For Decades, Authorities Let Rogue Abortion Provider Harm Women, Despite Pleas From Legitimate Doctors
On August 13, 2010, an 18-year-old New Jersey resident arrived in a clinic in Elkton, Maryland, to undergo a surgical abortion. She was 21-and-a-half weeks pregnant, and had driven just over an hour from a clinic in Voorhees, New Jersey, where the day before, Dr. Steven C. Brigham had initiated the procedure.
Just 15 minutes into the surgery in Maryland, the patient suffered major injuries. Her uterus was ruptured, and her bowel had been perforated and was protruding into her vagina.
Instead of immediately calling 911 for emergency assistance, her doctors—Brigham and his associate, Nicola I. Riley—waited nearly two hours, according to findings from the Maryland State Board of Physicians. They then dressed the patient, who was still sedated and slumped over, and lifted her into a wheelchair. They rolled her outside, put her in a car, and with Brigham at the wheel, took her to a nearby hospital. Her injuries were so severe that hospital staff had her airlifted to Johns Hopkins Health Center for emergency treatment.
The patient survived, and as was reported Thursday morning in the New York Times, her story now forms a key part of the evidence that is being used in an administrative proceeding brought by New Jersey's attorney general to have Brigham's medical license permanently suspended or revoked.
However, what has not yet been reported is the extent to which legitimate providers in the states where Brigham practiced went to warn state officials of the threat Brigham posed to the health of the women he served.
In numerous complaints, emails and phone calls over a period of more than two decades, legitimate abortion providers from New Jersey and neighboring states alerted authorities to Brigham's dangerous conduct, furnishing warnings they say went largely unheeded. Doctors provided copies of many of these complaints, as well as extensive logs of their calls, to RH Reality Check.
An investigation by RH Reality Check shows that New Jersey officials responsible for overseeing healthcare in that state could have prevented injuries to this and subsequent patients, had they acted on warnings about Brigham that predicted this exact scenario.
"If they had listened right in the beginning and taken appropriate action, I think these harms would have been prevented," Jen Boulanger, a clinic administrator who has spent years amassing complaints about Brigham and his associates, told RH Reality Check. "I think state agencies were afraid of raising eyebrows about abortion, but they just should have handled it like they do any other field of medicine."
A spokesman for the New Jersey attorney general's office, which has ultimate oversight of the New Jersey Board of Medical Examiners, said the office could not comment on Brigham, because of the ongoing dispute over his medical license.
Attempts to reach Brigham, as well as attorneys listed as his representatives on official documents, were unsuccessful.
Brigham has now had his medical license suspended or revoked in up to six states, but public records show that he remains at the helm of an abortion chain called American Women's Services, which is based in New Jersey, and owns or is affiliated with 15 clinics in four states. There is no requirement that the owner of a medical facility actually possess a medical license, state officials said.
The issue of abortion has once again leapt to the forefront of state and national politics. Already this year, dozens of anti-choice laws have been proposed or have passed at the state level, and a 20-week abortion ban recently passedin the U.S. House of Representatives.
Anti-choice advocates, including activists, and state and federal politicians, have capitalized on the case of another rogue provider—Kermit B. Gosnell—to falsely claim that he represented the norm in abortion care.
TIMELINE OF EVENTS
1986: Brigham graduates from Columbia University College of Physicians and Surgeons. In the coming years, National Abortion Federation leaders grow concerned about his skill level. Brigham fails to complete his NAF training, and his application for membership is denied.
APRIL 1992: Brigham agrees to voluntarily retire from practicing medicine in Pennsylvania in exchange for the state dropping a pending investigation regarding him. His license is placed on permanent inactive status, and he is ordered not to ever apply for renewal or reinstatement.
NOVEMBER 1993: The New Jersey attorney general's office files its first complaint about Brigham with the board of examiners. Two more complaints are filed in July and December of 1994.
JANUARY 1994: New York suspends Brigham's license, calling him an "imminent danger to the health of the people of New York."
FEBRUARY 1994: New Jersey restricts Brigham's license, determining that his unrestricted practice presents a clear and imminent danger to the people of New Jersey.
NOVEMBER 1994: New York revokes Brigham's license, finding him guilty of gross negligence and negligence on more than one occasion in practicing medicine.
FEBRUARY 1995: Florida suspends Brigham's license.
JUNE 1996: Florida revokes Brigham's license.
AUGUST 1996: Upon a favorable ruling by the Office of Administrative Law on the three complaints filed by the New Jersey attorney general, New Jersey reinstates Brigham's medical license subject to conditions that Brigham only perform abortions during the first trimester of pregnancy in the state.
SEPTEMBER 2005: A complaint lodged online by a doctor with the New Jersey Board of Medical Examiners warns that Brigham was performing second-trimester abortions in New Jersey.
SEPTEMBER 2009: Pennsylvania bans Brigham from owning or running abortion clinics in Pennsylvania.
FEBRUARY 2010: A group of New Jersey doctors, abortion clinic administrators, and counselors send a collection of complaints to the enforcement bureau of the New Jersey attorney general's office and to William Roeder, executive director of the New Jersey State Board of Medical Examiners.
AUGUST 2010: An 18-year-old patient is injured at Brigham's Elkton, Maryland, abortion clinic and is airlifted to Johns Hopkins Health Center for emergency treatment. Maryland issues a cease and desist order to Brigham, demanding that he stop practicing medicine in Maryland without a license.
OCTOBER 2010: New Jersey suspends, but does not revoke, Brigham's license.
FEBRUARY 2013: A patient dies at Brigham's Baltimore abortion clinic.
The documents provided to RH Reality Check, however, show that reputable providers tried for years to sound the alarm on a rogue provider. In Brigham's case, they made sustained efforts to prompt officials in New Jersey, Pennsylvania, and Maryland to enforce the regulations that already existed to ensure safe abortion care. The documents provided show that authorities were often slow to respond to those warnings, if they acted at all.
For the providers who spent years trying to stop the problems they saw at Brigham's clinic, the fact that he is still involved in women's health—and being used as justification for restricting access to abortion—signals systemic problems with how the authorities and politicians treat reproductive health issues. They also said they believe many of these new legal restrictions—in addition to being medically unnecessary—could push more women into the hands of rogue providers, such as Brigham or Gosnell.
"It's heart-breaking," said Claire Keyes, who worked for more than 30 years as director of the Allegheny Reproductive Health Center in Pittsburgh, where she treated dozens of patients who had been to clinics owned by Brigham. "This isn't throwing women under the bus. This is like backing up over and over and over them."
A Long History of Problems
Brigham had already accrued a long history of harming patients by the time he botched the abortion in 2010.
Over a period of more than two decades, Brigham has left patients with severe bowel injuries, severed ureters and sweeping lacerations to the uterus, and requiring emergency hysterectomies for procedures that, when done by a properly trained provider, has a very low risk of complication, public records show.
In fact, Brigham first came to the attention of national abortion providers shortly after graduating from Columbia University College of Physicians and Surgeons in 1986. His prestigious education and natural charisma led many colleagues to give him a warm welcome into the professional community.
"We were very enthusiastic about this doctor when he first came," said Suzanne Poppema, a former board chair of the National Abortion Federation (NAF) and Physicians for Reproductive Health. "He was young and socially adept and seemed to say all the right things, and asked good questions that you would expect someone just starting out to ask."
But that impression changed quickly, Poppema said. Colleagues noticed that Brigham continued to ask the same questions at subsequent meetings, which struck them as odd. And then they began to hear troubling reports about the young physician's medical practices.
"Right away we started hearing that he was moving into both early and later second-trimester abortions. And he had a complication," she said, referring to a problem with an abortion procedure.
In the hands of a skilled provider, abortion carries a very low risk of complication, even after 20 weeks' gestation, and certainly lower than the risks associated with giving birth. However, the risk of complication increases as the pregnancy progresses, and like any complex medical procedure, specialized training is required. NAF board members believed Brigham lacked those skills, and decided to confront him to express those concerns.
"I sat down with him and three other physicians, and we said to him, 'You have to promise that you will not do any second-trimester abortions until you have spent two weeks with one of our senior physicians,'" Poppema recalled.
But Poppema said Brigham never completed that training. NAF rejected his application for membership, and lodged their concerns with Pennsylvania authorities, including the attorney general and the State Board of Medicine.
By 1992, however, Pennsylvania's board of medicine had already become concerned about Brigham's conduct. In April of that year, Brigham reached a deal with the board in which he agreed never again to practice medicine in Pennsylvania. In exchange, the board dropped an investigation against him, according to court documents later filed in Florida. RH Reality Check was unable to ascertain what prompted that investigation.
"We thought that just getting his license revoked would take care of it," Poppema said. "But it turns out, it didn't do any good to revoke his license. He just goes to another state, or better yet, he figured out he doesn't need a license to open a clinic."
Indeed, two weeks after he agreed to stop practicing in Pennsylvania, Brigham botched a 23.5-week abortion in New York, leaving his patient with a lacerated uterus, a severed ureter, and a colon so damaged that she required a colostomy—a form of bowel surgery that frequently leaves patients needing an external bag to drain their digestive systems.