Maryland’s Path to an Accord in Abortion Fight


The 18-year-old woman arrived at Johns Hopkins Hospital by medevac helicopter in critical condition. Her uterus and bowel had been pierced during a late-term abortion that had started in New Jersey and ended at an unmarked, unregulated clinic in Elkton, in northeastern Maryland.The surgeons were able to repair the damage, but they were appalled by the woman’s tale of a procedure that spanned two states, a switch to an unfamiliar doctor who seemed to be learning on the job and a clinic unprepared for an emergency. They reported the case to the state medical board.

That young woman’s ordeal in late 2010 led to new scrutiny that continues today for the clinic owner and doctor who had directed her abortion, Steven C. Brigham. From a base in New Jersey, Maryland officials learned, Dr. Brigham operated abortion clinics in several states, and for two decades he had faced complaints of substandard care. He had been barred from medical practice in Pennsylvania and New York.

The near disaster in an Elkton mall led to something rare in this era of polarized abortion politics — sharply tightened oversight of Maryland abortion clinics that came into full force this year and won praise from both sides of the political divide. The state’s first system of licensing and inspecting the clinics has already improved patient safeguards without imposing costly burdens, defenders and opponents of abortion rights agree.

“We were shocked with the findings in the Brigham case, and we saw an important gap,” said Frances B. Phillips, who recently retired as Maryland’s deputy secretary for public health.

Once-obscure issues of clinic regulation are a new flash point in the abortion wars, exemplified by the restrictive billnow moving through the Republican-controlled Legislature in Texas, on Wednesday passing in the House. In addition to banning abortions after 20 weeks of pregnancy, the Texas bill, in the name of safety, would require all abortion clinics to meet the costly standards of ambulatory surgical centers, which could force dozens of clinics to close.

The bill, which would also mandate that abortion doctors obtain admitting privileges at local hospitals, is part of a wave of stringent rules on abortion facilities, equipment and staffing in 29 states, promoted by anti-abortion groups that often cite the squalid practices of Dr. Kermit Gosnell in Philadelphia, who was convicted of murder this year.

If the goal is to make abortions as safe as possible, the new Maryland rules — which were negotiated not by politicians, but by health officials in consultation with medical groups, clinic managers and anti-abortion leaders — may offer a different path.

Dr. Brigham, who was not licensed to practice in Maryland, had not even been required to notify the state health department when he set up the Elkton center to complete late-term abortions, after about the 14th week of pregnancy. He initiated the procedures in New Jersey, where he was not authorized to perform them, then led his startled patients to Maryland, where the abortions were completed.

“Both sides realized we needed new rules,” Ms. Phillips said. “But we kept the focus on patient safety.”

The Maryland regulations are not as rigid as those in some states: they do not dictate the width of hallways, the size of janitors’ closets or the number of parking spaces outside. Rather, they look at the goal: Is there a sound plan, for example, for rapid evacuation if a patient has a medical emergency?

The state also did not require abortion doctors to have local hospital admitting privileges, a measure that threatens to shut down clinics in several states. Officials concluded that in emergencies, hospitals are best equipped to provide care anyway, and the clinic doctor can advise the hospital staff without holding admitting privileges. Under the new rules, Dr. Brigham would have been required to seek a clinic license before operating his center in Elkton and his procedures would have been scrutinized.

“Maryland took a thoughtful approach that reflects a balance between ensuring access to service but also protecting public health,” said Heather Howard, a former commissioner of the New Jersey Department of Health and Senior Services and now a lecturer at Princeton University.

A Safe Procedure Over All

While the existence of abortion doctors with illegal or haphazard methods can never be ruled out, the medical record for abortions in the United States indicates the procedure is quite safe over all. Ten women died of abortion-related causes out of 1.2 million procedures in 2010, according to the Centers for Disease Control and Prevention; the number of deaths in 2009 was 12.