A botched abortion on an 18-year-old woman has led state medical officials to suspend the licenses of two doctors and to order a third — who was never licensed in Maryland — to stop practicing medicine in the state.
The Maryland Board of Physicians took action against the three after the woman was found to have suffered a ruptured uterus and other internal injuries during a procedure Aug. 13 in the American Women's Services clinic on Elkton's East High Street. The board says it was alerted by Elkton police and a surgeon at Johns Hopkins Hospital in Baltimore, where the critically injured patient ended up.
According to board documents, when the operation went awry, the drowsy, bleeding woman was placed by two of the doctors into the rear seat of a Chevrolet Malibu — and not in an ambulance, as her mother and boyfriend had urged — and driven to the emergency room of Elkton's Union Hospital. Once there, police said later, her condition required that she be transferred by helicopter to the Baltimore hospital, where she underwent emergency surgery to repair the damage.
The incident, first reported in The Philadelphia Inquirer, resulted in the suspensions Tuesday of Nicola I. Riley, 45, who had been licensed to practice medicine in Maryland for six weeks, and George Shepard Jr., 88, an obstetrician-gynecologist who helped run the five Maryland clinics of American Women's Services. The company has additional clinics in Virginia, Pennsylvania and New Jersey.
The doctor ordered to cease practicing in Maryland is Steven C. Brigham, 54, who state officials say owns the chain of clinics and who had previously run afoul of medical authorities in Pennsylvania and New York. The board lists five clinics in Maryland, in Baltimore, College Park, Frederick, Cheverly and Elkton.
Jason L. Allison, a lawyer in Elkton retained by Shepard, said Friday that he and his client were "reviewing the board's allegations and the facts" and that he was "confident that Dr. Shepard's license will be reinstated." Lawyers for Brigham and Riley did not respond to requests for comment.
Board investigators said they discovered that the 18-year-old woman, who was 21 weeks' pregnant, and two other patients were initially treated at an AWS clinic in Voorhees, N.J., where their cervixes were dilated and other preparations made for abortions. The next morning, according to documents from the physicians' board, the women were told to travel in their own cars in a convoy — with Brigham in the lead — to the AWS clinic in Elkton, a 60-mile trip, where the procedures were to be concluded.
The physicians' board did not speculate why Brigham split the abortion procedures between two states. But it criticized the arrangement, saying that it "potentially placed the patients at grave risk for harm and catastrophic outcomes."
Interviewed days afterward by Maryland authorities, the woman — who is not identified in board documents — recalled Riley "administering medications to her at Dr. Brigham's direction," and that she then passed out, the documents say. She remembered regaining consciousness later at Union Hospital.
In the meantime, the documents say, Riley had perforated the patient's uterus and suspected that she might have also injured the woman's bowel. Riley emerged from surgery and informed the woman's mother and boyfriend that she "would have to be transported to the hospital," although the doctor "refused to call for an ambulance," the documents say.
Riley contemplated using a wheelchair to take the woman to the emergency room, about two blocks away, according to the documents, "but ultimately decided to drive her there." The patient was helped into Brigham's rented Malibu, with Riley at her side and Brigham at the wheel.
Outside the emergency room, the patient was placed in a wheelchair, where she sat "slumped over, in a state of semi-consciousness" while Riley insisted on getting the identities of hospital staff members who had emerged to attend to the patient, and demanded to speak with a doctor. At the same time, according to the documents, Riley and Brigham "were circumspect about who they were, what had happened and from where they had come."
The suspension order for Riley says that her decision to transport the patient in a car and not an ambulance showed "poor judgment" and "placed her patient in potential life-threatening danger." It added that her behavior at Union Hospital "delayed or otherwise impeded emergency staff" from treating the woman.
Riley, who holds medical licenses in Utah and Wyoming, was only recently hired by Brigham and obtained her Maryland license on July 20. After the helicopter bearing the patient took off for Baltimore on Aug. 13, Riley returned to the AWS clinic in Elkton to perform another abortion, the suspension document says.
It goes on to accuse Riley of working for a person she knew to be unlicensed in Maryland — Brigham — and says she is "a danger to the public, her patients and the profession of medicine."
The language in Shepard's suspension is less severe but accuses him of "unprofessional conduct" in working for an unlicensed boss and participating in an arrangement in which patients are instructed to drive across state lines to complete abortions. Shepard told investigators that Brigham "comes down from New Jersey" and performs first- and second-trimester abortions in Elkton, according to the documents.
Lt. Matthew J. Donnelly, a spokesman for the Elkton Police Department, said that on Aug. 17 his department executed a search-and-seizure warrant on the AWS clinic on East High Street, seeking the woman's medical records. The records were not found, but officers located fetuses in a freezer and took them to the state medical examiner's office in Baltimore. The board documents say there were 35 later-term fetuses, some of them later determined to be from 20 to 35 weeks old.
An article in Friday's Philadelphia Inquirer reported that Brigham's four New Jersey clinics cannot provide abortions after the first trimester — 14 weeks of pregnancy — because they do not meet state safety requirements for such risky outpatient surgeries. The newspaper also said that for years Brigham has performed the first phase of such abortions — typically the dilation of the patient's cervix over a day or more — in New Jersey and sent patients to another state for the surgery.
In July, the Pennsylvania Department of Health revoked Brigham's permission to own clinics in that state because he had repeatedly employed unlicensed caregivers, a decision he is appealing, the Inquirer reported. The newspaper added that Brigham himself cannot perform medical procedures in Pennsylvania, the result of a confidential 1992 agreement in which he agreed to give up his license.
Brigham is licensed to practice in New Jersey. His New York license was revoked for "gross negligence" on more than one occasion, the Maryland board's documents say.
John Nugent, president and CEO of Planned Parenthood of Maryland, said Friday he was perplexed about what had compelled Brigham to bring his patients to Maryland.
"Based on the limited information that we have, there are some missing pieces there," Nugent said. "I think he was just unscrupulous. I don't think it was anything special about Maryland, other than that it was the next state, and he wasn't in trouble here yet."
Johns Hopkins — where the 18-year-old woman was taken for treatment — declined to comment on the matter, saying it was under investigation.
Baltimore Sun reporter Erica L. Green contributed to this article.