On the morning of Aug. 13, an 18-year-old woman 21-weeks pregnant entered a nondescript Elkton medical facility with her mother and boyfriend.
Three hours later, she woke up in the emergency room of Union Hospital with a hole in her uterus that required emergency surgery, according to the Maryland Board of Physicians.
As the details of what happened at Dr. Steven Chase Brigham's abortion practice emerge, the case has become as much about the state of abortion law in Maryland as it is a glimpse into a peculiar scheme by a controversial New Jersey doctor.
Both sides of the abortion debate tend to agree Maryland is one of the least restrictive states in the country in terms of procedural regulations.
"The state respects a woman's right to make her own decisions about an unwanted pregnancy while providing good access to safe practices," said Vicki Saporta, president of the National Abortion Federation, an abortion rights organization.
"Maryland has some of the most permissive abortion laws in the country, in fact, it ranked fifth in the country in a recent National Abortion and Reproductive Rights Action League poll," said Jeffrey Meister, the director of administration and legislation at Maryland Right to Life, an anti-abortion organization.
Maryland is only one of three states in the nation that does not require abortion providers to report procedures. As a result, the data collected by the Centers for Disease Control and Prevention is incomplete.
Statistics collected every five years by the Alan Guttmacher Institute are considered more accurate according to both organizations, despite the institute's stated mission in favor of reproductive rights. The reason is that institute contacts abortion providers and public sources directly.
"We don't have a lot of options, so we have to depend on the Guttmacher stats in Maryland," Meister said.
According to the latest Guttmacher report, released in 2005, more than 38,000 of 131,300 pregnancies in Maryland, or 29 percent ended in abortions, compared to 30 percent in New Jersey, 16 percent in Pennsylvania and 19 percent in Delaware.
Maryland prohibits abortion after the gestational term of viability, commonly accepted in other states at around 24 weeks, except in cases of life or health endangerment. The reality is complicated by the 1973 "Doe vs. Bolton" Supreme Court ruling, however, in which a woman's health was determined to include "all factors - physical, emotional, psychological, familial, and the woman's age - relevant to the well-being of the patient." A physician can justify an abortion after viability if the child were to impact a mother's health under that definition, Meister said.
Minors seeking abortions in Maryland only need to notify one parent of their intentions, but do not need their consent. The minor's physician is able to waive that notification requirement if the minor does not live with a parent or guardian, if notification may lead to physical or mental abuse, or if they deem the minor is capable of giving informed consent to the procedure.
New Jersey technically has no abortion statutes on its law books and abortion is legal there throughout all stages of pregnancy. Brigham was not able to perform abortions after 14 weeks, however, because his New Jersey facilities do not meet the state's safety regulations for outpatient surgery, the state attorney's general office said.
Meister believes this may be one reason why Brigham would choose to run facilities in Maryland for late-term abortions.
"Abortion facilities basically get a pass from the regulatory laws on Maryland's ambulatory surgical centers," Meister said. "(Brigham) is using our lack of oversight to perform these procedures without the safety net the regulations would supply."
Brigham retains a medical license in New Jersey after losing his medical licenses to revocation, forfeiture or expiration in New York, Pennsylvania, Florida, Georgia and California.
He currently owns a chain of 15 American Women's Services abortion clinics in Pennsylvania, New Jersey, Maryland and Virginia.
Recently, the New Jersey Attorney General's office filed a complaint with the state's medical licensing board accusing Brigham of illegally performing late-term abortions there. The complaint alleges that Brigham initiated late-term abortions in New Jersey because that was where he administered drugs that begin the abortion procedure.
Officials with the New Jersey Attorney General's office have said they are seeking to revoke or suspend Brigham's New Jersey medical license for trying to circumvent state laws by taking patients to other states to complete abortions.
Brigham has denied that administering the drugs counts as performing abortion, because a New Jersey administrative judge made that ruling in a previous case against him in the early 1990s.