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In Philadelphia, a doctor who performed abortions is on trial for murder. Kermit Gosnell is accused in the deaths of a female patient and seven babies that prosecutors say were born alive. When authorities raided Gosnell's clinic in 2010, they found squalid conditions.
As NPR's Jeff Brady reports, the case has led to changes in how abortion clinics are regulated in Pennsylvania.
JEFF BRADY, BYLINE: The Kermit Gosnell story is about more than abortion, it's also about class and race. For nearly four decades, Doctor Gosnell offered services to a mostly poor and African-American population in West Philadelphia. When authorities raided Gosnell's clinic three years back, they said there was blood on the floor, a stench of urine in the air and a flea-infested cat wandering through the facility.
In court, Gosnell's attorney says his client is unfairly being held to standards one might expect at the Mayo Clinic. A jury will decide Gosnell's fate. But what is clear now, is that state regulators were not doing their job. Maria Gallagher is a lobbyist with the Pennsylvania Pro-Life Federation.
MARIA GALLAGHER: Unfortunately and tragically, in Pennsylvania, facilities were going uninspected for years.
BRADY: Gosnell's clinic went 17 years without an inspection, according to prosecutors. Pennsylvania's Department of Health says that was a mistake. The agency now regularly inspects all abortion clinics.
The state legislature also passed a law requiring most clinics be held to a higher standard, the same as outpatient surgery centers. For some clinics, that required expensive remodeling.
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BRADY: At Planned Parenthood in downtown Philadelphia, CEO Dayle Steinberg swipes her security badge to get past a heavy wood door.
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BRADY: We're headed back to a room where abortions are performed so Steinberg can point out some of the retrofits. She says the tile floor had to be torn out and replaced with a smooth one that's easier to clean.
DAYLE STEINBERG: It's also a special grade linoleum that's quite costly
BRADY: Steinberg says the heating and air conditioning were upgraded. A new room was built just to house sterilization equipment.
STEINBERG: We had to replace the sinks in here to be hands-free sinks.
BRADY: Oh, so they have pedals on the bottom there.
STEINBERG: They have pedals on the bottom, correct.
BRADY: The price tag for two clinics: $450,000. Steinberg says this facility already had a low rate of complications - less than one-tenth of 1 percent. She contends Pennsylvania's new requirements did nothing to improve services for women here.
STEINBERG: They were thinly disguised as improving patient safety, when really it was about increasing the cost for abortion providers; hoping that some of them wouldn't be able to afford it.
BRADY: State Representative Matt Baker is the author of the law that put the tougher regulations in place. While Baker opposes abortion rights, he says limiting access was not the intent.
STATE REPRESENTATIVE MATT BAKER: We made it clear that we weren't going to arbitrarily and capriciously shut down abortion clinics.
BRADY: And abortion opponents were not the only ones supporting stricter regulations. State Representative Margo Davidson says her 22-year-old cousin died of sepsis and infection after an abortion at Gosnell's clinic. Davidson delivered an emotional speech on the State House floor.
STATE REPRESENTATIVE MARGO DAVIDSON: I honor her memory by voting yes on this legislation.
BRADY: Davidson says she hopes the law will safeguard the health of women seeking abortions.
DAVIDSON: So that never again will a woman walk into a licensed health care facility, in the State of Pennsylvania, and be butchered as she was.
BRADY: With the law in place, there are five fewer abortion clinics in Pennsylvania, though it's not clear the stricter regulations were the only reason they closed. That leaves 17 other providers in the state. Backers of the law say now if a woman enters a clinic in a poor neighborhood or a rich one, she can be assured it's meeting a basic standard of care.
Jeff Brady, NPR News, Philadelphia.