Sounding similar calls, abortion rights supporters and opponents alike say they want Maryland authorities to continue investigating a doctor and his clinic network in the wake of a botched abortion in Elkton last month that critically injured an 18-year-old woman.
The case has put a spotlight on Maryland's abortion law, which is less restrictive than those in nearby states such as New Jersey and Pennsylvania. In those states, unlike in Maryland, later abortions must be performed at a surgical center or hospital rather than at a doctor's office.
Maryland's more relaxed standard appears to explain why Steven C. Brigham, a doctor with a checkered disciplinary history, initiated abortions for the 18-year-old and other patients in New Jersey, then had them travel to Elkton in a caravan to complete the procedures. In New Jersey, pregnancies after 14 weeks cannot be ended at doctors' offices such as those Brigham runs; the 18-year-old was 21 weeks pregnant.
The Maryland Board of Physicians last week ordered Brigham to stop practicing medicine in the state. Brigham, 54, has never been licensed in Maryland. The board also suspended the licenses of two other doctors after the Aug. 13 abortion in which the young woman suffered a ruptured uterus and had to be flown to Johns Hopkins Hospital in Baltimore.
But Brigham's lawyer said Tuesday that his client had done nothing wrong.
"There's a statute in Maryland that permits licensed physicians from other states to collaborate with Maryland physicians," said the lawyer, Kevin Dunne. "Every time Dr. Brigham was in Maryland, there was a Maryland physician collaborating or consulting with him. Every time."
Brigham is the owner of five American Women's Services clinics in Maryland, with locations in North Baltimore, College Park, Frederick, Cheverly and Elkton, according to the physicians' board. On Tuesday, a woman who answered the phone at the Baltimore office said it was open. Calls to the other offices went to a call center where no information was given about their status.
The president of the National Abortion Federation, a Washington-based association of abortion providers, said Tuesday that Maryland health officials should scrutinize all of Brigham's clinics in the state. Vicki Saporta noted that Pennsylvania health officials in July ordered him to permanently shut his four clinics in that state for repeatedly employing unlicensed caregivers.
"They need to expand their investigation and look at all of the clinics he owns and operates in Maryland and determine if they, in fact, are also providing substandard care," Saporta said. "And if so," she added, regulators should "close them permanently."
Saporta said the practice of starting an abortion in one state and finishing it in another sounded like a practice from bygone decades: "This is the kind of thing you would think of when abortion was illegal."
Meanwhile, the anti-abortion group Operation Rescue posted a letter to Attorney General Douglas F. Gansler on its website. The letter, dated Sept. 1, calls on Gansler to investigate and file appropriate criminal charges against Brigham "for the unlicensed practice of medicine and possible fraud for falsely representing to patients" that he was licensed in Maryland.
The letter, which Gansler's office said it had not received by Tuesday afternoon, mentions the 1994 revocation of Brigham's medical license in New York State for "gross negligence," among other sanctions meted out over the past 18 years.
"In light of the fact that Brigham's actions have endangered the public and because he appears to be a scofflaw on whom normal discipline has little effect, we ask that he be charged criminally and be held to full accountability under the law," said the letter from Cheryl Sullenger, senior policy advisor.
Dunne, Brigham's lawyer, said the Maryland board's findings told "only a part of the story." He also said that while New York revoked Brigham's license and that Brigham voluntarily surrendered his license in Pennsylvania, he remains licensed to practice medicine in New Jersey.
Maryland health authorities say an investigation is continuing but said their regulatory reach was limited. "By state law, we do not and cannot license doctors' offices," said David Paulson, spokesman for the Department of Health and Mental Hygiene.
Doctors themselves are licensed by the Board of Physicians, and the department's Office of Health Care Quality has oversight over more sophisticated surgical centers. But Paulson said there was no state licensing of run-of-the-mill doctor's offices, except those with on-site laboratories.
Pennsylvania law, by contrast, gives its health authorities greater power. That is what allowed the Department of Health to order Brigham to close his doors there.