Kermit Gosnell was known in the West Philadelphia neighborhoods where he grew up and worked all his life as the go-to person for services other doctors wouldn't provide: a loosely-justified prescription or a late-night illegal abortion.
Still, neighbors reacted with shock Thursday to news of a grand jury report that described Gosnell severing the spinal cords of babies delivered in the third trimester of pregnancy, spreading disease with infected instruments, and perforating patients' wombs and bowels.
"I can't believe that somebody will go to that extent for a dollar," said Chanda Rice, 49, whose apartment is a block from Gosnell's home at 32nd and Wallace Streets. "I pray to God he repents."
Gosnell, a family practice physician, was arraigned Thursday on eight counts of murder in the deaths of seven babies and a 41-year-old patient. Nine employees also have been charged, including four with murder.
Gosnell, 69, asked in court that seven of the murder charges be explained and raised his eyebrows as Magistrate Jane Rice detailed the allegations of the baby deaths.
For years, Gosnell's medical practice had been growing increasingly reckless, with unlicensed, unsupervised workers as young as 15 administering intravenous sedation and assisting women in labor, according to the grand jury report.
But his practice continued to draw from his community, where he was once a "respected man," according to a 1972 Inquirer article. He was a finalist for the Junior Chamber of Commerce's "Young Philadelphian of the Year" because of his work directing the Mantua Halfway House, a rehab clinic for drug addicts.
Khloe Robinson, 22, said Gosnell's Mantua roots were one reason she went to him in September 2007 for an abortion nearly six months into a pregnancy.
"I trusted him because he lived in the neighborhood, and I grew up in the neighborhood," said Robinson, whose family lives a block from Gosnell.
But Robinson was alarmed when she learned a girl from her high school would assist on the procedure. Afterward, Robinson was hospitalized for more than a week with a kidney infection, she said.
Brittnye Drew, 20, said she still feels unsettled about the abortion Gosnell performed for her two years ago. Drew, who lives down the street from Gosnell, was three months pregnant when she paid him about $600 in cash for the procedure.
The exam room was filthy, she said, and "pickle jars" lined the walls. Investgators later found jars containing the feet of aborted fetuses.
"When I found out that he got locked up," Drew said, "I was speechless."
Philadelphia authorities raided his clinic at 3801 Lancaster Ave. in February, suspecting that he was dispensing painkillers illegally. That led to the investigation into his abortion practice.
A 21-year-old neighbor who declined to give her name said she was 6 1/2 months pregnant when she visited Gosnell, paying him $1,300 in cash for an abortion completed in the middle of the night. She was 16, naive, and was never told that her abortion was illegal under Pennsylvania law, she said.
At 24 weeks - about five and a half months - the fetus can usually survive outside the womb, so many states, including Pennsylvania, outlaw abortion except to save the woman's life or health.
The 21-year-old remembers nothing of what happened during the procedure.
"Did they snap that baby - my baby's - neck?" she wondered Thursday.
Prosecutors have said few, if any, of Gosnell's heavily sedated patients knew their babies had been born alive and then killed.
Renee Anderson, 57, who grew up in Mantua and lived six blocks from Gosnell's home for many years, said she worked at his Lancaster Avenue clinic briefly in 1986.
At that time, she said, his facilities and services were respectable. Although she left after less than a year, it was because she got tired of working "ungodly hours" and found the doctor "arrogant" - not because of deplorable conditions.
"When I worked there, it was a clean facility," said Anderson, who now lives in Darby. "And the medical waste was always picked up. I was surprised to read about the bags of waste and fetal parts."
Why and when did Gosnell's operation become a house of horrors? Current and former workers who testified before the grand jury painted a picture of a downward spiral that accelerated in recent years.
Gosnell's family practice clinic on the first floor of the three-story building "devolved into mainly a 'pain management' practice" over the past "several" years, the grand jury report says.
A decade ago, an employee told the grand jury, his abortion business at least nominally complied with Pennsylvania's requirement that women be counselled about abortion alternatives and wait 24 hours for their procedure. But by 2008, that employee said, the doctor offered same-day procedures "as long as the patient paid in full, typically in cash."
Gosnell also became reliant on referrals from out-of-state because local referral agencies knew his reputation and "would not recommend his clinic," the employee testified. He readily accepted women who were unable to get abortions elsewhere because their pregnancies were beyond 24 weeks.
One of those out-of-state referrals was Karnamaya Mongar, 41, a refugee from the Asian nation of Bhutan who was living with relatives in Woodbridge, Va. Gosnell is charged with murder in her November 2009 death; her heart stopped after an unlicensed clinic worker gave heavy, repeated doses of pain and sedation drugs.
On Wednesday, Philadelphia lawyer Bernard Smalley filed a lawsuit against Gosnell on behalf of Mongar's husband and children.
Smalley said he doesn't know why Mongar was referred to Gosnell since she was only 19 weeks pregnant, "but we'll find out."
Another question Smalley and his firm are delving into: Where is Gosnell's money?
The grand jury estimated that Gosnell "took in as much as $10,000 to $15,000 a night, mostly in cash" - generating $1.8 million a year. (The jury said this is not including the money from Gosnell's alleged illegal narcotics trafficking, which is still under investigation by federal authorities.)
Philadelphia District Attorney Seth Williams said $250,000 was found at Gosnell's home when authorities raided it.
But Gosnell's other obvious assets - his house, a shore home in Brigantine bought in 1992, and a multi-unit rental property - belie his estimated income.
"I have a keen interest in finding out where the money is," Smalley said.
The Associated Press contributed to this report.
Contact Chelsea Conaboy at firstname.lastname@example.org