In January, Philadelphia briefly became the focus of worldwide media attention when Kermit Gosnell, a West Philadelphia abortion doctor, was arrested and charged with a number of unbelievably grisly acts: In addition to presiding over a clinic with atrocious health practices, Gosnell, according to the District Attorney's Office, murdered seven babies and one woman. Prosecutors are seeking the death penalty for Gosnell, who is currently being held in prison without bail.
Not surprisingly, the news set passions aflame. Abortion opponents seized on the story, portraying it as confirmation of the evils of abortion. Pro-choice voices, on the other hand, saw in it a cautionary tale of the lack of affordable and accessible abortion options, especially for poor women.
Less talked about, however, was the haphazard, virtually accidental way in which Gosnell was finally shut down — federal agents raided his office looking for evidence of a prescription drug ring — and the question of why it hadn't happened much sooner.
Gosnell's clinic hadn't been inspected, it turned out, since 1993, despite the fact that abortion providers, women's rights advocates and even Dr. Donald Schwarz, now Philadelphia's health commissioner, had tried for years to get the state's Department of Health to do something about Gosnell. In the wake of the Gosnell revelations, state officials vowed to do better, promising to inspect all 24 abortion clinics in Pennsylvania, a process the Department of Health completed by last November.
City Paper recently obtained the results of these inspections via a public records request.
Fifteen clinics were issued "notices of deficiencies," mostly regarding relatively minor infractions. But one case among still-open facilities stood out: Six pages of violation notices were issued to a single abortion clinic — violations that have not yet been reported by the press — connected to a man named Steven Brigham.
Brigham, like Gosnell, has overseen abortion procedures in Pennsylvania for decades. Like Gosnell, he's run afoul of the law — throughout his career, in fact. And, as was the case with Gosnell, abortion providers and women's health advocates say they've alerted the state repeatedly to concerns over Brigham's clinics.
One big difference, however: These clinics are still open.
What's more, despite a recent Department of Health order prohibiting Brigham from "directly, or indirectly" owning, operating or starting an abortion facility in the state, City Paper has found that he still plays a role in at least two clinics in Pennsylvania — a revelation that has infuriated other abortion providers and women's health advocates.
The Brigham case, sums up a blunt Carol Petraitis of the Pennsylvania American Civil Liberties Union, "is bureaucratic inefficiency at its most glaring."
This article is not, by a long shot, Steven Brigham's first time in the news.
Brigham, who graduated from Columbia University's College of Physicians and Surgeons in 1986, opened one of his first abortion clinics in 1990, in Wyomissing, Pa., eventually establishing more than a dozen abortion clinics in this state, New Jersey, Virginia, Maryland and New York, including one in Voorhees, N.J., just across the Delaware.
Almost immediately, Brigham came under fire by state officials. In 1992, in fact, it appeared as though his career was over in Pennsylvania. In a confidential settlement, he voluntarily forfeited his medical license amid an investigation of his Wyomissing clinic. But instead of quitting the field, he simply moved, opening clinics in other states.
Brigham has now had his license pulled, suspended or relinquished in a total of five states. In 1994, the New York medical board found him guilty of "gross negligence" and injuring two women while conducting abortions. That same year, the New Jersey attorney general accused him of beginning abortions on women in Voorhees, N.J., and then having them to drive to New York to complete the procedure — in one case leaving a patient needing an emergency hysterectomy. Brigham allegedly waited hours to call an ambulance.
By the mid-'90s, Brigham found his way back to Pennsylvania: He couldn't practice medicine here, but he could still own abortion clinics. So he did, eventually opening Allentown Medical Services and American Women's Services–Pittsburgh among others.
As before, he began to run afoul of state guidelines. Shortly thereafter, Pennsylvania found that he employed an OB/GYN in 1997 whose license was suspended for, in part, sexually abusing patients. In 2004, the state's Department of Health found that he again employed a doctor without a license, who performed more than 1,600 abortions. In 2008, the health department discovered that, yet again, Brigham employed an unlicensed nurse. In 2010, New Jersey's medical board found that he began late-term abortions on women in that state and then drove them to Maryland to complete the procedures, in an attempt to skirt state law. One woman allegedly suffered life-threatening injuries as a result. They found no medical records for her. At Brigham's Maryland clinic, police say they found 35 late-term fetuses in his freezer — but records for only two.
Brigham declined comment for this article.
Abortion opponents have followed the activities and whereabouts of Brigham for years; he became a kind of anti-poster boy for their cause, and they've protested outside his clinics since the mid-'90s.
Choice advocates, on the other hand, see Brigham — and Gosnell — as rare exceptions who prove how little state oversight exists when it comes to abortion providers. "The state knew about Gosnell. They know about Brigham," says Vicki Saporta, president of the National Abortion Federation. "There were many complaints about both of these providers, yet they were allowed to remain open."
In fact, these choice advocates have wanted Brigham shut down as badly as the anti-abortion activists do.
Gosnell's clinic had hardly been unknown among women's health advocates who warned the state. The same advocates say they've long sounded alarms about Brigham — not, they say, to much avail. "Nobody understands why all these complaints came through with Gosnell and Brigham's clinics, and [the state] couldn't figure out a thing to do about it," says the ACLU's Petraitis.
Sarah Dittoe, who worked as a patient advocate at Brigham's clinic American Women's Services–Pittsburgh in 2004, says she contacted the health department numerous times about various incidents she says she witnessed, including one in which she says a doctor refused to call an ambulance when a patient began bleeding profusely.
"An hour and a half passed before he finally called 911," she says.
Dittoe says she shared all this, and more, to the state investigator. But, she claims, "He ... stopped returning my calls and following up with me."
Eli Kuti, another former employee of Brigham's who worked as the office manager of American Women's Services–Pittsburgh from 2000 to 2003, says she, too, contacted the health department after, she claims, discovering improperly stored medical waste. "I know that everything has to be registered and properly disposed of," says Kuti.
Kuti says she wrote five or six letters detailing this allegation, as well as many others, to state officials. But, she claims, "There was no follow-up."
Claire Keyes, who was longtime director of Allegheny Reproductive Health Center before recently retiring, says the health department hasn't thoroughly handled complaints from fellow abortion providers, as well: The "state either did not, or could not, respond" to the 20-plus complaints she filed on behalf of patients, she says.
But then last year, in the wake of the Gosnell case, women's advocates became hopeful that change was on the way. Then-Gov. Ed Rendell ordered inspections of all the state's abortion clinics, and Dr. Evi Avila, the Department of Health's acting secretary, later said at a public hearing in early 2011, "The department has instituted measures to ensure that such a public health breakdown does not occur again in our commonwealth," adding that new procedures are in place "to investigate all complaints promptly" and that "complaints will be taken from any source, even anonymously."
Months prior to this, in July 2010, the health department had ordered that Brigham could not have a "controlling ownership" or "equity interest" in any abortion clinic in Pennsylvania, citing the fact that he routinely employed unlicensed medical personnel. The order also prohibited Brigham from "directly, or indirectly" registering any abortion facility in the state. (Brigham has appealed this ruling.)
Abortion-rights advocates throughout the state say they were relieved, thinking the order would finally stop Brigham's operations. It would not.
By November 2010 — five months after Brigham was sent packing — the state's 24 clinics were finally inspected by health officials.
Brigham's "old" facilities were under "new" ownership, but they still racked up new notices of violations of state law.
In December 2010, the health department sent Allentown Medical Services six pages of "deficiencies" — more than any other open abortion clinic received — which the state released to City Paper.
The state's letter to Allentown Medical Services reveals that the facility "failed to ensure that each patient was supervised constantly while recovering from surgery or anesthesia." Several pieces of equipment "had not been inspected, certified for use and not calibrated." Many, many records were also missing.
Jen Boulanger, executive director of Allentown Women's Center, calls the missing records "very disturbing." She says, "There is no evidence that this office monitored patients during surgery nor afterward," adding, "the patient's health would be at risk if she has any difficulty breathing during the procedure."
Dittoe, who now is employed at another Pittsburgh abortion clinic, says the missing records are especially troubling given her experience working at Brigham's clinics: "Any time there was a complication, the chart ended up missing," she says. In a letter of response to the health department, the clinic's "operations coordinator," whose name was redacted, wrote that "the Department's letter involve only record-keeping issues. ... There is no evidence that any of the issues referred to by the Department resulted in any patient harm."
Meanwhile, CP has found proof that the "new" management isn't new at all.
According to the Department of Health's July 2010 order, Brigham is not supposed to have a "controlling ownership" or "equity interest" in any abortion clinic in the state. But Brigham's present role in two clinics here is unclear. The Maryland State Board of Physicians says that Brigham owns American Women's Services, which operates more than a dozen abortion clinics throughout the region and is allegedly headquartered in Voorhees, N.J. The company's two clinics in Pennsylvania go by the names Allentown Medical Services and American Women's Services–Pittsburgh.
But Brigham's attorney, Julia Gabis, says he owns neither. And the Department of State apparently agrees. Records show that in early 2010, he transferred ownership of the two clinics to Rose Health Services Co., owned by Judith Fitch. (Fitch also declined comment, through Gabis.)
In February, the Inquirer reported that Fitch is Brigham's mother.
What's more, CP has found that Brigham still holds a managerial role at those two clinics. When CP first asked two of Brigham's lawyers, Gabis and Joseph Gorrell, if he's had a role at either of the two Pennsylvania clinics following the ownership transfer, they declined comment.
Then, several sources told CP that, to their surprise, they saw Brigham last week at a mandatory health department meeting for abortion providers. Allentown Women's Center's Boulanger says that at the meeting, "Brigham introduced himself to our medical director as the Allentown office's CEO."
Holli Senior, a Department of Health spokeswoman, described the meeting's attendants as the "heads of their facility" but wouldn't release names.
Asked again about Brigham's role, attorney Gabis said, "Dr. Brigham ... does provide occasional managerial oversight. He has no ownership interest in or board position with Rose Health Services."
Brigham has made similar arguments before. In October 2010, he stood before the New Jersey Board of Medical Examiners over allegedly beginning late-term abortions in that state and then driving women to Elkton, Md., to complete them. According to the Inquirer , Brigham argued that he didn't need a Maryland license because he was simply "engaging in consultation" at the Elkton clinic. But he admitted, "I did the care."
According to state documents obtained by City Paper, other management within Allentown Medical Services remains unchanged: Donna Smith is the district manager; according to newspaper reports, she was its director as far back as 1999. City Paper asked the health department why Brigham is allowed to remain a manager at the two Pennsylvania clinics despite the July 2010 order, as well as why his mother is permitted to be the "owner." Spokeswoman Senior said that because Brigham appealed the order, "It has not yet been imposed." She declined to say if the health department is not enforcing the order by choice, or to comply with state law or a judge's ruling. That Brigham has been allowed to play an apparently "managerial" role was news to everyone in the pro-choice community with whom City Paper spoke.
"If a judge had ordered [not to impose the order], then why not tell [the media]? ... The Department of Health should be doing everything in its power to protect the lives and health of women in Pennsylvania," says the ACLU's Petraitis. "The part that I don't understand ... is that the state really did have the opportunity to shut his clinics down."
Meanwhile, as Brigham's fate here remains in legal limbo, women continue to have abortions at Allentown Medical Services and American Women's Services–Pittsburgh. Though Brigham's name has been all over the news for years, it's still easy for women to not know of his involvement in American Women's Services: The company's website doesn't list his name. It also has the lucrative number 1-888-ABORTION.
Says Saporta, of the National Abortion Federation, "He shouldn't be allowed to own or operate abortion clinics in any state in this country."
In the grand jury's 2011 report on Gosnell, investigators lay a great deal of blame on the Department of Health's lack of inspections. In the mid-'90s, it says, under pro-choice Gov. Tom Ridge's administration, the department "abruptly decided, for political reasons, to stop inspecting abortion clinics at all."
This provided an ostensibly easy way for the health department to solve the problem: Start inspecting clinics again, which it promptly did last year. But women's health advocates argue that Brigham's case proves that the health department's problems run deeper than just the need to do inspections.
Keyes, the former director of the Allegheny Reproductive Health Center, says the health department's persistent problems are somewhat a result of it losing funding years ago. When this happened, she says, the department "shrugged its shoulders and moved on" from abortion clinics, partly because of society's stigma toward the procedure.
"I don't think it was malevolent," she says. "It was just easier to ignore."
Ironically, women's rights advocates say this same stigma is what continues to drive women to Brigham's clinics: "People think they don't have many choices. Abortion is still a dirty word," says Kuti. "They think ... 'I deserve to go somewhere shitty.'"
The Department of Health, meanwhile, "is taking the necessary steps to ensure the health and safety of women seeking these services in the commonwealth," says spokeswoman Senior, noting that it has recently "adopted new procedures" to do so.
Some of these procedures are good news to abortion rights advocates — others are not. But a case like Brigham's, they argue, should be clear-cut: "If women's lives are at risk," asks Petraitis, "why is it taking so long?"