By Marie McCullough
Posted on Tue, Sep. 21, 2010
Inquirer Staff Writer
For more than a year online, "Grace Medical Care" has advertised abortions up to the last few weeks of pregnancy. It said it's located in a Philadelphia suburb, yet kept the address secret. And it has operated without the knowledge of state regulatory authorities.
Now, for the first time, the New Jersey Attorney General's Office says the person behind the clandestine enterprise is Steven Chase Brigham, the physician being investigated by New Jersey and Maryland on suspicion of licensing and criminal offenses.
Brigham's attorney, Joseph Gorrell of Roseland, N.J., did not return a call or e-mail requesting comment.
Brigham, 54, who has been in and out of trouble for much of his two-decade career, operates at least a dozen abortion clinics in New Jersey, Pennsylvania, Maryland, and Virginia under the name American Women's Services.
He has many other "entities," including Grace Medical Care, also called Grace Medical Services, say the attorney general's Sept. 8 charges.
Variations of Grace Medical turn up repeatedly in late-term abortion records recently seized from Brigham's offices.
Authorities said he initiated those abortions in the Voorhees headquarters of American Women's Services, then finished them the next day in Elkton, Md. - a scheme authorities say was designed to evade outpatient-surgery rules.
New Jersey is also looking into why state agencies that oversee businesses and medical facilities have no records for Grace Medical, said the attorney general's spokesman, Paul Loriquet.
Grace Medical remained a mystery even to doctors recruited by Brigham over the last year to work in Elkton, transcripts of interviews with investigators show.
Kimberly Walker, a young doctor who began training with Brigham in January, told investigators: "He basically calls the later-[term] cases, he calls them Grace patients. I don't know what Grace means."
George Shepard, an 88-year-old Delaware gynecologist hired as medical director at Elkton, was asked by investigators whether the Elkton facility was called "Grace something."
"I've heard the word Grace, but I'm not sure that they call it that," he responded. "All I know is Elkton."
The latest inquiry was launched after one of Brigham's bistate abortions went awry. An 18-year-old New Jersey woman who was 21 weeks pregnant suffered life-threatening complications Aug. 13 and had to be airlifted from Elkton to Johns Hopkins Hospital in Baltimore. She and a Hopkins physician later filed complaints.
Investigators soon discovered that Brigham has never had a medical license in Maryland. They also seized 35 frozen fetuses and fetal parts from Elkton, but they could not find medical records for 33 of those abortions either in Elkton or Voorhees.
Brigham has a hearing scheduled for Oct. 13 before the New Jersey Board of Medical Examiners to say why he should not lose his medical license there, the only state where he still has one. Pennsylvania, New York, and Florida took away his practice privileges in the 1990s.
Although Grace Medical Services was a regulatory phantom, it caught the attention of other abortion providers last summer. They were startled because its online ad explicitly offered "abortions up to 36 weeks" - two weeks shy of a full-term delivery - a risky procedure most doctors are loath to perform. The website said payments had to be in cash, while practically all providers accept health insurance. And not only was no address listed, but Grace Medical's phone receptionist would not readily divulge it.
Even in this era of heightened security amid fears of antiabortion violence, the secrecy seemed intended to hide the clinic, not protect it, said Vicki Saporta, president of the National Abortion Federation. The trade group, whose members must meet care standards, has long excluded and criticized Brigham.
Grace Medical's website says it is in a suburb "just minutes from Philadelphia" in a "multi-story, multi-practice professional building." That fits Brigham's Voorhees headquarters.
The Voorhees facility, as well as his five other New Jersey locations, has never been approved to perform abortions beyond 14 weeks, when the fetus becomes too big to be extracted by mechanical suction. The charges explain the reason why: The clinics do not meet state safety requirements for outpatient surgery. Brigham has no hospital privileges if a patient needs emergency care. And he does not have certification from the Board of Medical Examiners, which requires doctors doing late abortions to have "superior training."
To skirt these rules, the charges say, Brigham exploited the complicated medical protocol used for late abortions: On the first day in Voorhees, he inserts absorbent rods to slowly widen the patient's cervix over 24 hours, and gives the fetus a lethal injection of digoxin. On the second day in Voorhees, the patient receives a labor-inducing drug called Cytotec. Then the patient and her driver follow Brigham to the Elkton clinic, where he dismembers and extracts the fetus.
The 18-year-old - one of three patients on Aug. 13 - told investigators their hour-long car caravan to Elkton was a surprise because she had been led to believe Voorhees staff would take her to a surgery center in Philadelphia.
"Transportation in a private vehicle for completion at a distant location is dangerous to the patient," the charges say.
Brigham falsified recovery room records to make his Elkton abortions appear to have been performed by Shepard or Walker, authorities allege.
Those records list terminations up to 33 weeks of pregnancy and payments, most ranging from about $900 to $2,600. Some patients are identified with the notation "Grace."
Maryland has temporarily suspended Shepard's license for aiding Brigham. It has also suspended Nicola Riley, a Utah physician whom Brigham hired in July to work part-time. No disciplinary action has been taken against Walker.
Under Brigham's guidance, Riley did the abortion that left the 18-year-old with a hole in her uterus and bowel, authorities say. Riley's three-page summary is handwritten on forms headed "Grace Medical Services."
Maryland has few restrictions on abortions performed after the fetus is "viable" - meaning able to survive outside the womb, at about 24 weeks. It allows such abortions to preserve the mother's health, or if the fetus has a serious abnormality.
Grace Medical's website says it specializes in caring for women who need late abortions because of maternal or fetal health problems.
Records released Monday of three post-viability abortions show one involved a 33-week-old Down's syndrome fetus, for which Grace Medical charged $21,900. But another case involved 25-week-old twin fetuses that the parents wanted to abort because they felt "stress" and regret that they had conceived through fertility treatment with donated sperm. In a third case, no health problems were documented - until the 20-year-old Pittsburgh woman could not go to the bathroom because of the absorbent rods.
She wound up being rushed from her hotel, in labor, to Virtua Hospital in Voorhees where she delivered a dead fetus.
Brigham has a history of doing abortions that straddle state lines. That was one of the reasons New Jersey restricted his license in 1993. He was accused of malpractice and incompetence in six abortions, including one started in his Voorhees clinic and completed in a facility he ran in New York at the time.
Brigham's license was stripped in New York, but in New Jersey, he got it restored after three years of appeals.
Back then, the prosecutors argued that Brigham's insertion of the absorbent cervical rods, called "laminaria," was tantamount to doing a late abortion in Voorhees. An administrative judge ultimately disagreed, saying the rules did not address the use of dilators.
This time around, investigators have documents that show Brigham not only inserted laminaria, but injected a drug to kill the fetus and gave another drug to induce labor - all in Voorhees.
Investigators also cite the consent forms that Brigham's patients must sign.
"Remember that your abortion really begins," says one form, "when the laminaria is inserted into your cervix."