In Maryland, Brigham has been charged with practicing medicine without a license. He filed legal papers there contending that he didn't need a license because he was simply "engaging in consultation."
He asked the Maryland Board of Physicians to dismiss his case and allow him "to continue providing demonstrations, training, and assistance to Maryland doctors who seek his expertise and guidance."
The board had no comment on Friday.
Brigham, 54, owns a Voorhees-based chain of abortion clinics called American Women's Services. It operates in New Jersey, Maryland, and Virginia, and, until earlier this year, was in Pennsylvania.
He transferred his four Pennsylvania facilities to a newly created company headed by a close relative, and is appealing that state's revocation of his ownership rights for persistently employing unlicensed caregivers.
Brigham has spent much of his 20-year career fighting lawsuits and disciplinary actions. The latest investigations - which authorities say could result in criminal as well as regulatory charges - were launched after one of the bistate abortions went awry in August.
The patient, an 18-year-old New Jersey woman who was 21 weeks pregnant, suffered a punctured uterus and bowel at Brigham's Elkton, Md., clinic. She had to be airlifted to a Baltimore hospital for emergency surgery to repair her uterus and bowel. She and the surgeon subsequently filed complaints against Brigham, according to medical records and documents released by investigators.
Investigators allege that Brigham exploited the complex process of late-term abortion at the expense of patients' safety: in Voorhees, he allegedly inserted absorbent rods called laminaria to widen patients' cervixes over 24 hours or more, and gave their fetuses lethal injections. The next day, he allegedly gave the patients a drug to induce labor, then led them in an hour-long car caravan to Elkton for extraction of their dead fetuses.
One patient, documents show, didn't make it to Elkton. She began having severe abdominal pains at night in her hotel and was rushed to Virtua Hospital in Voorhees, where she delivered a dead fetus.
Prosecutors say Brigham's scheme was intended to evade New Jersey safety rules. None of Brigham's six New Jersey clinics is permitted to do abortions after 14 weeks because they do not meet outpatient surgery requirements.
In his legal papers, Brigham argues that the question of whether he may legally insert laminaria in Voorhees was decided by New Jersey regulators in 1996 - in his favor. (New York, however, revoked his medical license there for "gross incompetence" in performing late-term abortions, two of which were initiated in Voorhees.)
"The repeated investigation and harassment by [the attorney general], even after [Brigham] was exonerated by the New Jersey State Board of Medical Examiners in 1996 for the very same alleged wrongdoings that are now claimed again, raises real questions as to the good faith" of the allegations, his legal papers say.
Warhaftig, in her response, said the 1996 decision did not address his current conduct, which allegedly includes killing fetuses and giving the labor-inducing drug in Voorhees.
"If anything, those earlier actions drew a line in the sand," she wrote. Brigham "has stepped over, far over, the board's line and his conduct poses a clear and imminent danger to the public."
Warhaftig also cited records and testimony that undercut Brigham's contention that he was just "consulting" in Maryland: the completion of an abortion for a woman who was almost eight months pregnant happened on a day when a young physician Brigham was training "was not present in the clinic."
Brigham, whose New Jersey license has been temporarily suspended, has a hearing Wednesday before the New Jersey Board of Medical Examiners. The board will consider his argument that it cannot prosecute him. It will also consider the attorney general's request to strip his license for good.
Contact staff writer Marie McCullough at 215-854-2720 or firstname.lastname@example.org.