Update: Kermit Gosnell makes an appearance

It's been 15 months since Dr. Kermit B. Gosnell was accused of murder and related charges by the Philadelphia District Attorney's office for performing illegal late-term abortions at his West Philadelphia women's clinic.

It's been almost that long since he was last seen in court.

But he was back Thursday – still in custody and looking vigorous at age 71 after a recent heart pacemaker implant – this time in federal court to be arraigned on an amended federal indictment charging him and three employees with selling prescriptions for almost a million pills containing the narcotic painkiller Oxycodone and the generic version of the antianxiety drug Xanax.

Wearing an olive prison jumpsuit, his hands cuffed behind him, Gosnell smiled broadly and winked at defense attorney Emily B. Cherniack as he waited his turn to be arraigned by U.S. Magistrate Judge Elizabeth T. Hey.

Gosnell quietly responded "not guilty" after Hey read the list of charges in the April 11 superseding indictment: conspiracy to distributed controlled substances, counts involving distribution of controlled drugs, and operating a continuing criminal enterprise.

Gosnell and three workers at his Women's Medical Society Clinic at 3801 Lancaster Ave. were originally charged by the federal grand jury in December 2011 with operating the "pill mill" from 2008 until January 2010. The alleged scheme netted Gosnell at least $200,000 in illegal profits, prosecutors said.

Assistant U.S. Attorney Jessica Natali said the superseding indictment does not lodge additional criminal charges against Gosnell but does make some editorial changes. Two of Gosnell's three codefendants were also arraigned Thursday and entered not-guilty pleas.

Four other former Gosnell workers were charged separately in the alleged pill mill's operation. Three of the four have pleaded guilty and are expected to testify for the government when the case goes to trial.

That could be some time, however. U.S. District Judge Cynthia M. Rufe has marked the trial "complex" and a trial date has not been scheduled.

When federal and state investigators raided Gosnell's clinic in February 2010, it was part of the probe into the sale of prescription pharmaceuticals. Once inside, however, authorities were confronted by what was later described as a "charnel house" of stored and dismembered fetuses – evidence that Gosnell's West Philadelphia clinic was performing illegal late-term abortions for poor women.

The clinic and Gosnell became the subject of an investigation by a Philadelphia County grand jury and in January 2011 Gosnell and nine employees were charged by the District Attorney's office.

Gosnell faces the most serious charges including third-degree murder in the 2009 death of a Virginia woman undergoing an abortion and seven counts of first-degree murder in the deaths of seven infants who were allegedly born live and viable but then killed by Gosnell, who snipped their spinal cords with scissors. Gosnell faces the death penalty if a jury finds him guilty of the first-degree murder charges.

But as with the federal trial, Gosnell will spend months more behind bars before he gets his day in court in the state case. The trial has been set for next March 14 before Philadelphia Common Pleas Court Judge Jeffrey P. Minehart.

Two former clinic employees will be tried with Gosnell. The remaining seven who were charged, including Gosnell's wife, Pearl, 51, have pleaded guilty but will not be sentenced until after Gosnell's trial is over.