The case of a New Jersey doctor found to be illegally providing abortions in Maryland last year is prompting lawmakers and regulators to consider toughening requirements for abortion providers in the state.
In August, authorities discovered Steven C. Brigham was initiating abortions in New Jersey and instructing women to drive to his Elkton clinic to finish the procedures, though he holds no medical license in Maryland. In response, the state's Board of Physicians issued a cease-and-desist order against him and revoked or suspended the licenses of two of his Maryland colleagues.
Spurred by the board's "serious and disturbing findings," the Department of Health and Mental Hygiene is considering "additional regulatory measures" for abortion providers, said spokesman David Paulson.
The health department is in the beginning stages of examining Maryland and other states' laws and consulting with experts to determine what other regulatory measures would be appropriate, Paulson said.
Maryland law, passed in 1991 and approved by voter referendum in 1992, requires abortions to be performed by a licensed physician but establishes few other restrictions. The law authorizes the Department of Health and Mental Hygiene to regulate abortion providers, provided the regulations are the "least intrusive method" to protect women's health and in keeping with standard medical practices.
Some Maryland lawmakers hope to change that in the coming General Assembly session with legislation that would regulate abortion providers as surgical centers — a change they say would protect women but that abortion-rights advocates argue would limit access to the procedure.
"Now that it's hit home, I think it's much more convincing to people that this is not a pro-life, pro-choice issue but rather a safety issue," said state Sen. Nancy C. Jacobs, a Republican who represents the area where Brigham's practice was located.
In the House, Dels. Adelaide C. Eckardt, a Republican who represents parts of the Eastern Shore, and Pamela G. Beidle, a Democrat from Anne Arundel County, have filed a bill that would require abortion providers to register as outpatient surgical centers.
Jacobs said she plans to introduce a similar bill in the first weeks of the new session.
Surgical centers have more stringent requirements than doctor's offices or clinics, where women in Maryland can currently obtain abortions.
Those requirements include written agreements with hospitals to transfer patients in emergencies and wider doors and hallways. And surgical centers must have medical equipment, such as ventilators, which are not required in regular clinics.
Abortion-rights advocates argue that the majority of procedures do not require the emergency equipment and protocol required of outpatient surgical centers. The legislation, they say, would throw hurdles in the way of women and their doctors.
"It's disguised as a quality-of-care bill, but it's targeted for one procedure," said John Nugent, president of Planned Parenthood of Maryland. "They're putting an obstacle to women having access to abortion."
Few if any of the approximately 41 abortion providers in Maryland meet the requirements of surgical centers or could afford to replace their clinics, Nugent said.
Nugent said he would not oppose health department regulations within the confines of the state's current abortion law because he does not believe those regulations would limit access in the same way.
Any regulations considered by the health department, Paulson said, would aim to "preserve the important balance of safety and choice."
Beidle said she personally does not support abortion because of her religious beliefs but is not aiming to end the procedure in Maryland with her legislation.
"If that's a woman's choice, I'm not trying to stop her choice," she said. "But when women are dying because a clinic is not properly equipped, I think that's wrong."
Fifteen states require clinics that provide abortions to be licensed as surgical centers, said Elizabeth Nash, who analyzes state-level reproductive health policies for the Guttmacher Institute, a New York-based reproductive health think tank.
Of Maryland's neighbors, Pennsylvania requires abortion providers to have a transfer agreement with a nearby hospital but does not require them to have a surgical-center license, Nash said.
Jacobs and a group of anti-abortion lawmakers calling themselves the "Pro-Life Caucus" sponsored legislation in both chambers in 2004 that would have regulated such clinics as surgical centers. Both bills died after committee hearings.
But legislators and advocates believe that this time around, their case is bolstered by both the Brigham incident and one involving Romeo A. Ferrer, a Severna Park doctor whose license was suspended in September for giving a woman too much anesthesia and failing to resuscitate her in a 2006 procedure.