Roughly two months after one of the city's two abortion clinics closed, the second clinic has been informed that its license will be suspended. In both cases, the clinics were unable to secure a hospital transfer agreement at a facility that meets new state criteria.
Roughly two months after one of Toledo, Ohio’s two abortion clinics closed, the second clinic has been informed that its license will be suspended and it could be forced to close as well. In both cases, the clinics were unable to secure a hospital transfer agreement at a facility that meets new state criteria.
On June 30, Republican Gov. John Kasich signed the state’s 2014 budget, which included several anti-choice restrictions, among them an amendment forbidding hospitals that accept public funding from having transfer agreements with clinics that provide abortions.
The Capital Care Network clinic in Toledo received a notice from the Ohio Department of Health (ODH) on July 30 informing the clinic that its transfer agreement with the University of Toledo Medical Center was set to expire the following day, on August 1. On the 1st, ODH representatives visited and called Capital Care asking the clinic to produce a current agreement; the department cited the clinic with a violation for continuing to see patients while not having a finalized transfer agreement in place. On its “summary statement of deficiencies,” the department noted that a clinic staffer reported that the clinic does “have another transfer agreement with another hospital although it has not been signed into agreement yet. A transfer agreement was presented that did not have the name of the hospital or the appropriate signatures.”
The following day, August 2, ODH sent a follow-up letter to the clinic noting that the department proposes to “issue an Order revoking and refusing to renew Capital Care Network of Toledo’s health care license (ambulatory surgical facility),” because the clinic did not have a current transfer agreement on file.
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The Center for Choice, which had been Toledo’s other legal abortion clinic, closed in May when the University of Toledo Medical Center announced it would discontinue negotiations regarding a transfer agreement with the abortion provider, amid news that the transfer agreement rule was being considered.
Another Capital Care clinic in Ohio closed in April after being cited by the DOH for violations including a lapsed pharmacy license, poor clerical documentation, lack of transfer agreement, and issues surrounding its controlled substances.
Mike Gonidakis, president of Ohio Right to Life, told the Toledo Blade that the potential closure of the city’s last legal abortion clinic is “a great opportunity for women with unexpected pregnancy to go to Toledo pregnancy centers, get some real health care, and find ways to keep the child, raise the child, or put the child up for adoption. The key is to offer more options. … Abortion isn’t the answer.”
Correction: A version of this article incorrectly noted that the Center for Choice closed three months ago. It closed roughly two months ago. We regret the error.
“It causes us great concern when we think about vulnerable populations ... [who] may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, told Rewire.
One of the largest Catholic health systems is set to begin running health clinics inside 27 Walgreens stores in Missouri and Illinois next week. The deal between Walgreens and SSM Health has raised concerns from public interest groups worried that care may be compromised by religious doctrine.
Catholic health systems generally follow directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, contraception, tubal ligations, vasectomies, and fertility treatments.
“We are concerned that the clinics will likewise be required to follow the [directives], thereby severely curtailing access to important reproductive health services, information, and referrals,” MergerWatch, the National Health Law Program, and the American Civil Liberties Unions of Illinois and Missouri wrote in a letter to Walgreens on Wednesday. They also sent a letter to SSM Health.
In a statement emailed to Rewire, Walgreens said its relationship with SSM Health “will not have any impact on any of our current clinic or pharmacy policies and procedures.”
SSM Health emailed a statement saying it “will continue to offer the same services that are currently available at Walgreens Healthcare Clinics today.” If a patient needs services “that are beyond the scope of what is appropriate for a retail clinic setting, they will be referred to a primary care physician or other provider of their choice,” the statement read.
A spokesperson for SSM Health demurred when Rewire asked if that would include referrals for abortion care.
“I’ve got to check this part out, my apologies, this is one that hadn’t occurred to me,” said Jason Merrill, the spokesperson.
Merrill later reiterated SSM Health’s statement that it would continue to offer the same services.
Catholic health systems have in recent years expanded control over U.S. hospitals, with one in six acute-care hospital beds now in a Catholic-owned or -affiliated facility. Patients in such hospitals have been turned away while miscarrying, denied tubal ligations, and refused abortion care despite conditions like brain cancer.
Catholic health systems have also expanded into the broader landscape of outpatient services, raising new questions about how religion could influence other forms of care.
“The whole health system is transforming itself with more and more health care being delivered outside the hospital,” Lois Uttley, director of MergerWatch, told Rewire. “So we are looking carefully to make sure that the religious restrictions that have been such a problem for reproductive health care at Catholic hospitals are not now transferred to these drug store clinics or to urgent care centers or free-standing emergency rooms.”
Walgreens last year announced a similar arrangement with the Catholic health system Providence Health & Services to bring up to 25 retail clinics to Oregon and Washington. After expressing concerns about the deal, the ACLU of Washington said it received assurances from both Walgreens and Providence that services at those clinics would not be affected by religious doctrine.
Meanwhile, the major urgent care provider CityMD recently announced a partnership with CHI Franciscan Health–which is affiliated with Catholic Health Initiatives–to open urgent care centers in Washington state.
“We’re seeing [Catholic health systems] going into the urgent care business and into the primary care business and in accountable care organizations, where they are having an influence on the services that are available to the public and to consumers,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Rewire.
GoHealth Urgent Care, which describes itself as “one of the fastest growing urgent care companies in the U.S.,” announced an agreement this year with Dignity Health to bring urgent care centers to California’s Bay Area. Dignity Health used to be called Catholic Healthcare West, but changed its name in 2012.
“This is another pattern that we’ve seen of Catholic health plans and health providers changing their names to things that don’t sound so Catholic,” Lois Uttley said.
In the letters sent Wednesday, the National Health Law Program and other groups requested meetings with Walgreens and SSM Health to discuss concerns about the potential influence of religion on the clinics.
“It causes us great concern when we think about vulnerable populations, we think about low-income people… people who… may need to use these clinics for things like getting their contraception prescribed and who would never think that when they went into a Walgreens they would be restricted by Catholic doctrine,” Lorie Chaiten, director of the Reproductive Rights Project of the ACLU of Illinois, told Rewire.
The new clinics in Walgreens will reportedly be called “SSM Health Express Clinics at Walgreens.” According to SSM Health’s website, its initials “[pay] tribute” to the Sisters of St. Mary.
“We are fairly forthcoming with the fact that we are a mission-based health care organization,” Merrill told Rewire. “That’s something we embrace. I don’t think it’s anything we would hide.”
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HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited. They trot out many of the worn theories that have been rejected by medical and public health experts. The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.
Another day, another secret recording made in an abortion clinic.
At least, that’s the very strong impression given by some of the scenes contained within the documentary film HUSH, which premiered late last year and is currently making the rounds of film festivals and anti-choice conferences in the United States and internationally, including the National Right to Life Convention that took place in Virginia last month.
The film is the creation of Mighty Motion Pictures and Canadian reporter Punam Kumar Gill, who says in the film that she is pro-choice, a “product of feminism.” It purports to tell the story of “one woman,” Gill, who “investigates the untold effects of abortion on women’s health.”
HUSH—which claims in the film’s credits to have received support from the Canadian government—attempts to cast itself as neither pro-choice nor “pro-life,” but simply “pro-information.” The producers insist throughout the film, in their publicity materials, and in private emails seen by Rewire that their film is objective and balanced.
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That’s how they pitched it to Dr. David Grimes, a highly respected OB-GYN and a clinical professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, who agreed to do on-camera interviews for the film. Grimes now says the producers and reporter misled him about their intentions.
“There was no balance,” Grimes told Rewire. “It’s a hatchet job. It’s obvious.”
Indeed, HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited, many of whom are featured in Rewire‘s gallery of False Witnesses. They trot out many of the worn theories that have been rejected by medical and public health experts—namely, that abortion is linked to a host of grave physical and mental health threats, “like breast cancer, premature birth, and psychological damage.”
The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.
When Anti-Choice “Science” Goes Conspiracy Theory
As a piece of propaganda, the use of the conspiracy theory has the advantage of removing the debate over abortion’s safety from the realm of logic. In HUSH‘s topsy-turvy world, the medical establishment becomes the scare-quoted “Medical Establishment,” and the more distinguished or authoritative a person or organization, the more suspect they become.
For reasons that remain murky, the film’s thesis is that the world’s leading reproductive and health organizations—including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, along with all of their staff, contractors, and affiliated experts—have been hiding information about the risks of abortion.
This is most apparent when the reporter, Gill, tells the viewers that “if women have the right to abortion, they should also have the right to know” about the risks she believes she has identified.
Later, the film shows graphics highlighting the states that have various informed consent laws—some of which are literally called “A Woman’s Right to Know” acts—that force providers to give patients false information about the safety of abortion. Rather than concluding that the authority of the state has been used to mandate that doctors provide medically unsound “counseling” using the very junk science that Gill presents throughout the film, she hews to the back-to-front logic of all conspiracy theories. In her view, the existence of these laws shows that the risks are real, but that the faceless, nameless “they” still won’t let women in on the their deadly secrets.
In Gill’s world, the unwillingness of organizations to speak with her becomes evidence that they are hiding something.
The American Congress of Obstetricians and Gynecologists tells Gill that it won’t fulfill her requests by giving her an interview because the science is settled; Gill sees this as a sign of conspiracy.
“This is where I started to feel equally suspicious of those denying any link,” Gill tells the viewer, her voice floating over inky footage of the U.S. Capitol at night. Lights from the Capitol dance on the velvety surface of the Lincoln Memorial Reflecting Pool, and Gill confides: “I felt like I was digging into something much deeper and darker.”
A comical scene ensues where Gill is astonished to find that turning up with a film crew on the grounds of the National Cancer Institute does not suddenly persuade it to grant her an interview with one of its experts.
“What was going on here?” says Gill in her voiceover. “It was like they really didn’t want any questions being asked.”
In fact, the National Cancer Institute had replied to Gill’s multiple requests with links to its website, which contains the conclusive studies that have long since dispelled the notion that any link exists between abortion and breast cancer. The film shows footage of those emails.
Furthermore, Grimes provided Rewire with copies of emails he had exchanged with the film’s producers during its production, in which he gave them citations to relevant studies and warned them that the work of the anti-choice “experts” they had approached had been thoroughly debunked.
After seeing the film, Grimes emailed the producers inquiring why they hadn’t simply asked him to connect them with additional experts.
“Had you truly wanted more pro-choice researchers to speak to these issues, I could have named scores of colleagues from the membership of the Society for Family Planning and Physicians for Reproductive Health who would have been happy to help,” Grimes wrote in a note he shared with Rewire. “You did not ask. That some organizations like the National Cancer Institute did not want to take part in your film in no way implies a reluctance on the part of the broader medical community to speak about abortion research.”
It seems that Gill—whose online biographies give no indication that she is a scientist—would not have been satisfied in hearing about existing research. She tells the viewers that, in her view, “more study is needed to determine the extent of the abortion-breast cancer link,” and concludes that “to entirely deny the connection is ludicrous.”
In an interview with Rewire, Grimes noted that doing such research would be viewed as unethical by reputable scientists.
“That issue is settled, and we should not waste limited resources that should be directed to urgent, unanswered questions, such as the cause of endometriosis and racial disparities in gynecologic cancers,” he said.
Grimes made his dissatisfaction clear to the producers. He wrote to them: “My inference after viewing the film is that you are suggesting a large international conspiracy of silence on the part of major medical and public health organizations, the motivation for which is not specified.”
The corollary to the suspicion cast over the most reputable research and representative bodies is that the film transforms the marginal status of the anti-choice “experts” into a boon.
Seen through HUSH‘s conspiracy theory lens, the fact that the work of people like Priscilla Coleman, David Reardon, and Angela Lanfranchi is rejected by the medical establishment becomes proof not of the unsoundness of their ideas, but rather that a conspiracy is afoot to silence them.
Instead of presenting this small but vociferous group of discredited activists as outliers—shunned because their theories have no scientific basis, or because they lack any credentials relevant to reproductive or mental health, or because they have repeatedly mischaracterized data—HUSH paints them as whistle-blowing renegades determined to set the truth free.
A tearful Lanfranchi recounts the story of patients who came to her with aggressive breast cancer in their 30s. Lanfranchi says she strove to understand “why this was happening,” and realized that each of these young women had had abortions, which she then concluded had caused their cancer. Lanfranchi said her hopes that the public would learn of this risk were dashed over time.
“Over the years I’ve realized that, no, it didn’t matter how many studies there were,” she tells viewers. “That information was not going to get out.”
Joel Brind says that he has worked with a colleague whom he says he later discovered was pro-choice, but that their views on abortion never came up. “This is about science,” he tells Gill. “This is about the effect on women and whether or not abortion increases the risk of breast cancer. Period.”
Gill asks both Lanfranchi and Brind whether they are trying to “stop abortion,” or whether they “want abortion to go away.” Both answer that all they want is for women to be informed when they exercise their choice.
The film makes no mention of the fact that both have been anti-choice activists for decades; they have each testified in support of anti-choice laws in both legislative and judicial proceedings, and both have participated in the extreme right-wing, anti-choice, anti-LGBTQ World Congress of Families.
To the extent that HUSH acknowledges these activists’ bias, it is couched in a softer light that is linked, implicitly, to their religious views—a reality raised by Grimes in his on-camera interview, in which he notes, accurately, that the anti-choice “intellectuals” often lack the relevant medical or scientific qualifications to do the type of work they purport to do, but that they do tend to share religious convictions that lead them to oppose abortion and contraception.
That allows the producers to imply that the False Witnesses are perhaps victims of discrimination; to suggest that their work is being discounted because of the activists’ religious beliefs, and not because the work itself has been thoroughly debunked. Play the ball, not the man, appears to be the producers’ plea.
It’s a conspiracy theory twilight zone: where medical groups withhold information for reasons so cloudy that they cannot be articulated, but where people who have for years worn their beliefs on their sleeves cannot be evaluated with those political views in mind.
After asserting that she is, herself, pro-choice, Gill says she “finds validity” in the claims of the anti-choice advocates, and that she finds it “sickening” that the “media and health organizations have spent their energies closing the case and vilifying those who advocate in favor of the link, instead of investigating any and all reasons why breast cancer rates among young women have increased and women are dying.”
The producer, Joses Martin, did not answer Rewire’s questions about the experts he and his team had selected, other than to say, “We are very proud of the balanced approach that we’ve taken in this documentary that is neither anti-abortion nor pro-abortion.”
Another Instance of Secret Recordings Made in Abortion Clinics
What troubles Grimes most about the film is not so much that he was cast as the face of an international conspiracy by virtue of being the sole pro-choice physician to appear on camera, but that he may be associated with people who appear to have made secret recordings in at least one abortion clinic.
The footage and audio in question have been heavily edited, and it is difficult to discern what is real from what has been staged or spliced to give certain effects.
Early in the film, Gill is shown standing in the entry path to what the producers identify as a “Seattle abortion clinic.” As she makes her way inside, the footage swaps to guerilla-style, hidden camera shots, which capture wall artwork that appears in some Planned Parenthood clinics. Viewers see Gill’s face in the waiting room, as well as blurs of other people there. The film then swaps to audio recordings without any video footage. Gill can be heard posing as a patient, receiving counseling from a woman who is identified as a “health center manager.” This audio is used twice more during the film.
In Washington state, it is a crime to make audio or video recordings of people without their consent. Similar laws are in place in California, Florida, and Maryland, states where David Daleiden and his co-defendants from the Center for Medical Progress made their surreptitious videos of Planned Parenthood employees and members of the National Abortion Federation.
Grimes asked the producers whether they had obtained permission to make any of those recordings; Rewire asked the producers whether the recordings were in fact made in Seattle.
The producer, Joses Martin, replied to Grimes that he would “not be disclosing the name or location of the clinic or the name of the individual recorded to yourself or anyone else.”
“We have kept this information undisclosed and private both in the film and out of the film to not bring any undue burden on them. We’re certainly not implicating anyone involved of wrong doings, as was the goal in the Center For Medical Progress case,” Martin wrote in an email shared with Rewire.
In an email to Rewire, Martin did not answer our specific questions about the recordings, but asserted, “We did not break any laws in the gathering of our footage.”
Planned Parenthood had no comment on whether the crew had obtained consent to film inside its clinics, or whether Gill had misrepresented herself throughout her conversation with the counselor. Nor did the organization comment on the increasing use of secret recordings by anti-choice activists within its clinics. In a federal suit, Planned Parenthood has sued Daleiden for breaches of similar laws in California, Florida, and Maryland.
The branch of the Canadian government that the producers credited with supporting the film was less sanguine when informed about the apparent use of secret recordings made in American abortion clinics.
The film’s credits say that it was produced “with the assistance of the Government of Alberta, Alberta Media Fund,” but when Rewire contacted that Canadian province to learn why it had funded a piece of anti-choice propaganda, a spokesperson distanced the fund from the film.
“We have entered into conversations with the production company but we do not at this point have a formal agreement in place, and we were not aware that the production had been completed,” the spokesperson said. “We’re not able to comment on any funding because to date we have not funded the project. Thank you for bringing the use of our logo to our attention and we’ll be in touch with the producers to discuss.” The producers did not reply to Rewire’s question about their use of the logo.
Ironically, while the producer, Martin, did reply to emails from both Grimes and Rewire (albeit without answering specific questions), the reporter, Gill, remained silent. She never answered questions about what she knew about the backgrounds of the False Witnesses to whose work she lent such credence. She didn’t respond to our questions about whether she obtained permission to record video or audio within abortion clinics, or where those clinics were located. And she didn’t reply to our questions about the nature of her relationship with the extreme anti-choice group Live Action, who also received a credit at the end of the film.
To a reporter such as Gill, such silence would surely have been deeply suspicious.
Rewire Investigative Reporter, Amy Littlefield, contributed to this report.