Philadelphia Daily News/MCT /Landov Dr. Kermit Gosnell

Depending on where people fall in the reproductive rights vs. fetal rights debate, their views on abortion doctors are different. To some, these doctors are heroic figures, helping needy women in the face of considerable public opprobrium, if not death threats. To others, they’re taking away the lives of the yet-to-be-born. But if the grand-jury report released Wednesday by the Philadelphia district attorney is to be believed, abortion provider Dr. Kermit Gosnell would be hard for anyone to defend. (Warning: the following story is quite disturbing.) (More on Time.com: National Abortion Rates Plateau, While Protests Increase)

Gosnell, 69, operated a clinic called the Women’s Medical Society in a low-income neighborhood in West Philadelphia, until the clinic was closed early in 2010. Authorities raided the place last February, after it was fingered as a source of illegal oxycontin prescriptions. There, they stumbled across the appalling conditions at the abortion clinic, which sparked a full investigation. The Philadelphia Inquirer reported:

Semiconscious, moaning women sat in dirty recliners and on bloodstained blankets. The air reeked of urine from the flea-infested cats permitted to roam the clinic. There was blood on the floor and cat feces on the stairs. One investigator likened the scene to “a bad gas-station restroom.”

On Jan. 20 this year, Gosnell was formally charged. The Report of the Grand Jury includes further details on the doctor’s practice that are so bizarre they could be plot points in one of those torture-porn movies that were popular a few years back. (Read the PDF here, but be warned of shocking images and content.) According to the report, investigators found:

*Fetuses, fetal remains and dismembered baby parts — especially, for some reason, baby feet — in bags, jars, milk jugs and cat-food containers kept around the clinic, in the freezer and in the basement; some containers were stored in the same refrigerator where clinic staff kept their lunches

*Instruments that were not properly sterilized or discarded, which allegedly spread venereal disease to several patients

*Cats roaming and excreting freely in the filthy clinic

The charges Gosnell is facing are much more grave. He is alleged to have performed illegal late-term abortions (in Pennsylvania, the law prohibits abortion later than 24 weeks). These procedures are difficult, so Gosnell’s method, according to the charges, was to induce labor, deliver a live baby then kill it — or “ensure fetal demise,” as Gosnell referred to it. He did this, the grand-jury report says, by “sticking scissors into the back of the baby’s neck and cutting the spinal cord.” (More on Time.com: Late-Term Abortions: Q&A With the Last Remaining Doctor Who Performs Them)

In order to cover up the advanced age of the fetuses in state-mandated ultrasound reports, he trained his staff to take ultrasound pictures at an angle that would make them look smaller, according to the report.

His treatment of patients was worse than slipshod. The report describes instances of his failure to remove all the fetal parts from a uterus, his puncturing a uterus, tearing a cervix and colon, and refusing to call in assistance from another hospital when a patient convulsed and fell on the floor.

At least one woman, Karnamaya Mongar, 41, died in Gosnell’s care, after his untrained staff administered an overdose of Demerol — the doctor regularly asked his staff to give patients drugs — and her heart stopped beating. (Nine of Gosnell’s employees, none of whom were licensed to practice medicine, were charged as well.)

Pro-choice and pro-life organizations are probably formulating reasons right now as to why this case is proof that the other side is wrong and dangerous. But the sad truth is that Gosnell’s long-running practice probably has much more to do with poverty than with Roe v. Wade. (More on Time.com: The Complicated Link Between Abortion and Mental Health)

Clearly, the Women’s Medical Society was a health-care provider of last resort. Many of the women who came were too young, or too far along in their pregnancies to be treated by the mainstream medical establishment. They came because they were out of options or, at least, they believed they were. The abortion rate in America, which had been declining for several years, has flattened out recently, and are more common among women who lack education and access to affordable health control — and especially among black and Hispanic women.

Many of Gosnell’s clients might have been afraid to report him because it would have meant admitting an illegal act on their part. But not everybody maintained a code of silence: several complaints had been lodged against the Women’s Medical Society, the grand-jury report says, but either because of the zip code the clinic was in, or because of bureaucratic bungling, or because of the low socioeconomic status of the complainants, very little was done.

The grand jury’s report does not fail to make note of this, singling out several institutions as having been asleep on the job. The Pennsylvania Department of Health failed in its duty to monitor the clinic or explore complaints. The Board of Medicine at the Pennsylvania Department of State also had a number of complaints against Gosnell on record. The hospitals who took in Gosnell’s patients after things went south and fixed his botched work were supposed to report that, but only one did.

It wasn’t just the public agencies either. The Women’s Medical Society applied for membership in the National Abortion Federation (NAF), a network of providers that upholds health and legal standards for its members. Having checked the practice out, an NAF official said it was the worst abortion clinic she had ever seen, and rejected Gosnell’s application, but never passed the information on to other authorities.

Gosnell’s techniques — using untrained staff, operating the business day and night, not maintaining equipment and not keep up with modern medical techniques (using Demerol is frowned upon these days) — are typical of those in any business trying to cut corners to keep costs low. It’s likely that he was the cheapest abortion provider around in a community that’s not accustomed to the highest health-care standards anyway.

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