PHILADELPHIA (AP) — If pioneering physician Kermit Gosnell set out to offer women safe, legal abortions in the 1970s, that's far from what drug investigators say they found inside his West Philadelphia clinic in 2010.
By then, Gosnell had gone years without health department inspections, perhaps because state officials preferred a hands-off approach to a political misstep in the abortion quagmire.
The result, according to a grand jury report, is that Gosnell's patients received the equivalent of the back-alley abortions that advocates of legalized abortion had hoped to eradicate.
Gosnell, now 72, goes on trial Monday for murder in the deaths of a woman patient and seven babies allegedly born alive. Eight clinic workers charged with him have pleaded guilty, including his wife, a beautician accused of helping him perform stealth third-term abortions on Sundays.
The devastating 2011 grand jury report describes nearly unfathomable conditions: fetal body parts stored in glass jars and staff refrigerators; filthy, blood-stained operating areas; women and teens maimed after Gosnell perforated a uterus or colon.
"Anybody walking into that clinic should have known immediately that it should have been shut down," said Bernard Smalley, a lawyer for the family of Karnamaya Mongar, the 41-year-old refugee who died after being given too much anesthesia and pain medication during a 2009 abortion.
Philadelphia prosecutors accuse state and local authorities of turning a blind eye to laws requiring regular inspections. And they say the occasional complaints that trickled in, one after an earlier patient death, went nowhere.
"Bureaucratic inertia is not exactly news. ... But we think this was something more. We think the reason no one acted is because the women in question were poor and of color, because the victims were infants without identities, and because the subject was the political football of abortion," said the 2011 grand jury report, released by the district attorney.
The case drew national attention and prompted state lawmakers to tighten clinic regulations. Pennsylvania abortion clinics now have to meet the same standards of care required by ambulatory surgical facilities, and other states are also adopting that rule.
Planned Parenthood and other providers complain that the cost of updating facilities to meet ambulatory clinic rules can be prohibitive and further restricts women's access to abortions. Pennsylvania already required parental or judicial consent for minors, a 24-hour waiting period and a ban on abortions after 24 weeks gestation.
The Guttmacher Institute, which supports abortion rights and tracks women's health laws, believes abortion foes are capitalizing on the Gosnell case. Pennsylvania's 2012 changes to the law came under Republican Gov. Tom Corbett, who opposes abortion.
"They're using the Gosnell example in the argument to promote clinic regulations," policy analyst Elizabeth Nash said. "But in the past couple of years, the heat has been turned up under abortion restrictions in general."