The violations found by state investigators didn't present "an immediate and serious threat to the health and safety of patients," the letter to the committee chairs said. Common deficiencies were failures to document the professional credentials of doctors and to include the condition of patients at discharge in medical records.

In one example from state records, inspectors found that a staff member at Planned Parenthood of Maryland's Baltimore clinic was not trained on transferring a patient to a hospital in an emergency. The inspection found medical records for five patients that did not include their condition at discharge.

The facility has since added discharge information to medical records, including check boxes that indicate a completed or incomplete abortion, state records show. Random chart audits now look for discharge diagnosis.

In a statement Friday, Planned Parenthood said a patient's discharge diagnosis had been included previously but wasn't clearly labeled. As for the improperly trained staff member, it said she was on medical leave and her file was not updated at the time of the inspection. Documentation of all of training was entered into her personnel file, including her training on emergency transfer of a patient to the hospital, before she returned to work.

"Planned Parenthood of Maryland welcomes appropriate regulatory steps that help ensure patient safety in medical facilities across the state," the group said in a statement.

Planned Parenthood said its staff reported the incident that led to the state investigation of OB/GYN Care. Because of privacy laws, the group could not say if the woman ultimately got an abortion at its facility.

According to the state account, the doctor at OB/GYN Care gave the patient three options after refusing to perform the procedure.

He told the patient she could be taken to a OB/GYN Care facility in New Jersey to have an abortion performed under general anesthesia or go to a local hospital to have the procedure completed, state documents said. He also said gave her the option of traveling two days later to the clinic in Frederick to get additional Misoprostol and a type of seaweed to dilate the cervix. The woman could then have a procedure the following day in Baltimore and a second one if needed a day later in Cheverly or Silver Spring.

The woman ultimately underwent an abortion with no complications, according to the state report, which didn't say where.

While there were no "serious and adverse" effects, state investigators said the actions by OB/GYN Care posed "a serious and immediate danger to patients."

Sen. Thomas M. "Mac" Middleton, chair of the Senate Finance Committee, said he was pleased with how the new regulations were working.

"When you are talking about abortion procedures, you are talking about a very, very serious procedure," the Charles County Democrat said. "A lot of complications could arise, and there has to be the proper medical oversight and it has to be done safely."

Del. Nic Kipke, an Anne Arundel County Republican, said that the state has made some strides with the new regulations but that weaknesses remain in the system.

He said there are abortion clinics that advertise on the Internet but are not licensed by the state.

"The Office of Health Care Quality is moving in the right direction to protect women, but the state can do more," Kipke said.

Sharfstein said state investigators are working to find facilities that should have licenses.

"We are actively investigating whether there are clinics that aren't licensed and should be," Sharfstein said.

andrea.walker@baltsun.com

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