News Law and Policy

Lawmaker Takes Aim at Anti-Choice Misinformation in Nurse Courses

Nicole Knight

A California state senator is calling for legislative reforms and an inquiry after an investigation by Rewire revealed that national anti-choice groups were teaching nurses dubious science with the tacit approval of the state.

A California state senator is calling for legislative reforms and an inquiry after an investigation by Rewire revealed that national anti-choice groups were teaching nurses dubious science with the tacit approval of the state.

State Sen. Jerry Hill, chair of the Senate Committee on Business, Professions, and Economic Development, said in a phone interview Wednesday that “we’ll be exploring all avenues, whether it’s legislation or hearings, to be sure the Board of Registered Nursing is approving continuing education providers that only teach accepted scientific principles to nurses.”

An Rewire investigation published Tuesday found that some of the nation’s largest abortion opponents, such as Heartbeat International and Care Net, had gained approval by the state Board of Registered Nursing to teach continuing education courses to nurses. The classes covered such medical myths as abortion pill reversal, a treatment rejected by the medical establishment, and other biased subjects.

Presented with Rewire’s findings, the state Board of Registered Nursing said in a written response that the law required it to approve providers, not courses.

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“This was astonishing,” Hill said of the results of Rewire’s six-week investigation. The state board, he continued, “needs to look at what is actually being taught. This is really a problem that we need to address.”

The San Mateo Democrat said he intends in the next couple of months to convene a hearing of the Committee on Business, Professions, and Economic Development, which has oversight over the Board of Registered Nursing, to investigate the extent of the problem with continuing education.

Calls for reform of the state Board of Registered Nursing (BRN) are not new. Last year, a scathing oversight report listed more than a dozen recommendations, including tightening the standards applied to continuing education (CE) classes and continuing education providers (CEP):

ISSUE #14: (OVERSIGHT OF CONTINUING EDUCATION FOR LICENSEES) The BRN has not provided appropriate oversight of its continuing education program despite admonition to do so in the previous review.

The BRN should review its criteria for CEPs and require content to be science-based and directly related to professionally appropriate practice. The BRN should continue to pursue additional staffing for CE auditors, but should simultaneously rebalance its existing workload and prioritize ongoing CE and CEP audits.

The report noted the infrequency of audits, concluding the “BRN completed only 200 RN CE audits from 2011 to 2014 and no CEP audits since 2001, citing lack of staff.”

Rewire in its investigation learned that three of the anti-choice organizations approved by the board had never been audited, although two had been approved years ago when Arnold Schwarzenegger was governor. The third was approved in 2012.

Hill said he will push to amend state code to require audits of providers every five years and to make sure classes adhere to “accepted scientific principles.”

Continuing education credits are required of nurses and doctors to maintain licensure in California. State law requires the Board of Registered Nursing to vet nursing continuing education providers, which range from private companies to universities. Class content, by law, “must be related to the scientific knowledge and/or technical skills required for the practice of nursing, or be related to direct and/or indirect patient/client care.” But the board leaves it to approved providers to ensure the class material abides by the law.

“We do not approve courses, we only approve the providers,” Christina Sprigg, chief of licensing and administrative services with the state board, previously told Rewire.

Hill questioned the adequacy of the screening process, and said applications from major abortion opponents like Heartbeat International and Care Net should have raised red flags.

“Someone should have been suspicious from the start and looked into it,” Hill said.

A quick Google search reveals that Heartbeat International is behind the nationwide billboards—“Pregnant? Scared? Need Help? Call us…”—designed to ensnare women seeking abortions. The Ohio-based organization is the umbrella group for 1,800 CPCs on six continents with the goal of “saving babies.”

Rewire found that the organization appears to be teaching dubious medicine to nurses with the class “Abortion Pill Reversal and Your Clinic.” And although Heartbeat International is offering continuing education credit for the course, the organization failed to list “Abortion Pill Reversal and Your Clinic” on its application to the state.

Screenshot 2016-01-15 10.34.35

An “Abortion Pill Reversal and Your Clinic” course was among those available for health-care workers at the Heartbeat International conference in St. Louis.

Heartbeat International, and other abortion opponents, have treated the notion of abortion pill reversal, or undoing a pill-induced abortion, as a medical fact.

A statement sent to Rewire from a Heartbeat International representative asserted, “There are 150 children alive today—and 80 more on the way—because of the RU-486 reversal process. Why not celebrate the introduction of a medicine that further empowers a mother to make the healthiest choice for everyone involved in an unexpected pregnancy?”
The statement continued, “It might be helpful to add that those ‘accepted scientific principles’ one generation has thought unmovable have been thoroughly disproven and discredited by the next. ‘Scientific principles’ always allow for innovation and progress. Women deserve to know the whole truth about abortion, parenting and making an adoption plan for their child.”

But the science behind abortion pill reversal is scanty, at best.

single 2012 paper in Annals of Pharmacotherapy claimed to have reversed the medication abortions of four of six women included in the study. Experts say the six cases cited in the Annals of Pharmacotherapy paper are insufficient to draw conclusions.

The American Congress of Obstetricians and Gynecologists (ACOG), a professional organization of 58,000 OB-GYNs and women’s health-care professionals, is dismissive of the purported treatment.

“There is really no clear evidence that this works,” Dr. Daniel Grossman, ACOG fellow and director of Advancing New Standards in Reproductive Health, a research group at the University of California, San Francisco, said in an interview with MedPage Today.

Care Net, another anti-choice organization approved by the state Board of Registered Nursing, has offered the class, “Fetal Pain: What’s the Evidence?” for California continuing education credit.

A class available for continuing education credit at a Care Net conference.

A class available for continuing education credit at a Care Net conference.

Fetal pain is a notion embraced by anti-choice lawmakers in Arizona and elsewhere in failed attempts to ban abortion after the first trimester.

The medical establishment agrees that the fetal nervous system lacks the development necessary to feel pain until the third trimester. ACOG has said that fetal pain is unlikely before the third trimester and “no studies since 2005 demonstrate fetal recognition of pain.”

Dr. Sandra Christiansen is the instructor for “Fetal Pain: What’s the Evidence?”; her name also appeared on Care Net’s nine-year-old state application. But the application neglects to mention the fetal pain class, making it difficult to say precisely what Christiansen may have taught nurses.

What is clear is that Christiansen gave testimony two years ago in support of Maryland’s Pain-Capable Unborn Child Protection Act, an attempt to ban abortion care after 20 weeks.

Care Net did not respond to requests for comment.

Dr. Pratima Gupta, a reproductive health advocacy fellow with New York City-based Physicians for Reproductive Health, previously expressed concern that these classes are introducing bias or worse, at a time when evidence-based reproductive health care is under attack by legislators and powerful, well-funded anti-choice organizations.

“It’s obviously going to impact women’s health in that a nurse is receiving information that he or she is then disseminating to their patients,” Gupta said. “I think that’s the concern.”

UPDATE: This piece has been updated to include a statement from a Heartbeat International representative.

News Abortion

Anti-Choice Leader to Remove Himself From Medical Board Case in Ohio

Michelle D. Anderson

In a letter to the State of Ohio Medical Board, representatives from nine groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Anti-choice leader Mike Gonidakis said Monday that he would remove himself from deciding a complaint against a local abortion provider after several groups asked that he resign as president of the State of Ohio Medical Board.

The Associated Press first reported news of Gonidakis’ decision, which came after several pro-choice groups said he should step down from the medical board because he had a conflict of interest in the pending complaint.

The complaint, filed by Dayton Right to Life on August 3, alleged that three abortion providers working at Women’s Med Center in Dayton violated state law and forced an abortion on a patient that was incapable of withdrawing her consent due to a drug overdose.

Ohio Right to Life issued a news release the same day Dayton Right to Life filed its complaint, featuring a quotation from its executive director saying that local pro-choice advocates forfeit “whatever tinge of credibility” it had if it refused to condemn what allegedly happened at Women’s Med Center.

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Gonidakis, the president of Ohio Right to Life, had then forwarded a copy of the news release to ProgressOhio Executive Director Sandy Theis with a note saying, “Sandy…. Will you finally repudiate the industry for which you so proudly support? So much for ‘women’s health’. So sad.”

On Friday, ProgressOhio, along with eight other groupsDoctors for Health Care Solutions, Common Cause Ohio, the Ohio National Organization for Women, Innovation Ohio, the Ohio House Democratic Women’s Caucus, the National Council of Jewish Women, Democratic Voices of Ohio, and Ohio Voice—responded to Gonidakis’ public and private commentary by writing a letter to the medical board asking that he resign.

In the letter, representatives from those groups shared comments made by Gonidakis and said he lacked the objectivity required to remain a member of the medical board. The letter’s undersigned said the board should take whatever steps necessary to force Gonidakis’ resignation if he failed to resign.

Contacted for comment, the medical board did not respond by press time.

The Ohio Medical Board protects the public by licensing and regulating physicians and other health-care professionals in part by reviewing complaints such as the one filed by Dayton Right to Life.

The decision-making body includes three non-physician consumer members and nine physicians who serve five-year terms when fully staffed. Currently, 11 citizens serve on the board.

Gonidakis, appointed in 2012 by Ohio Gov. John Kasich, is a consumer member of the board and lacks medical training.

Theis told Rewire in a telephone interview that the letter’s undersigned did not include groups like NARAL Pro-Choice and Planned Parenthood in its effort to highlight the conflict with Gonidakis.

“We wanted it to be about ethics” and not about abortion politics, Theis explained to Rewire.

Theis said Gonidakis had publicly condemned three licensed doctors from Women’s Med Center without engaging the providers or hearing the facts about the alleged incident.

“He put his point out there on Main Street having only heard the view of Dayton Right to Life,” Theis said. “In court, a judge who does something like that would have been thrown off the bench.”

Arthur Lavin, co-chairman of Doctors for Health Care Solutions, told the Associated Press the medical board should be free from politics.

Theis said ProgressOhio also exercised its right to file a complaint with the Ohio Ethics Commission to have Gonidakis removed because Theis had first-hand knowledge of his ethical wrongdoing.

The 29-page complaint, obtained by Rewire, details Gonidakis’ association with anti-choice groups and includes a copy of the email he sent to Theis.

Common Cause Ohio was the only group that co-signed the letter that is decidedly not pro-choice. A policy analyst from the nonpartisan organization told the Columbus Dispatch that Common Cause was not for or against abortion, but had signed the letter because a clear conflict of interest exists on the state’s medical board.

Analysis Law and Policy

California Bill Aimed at Anti-Choice Videos Draws Free Speech Concerns

Amy Littlefield

“We wanted to make sure that we updated ... laws to kind of reflect a changing world and to make sure that we actually protect the doctors who provide these important services to women,” California Assemblymember Jimmy Gomez said, adding that his legislation would also protect patient safety and access to abortion.

A California bill that would make it a crime to distribute secret recordings of health-care providers—like the ones David Daleiden used in his smear campaign against Planned Parenthood—has cleared a legislative hurdle, but faces opposition from media groups and civil liberties advocates, who say the legislation is overly broad.

It is already illegal in California to record, whether in audio or video form, a confidential communication without the consent of all parties involved. But California Assemblymember Jimmy Gomez, who introduced AB 1671, told Rewire that while current law specifically forbids the distribution of illegally recorded telephone calls, there is no similar protection for videos.

“We wanted to make sure that we updated those laws to kind of reflect a changing world and to make sure that we actually protect the doctors who provide these important services to women,” Gomez said, adding that his legislation would also protect patient safety and access to abortion.

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AB 1671 makes it a crime if someone who violates California’s existing law against secret recordings “intentionally discloses or distributes, in any manner, in any forum, including, but not limited to, Internet [websites] and social media, or for any purpose, the contents of a confidential communication with a health care provider that is obtained by that person.”

Violators could be jailed for up to a year and fined up to $2,500, penalties similar to those already in place for making illegal recordings. But the new measure specifies that for both recording and distribution, the fines apply to each violation; that means someone like Daleiden, who circulated his videos widely, could quickly rack up heavy fines. Repeat offenders could face fines of up to $10,000 per violation.

The effort to pass the bill comes as abortion providers face a rising tide of threats and secret recordings. Besides Daleiden’s efforts, covertly recorded footage of clinic staff has cropped up in the documentary HUSH and in videos released by the anti-choice group Live Action. Planned Parenthood reported a ninefold increase in harassment at its health centers in July last year, when Daleiden began releasing the deceptively edited videos he claimed showed the organization was illegally profiting from fetal tissue donation. (Multiple federal and state investigations have found no wrongdoing by Planned Parenthood.) The National Abortion Federation recorded an “unprecedented” spike in hate speech and threats against abortion providers last year, peaking with the fatal shooting of three people at a Colorado Springs Planned Parenthood.

Increased Threats

“It was so alarming and so extensive that our staff that normally tracks threats and violence against providers could not keep up,” NAF President and CEO Vicki Saporta told Rewire. The organization was forced to hire an outside security firm.

Beth Parker, chief legal counsel for Planned Parenthood Affiliates of California, told Rewire the new legislation is needed to protect the safety of abortion providers.

“If our providers aren’t safe, then they won’t provide, and we won’t have access to reproductive health care,” Parker said in a phone interview.

Daleiden’s group, the Center for Medical Progress, is based in California, and much of his covert recording took place there. Of the four lawsuits he and his group face over the recordings, three have been filed in federal court in California. Yet so far, the only criminal charges against Daleiden have been lodged in Texas, where a grand jury tasked with investigating Planned Parenthood instead indicted Daleiden and fellow anti-choice activist Sandra Merritt for purportedly using fake California driver’s licenses as part of their covert operation. The charges were later dropped for procedural reasons.

Last summer, California Attorney General Kamala Harris announced plans to review whether the Center for Medical Progress violated any laws, and in April, state investigators raided Daleiden’s apartment. Harris has not yet announced any charges. Daleiden has accused officials of seizing privileged information, a claim the attorney general’s office told Rewire it is working on resolving in court.

Harris, meanwhile is running for Senate; her campaign website describes her as “a champion for a woman’s right to choose.”

“We think there is an excellent case and the attorney general should have prosecuted,” Beth Parker of Planned Parenthood Affiliates of California told Rewire. “Daleiden did more than just publish the videos, as we know, I mean he falsified driver’s licenses, he falsified credit cards, he set up a fake company. I mean, we have, as you know, a major civil litigation against him and his conspirators. I just can’t answer to why the attorney general hasn’t prosecuted.”

Parker said AB 1671 could increase incentives for law enforcement to prosecute such cases.

“What we’ve heard as we’ve been working [on] the bill is that criminal law enforcement almost never prosecutes for the violation of illegal recording,” Parker said. “It’s just too small a crime in their view.”

Assemblymember Gomez also said he hopes his bill will facilitate the prosecution of people like Daleiden, and serve as a deterrent against people who want to use illegal recordings to “undermine the fact that people have this right to have control over their bodies.”

“That’s the hope, is that it actually does change that landscape, that DAs will be able to make a better case against individuals who illegally record and distribute,” Gomez said.

Vicki Saporta of the National Abortion Federation says the actions of law enforcement matter when it comes to the safety of abortion providers.

“There’s certainly a correlation between law enforcement’s response to criminal activity aimed at abortion providers and the escalation or de-escalation of that activity,” Saporta said, citing the federal government’s response to the murders of abortion providers in the 1990s, which included the deployment of federal marshals to guard providers and the formation of a task force by then-Attorney General Janet Reno. “We had more than a decade of decreases in extreme violence aimed at abortion providers, and that ended in 2009 with the murder of Dr. [George] Tiller.”

But media and civil liberties groups, including the Electronic Frontier Foundation and American Civil Liberties Union of California, have expressed concerns the bill could sweep up journalists and whistleblowers.

“The passing of this law is meant to chill speech, right, so that’s what they want to do,” Nikki Moore, legal counsel of the California Newspaper Publishers Association, which opposes the legislation, said in an interview with Rewire. In addition to potential criminal penalties, the measure would create new civil liabilities that Moore says could make journalists hesitant to publish sensitive information.  

“A news organization is going to look at it and say, ‘Are we going to get sued for this? Well, there’s a potential, so we probably shouldn’t distribute it,’” Moore said.

As an example of the kind of journalism that could be affected by the bill, Moore cited a Los Angeles Times investigation that analyzed and helped debunk Daleiden’s footage.

“Planned Parenthood’s bill would criminalize that behavior, so it’s short-sighted of them if nothing else,” Moore said.

Assemblymember Gomez disagrees about the scope of the bill. “We have tailored it narrowly to basically say it applies to the person who illegally recorded the video and also is distributing that video, so it doesn’t apply to, say, a news agency that actually ends up getting the video,” he said.

Late last week, the California Senate Appropriations Committee released AB 1671 to the state senate floor on a vote of 5 to 2, with Republicans opposing it. The latest version has been amended to remove language that implicated “a person who aids and abets” the distribution of secret recordings, wording civil liberties groups said could be used to sweep in journalists and lawyers. The latest draft also makes an exception for recordings provided solely to law enforcement for investigations.

But the ACLU of California and the California Newspaper Publishers Association said they still oppose the bill. (The Electronic Frontier Foundation said it is still reviewing the changes.)

“The likelihood of a news organization being charged for aiding and abetting is certainly reduced” under the new language, Moore said. But provisions already exist in the California penal code to implicate those accused of aiding and abetting criminal behavior.

“You can imagine scenarios where perhaps the newspaper published it and it’s an anonymous source, and so now they’re aiding and abetting the distribution, and they’re the only person that the prosecutor knows might have been involved,” Moore says.

In letter of opposition sent in June to Assemblymember Gomez, Kevin Baker, legislative director of the ACLU of California, raised concerns about how the measure singles out the communications of health-care providers.

“The same rationale for punishing communications of some preferred professions/industries could as easily be applied to other communications —e.g., by law enforcement, animal testing labs, gun makers, lethal injection drug producers, the petroleum industry, religious sects,” Baker wrote.

Gomez said there could be further changes to the bill as talks aimed at resolving such opposition continue. An earlier version passed the assembly easily by a vote of 52 to 26. The latest draft faces an August 31 deadline to pass the senate and a concurrence vote in the assembly before the end of the session. After that, Gomez said he hopes California Gov. Jerry Brown (D) will sign it.

“If we can strike the right balance [between the rights of privacy and free speech], my hope is that it’s hard for him not to support it,” Gomez said. 

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