Dr. Kermit Gosnell has been brought to federal court twice over the plea offer, and both times he balked. He now faces a Sept. 9 trial on charges that he illegally distributed vast quantities of prescription painkillers.
Gosnell, 72, had been convicted in May of killing three babies born alive at his West Philadelphia clinic. He gave up his right to appeal the verdict to avoid a death-penalty hearing, and was sentenced to life without parole.
Defense lawyer Jack McMahon has said his client would therefore plead guilty to the federal charges.
But the doctor refused to sign the plea agreement during McMahon's four-hour prison visit on Tuesday or in the hours before Wednesday's hearing.
U.S. District Judge Cynthia Rufe offered him more time to mull the decision, but Gosnell said that wouldn't help.
"I don't feel that I need any more time, in terms of the document that's before me," said Gosnell, who described himself as physically and emotionally well.
The offer proposed the mandatory minimum sentence of 20 years, to run concurrent with his state sentence in the infant deaths. The maximum sentence for the 23-count indictment is life.
Federal prosecutors say Gosnell flooded Philadelphia streets with more than 700,000 oxycodone or OxyContin pills by selling prescriptions to addicts, dealers and others who lined up at the clinic.
"Even if he were to get life, it's really a moot point," McMahon told Rufe.
Gosnell had earlier turned down a federal plea agreement that would have spared his wife prison time, and let her keep the house where she is raising their teenage daughter. Pearl Gosnell has since been sentenced to seven to 23 months in jail for helping perform third-trimester abortions.
He would have also served his time in federal custody, where he will now await trial. Some consider that a better option than state prison, where he has spent most of his time since his 2011 arrest.