Editor’s note. Abortionist Kermit Gosnell is charged with eight counts of murder and will be arraigned March 2. One of those eight counts is for the death of 41-year-old Karnamaya Mongar
Section V: The Death Of Karnamaya Mongar
On November 19, 2009, 41-year-old Karnamaya Mongar suffered a fatal drug overdose during an abortion procedure at the Women’s Medical Society in West Philadelphia. Along with her husband, Ash, the mother of three and grandmother of one had arrived in the United States only four months before, after spending nearly 20 years in a refugee camp in Nepal. She and her family had been among the thousands expelled from their homeland of Bhutan following pro-democracy protests. They came to the United States on July 19, 2009, as part of a humanitarian resettlement program. Her husband had just found a job in a chicken factory in Virginia where they lived. Mrs. Mongar spoke no English.
When Mrs. Monger was more then 18 weeks pregnant, she asked a family friend, Damber Ghalley, to take her to a clinic in Virginia to terminate her pregnancy. But the Virginia clinic, and another in Washington, D.C., would not do the second-trimester procedure. She was referred to the Women’s Medical Society because Gosnell had a reputation for performing abortions regardless of gestational age.
Mr. Ghalley drove Mrs. Mongar and her daughter to the Women’s Medical Society on November 18, 2009, and waited for them in the car. That afternoon, Latosha Lewis conducted the clinic’s version of a “pre-examination.” She performed an ultrasound, which showed that Mrs. Mongar was 19 weeks pregnant, and drew blood, purportedly for lab work. No one counseled the patient, as is required by Pennsylvania’s Abortion Control Act, or recorded her weight. (The next day it was recorded as 110 pounds.) Gosnell did not even meet her, although he had pre-signed a form entitled “24 Hour Counseling Certificate” that falsely certified he had counseled her – a fraud that was his customary practice.
Mrs. Mongar’s initials, perhaps written by someone else, appear on a form entitled “Consent to Office Procedure Administration of Anesthesia and Rendering of Other Medical Services.” This form purported to authorize Gosnell or “whomever he may designate as his assistant” to perform a therapeutic abortion. Unspecified anesthesia was to be administered “by or under the direction of one of the staff members.” The consent form and waiver were supposedly initialed by the non-English-speaking patient. Her daughter, who also spoke almost no English, was asked to sign as a witness.
After the pre-exam signing of forms, Randy Hutchins, the part-time physician’s assistant who worked without State Board of Medicine approval, inserted laminaria to dilate Mrs. Mongar’s cervix and administered Cytotec. Hutchins instructed Mrs. Mongar to return the next day to complete the abortion procedure.
Mrs. Mongar arrived at the clinic on November 19 around 2:30 p.m., accompanied by her daughter and her mother-in-law. (Damber Ghalley, who drove them, again waited in the car.) At the front desk, Tina Baldwin gave the patient her initial medication – 200 mg. pill of Cytotec (misoprostol) to soften the cervix and to cause contractions; and a 45 mg. pill of Restoril (temazapan), a drug that causes drowsiness. Mrs. Mongar was then instructed to wait in the recovery area until the doctor arrived to perform the abortion.
Lynda Williams and Sherry West, by all accounts the least competent and most careless of Gosnell’s unlicensed and unqualified crew, were supposed to medicate and attend to Mrs. Monger in the “recovery room,” where she awaited her procedure. Gosnell assigned Williams this duty even though Kareema Cross had warned him, at least a year earlier, that Williams did not know what she was doing and that she routinely overmedicated patients. Randy Hutchins also spoke to Gosnell about Williams anesthetizing patients in Gosnell’s absence. Gosnell assured him that “Williams was a trained professional and that it was not a problem.”
Mrs. Mongar’s daughter, Yashoda Gurung, clearly believed Williams was a trained medical professional – she referred to the unlicensed and unskilled worker as a “doctor” when she testified. Mrs. Gurung told the Grand Jury, through an interpreter, that she was permitted to wait with her mother in the recovery room for several hours. Mrs. Gurung testified that, between 3:30 and 8:00 p.m., her mother was given five or six doses of oral medicine – pills that were placed between her mother’s lip and cheek, which is consistent with how the clinic administered Cytotec orally.
Mrs. Gurung also saw her mother receive additional medication by injection through an IV line they inserted in Mrs. Mongar’s hand. This was consistent with Gosnell’s standard practice, which was to keep the second-trimester patients asleep while the Cytotec induced cramping and labor, in the hope that the women would deliver their babies without a surgical procedure. Also consistent with standard practice at the clinic, no equipment was available to ensure proper monitoring of Mrs. Mongar’s vital signs.
Mrs. Gurung did not know what drugs were being given throughout the afternoon and evening, but typically the doctor’s employees gave repeated injections of the concoction of sedative drugs that Gosnell referred to as a “twilight” dose. Each of these “twilight” doses, repeated a number of times at the discretion of the unlicensed workers, consisted of 75 milligrams of Demerol (meperidine); 12.5 milligrams of promethazine (Phenergan); and 7.5 milligrams of diazepam (Valium).
Lynda Williams admitted to detectives that she had administered IV sedation to Mrs. Mongar in the recovery room when the doctor was not on site. But she claimed that the amount she gave was significantly less than what others said was standard – Williams said she gave only 10 mg. of Demerol and 12.5 mg. of promethazine, a dosage she called a “local.” (The chart describing the clinic’s anesthesia options, however, describes the “local” dose as 10 mg. of a different drug, nalbuphine, and 12.5 mg. of promethazine.) [See Appendix A.]
A little before 8:00 p.m., West and Williams told Mrs. Gurung that she would have to leave the recovery room. Gosnell was not yet at the clinic, but they told her that he would be arriving at about 8:00 p.m. Mrs. Gurung tried to wake her mother before she left the recovery room, but was unsuccessful. West and Williams told her not to rouse her mother because the medication was supposed to keep her asleep. Mrs. Gurung was sent to another waiting room, away from her mother. She heard nothing else about her mother’s condition until after an ambulance arrived after 11:00 p.m. to take her lifeless mother to the hospital.
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