LeRoy Carhart travels from his home in Nebraska almost every week to perform abortions at a clinic in Germantown, Md. He rarely stays at the same hotel twice. He rolls dice to pick the route he'll take to work, because "the biggest part of security is not being predictable," he said.

As one of the few doctors in the nation who openly acknowledge performing abortions late in a pregnancy, and because he wants to expand his services, Carhart is the top focus of antiabortion groups. He took on that role after Kansas doctor George Tiller, his friend and mentor, was fatally shot by an abortion opponent in 2009. Tiller was attending church at the time - the only predictable event in his schedule.

In a wide-ranging interview last week - his first extensive comments since he began traveling to Maryland in December - Carhart, 69, discussed his work, his plans to broaden health-care and social services to include adoption counseling, and security measures that he and his staff members take.

Carhart, a grandfather and retired Air Force general surgeon, has an understated manner, speaking so softly that he can barely be heard. His voice was weary at the end of a recent workday as he went over logistics with his wife, Mary, a straight-talking former schoolteacher who helps manage the clinic. During a takeout dinner in the hotel lobby, and later in his room, he became visibly angered, his eyes hardening, while describing what he called "ridiculous" abortion restrictions nationwide. Kansas regulates the size of janitorial supply closets. South Carolina regulates how grass is cut outside clinics.

The obstacles only make him more committed, he said. The women who have turned to him for abortions have had severe fetal abnormalities, he said. "We have helped them. . . . They'd rather die than have these pregnancies," he said.

Carhart began working in Germantown after Nebraska made it illegal last year to perform most abortions beyond 20 weeks of gestation. He chose Maryland because it has some of the least-restrictive abortion laws in the nation, is centrally located on the East Coast and because Germantown is accessible from three airports. Protesters plan to hold street rallies and prayer vigils starting next weekend in a continuing attempt to stop him.

Abortion opponents condemn the procedure regardless of the circumstances.

"There is no moral distinction," said Troy Newman, president of Operation Rescue, which has targeted Carhart for years. "Ninety-eight percent are simply elective procedures for mothers who want to have dead children."

Most doctors will not perform abortions beyond 22 or 24 weeks for various reasons, including legal concerns, social stigma, inadequate training or inexperience.

Carhart performs about 60 abortions a month in Germantown. Many of the women have been referred by other doctors. Six to 10 per month are late-in-pregnancy abortions; he declines to specify how late.

The Germantown clinic is small. He is the only doctor working there. But four other doctors - including one from the Washington area - have asked to train with him.

Carhart said training can begin if the clinic receives more patients.

That may happen soon.

This fall, Virginia health officials are expected to issue new draft regulations that will make abortion clinics, now treated like doctors' offices, follow rules imposed on ambulatory surgical centers. Those include guidelines about the width of hallways. Antiabortion activists have said the rules will make the facilities safer, but providers and abortion rights supporters say the rules could force many clinics to close.

Attorney General Ken Cuccinellii (R) and Gov. Robert McDonnell (R), a longtime abortion opponent, must approve the regulations before they go into effect Jan. 1.

Other aspirations

Carhart, who once dreamed of becoming a hand surgeon, said he witnessed how abortions often went bad when he was a medical resident in Philadelphia in the 1970s. In emergency rooms, he saw women who had tried to self-abort with knitting needles and coat hangers. Many required serious surgery; some died.

After retiring from the Air Force in 1985, he worked for a few years as a general surgeon but began performing abortions part time at an Omaha, Neb., clinic at the request of a former patient, also the clinic's nursing director.

On Sept. 6, 1991, the day Nebraska passed its parental-notification law, his farm burned down. No family members were hurt, but the fire destroyed his house and other buildings, and killed his dog, cat and 17 horses. The next day, Carhart received a letter informing him that the fire was in retaliation for the abortions. Local officials were unable to determine the fire's cause.

"That was when I decided I would not be part time," he said. "It's where my tenacity comes from." He resigned his hospital privileges. He began training other doctors. He opened his own abortion clinic the next year.

"I decided I wasn't going to just be a provider, I was going to be an activist."

To help private abortion providers in the Washington area, Carhart wants to create an informal coalition of doctors and clinic administrators who would meet regularly to share medical information and tips for handling protests and increasing morale.

Abortion providers say they often feel isolated because of the stigma surrounding abortion, because complications are uncommon, and because hospital doctors rarely discuss clinical issues related to abortions during rounds, said one 57-year-old doctor who works in a District of Columbia ob/gyn practice and provides abortions in the first trimester. She spoke on the condition of anonymity to avoid being targeted by protesters.

She and others said they welcome the idea of a regular provider give-and-take.

Said Carhart: "Even though you feel like you're alone in the world, it's good to find out that there's . . . people like you out there, that are alone with you."

Carhart also wants to expand the services at Germantown clinic to include adoption counseling, HIV/AIDS screening, and preventive health services for lesbians, gay men and transgendered people. Some can't get pap smears to detect cervical cancer because doctors refuse to examine them, Carhart said.

He hopes to begin health screenings and adoption counseling by next year. His community-outreach director has received adoption training, and they are looking to partner with agencies that support adoptions by gay and biracial couples as well as single parents.

Most of the abortions Carhart performs are between the 18th and 24th weeks of pregnancy. If the medical situation warrants, he can perform one as late as 32 weeks. A full-term pregnancy lasts about 40 weeks from the first day of the last menstrual period, according to the American College of Obstetricians and Gynecologists.

After that, his clinic is too small to accommodate the additional personnel needed should problems arise, so he refers patients to a Colorado colleague, Warren Hern, one of the few others who specialize in late-in-pregnancy abortions.

All the late abortions Carhart has done in Germantown have involved fetuses with anomalies, he said. One patient last week was just under 21 weeks pregnant; the fetus had spina bifida and would have been paralyzed from the navel down, he said. About 50 percent of his patients are local.

Tight security

Protesters holding graphic signs are a constant presence outside privately owned Reproductive Health Services clinic, which is tucked in a small office park in Germantown.

Carhart has installed two security cameras outside the clinic. Visitors to his Nebraska clinic have to walk through a metal detector, similar to those in airports; he would like to install one in Germantown.

Operation Rescue and the Maryland Coalition for Life opened a crisis center in April across the parking lot from the Germantown clinic to offer pregnancy counseling. Operation Rescue's Newman said activists have persuaded at least four women not to have abortions.

Operation Rescue also filed a complaint with the Maryland Board of Physicians alleging that Carhart did not disclose that he would be providing late-in-pregnancy abortions when he applied for his Maryland license. The board is investigating. A board spokeswoman said she could not comment. Carhart said he answered all questions appropriately, and an attorney is handling the complaint.

Protesters say they are riding a national wave of success, with states enacting 80 abortion restrictions this year, according to the Guttmacher Institute, a reproductive health research group.

On Saturday, antiabortion groups - including Operation Rescue - plan to begin nine days of street rallies and prayer vigils at the clinic, the Maryland State House, and outside the Washington office of House Speaker John Boehner, R-Ohio.

Organizers are calling it "Summer of Mercy 2.0," a reprise of demonstrations 20 years ago, when thousands took part and hundreds were arrested at Tiller's Kansas clinic, which was then the focal point of the antiabortion movement.

Carhart and groups such as the Religious Coalition for Reproductive Choice plan to hold their own walk outside the clinic Sunday to begin a week-long "Summer Celebration of Choice."