The Pawnshop Abortion Doctor

There's a lot of conversation, this week, around my old colleague Ross Douthat's column on marriage, abortion and birth control. I think that conversation could benefit from Eyal Press' profile, in this week's New Yorker, of Dr. Steven Brigham. This is not a piece rooted in theory and hypotheticals about a future where women lack control over their bodies. This is a piece of reporting that demonstrates what the world of back-alley abortions would like, because that world is already here: February, 2010, the New Jersey Board of Medical Examiners and the New Jersey Attorney General’s office received packets of letters about an enterprise called Grace Medical Care, whose Web site advertised second- and third-trimester abortions but failed to provide potential patients with basic information, such as the location of the facility. The letters came from staff members at the Cherry Hill clinic where Jen Boulanger works. Elizabeth Barnes, the clinic’s director, informed the board that she had learned that Grace Medical Care, at a facility in New Jersey, was initiating cervical dilation in patients with advanced-gestation fetuses; later, the patients were driven to another state—most likely Maryland—for surgery. Why the elaborate protocol? In New Jersey, after the fourteenth week of pregnancy, an abortion had to be performed in a licensed ambulatory facility or in a hospital, to insure safety. Maryland had no such rule. New Jersey officials did not respond to Barnes.

Several months later, on August 13th, a procession of cars drove south from Voorhees, New Jersey, through Delaware, and across the Maryland border. Among the passengers was an eighteen-year-old African-American girl who was twenty-one weeks pregnant. The convoy stopped outside an unmarked storefront in Elkton, Maryland. Inside, Nicola Riley, a physician the girl had never met before, performed an abortion while another doctor—Steven Brigham, the founder of Grace Medical Care—observed. Riley seemed to be training on the job, the patient later told a Maryland investigator. During surgery, the girl’s uterus was perforated and her bowel was damaged, and she was taken by car to a local hospital. She eventually had to be airlifted to Johns Hopkins Hospital. (The girl, who spent a week in the hospital, declined to be interviewed.)

A few days afterward, a detective in Elkton got in touch with the Maryland Board of Physicians to find out if Brigham was licensed to practice medicine in the state. He was not. The police obtained a search warrant and raided the building in Elkton. Inside a dingy storeroom, officers pried open a freezer filled with red biohazard bags that contained thirty-five advanced-gestation fetuses—medical remains that had not yet been disposed of. Some of the fetuses were past twenty-four weeks’ gestation, the point of viability. This ghoulish discovery triggered a grand-jury investigation, and in December, 2011, Brigham was arrested and charged with ten counts of murder. A week or so later, he was released, after posting bail of half a million dollars.

The story is chilling. Brigham claimed to be trained by people who don't remember him. He overcharged patients (accepting jewelry and personal property as collateral) and injured women. And our current geography insures that men like him (and the notorious Kermit Gosnell) will continue to exist:

In Maryland, a medical abortion generally costs about three hundred and seventy-five dollars. LeRoy Carhart, the doctor who had worked closely with George Tiller, told me that for a clinic that uses methotrexate “the profit margin is huge.” Carhart, now seventy-two, is an avuncular man with a shock of gray hair and soft pouches beneath his eyes. Based in Omaha, he flies to Maryland every week to perform surgery at the Germantown clinic. Since Tiller’s murder, there are only four doctors in the country who openly provide third-trimester abortions. Carhart told me that, the next day, he was seeing patients in Indiana. When wasn’t he working? “Never,” he said. “When George died, that was the last time I had time off.”

Since Carhart started performing abortions, in 1988, the number of abortion providers in the U.S. has fallen by a third—a decline that he attributes to protesters. “They have made it so the good physicians don’t really want to get involved,” he explained. “Now you have two types of doctors doing abortions—the doctors who are totally committed to women’s health and are going to do them even if they never get another dime, and the people that just want to take advantage of the situation and milk everything they can out of it.

Reading this piece, it's hard to avoid the conclusion that terrorism sometimes works. If you truly believe that abortion is murder, than the killing of George Tiller must be viewed as a success. The killings in the 80s and 90s may well have been bad PR for the movement. But they terrorized doctors and were essential to the broader campaign that cleaved abortion away from mainstream medicine.