PHILADELPHIA -- A woman trained only as a medical assistant told jurors Wednesday that she gave anesthesia, set dosing amounts and performed ultrasounds when she worked at a now-shuttered abortion clinic whose owner is charged with killing a patient and seven babies.
Latosha Lewis testified as prosecutors wrap up their five-week case against Dr. Kermit Gosnell, 72. A string of former employees have testified that they went to work at the chaotic, rundown clinic because they were desperate for work, or were former patients, or knew Gosnell through his family or the gritty West Philadelphia neighborhood. A final employee was expected to testify Thursday before the prosecution rests.
Most of the former co-workers have pleaded guilty to criminal charges for the work they did, and face years in prison for murder, conspiracy, racketeering, drug distribution or abortion law violations.
Investigators say Gosnell ran a "pill mill" by day frequented by addicts and drug dealers; and an illegal "abortion mill" by night, where poor women with late-term pregnancies endured long, painful procedures performed by untrained staff until Gosnell arrived for the final phase of the surgical abortions.
Lewis, 31, had gone to a career school for eight months to qualify as a medical assistant, and was sent to Gosnell's clinic as part of training. Before long, she was hired to do paperwork and draw blood.
But that quickly morphed into skilled work as she delivered intravenous drugs, performed ultrasounds and made independent decisions about how much anesthesia patients should get. At one point, she had a scare with a patient.
"I had given her too much (medication) and I was concerned whether or not she would come (back) from anesthesia," Lewis testified.
Women often got near-hourly doses of Cytotec, a drug designed to induce labor, as they waited for Gosnell, along with painkillers to quell the powerful cramping, Lewis said. She sometimes chose to reduce the clinic dosages.
By 2008, Lewis had moved to the front desk because she was no longer comfortable with the amount of drugs the patients were given.
"The women were going into labor too fast, and I didn't want to deal with it," Lewis testified, adding that she still handed out some medications.
The patient who died, 41-year-old refugee Karnamaya Mongar, was given four doses of Cytotec during her November 2009 visit, along with Demerol and other drugs, according to notes scrawled randomly across her medical paperwork. A medical examiner said she died of an overdose.
Lewis, who checked in Mongar when she arrived at the clinic from Virginia, said her chart does not list her weight because the clinic's scale was broken.
As many as two dozen women a day came in for abortions, some of whom delivered babies in toilets or waiting areas before Gosnell arrived, according to staff testimony. Gosnell had taught them to snip the babies in the back of the neck to "ensure fetal demise," according to the testimony of unlicensed doctor Stephen Massof and others.
Massof and two others have pleaded guilty to third-degree murder.
On cross-examination by defense lawyer Jack McMahon, Lewis acknowledged that several relatives had gone to Gosnell for abortions or other medical care.
McMahon has told jurors there were no live births at the clinic, and that any movement seen by the staff was an involuntary response. He has suggested that Mongar had respiratory problems and died of unforeseen complications.
The only clinic employee to go to trial with Gosnell is unlicensed doctor Eileen O'Neill, 56, of Phoenixville, who is charged with racketeering and billing as a doctor. O'Neill saw gynecological patients but did not perform abortions.
A former patient testified Thursday that she had been treated by O'Neill for eight years, presumed she was a doctor and never saw Gosnell.
O'Neill's lawyer has tried to show that O'Neill was working under Gosnell's tutelage as she tried to regain her medical license.
A look at the facts in the case:
In February 2010, agents from Drug Enforcement Administration and the FBI who were conducting two raids on Gosnell's clinic in search of drug violations instead stumbled upon "deplorable and unsanitary" conditions, including blood on the floor and parts of aborted fetuses in jars.
State regulators shut down the Women's Medical Society clinic in west Philadelphia and suspended Gosnell's license.
THE GRAND JURY REPORT
A nearly 300-page grand jury report released in January 2011 described Gosnell's clinic as a filthy, foul-smelling "house of horrors" that was overlooked by regulators.
Prosecutors said Gosnell made millions of dollars over three decades performing thousands of dangerous abortions, many of them illegal late-term procedures. His clinic had no trained nurses or medical staff other than Gosnell, a family physician not certified in obstetrics or gynecology, yet authorities say many administered anesthesia, painkillers and labor-inducing drugs.
The grand jury report stated furniture and blankets in Gosnell's clinic were stained with blood, instruments were not properly sterilized, disposable medical supplies were used repeatedly. Bags, jars and bottles holding aborted fetuses were scattered throughout the building, which reeked of cat urine because of the animals allowed to roam freely.
State regulators ignored complaints about Gosnell and the 46 lawsuits filed against him and made just five annual inspections, investigators said, since the clinic opened in 1979. Several state employees were fired and two agencies overhauled their regulations in the wake of allegations.
Gosnell was charged with eight counts of murder. He stands accused of first-degree murder in the deaths of seven newborns and third-degree murder in the 2009 death of a 41-year-old Bhutanese refugee prosecutors say received lethal doses of sedatives and painkillers at the clinic while awaiting an abortion. He is also charged with violating Pennsylvania abortion law by performing abortions after 24 weeks, operating a corrupt organization and other crimes.
He pleaded not guilty and has remained held without bail since his arrest. Prosecutors are seeking the death penalty in the infant deaths.
Prosecutors estimated Gosnell ended hundreds of pregnancies by inducing labor and cutting the babies' spinal cords, and caused scores of women to suffer infections and permanent internal injuries, but they said they couldn't prosecute more cases because he destroyed files.
Eight clinic workers charged with Gosnell have pleaded guilty to a variety of charges, including his wife, a beautician accused of helping him perform illegal third-term abortions. Three of Gosnell's staffers -- including an unlicensed medical school graduate and a woman with a sixth-grade education -- pleaded guilty to third-degree murder for their roles in the woman's overdose death or for cutting babies in the back of the neck to ensure their demise.
In an interview with the Philadelphia Daily News after his clinic was raided, Gosnell described himself as someone who wanted to serve the poor and minorities in the neighborhood where he grew up and raised his six children, who include a doctor and a college professor.
Gosnell's defense lawyer, Jack McMahon, disputes that any babies were born alive. He has suggested that the woman who died, Karnamaya Mongar, had undisclosed respiratory problems that could have caused fatal complications.
McMahon has accused officials of "a targeted, elitist and racist prosecution" and "a prosecutorial lynching" of his client, who is black, and of applying "Mayo Clinic" standards to Gosnell's inner-city, cash-only clinic. He said Gosnell performed as many as 1,000 abortions a year, and at least 16,000 over his long career, with a lower-than-average complication rate.
After about a week of jury selection, seven woman and five men were chosen along with six alternate jurors. The trial began March 18 and is expected to last about two months.
Gosnell's former employees have testified that they were just doing what their boss trained them to do and described long, chaotic days performing gruesome work for little more than minimum wage paid under the table. An assistant testified she snipped the spines of at least 10 babies at Gosnell's direction, sobbing as she recalled taking a cellphone photograph of one baby she thought he could have survived, given his size and pinkish color.
Mongar's 24-year-old daughter testified about the labor-inducing drugs and painkillers her mother was given as she waited hours for Gosnell to arrive for the procedure. She said her mother was later taken to a hospital, only after firefighters struggled to cut bolts off a side door of the clinic, but she died the next day.
As prosecutors started wrapping up their five-week case against Gosnell, a woman trained only as a medical assistant told jurors that she gave anesthesia, set dosing amounts and performed ultrasounds when she worked at the clinic.