It's not clear what first prompted federal agents to raid a West Philadelphia clinic in February, but investigators found unsanitary conditions and an unlicensed worker treating patients without supervision. And the raid resulted in the suspension of abortion provider Dr. Kermit Gosnell's medical license.
As authorities sort though allegations against Gosnell, many are wondering how a bad doctor stays in business.
Sharing Their Stories
After the raid, several women came forward with stories of botched and incompetent care.
When Marie Smith went to the Women's Medical Society 11 years ago, she says the clinic was known as a cheap place to get an abortion. She didn't know anything about Gosnell.
"He looked like an all-right man 'cause there were a lot of ladies in there waiting for abortions," Smith says.
Smith was 19 at the time. The clinic recovery area disturbed her most.
"It's nasty and dirty, and [there's] blood on the floor. Just nasty. It was real crowded, and girls were slumped over after they got their abortion," Smith says.
After a week of fever and vomiting, Smith was rushed to a local hospital. She says X-rays revealed that parts of the fetus were still lodged in her uterus.
Over the years, other women shared their stories with local abortion-rights groups who documented problems but didn't take them to state authorities.
"We never had any proof. All we had was the women's stories, and they were the ones that had the proof. So we encouraged them to make the complaint," says Susan Schewel, who leads the Women's Medical Fund, a nonprofit group that raises money for patients who can't afford abortions.
"The people that we help are women who are struggling to get by," Schewel says, "and their life is chaotic and busy enough as it is. So the thought of talking to a state bureaucrat about something as stigmatized as an abortion, it's a low priority when you are trying to figure out how to pay your electric bills."
Blowing A Whistle
Before news reports surfaced, Pennsylvania didn't log one patient complaint about Gosnell.
Basil Merenda oversees professional licensing in Pennsylvania. He says the state relies most heavily on patient reports, but he says physicians should help police their profession, too.
"It's up to that bad doctor's colleagues to come forward and say, 'Look, Dr. So-and-So is not practicing up to snuff, and I think you folks should take a look at his procedures," Merenda says.
Initial complaints are confidential to shield doctors from false allegations and to guard the privacy of complainers. But Dr. James Goodyear, president of the Pennsylvania Medical Society, says that's little reassurance. Goodyear says physicians may be just as hesitant as patients to file a report.
"Unfortunately, sometimes health care professionals are a little bit reluctant to report some colleagues for fear of retribution. There is no protective laws that protect physicians," Goodyear says.
According to court reports, Gosnell has been sued for malpractice twice since 2002. Licensing commissioner Merenda says investigators reviewed those cases but didn't find enough evidence to take action.
"Our lawyers made that decision, I guess, for whatever reason. I have to have some confidence and trust that they did their due diligence," Merenda says.
Gosnell has refused to answer the allegations against him. He has hired defense attorney William Brennan. Brennan says his client offers an important service in West Philadelphia.
"He provides family care to individuals who otherwise would have to most likely travel outside their neighborhood. I hope people keep in perspective the long years of service that the doctor has provided the community and not rush to judgment. He's not charged with any crimes at this point," Brennan says.
In addition to the licensing-board investigation, both state and federal law enforcement officials are investigating Gosnell's practice.