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Dr Kermit Gosnell began as a pillar of his community. Now, he’s a national disgrace. For years, officials knew of problems at his clinic but did nothing about them. Some say a new law passed in response to the scandal is putting patients at further risk.

Dr Kermit Gosnell is no longer a danger to others. He spends his days writing poetry, learning Spanish and jogging on the spot. At 72, he keeps active. But he’s disappointed. He really thought he could beat the murder charges.

“He still believes, despite what the jury found, that he never killed a live baby,” says his lawyer, Jack McMahon.

Gosnell performed some 16,000 abortions over 31 years at his clinic in west Philadelphia – a poor neighbourhood in one of the poorest big cities in the United States.

According to those responsible for regulating abortion clinics, his practice was fine. But they hadn’t checked. Or listened to complaints from doctors and other professionals. Or done anything after two women died from treatment there.

Gosnell was only stopped in 2010, when police executing a drug warrant entered the clinic and found feet in jars, bones in drains and foetuses stored in freezers above refrigerators that held workers’ lunches.

The gruesome details – including the dangerous, even lethal practice of using untrained staff to sedate women – are catalogued in the grand jury report. Last month a judge sentenced Gosnell to three consecutive life sentences for killing three newborns by snipping their spinal cords at the neck.

“Children were being born alive… they breathed and moved, they cried, and he severed their spinal cords and murdered them”

Seth Williams

District Attorney Seth Williams

Jack McMahon says in 35 years as an attorney, he’s never seen such a backlash against a client, who was widely termed a “monster”. His own cousin told him, “I love you, but I hope you don’t win,” McMahon says.

That strength of feeling is now driving the debate about abortion in the United States.

Kermit Gosnell is the son of a prominent African-American family in west Philadelphia. He attended one of the city’s top high schools before going on to study medicine locally at Thomas Jefferson University.

“He was probably at that time the only African-American medical student there,” says Joe Slobodzian, who has covered Gosnell for the Philadelphia Inquirer. “And from every indication, he excelled.”

Kermit Gosnell's clinic, The Women's Medical Society
Several former clinic employees pleaded guilty to murder

In 1979, Gosnell opened the Women’s Medical Society in his old neighbourhood, at 3801 Lancaster Avenue. Pete Wilson, a local political activist with an office just up the road, says people used to look up to him.

“I guess he did the best he could for the community he lived in. Initially, he thought he was helping people, 13, 14, 15-year-old girls that had made mistakes, their parents bought them in.”

Wilson says the rooms inside were small and dimly lit. “It just didn’t seem like it was the kind of medical situation you would want to be in – not unless you were desperate. Because the abortions weren’t expensive. He was cheap. So that brought people who couldn’t afford to go anywhere but to him.”

It’s estimated Gosnell was making $1.8m (£1.1m) a year. He saved money by hiring unqualified staff. One “anaesthetist” had never finished high school.

District attorney Seth Williams ties Gosnell’s attitude to money directly to the murders. In a legal abortion, the foetus is injected with a lethal drug before the mother gives birth – but Gosnell didn’t do this.

“That takes money and it was cheaper for him to just induce labour and then murder the child,” Williams says.

Abortion has been legal in the United States since 1973. Each state sets limits on when abortions can be done, up to a national maximum of 24 weeks. The average pregnancy lasts 38 weeks. In Pennsylvania, where Gosnell practiced, the limit is 24 weeks.

“He was known in the community for doing abortions – didn’t matter what the gestation was,” says Pennsylvania State Representative Margo Davidson. Her cousin died following an abortion at Gosnell’s clinic in 2000. “You could get it done quickly, you could get it done cheaply, without any questions asked.”

Joe Slobodzian says Gosnell had gained a reputation as “the abortion doctor of last resort” across the east coast of the United States.

Now, his notoriety has spread nationwide. Pro-life organisations, which see any abortion as the murder of a child, have put great emphasis on the Gosnell case. One says it has put abortion itself on trial.

“There are a lot of people thinking very differently because of this case than they ever thought before,” says Dr Day Gardner, president of the National Black Pro-Life Union.

“There are many member of Congress who are saying, ‘We need to change the laws.’”

Shortly after that interview, members of Congress proved her right. They said “Gosnell” 63 times in a 60-minute debate last week, which ended in a vote to approve a Republican bill, H.R. 1797, that would ban abortions nationwide after 20 weeks.

Congresswoman Marsha Blackburn called it “an appropriate response to Kermit Gosnell’s house of horrors.” Opponents noted that murdering babies was already illegal – it’s just that in Gosnell’s case, no one was enforcing the law.

“It was a total failure of the governmental entities that have oversight over these facilities,” says District Attorney Seth Williams. He found that Gosnell’s clinic was last inspected in 1993.

“There was more inspection and oversight over public pools than over abortion clinics unfortunately in the commonwealth of Pennsylvania.”

Pennsylvania Governor Tom Corbett has said bureaucrats simply weren’t doing their jobs, and some have been fired. No-one from the health departments of the City of Philadelphia and the State of Pennsylvania would agree to be interviewed by the BBC. But a lawyer for the state Department of Health, Kenneth Brody, is quoted in a grand jury report into Gosnell, saying that a decision was taken to not regularly inspect clinics.

“There was a concern that if they did routine inspections, that they might find a lot of these facilities didn’t meet [the standards]… and then there would be less abortion facilities, less access to women having abortion”, he said.

The political reaction in Pennsylvania was swift.

A new law, Act 122, came into force last year and since then the State Department of Health has spent “1,500 man hours” inspecting abortion facilities, a spokeswoman told the BBC in an email.

“Our dedication to tougher oversight and ensuring full compliance with the law will continue far beyond Gosnell. We have a responsibility to create safer environments for women and to hold facilities accountable to higher standards and we will continue to fulfil that responsibility.”

This debate about standards is happening in many states, most notably in Texas – where pro-Life campaigners have branded one clinic providing abortions “another Gosnell”.

Wendy Davis
State senator Wendy Davis spoke for 10 hours to block a 20-week limit in Texas

But those who provide abortions say some of the higher standards have nothing to do with Gosnell, or even making women safer.

The Philadelphia Women’s Center is the city’s oldest abortion provider, part of the National Abortion Federation, an industry body which regularly inspects member clinics. (Gosnell’s clinic, of course, was not a member.) It’s always been clean and airy, says director Elizabeth Barnes, but recently installed a new heating and cooling system to comply with Act 122.

“We actually had to cut through the roof of our building, through the business of the floor above us and hire a crane to bring in the units which were brought in from the Midwest, because there was nowhere local that even made them,” Barnes says.

Her overall bill for complying with Act 122 is almost $500,000 (£326,000). Money wasted, she says, because it doesn’t make things safer “in any meaningful way”.

In fact, she says, by driving up the cost, Act 122 is putting clinics out of business and making it prohibitive for new ones to open.

“Gosnell was able to stay open because there was a need and no-one was filling it in his community,” she says. “And what we would hope for is that a good provider would rise in the place to fill the need. But if there is no way to make a facility financially viable, then facilities will not open.”

The result in that case, she says, will be “more Gosnells” – more unsafe abortions.

There were 24 abortion clinics in Pennsylvania before Act 122. Today, there are 19. Demand for abortion, based on calls to Philadelphia’s sexual health hotline, Choice, has not changed.

It’s hard to say what that means. It could mean existing clinics are picking up the slack. Women could be going to other states, or underground. Or it could mean there will be fewer abortions. Official figures for the number of abortions performed in 2012 won’t be published for months.

But State Representative Margo Davidson, who made an emotional appeal for Act 122 during a debate in the State legislature, telling the story of her 22-year-old cousin – who died “a gruelling and painful death” after an abortion at Gosnell’s clinic – says it’s crazy to think women today are less safe because of the new law.

“I was a poor black woman and I was a poor black girl, so if there was a need for an abortion even in my circle of friends, we came up with the money.

“As long as there are clinics that are providing safe services, poor women will find a way to terminate a pregnancy if they feel that they desperately need to do so.”

A cartoon showing pro-life and pro-choice campaigners nailing closed the door to Gosnell's clinic

It’s been three years since officers first raided Gosnell’s clinic. After his conviction in April, DA Seth Williams was given a framed cartoon, which he keeps on his desk.

“Why it’s funny is that both political extremes will argue that they were victorious with this conviction. I just try to continue to tell people that our investigation and our prosecution had nothing to do with the political or the moral decision of whether or not abortions are correct.

“Just that what he did was criminal. Children were being born alive, that they breathed and moved, they cried, and he severed their spinal cords and murdered them.”