the Inquirer at www.Twitter.com/PhillyInquirer and www.Facebook.com/PhillyInquirer