Kermit Gosnell, 72, faces the death penalty if convicted of killing babies born alive. A string of former clinic employees testified over the past two months, telling jurors that Gosnell cut live babies in the back of the neck to ensure they were dead.
Four of them have pleaded guilty to murder charges for the babies they say they killed or for helping sedate a 41-year-old patient who died of an overdose. They accused Gosnell of killing two of the four babies, but he could be convicted in all four deaths if the jury deems him an accomplice or conspirator.
"He has to share the specific intent to kill," Common Pleas Judge Jeffrey Minehart explained as he instructed jurors, who deliberated for about two hours Tuesday without reaching a verdict and were to resume Wednesday.
Under Pennsylvania law, Minehart explained to jurors, for babies to be born alive, they must be expelled or removed from the mother and show one of the following signs of life: brain activity, breathing, the definitive movement of a muscle or the pulsing of the umbilical cord.
Gosnell is also charged in the patient's 2009 death. By that point, state officials had not inspected Gosnell's clinic since the early 1990s, prosecutors said.
The defense argues that Gosnell helped desperate women who had no medical care and nowhere else to turn.
"He provided those desperate young girls with relief. He gave them a solution to their problems," defense lawyer Jack McMahon said in closing arguments Monday.
Gosnell faces 258 counts in all, including four first-degree murder counts, which could bring the death penalty.
Other charges against him include one count each of infanticide and racketeering, 24 counts of performing third-trimester abortions and 227 counts of failing to counsel patients a day in advance.
Gosnell performed thousands of abortions over a 30-year career, and authorities say he got rich doing so by charging nearly $3,000 cash from mostly poor women and teens for illegal, late-term abortions.
McMahon argued that prosecutors who blasted the clinic as a filthy, flea-infested "house of horrors" in a 2011 grand jury report sensationalized the case to make headlines.
"This isn't a perfect place by any stretch of the imagination but it isn't what they say it is," McMahon argued.
Cameron called Gosnell's operation an assembly line for a stream of poor, mostly minority women and teens, including Karnamaya Mongar, who came from Virginia for an abortion after she was turned away at three other clinics, starting when she was 15 weeks pregnant. Gosnell is charged with third-degree murder in her overdose death.
The doctor sat calmly at the defense table, as he has throughout the often graphic six-week trial.
Former clinic employee Eileen O'Neill, 56, of Phoenixville, is also on trial, charged with six counts of theft for allegedly billing as a doctor when she was not licensed. O'Neill's lawyer has argued that O'Neill worked under Gosnell's supervision. The jury, asking its first question barely an hour into deliberations, had Minehart repeat that charge, suggesting they may be starting with O'Neill's case.
Gosnell did not testify but might take the stand if he is convicted and the trial moves to the penalty phase.