Late last year, activists on both sides of the abortion divide cheered when New Jersey regulators permanently yanked the medical license of Steven Brigham, 58, an abortion doctor they had been sounding alarms about for decades.
The action meant Brigham - whose macabre practices were found to endanger and deceive patients - was required to divest his ownership in eight clinics in New Jersey, which made up the bulk of his multistate abortion business, advertised as American Women's Services.
But Brigham's critics are not cheering the latest development: Brigham sold his interests to his medical director, Vikram Kaji, whose medical license was suspended in New Jersey and Pennsylvania in the mid-1990s for sexually abusing patients and wrongly prescribing controlled substances.
In 2013, the New Jersey State Board of Medical Examiners found that Kaji, 79, "had failed to adequately fulfill his responsibilities as medical director," a job that includes overseeing controlled substances. Kaji admitted he had suffered a stroke that had affected his memory and vision, and was ordered to undergo "neuropsychological evaluation," according to public records.
Reached by phone, Kaji declined to comment. Joseph M. Gorrell, a lawyer for Brigham and Kaji, did not respond to e-mail and phone requests for comment.
Neal Buccino, spokesman for New Jersey's Division of Consumer Affairs, wrote in an e-mail that "Dr. Kaji's license is currently active, and not subject to restrictions."
In the view of Brigham's detractors, the ownership transfer is just another example of how he manipulates the system.
"I am not surprised at Brigham," said Vicki Saporta, president and CEO of the National Abortion Federation. "This is the type of deceptive activity we've come to expect from him. But I am surprised the state would accept this as being in compliance with their [divestiture] order, since Kaji is clearly unable and unsuitable to be running abortion clinics in New Jersey. Brigham is clearly trying to ... continue to maintain control over the clinics."
Jennifer Boulanger, communications director at the Cherry Hill Women's Center, said by e-mail, "Although we have come to expect that Steven Brigham would allow someone so grossly unqualified to manage patient care, we are hopeful that New Jersey regulators will use the power granted to them to disallow this ownership transfer."
Marie Tasy, executive director of New Jersey Right to Life, called the transfer an "outrage," adding, "Here you have a doctor who pleads guilty to sexual abuse of patients and he's been allowed to take over abortion clinics. It's unbelievable."
Brigham, a graduate of Columbia University College of Physicians and Surgeons, has insisted he is a champion of women's right to choose, and is besieged by abortion foes and competing abortion providers.
"To revoke my license would be to give in to the forces of hate. You know I am a good doctor," Brigham told the New Jersey Board of Medicine last October just before the 16 members voted unanimously against him.
Public records chronicle his 25-year, multistate history of battling medical boards, regulators, the IRS, landlords, creditors, and criminal prosecutors in Maryland.
Despite all this, American Women's Services has continued to operate clinics, even in states where Brigham has lost a license or never had one. New Jersey is among a minority of states where a doctor who is barred from practicing medicine cannot own a medical practice.
Currently, American Women's Services' website advertises 16 clinics in New Jersey, Virginia, Maryland, and Pennsylvania.
The two Pennsylvania sites - Pittsburgh and Allentown - are listed as "temporarily closed," even though in 2012, the state ordered Brigham to let the public know the clinics were permanently shuttered.
Pennsylvania barred Brigham from owning any abortion clinics in the state in 2010, although it took two more years to actually shut him down because he transferred ownership to his mother in Ohio.
Pennsylvania banished Brigham after years of intermittent sanctions for flouting health and safety laws, particularly by employing unqualified or unlicensed workers in his clinics.
Among those workers: Kaji, a Bombay-trained obstetrician-gynecologist.
Kaji went to work for Brigham in the mid-1990s while his license was restricted in both Pennsylvania and New Jersey. Kaji admitted having sex with a patient in his Yardley office, improperly prescribing controlled substances for her, and giving two other patients improper rectal or breast exams.
In New Jersey, Brigham has also faced protracted battles with regulators.
The most recent began five years ago, when Brigham was caught - after a critically injured patient went to police - doing what he was disciplined for doing in the mid-1990s. He started late-term abortions in New Jersey by dilating the patient's cervix and giving the fetus a lethal injection, then extracting the dead fetus in another state a day or two later.
In the 1990s, Brigham lost his license in New York, the state where he extracted the fetuses, but he ultimately kept his New Jersey privileges.
This time around, the extraction was in a clandestine clinic in Maryland, where Brigham was never licensed. Maryland charged Brigham under its fetal homicide law, but had to drop the case because the fetal deaths occurred in New Jersey.
Why the elaborate bistate scheme? Brigham said it was because late-term abortion doctors are subject to antiabortion violence. Prosecutors said it was because Brigham's New Jersey clinics do not meet the state's outpatient surgical safety requirements, and he is not credentialed to perform the risky surgeries.
Brigham testified that he is in financial straits. He had more than $500,000 in federal IRS liens for not paying employee taxes - and that was before the New Jersey board ordered him to pay $561,000 in penalties and prosecution costs.
But he fights on. He has appealed his New Jersey license revocation to Superior Court's Appellate Division.
Saporta, the National Abortion Federation leader, said, "People who read about this should be alarmed. Enough, enough, enough with these people."