Investigations Abortion

For Decades, Authorities Let Rogue Abortion Provider Harm Women, Despite Pleas From Legitimate Doctors

Sharona Coutts

Since the early 1990s, public records show, Brigham’s patients have suffered emergency hysterectomies, severe bowel injuries, severed ureters, and sweeping lacerations to the uterus. Over a period of two decades, Brigham has been barred from practicing medicine in at least six states, sued by his landlords and business associates, and even served jail time for failing to pay taxes. And yet today, Brigham remains in control of a network of 15 abortion clinics in four states, and there appears little that most state authorities are able—or willing—to do about it.

Read more of Rewire‘s articles on Steven Brigham here.

On August 13, 2010, an 18-year-old New Jersey resident arrived in a clinic in Elkton, Maryland, to undergo a surgical abortion. She was 21-and-a-half weeks pregnant, and had driven just over an hour from a clinic in Voorhees, New Jersey, where the day before, Dr. Steven C. Brigham had initiated the procedure.

Just 15 minutes into the surgery in Maryland, the patient suffered major injuries. Her uterus was ruptured, and her bowel had been perforated and was protruding into her vagina.

Instead of immediately calling 911 for emergency assistance, her doctors—Brigham and his associate, Nicola I. Riley—waited nearly two hours, according to findings from the Maryland State Board of Physicians. They then dressed the patient, who was still sedated and slumped over, and lifted her into a wheelchair. They rolled her outside, put her in a car, and with Brigham at the wheel, took her to a nearby hospital. Her injuries were so severe that hospital staff had her airlifted to Johns Hopkins Health Center for emergency treatment.

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The patient survived, and as was reported Thursday morning in the New York Times, her story now forms a key part of the evidence that is being used in an administrative proceeding brought by New Jersey’s attorney general to have Brigham’s medical license permanently suspended or revoked.

However, what has not yet been reported is the extent to which legitimate providers in the states where Brigham practiced went to warn state officials of the threat Brigham posed to the health of the women he served.

In numerous complaints, emails and phone calls over a period of more than two decades, legitimate abortion providers from New Jersey and neighboring states alerted authorities to Brigham’s dangerous conduct, furnishing warnings they say went largely unheeded. Doctors provided copies of many of these complaints, as well as extensive logs of their calls, to Rewire.

An investigation by Rewire shows that New Jersey officials responsible for overseeing healthcare in that state could have prevented injuries to this and subsequent patients, had they acted on warnings about Brigham that predicted this exact scenario.

“If they had listened right in the beginning and taken appropriate action, I think these harms would have been prevented,” Jen Boulanger, a clinic administrator who has spent years amassing complaints about Brigham and his associates, told Rewire. “I think state agencies were afraid of raising eyebrows about abortion, but they just should have handled it like they do any other field of medicine.”

A spokesman for the New Jersey attorney general’s office, which has ultimate oversight of the New Jersey Board of Medical Examiners, said the office could not comment on Brigham, because of the ongoing dispute over his medical license.

Attempts to reach Brigham, as well as attorneys listed as his representatives on official documents, were unsuccessful.

Brigham has now had his medical license suspended or revoked in up to six states, but public records show that he remains at the helm of an abortion chain called American Women’s Services, which is based in New Jersey, and owns or is affiliated with 15 clinics in four states. There is no requirement that the owner of a medical facility actually possess a medical license, state officials said.

The issue of abortion has once again leapt to the forefront of state and national politics. Already this year, dozens of anti-choice laws have been proposed or have passed at the state level, and a 20-week abortion ban recently passed in the U.S. House of Representatives.

Anti-choice advocates, including activists, and state and federal politicians, have capitalized on the case of another rogue provider—Kermit B. Gosnell—to falsely claim that he represented the norm in abortion care.

TIMELINE OF EVENTS

1986: Brigham graduates from Columbia University College of Physicians and Surgeons. In the coming years, National Abortion Federation leaders grow concerned about his skill level. Brigham fails to complete his NAF training, and his application for membership is denied.

APRIL 1992: Brigham agrees to voluntarily retire from practicing medicine in Pennsylvania in exchange for the state dropping a pending investigation regarding him. His license is placed on permanent inactive status, and he is ordered not to ever apply for renewal or reinstatement.

NOVEMBER 1993: The New Jersey attorney general’s office files its first complaint about Brigham with the board of examiners. Two more complaints are filed in July and December of 1994.

JANUARY 1994: New York suspends Brigham’s license, calling him an “imminent danger to the health of the people of New York.”

FEBRUARY 1994: New Jersey restricts Brigham’s license, determining that his unrestricted practice presents a clear and imminent danger to the people of New Jersey.

NOVEMBER 1994: New York revokes Brigham’s license, finding him guilty of gross negligence and negligence on more than one occasion in practicing medicine.

FEBRUARY 1995: Florida suspends Brigham’s license.

JUNE 1996: Florida revokes Brigham’s license.

AUGUST 1996: Upon a favorable ruling by the Office of Administrative Law on the three complaints filed by the New Jersey attorney general, New Jersey reinstates Brigham’s medical license subject to conditions that Brigham only perform abortions during the first trimester of pregnancy in the state.

SEPTEMBER 2005: A complaint lodged online by a doctor with the New Jersey Board of Medical Examiners warns that Brigham was performing second-trimester abortions in New Jersey.

SEPTEMBER 2009: Pennsylvania bans Brigham from owning or running abortion clinics in Pennsylvania.

FEBRUARY 2010: A group of New Jersey doctors, abortion clinic administrators, and counselors send a collection of complaints to the enforcement bureau of the New Jersey attorney general’s office and to William Roeder, executive director of the New Jersey State Board of Medical Examiners.

AUGUST 2010: An 18-year-old patient is injured at Brigham’s Elkton, Maryland, abortion clinic and is airlifted to Johns Hopkins Health Center for emergency treatment. Maryland issues a cease and desist order to Brigham, demanding that he stop practicing medicine in Maryland without a license.

OCTOBER 2010: New Jersey suspends, but does not revoke, Brigham’s license.

FEBRUARY 2013: A patient dies at Brigham’s Baltimore abortion clinic.

The documents provided to Rewire, however, show that reputable providers tried for years to sound the alarm on a rogue provider. In Brigham’s case, they made sustained efforts to prompt officials in New Jersey, Pennsylvania, and Maryland to enforce the regulations that already existed to ensure safe abortion care. The documents provided show that authorities were often slow to respond to those warnings, if they acted at all.

For the providers who spent years trying to stop the problems they saw at Brigham’s clinic, the fact that he is still involved in women’s health—and being used as justification for restricting access to abortion—signals systemic problems with how the authorities and politicians treat reproductive health issues. They also said they believe many of these new legal restrictions—in addition to being medically unnecessary—could push more women into the hands of rogue providers, such as Brigham or Gosnell.

“It’s heart-breaking,” said Claire Keyes, who worked for more than 30 years as director of the Allegheny Reproductive Health Center in Pittsburgh, where she treated dozens of patients who had been to clinics owned by Brigham. “This isn’t throwing women under the bus. This is like backing up over and over and over them.”

A Long History of Problems

Brigham had already accrued a long history of harming patients by the time he botched the abortion in 2010.

Over a period of more than two decades, Brigham has left patients with severe bowel injuries, severed ureters and sweeping lacerations to the uterus, and requiring emergency hysterectomies for procedures that, when done by a properly trained provider, has a very low risk of complication, public records show.

In fact, Brigham first came to the attention of national abortion providers shortly after graduating from Columbia University College of Physicians and Surgeons in 1986. His prestigious education and natural charisma led many colleagues to give him a warm welcome into the professional community.

“We were very enthusiastic about this doctor when he first came,” said Suzanne Poppema, a former board chair of the National Abortion Federation (NAF) and Physicians for Reproductive Health. “He was young and socially adept and seemed to say all the right things, and asked good questions that you would expect someone just starting out to ask.”

But that impression changed quickly, Poppema said. Colleagues noticed that Brigham continued to ask the same questions at subsequent meetings, which struck them as odd. And then they began to hear troubling reports about the young physician’s medical practices.

“Right away we started hearing that he was moving into both early and later second-trimester abortions. And he had a complication,” she said, referring to a problem with an abortion procedure.

In the hands of a skilled provider, abortion carries a very low risk of complication, even after 20 weeks’ gestation, and certainly lower than the risks associated with giving birth. However, the risk of complication increases as the pregnancy progresses, and like any complex medical procedure, specialized training is required. NAF board members believed Brigham lacked those skills, and decided to confront him to express those concerns.

“I sat down with him and three other physicians, and we said to him, ‘You have to promise that you will not do any second-trimester abortions until you have spent two weeks with one of our senior physicians,’” Poppema recalled.

But Poppema said Brigham never completed that training. NAF rejected his application for membership, and lodged their concerns with Pennsylvania authorities, including the attorney general and the State Board of Medicine.

By 1992, however, Pennsylvania’s board of medicine had already become concerned about Brigham’s conduct. In April of that year, Brigham reached a deal with the board in which he agreed never again to practice medicine in Pennsylvania. In exchange, the board dropped an investigation against him, according to court documents later filed in Florida. Rewire was unable to ascertain what prompted that investigation.

“We thought that just getting his license revoked would take care of it,” Poppema said. “But it turns out, it didn’t do any good to revoke his license. He just goes to another state, or better yet, he figured out he doesn’t need a license to open a clinic.”

Indeed, two weeks after he agreed to stop practicing in Pennsylvania, Brigham botched a 23.5-week abortion in New York, leaving his patient with a lacerated uterus, a severed ureter, and a colon so damaged that she required a colostomy—a form of bowel surgery that frequently leaves patients needing an external bag to drain their digestive systems.

And in November 1993, a 20-year-old patient who had gone to Brigham in New York for an abortion at 26-weeks’ gestation required an emergency hysterectomy after Brigham lacerated her cervix, uterus, and uterine artery.

In its ruling following these incidents, New York’s State Board for Professional Medical Conduct concluded that Brigham was an “imminent danger to the health of the people of New York,” found him guilty of gross negligence, and suspended his medical license. Relying partly on those conclusions, Florida also stripped Brigham’s license to practice in that state.

The New York board also drew damning conclusions about the doctor’s character.

“[Brigham] repeatedly exaggerated his medical training, experience and skill,” wrote the committee that heard Brigham’s case. He “has demonstrated he lacks appropriate judgment and insight as to his own limitations.”

The New York regulators also echoed Poppema’s concerns that Brigham lacked the skill and training required to perform later abortions. Brigham inflated his qualifications, but eventually “testified that what he referred to as special training in preparation for his activities in the abortion field consisted of limited interludes of observation of other physicians,” the board wrote.

New Jersey initially followed suit; the state restricted Brigham’s practice in February 1994, and banned him from performing second-trimester abortions, and required him to hire someone to supervise his practice, and to review patient records.

Brigham fought the decision to suspend his license, and eventually prevailed. The New Jersey medical board found in August 1996 that Brigham had not violated the required standard of care, and restored his medical privileges.

Brigham would soon expand his activities to multiple other states—including those where he could no longer legally practice medicine himself.

Brigham Finds Loophole, Continues Pattern of Harm

By the mid-2000s, Brigham’s abortion clinic network had grown bigger than ever. At its peak, American Women’s Services and its affiliates had at least 17 locations in New Jersey, Florida, Pennsylvania, Virginia, and Maryland, public records show.

Brigham also established multiple other companies with interlocking ownerships and linked addresses, which were associated with numerous nonprofit entities. He hired other physicians, technicians and administrative employees—some of whom have also faced disciplinary proceedings from multiple state medical boards.

Physicians in surrounding states were now receiving frequent complaints from patients who had been treated at a Brigham clinic, according to doctors interviewed by Rewire.

“We had a standard complaint form, believe it or not,” said Claire Keyes, whose clinic in Pittsburgh often treated patients who had been seen at a Brigham clinic. She said they developed the form specifically for patients from those clinics. “We never got them from any other place, only from Brigham’s clinic, where patients were mistreated or they were so uncomfortable that they left, or they left but they discovered that they were still pregnant but they wouldn’t go back there.”

Keyes said that she and her staff regularly sent the complaint forms to the Pennsylvania Department of Health or occasionally to the state attorney general.

“I kept hoping that the evidence that we were giving the state would prompt them to want to do something,” Keyes said. “But as far as I know, that was not the case.”

Jen Boulanger, who was executive director of the Allentown Women’s Center at the time, also recalls dozens of patients reporting problems with Brigham’s clinics, ranging from confusing information, exorbitant fees, and allegations of improper sexual conduct by a doctor who worked for Brigham. (The doctor was stripped of his New York medical license after the Board of Medical Examiners found that he had sex with a patient at one of his clinics and was accused of sexually abusing three others.)

Boulanger maintained a log both of these complaints, and of her attempts to alert officials at the Pennsylvania health department, attorney general’s department, and medical board. The log, a copy of which she provided to Rewire, includes names and contact information for officials who were later implicated in that state’s failure to perform basic inspections of abortion facilities, or to act on warnings about the criminal conduct of Kermit Gosnell.

“It was almost one complaint a month on average that we received from a patient,” Boulanger said. “It was so frustrating because I felt like we did everything we could do.”

A spokesman for the Pennsylvania Department of State said he could not comment on complaints of investigations into individual practitioners.

New Jersey doctors were also trying to alert authorities there of what they saw as the threat posed by Brigham and his associates.

In a complaint lodged online with the New Jersey Board of Medical Examiners in September 2005, a doctor alleged that Brigham had resumed performing second-trimester abortions at his clinic in Voorhees, despite the fact that his facility lacked the license required to do abortions past 14-weeks gestation. A copy of the electronic receipt confirmation was provided to Rewire.

The doctor outlined the procedure that patients had described to her. They said Brigham would commence the abortion procedure at his private offices in Voorhees, by inserting laminaria, a type of seaweed commonly used in abortion procedures to soften the cervix in preparation for a later abortion. Because the cervix can require more than 24 hours to dilate, some providers ask their patients to return the following day to complete the procedure.

Reputable clinics usually require patients to stay for a short period of observation after laminaria are inserted, and ask them to remain under the supervision of a responsible adult until they return. In normal circumstances, a registered nurse and doctor are on call at all times in the event that a patient requires urgent treatment.

New Jersey law also requires all abortions at more than 14-weeks gestation to take place in a hospital or licensed surgical ambulatory facility—Brigham’s office did not fall within those definitions.

According to the doctor who filed the complaint, Brigham’s patients reported that he did not follow any of these best practices.

Instead, when patients returned the following day, he would inform them that they had to drive themselves to another clinic in a neighboring state to complete the operation. Brigham would often lead a group of patients, all traveling in separate vehicles, to an out-of-state clinic, in what was described in legal filings as an abortion “caravan.”

“These methods are not within the normal national standard of care for second trimester abortion services as put forth by the American College of Obstetrics and Gynecology (ACOG), the National Abortion Federation (NAF), and other nationally recognized experts in abortion care,” wrote the physician who lodged the complaint. The method posed “a serious threat to the health, safety and welfare of the public,” the doctor wrote.

But if New Jersey took any action on those warnings, the person who filed the complaint didn’t hear about it. In fact, over the following years, the parade of injured or distraught patients swelled as doctors continued to file complaints and write letters to New Jersey authorities.

On February 17, 2010, a group of New Jersey doctors, abortion clinic administrators, and counselors collected their complaints and sent a 24-page packet to Sandra Murray, an investigator in the enforcement bureau of the New Jersey Office of the Attorney General, as well as to William Roeder, executive director of the New Jersey State Board of Medical Examiners. Fax records indicate that the complaints were received at the number listed on Murray’s business card.

The complaints centered on a company called Grace Medical Care, one of Brigham’s many companies, as court filings would later show.

“Patients are being directed through Grace Medical to another state, likely after their initial laminaria insertion, and probably to Maryland, where there exist no guidelines for monitoring outpatient second trimester termination of pregnancy, and where the law is unclear at which point in the pregnancy termination becomes illegal—leaving murky waters for providers like Brigham to expand their reach unnoticed,” one doctor wrote.

“In my professional opinion, this practice is dangerous,” wrote another doctor who contributed to the complaint. “To ask a woman in the midst of second trimester abortion to cross state lines to an unfamiliar facility, which may be hours away, is potentially life-threatening.”

Neither Murray nor Roeder would comment for this story, but some seven months after Murray’s office received the packet, the precise scene predicted in these complaints played out when Brigham and his associate had the 18-year-old patient drive herself from Voorhees, NJ, to Elkton, MD, botched the abortion, and left her requiring emergency surgery at Johns Hopkins Health Center.

States Take Action

In the wake of that botched abortion, Maryland authorities raided the Elkton clinic, where they discovered at least five fetuses, though news reports said there were many more.

Based on the size of the fetuses, officials allege that Brigham—who had never held a license to practice medicine in Maryland—performed abortions up to 26-weeks gestation at the Elkton clinic. Additional patient records produced by the New Jersey attorney General in proceedings in that state indicate that Brigham performed up to 50 abortions between January and August 2010 at the Elkton clinic, including on fetuses up to 31-weeks gestation.

New Jersey’s Board of Medical Examiners temporarily suspended Brigham’s license in October 2010, and alleged almost identical facts to those contained in the multiple complaints lodged to its own office over a period of more than five years.

“Dr. Brigham has constructed an elaborate sham to allow him to do an end-run around New Jersey’s regulatory requirements,” the board wrote.

“Dr. Brigham’s deceptions extend even to his patients, who are kept uninformed of information as basic as where their procedure would be performed and even, in some instances, the identity of the physician who would be performing the procedure,” the board said. “His willingness to do so, and the lengths to which he has gone to further his scheme, manifestly support a conclusion that his continued practice would present clear and imminent danger.”

But Brigham’s clinics remained open. Doctors working nearby continued to receive complaints from patients who’d had a brush with his clinics, and they continued to write to the Board of Medical Examiners, pleading with them to take action.

On October 14, 2011, William Roeder, the board’s executive director, replied to yet another series of complaints from doctors who worked near Brigham’s New Jersey clinics. He informed the doctors that the board “appreciated” their “interest in this matter.”

“Please be advised that Dr. Brigham’s medical license has been temporarily suspended,” he wrote. “However, he can open another facility.”

A Patient Death

New Jersey’s administrative proceeding to permanently strip Brigham’s medical license is ongoing, but in February of this year, a patient died at the Baltimore office of Associates in OB/GYN Care, a group of four clinics listed on Brigham’s website as the Maryland facilities for his network, American Women’s Service.

Following the death, inspectors from Maryland’s Office of Health Care Quality found that all four OB/GYN Care facilities—located in Silver Spring, Cheverly, Frederick, and Baltimore—had an “unwritten protocol” that allowed unlicensed staff to perform and interpret ultrasounds and administer drugs, without any supervision.

“These deficiencies… could have resulted in serious or life-threatening harm or death to the patient,” the report found. On May 23, 2013, the state department of health decided to continue a temporary suspension because Associates in OB/GYN Care had not shown any compelling evidence as to why it should be allowed to reopen.

As recently as mid-June, callers to American Women’s Services were told that they could obtain abortions at their clinics in New Jersey or Virginia.

Staffers also told reporters that the Maryland clinics were temporarily closed “for renovations.” When asked directly by RH Reality, the person answering the company’s 1-888 number denied that the closures were related to regulatory problems. Maryland officials declined to comment when told about that answer.

A Florida clinic, American Family Planning, is controlled by one of Brigham’s companies and continues to operate from its premises in Pensacola, according to state officials.

However, American Women’s Services’ web site tells patients seeking treatment in Pennsylvania that they can attend Brigham’s New Jersey clinics. Since September 2009, Pennsylvania has banned Brigham from owning or running an abortion clinic, making it the only state to do so. Pennsylvania officials said they were prevented from commenting on complaints or investigations into medical practitioners.

For the doctors who had tried for decades to stop Brigham’s dangerous conduct, this reality comes as a blow.

“You feel completely powerless,” said Poppema, the former chair of NAF and Physicians for Reproductive Health. “We spend enough of our time trying to beat back harassment, threats, and anti-abortion legislation. The fact that we have to spend time policing someone in our own profession is just depressing.”

Correction: A version of this article incorrectly identified Jen Boulanger as a physician. She is in fact a clinic administrator. We regret the error.

Imani Gandy, Rewire’s senior legal analyst, contributed to this report.

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Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.