Bucking Trend, Md. Avoids Partisan Fight Over Abortion Clinic Safety

July 11, 2013 — In contrast with many other states, Maryland officials have avoided heated political battles over new abortion clinic standards by focusing on safety and proper medical care, rather than restricting access to the procedure, the New York Times reports.

Maryland adopted new licensing and inspection requirements in response to complaints about a substandard abortion provider operating in the state. The Times notes that despite the existence of doctors who break the law or defy medical guidelines, the medical record for abortions in the U.S. shows that the procedure is safe overall. There were 10 deaths from abortion-related causes out of 1.2 million procedures in 2010, according to CDC. David Grimes, a professor of obstetrics and gynecology at the University of North Carolina School of Medicine and a former chief of abortion surveillance at CDC, described having an abortion as "safer than an injection of penicillin." Data from the Guttmacher Institute show the risk is lowest early in pregnancy and increases as gestation advances.

In the Maryland case, the state medical board in 2010 began gathering evidence against physician Steven Brigham -- who already was barred from practice in New York and Pennsylvania and the subject of decades of complaints -- in connection with an abortion procedure that ended with emergency hospital intervention.

The officials learned that for months Brigham had been circumventing state authorities in New Jersey by taking patients across state lines to perform abortions at various stages. In one case, Brigham initiated an abortion at about 21 weeks of pregnancy at his clinic in New Jersey, then helped transport the patient 60 miles to Maryland, where a physician with limited experience in second-trimester abortions attempted to complete the procedure. There were serious complications and the woman was taken to an emergency room and required transport by medevac helicopter to another hospital.

About the Rules

Unlike in many other states, the Maryland regulations were developed by health officials, not lawmakers. The officials solicited input from medical groups, abortion clinic managers and leaders of antiabortion-rights groups.

"Both sides realized we needed new rules," said Frances Phillips, who recently retired as Maryland's deputy secretary for public health. She added, "But we kept the focus on patient safety."

Also unlike some other states, Maryland's rules do not specify the width of hallways, the size of janitors' closets or the number of parking spaces outside -- requirements that clinics say have nothing to do with improving safety. The rules also do not require abortion providers to have admitting privileges at local hospitals. Maryland officials concluded that in emergency situations, hospitals are best equipped to provide care and that clinic doctors can advise hospital staff without having admitting privileges.

The new rules require abortion providers to be licensed and undergo regular inspections. The rules also prohibit physicians who have violated state licensing rules from operating clinics.

So far this year, Maryland officials have identified easily correctable sanitary and records violations in several clinics, as well as more severe deficiencies at four clinics that posed "a serious and immediate danger to patients." Officials suspended the licenses of the four clinics.

The four clinics run were by Associates in Ob/Gyn Care, which has ties to Brigham, according to an investigation by the Times. Maryland regulators also are looking into a possible link between the clinics and Brigham.

Positive Response From Both Sides

Both supporters and opponents of abortion rights seem satisfied with the Maryland regulations, the Times reports.

Officials at Planned Parenthood of Maryland said the licensing rules are reasonable and have been helpful.

Jeffrey Meister, legislative director of Maryland Right to Life, said that while his group lobbied for stricter, surgical-center standards, the new rules are "a step in the right direction" (Eckholm, New York Times, 7/10).