On Monday, March 18, opening arguments began in the murder trial of Kermit Gosnell, a Philadelphia abortion doctor who is charged with running a charnel house for babies. Gosnell is charged with first degree murder, causing the deaths of seven viable infants who were born alive, killing them by cutting into their necks and cutting their spinal cords with scissors in a technique he called “snipping.”

In addition, Gosnell is charged with third-degree murder in the death of 41-year-old Karnamaya Mongar, a refugee from Bhutan who came to his clinic from Virginia seeking an abortion. Mongar, who weighed 90 pounds and spoke no English, died after being given a lethal dose of anesthesia and painkillers by members of Gosnell’s untrained, unlicensed and underage staff.

Gosnell’s attorney, Jack McMahon, accused city officials of a “prosecutorial lynching” of his client, who is Black, and of applying “Mayo Clinic” standards to Gosnell’s inner-city Women’s Medical Society, a clinic located in the Mantua section, one of Philadelphia’s poorest and most depressed areas.

McMahon told the jury of seven men and five women, “This is a targeted, elitist and racist prosecution of a doctor who’s done nothing but give [back] to the poor and the people of west Philadelphia.” He painted Gosnell as a dedicated doctor with a medical degree from Thomas Jefferson University who chose to forego more lucrative opportunities to stay and help the neighborhood.

But prosecutors paint a different picture, charging Gosnell with running a rogue clinic, preying on poor, desperate, minority women looking for late-term abortions and making a fortune from it. Assistant District Attorney Joanne Pescatore, cited a 281-page 2011 grand jury report that detailed Gosnell’s gruesome operation, telling jurors “The standard practice here was to slay babies. That’s what they did.”

Gosnell ran a high-volume, highly profitable operation, specializing in late-term abortions. In Pennsylvania, abortion is illegal after 24 weeks. Pescatore told the jury that the case was about murder, not abortion.

Gosnell simply ignored the state ban on late-term abortions. The staff was instructed to manipulate ultrasounds and other records to deceptively report the gestation age and size of babies, most of whom were routinely recorded at 24.5 weeks. Babies were born alive and simply killed moments after birth.

On Feb. 18, 2010, FBI agents raided the Women’s Medical Society, located at 3801 Lancaster Ave., which was on the radar for being a pill mill under the guise of a clinic. The raid was planned for the evening as not to encounter patients. However, the agents found something much more gruesome and sinister than a pill mill. They found a house of horrors, with dazed women on filthy recliners under bloody blankets in various stages of the abortion procedure, a filthy facility that reeked of urine from flea-infested cats that roamed around freely, bags of uncollected medical waste and dead babies stored in the refrigerator with staff lunches, dead babies in the freezers and milk jugs. And then there were the jars of babies’ feet. FBI agent Jason Huff said in a story reported on Philly.com, “We were quite surprised when we walked in and saw what we saw.”

Pescatore argued that Gosnell not only preyed on women desperate to end their pregnancies, but on his staff as well, most of whom were also poor, desperate and low-paid. The two other “doctors” on staff were unlicensed medical student doctors. The anesthesiologist was a sixth-grade dropout. A high school student was promoted from the reception desk to helping in the surgical and recovery rooms, sometimes working until 3 a.m. and having to go to school the next day. Eight co-defendants have pled guilty and face their own trials, which could net them 20 to 40 years in prison. Most are scheduled to testify against Gosnell. Gosnell’s wife, Pearl, also pled guilty to assisting Gosnell on Sundays when he handled the bigger babies.

Jurors were denied a chance to visit the shuttered facility, but prosecutors recreated the scene with a patient room complete with a hospital bed, stirrups and aging obstetric equipment. The first to testify was 35-year-old Adrienne Moton, a family friend who moved in with the Gosnells. Moton, who has been in prison since the indictment two years ago, worked at the clinic from 2005 through 2008, earning between $8 to $10 an hour. She testified to “snipping” the necks of at least 10 babies herself, as per Gosnell’s instruction, and is charged with third-degree murder.

It was Moton herself who delivered one of the most compelling pieces of evidence against Gosnell. It was a cell phone image taken of a child called “Baby A,” who was estimated to be 27 to 30 weeks. Moton testified that she took the picture because she was disturbed by the child’s size and pinkish color. Gosnell later joked that the child that was “big enough to walk to the bus stop.”

The mother of Baby A, who was 17 at the time of the procedure, testified that an aunt had taken her to Gosnell’s other clinic in Delaware, without her mother’s knowledge, paying $2,500 in cash. Abortions were banned in Delaware after 20 weeks so she came to the west Philadelphia clinic to finish the procedure. She already had an infant daughter.

Baby A’s mother testified to being in extreme and excruciating pain after the procedure and that it got worse. She ended up in a hospital two weeks later with a large abscess and a blood clot near her heart. Prosecutors hope to prove that she is just one example of the botched and dangerous procedures at the hands of Gosnell.

Gosnell made a fortune over his 40-year career. Authorities found $250,000 in cash when they searched his home. Gosnell charged between a few hundred dollars in cash for a first-term abortion to $3,000 for late-term abortions. The bigger the baby, the more he charged. Patients were even allowed to choose their anesthesia cocktail, local, heavy or twilight, based on how much they could pay. Gosnell made hundreds of thousands more by operating a pill mill and had a steady stream of customers at the west Philadelphia facility, where he sold fake prescriptions.

An even more disturbing point is that despite numerous complaints from women who suffered sterility, perforated bowels, cervixes and uteruses and venereal diseases at Gosnell’s hands, the death of at least one woman, the deaths of countless viable babies and the knowledge that other medical facilities knew something was very wrong at 3801 Lancaster Ave., nothing was done to shut the clinic down. Not even the death of Mongar was enough to shut the clinic down. The FBI agents who raided the clinic were admittedly shocked by what they found. We as a human community should be even more shocked that Gosnell was allowed to carry out his barbaric and macabre operation for decades, right under the noses of those who could have and should have stopped him. There were so many glaring red flags, yet Gosnell was finally caught by “accident.”

Prosecutors call the case “a complete regulatory collapse.” “Pennsylvania is not a third world country,” the district attorney’s office declared in the grand jury report. “There were several oversight agencies that stumbled upon and should have shut down Kermit Gosnell long ago.”

Why did that not happen? Where was the Pennsylvania Department of Health and why did they do nothing?

The report calls out the Pennsylvania Department of Health, citing that it was their job to audit facilities such as Gosnell’s to make sure that patients were receiving proper care. The agency first had contact with the Women’s Medical Society in 1979, when it was first approved to operate as an abortion clinic, but did not conduct another site review until 1989. Numerous violations were already evident that Gosnell promised to fix.

The district attorney’s report cites that a doctor from Children’s Hospital of Philadelphia hand-delivered a complaint advising the department that numerous patients he had referred to Gosnell for abortions came back with the same venereal disease. Several attorneys representing women injured by Gosnell also contacted the agency to no avail. The medical examiner of Delaware County informed the department that Gosnell had performed an illegal 30-week abortion on a 14-year-old. Then there was the notice of Mongar’s death, but not even that was enough to shut Gosnell down. Not until the raid and the ensuing story hit the press did the department finally act.

Gosnell faces 43 criminal counts, including eight counts of murder in the deaths of Karnamaya Monger and seven newborn infants, conspiracy, drug delivery resulting in death, infanticide, corruption of minors, evidence tampering, theft by deception, abuse of corpse and corruption. He faces the death penalty if convicted and faces a mandatory minimum of 20 years. The trial is expected to last for eight weeks.