News Science

California Lawmaker: Root Out Anti-Choice Misinformation in Nurse Courses

Nicole Knight Shine

An Rewire investigation found that anti-choice groups were taking advantage of loopholes and lax oversight to teach nurses dubious medicine.

A California bill introduced this month requires continuing education courses for nurses to be based in fact, after Rewire revealed that national organizations were teaching classes containing anti-choice ideology.

SB 1039, introduced by state Sen. Jerry Hill (D-San Mateo), mandates that classes taken to maintain state licensure be based on “generally accepted scientific principles.”

“At the end of the day, this will ensure that any continuing education courses offered to the nursing profession are professional and based on sound scientific research and evidence,” Hill told Rewire.

The omnibus reform bill imposes new safeguards in nursing education, directing the Board of Registered Nursing (BRN) to audit continuing education providers at least once every five years and to withhold or rescind approval from those found in violation of state laws and regulations.

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An Rewire investigation published in January described how some of the nation’s more prominent abortion opponents gained the approval of the BRN to teach continuing education courses on subjects such as “abortion pill reversal”—a treatment rejected by the medical establishment—and other scientifically unsupported topics.

The providers were capitalizing on a loophole in state law and lax oversight. Current law requires continuing education course materials to “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.” The board, however, doesn’t actually approve the materials that providers teach.

And, even though the law provides for it, the BRN failed to audit a single continuing education provider between 2001 and 2014, according to a 2015 joint oversight report prepared for the state Senate Committee on Business, Professions and Economic Development and the Assembly Business and Professions Committee.

Continuing education credits are required of nurses and doctors to maintain licensure in California. The BRN regulates more than 400,000 California licensees, such as nurses and nurse practitioners, and continuing education providers. State law requires the BRN to vet the providers, which range from private companies to universities.

Rewire reviewed the state-approved applications of three organizations—Heartbeat International, Care Net, and National Institute of Family and Life Advocates—and found the providers failed to disclose to the board the medically questionable subjects they taught to nurses.

Stephanie Roberson, lead lobbyist with the 85,000-member California Nurses Association, said the union was reviewing the reform bill ahead of a committee hearing expected in March.

“We believe, of course, that there should be proper oversight of continuing education courses and providers,” Roberson told RH Reality Check.

Calls for reform of the BRN aren’t new.

The 2015 oversight report laid out more than a dozen reforms, telling the board to tighten the standards applied to continuing education (CE) classes and continuing ed 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 BRN responded that it’s running out of money and, without a fee hike, may need to cut staff. In the past few years, the BRN has loaned the state General Fund $13.3 million, and has been paid back $3 million.

Roberson said the BRN has asked for more staff to perform audits.

”We hope that happens,” she said. “We want to make sure that the board has adequate staff to do its job.”

The Ohio-based anti-choice group Heartbeat International last year offered the class “Abortion Pill Reversal and Your Clinic” for continuing education credit to nurses at a St. Louis conference.

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

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 is the umbrella group for 1,800 crisis pregnancy centers around the world whose expressed mission is “saving babies.”

The organization, and other abortion rights opponents, have treated the notion of “abortion pill reversal,” or undoing a pill-induced abortion, as medically feasible.

A Heartbeat International representative told Rewire in a statement: “There are 150 children alive today—and 80 more on the way—because of the RU-486 reversal process. 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.”
 

But the science behind abortion pill reversal is thin.

single 2012 paper in Annals of Pharmacotherapy claimed to have reversed the medication abortions of four of six women included in the study. Medical experts, such as those at the American Congress of Obstetricians and Gynecologists (ACOG), say the six cases cited in the Annals of Pharmacotherapy paper are not enough to draw conclusions.

“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.

As previously reported by Rewire, Care Net, another national anti-choice organization approved to teach CE classes to nurses, offered the class, “Fetal Pain: What’s the Evidence?” in San Diego last year.

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 taught “Fetal Pain: What’s the Evidence?” in San Diego; her name also appeared on Care Net’s nine-year-old state application to teach classes. But the application did not list the fetal pain class, making it difficult to evaluate the content of Christiansen’s classes for 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.

Hill, chair of the state Senate Committee on Business, Professions, and Economic Development, said that following Rewire’s investigation, BRN officials said the board would issue cease-and-desist letters to Care Net and the two other providers.

“And we have not seen evidence of that,” Hill said Tuesday.

Heartbeat International, Care Net, and the National Institute of Family and Life Advocates remain on the BRN’s website in good standing.

Rewire filed a Public Records Act request for recent documents and communications between the board and these three providers. The BRN denied that request last week, citing “section 6254 of the Government Code, relating to records of complaints made to and investigations conducted by a state licensing agency.”

Hill maintains the providers “slipped through the cracks because of a lack of auditing and oversight on behalf of the board.” He said more work is needed to hold the board accountable.

“My job is now what’s the best way to get to that goal,” he said.

News Abortion

Texas Pro-Choice Advocates Push Back Against State’s Anti-Choice Pamphlet

Teddy Wilson

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated since 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature.

Reproductive rights advocates are calling for changes to information forced on pregnant people seeking abortion services, thanks to a Texas mandate.

Texas lawmakers passed the Texas Woman’s Right to Know Act in 2003, which requires abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated or revised since it was first made public in 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature. 

The Texas Department of State Health Services (DSHS) in June published a revised draft version of the pamphlet. The draft version of “A Woman’s Right to Know” was published online, and proposed revisions are available for public comment until Friday.

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John Seago, spokesperson for the anti-choice Texas Right to Life, told KUT that the pamphlet was created so pregnant people have accurate information before they consent to receiving abortion care.

“This is a booklet that’s not going to be put in the hands of experts, it’s not going to be put in the hands of OB-GYNs or scientists–it’s going to be put in the hands of women who will range in education, will range in background, and we want this booklet to be user-friendly enough that anyone can read this booklet and be informed,” he said.

Reproductive rights advocates charge that the information in the pamphlet presented an anti-abortion bias and includes factually incorrect information.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet was medically inaccurate, according to a study by a Rutgers University research team.

State lawmakers and activists held a press conference Wednesday outside the DSHS offices in Austin and delivered nearly 5,000 Texans’ comments to the agency.  

Kryston Skinner, an organizer with the Texas Equal Access Fund, spoke during the press conference about her experience having an abortion in Texas, and how the state-mandated pamphlet made her feel stigmatized.

Skinner told Rewire that the pamphlet “causes fear” in pregnant people who are unaware that the pamphlet is rife with misinformation. “It’s obviously a deterrent,” Skinner said. “There is no other reason for the state to force a medical professional to provide misinformation to their patients.”

State Rep. Donna Howard (D-Austin) said in a statement that the pamphlet is the “latest shameful example” of Texas lawmakers playing politics with reproductive health care. “As a former registered nurse, I find it outrageous that the state requires health professionals to provide misleading and coercive information to patients,” Howard said.

Howard, vice chair of the Texas House Women’s Health Caucus, vowed to propose legislation that would rid the booklet of its many inaccuracies if DSHS fails to take the thousands of comments into account, according to the Austin Chronicle

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by legislators and organizations that oppose legal abortion care. 

The American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to DSHS that said the organization has “significant concerns with some of the material and how it is presented.”

Among the most controversial statements made in the pamphlet is the claim that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

Texas Right to Life said in a statement that the organization wants the DSHS include “stronger language” about the supposed correlation between abortion and breast cancer. The organization wants the pamphlet to explicitly cite “the numerous studies that indicate undergoing an elective abortion contributes to the incidence of breast cancer in women.”

Rep. Sarah Davis (R-West University Place) said in a statement that the state should provide the “most accurate science available” to pregnant people seeking an abortion. “As a breast cancer survivor, I am disappointed that DSHS has published revisions to the ‘A Woman’s Right to Know’ booklet that remain scientifically and medically inaccurate,” Davis said.

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

DSHS spokesperson Carrie Williams told the Texas Tribune that the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

“We carefully considered medical and scientific information when updating the draft booklet,” Williams said.

News Law and Policy

Three Crisis Pregnancy Centers Served for Breaking California Law

Nicole Knight Shine

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act.

The Los Angeles City Attorney is warning three area fake clinics, commonly known as crisis pregnancy centers (CPCs), that they’re breaking a new state reproductive disclosure law and could face fines of $500 if they don’t comply.

The notices of violation issued this month mark the first time authorities anywhere in the state are enforcing the seven-month-old Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act, advocates and the state Attorney General’s office indicate.

The office of City Attorney Mike Feuer served the notices on July 15 and July 18 to two unlicensed and one licensed clinic, a representative from the office told Rewire. The Los Angeles area facilities are Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

The law requires the state’s licensed pregnancy-related centers to display a brief statement with a number to call for access to free and low-cost birth control and abortion care, and for unlicensed centers to disclose that they are not medical facilities.

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“Our investigation revealed,” one of the letters from the city attorney warns, “that your facility failed to post the required onsite notice anywhere at your facility and that your facility failed to distribute the required notice either through a printed document or digitally.”

The centers have 30 days from the date of the letter to comply or face a $500 fine for an initial offense and $1,000 for subsequent violations.

“I think this is the first instance of a city attorney or any other authority enforcing the FACT Act, and we really admire City Attorney Mike Feuer for taking the lead,” Amy Everitt, state director of NARAL Pro-Choice California, told Rewire on Wednesday.

Feuer in May unveiled a campaign to crack down on violators, announcing that his office was “not going to wait” amid reports that some jurisdictions had chosen not to enforce the law while five separate court challenges brought by multiple fake clinics are pending.

Federal and state courts have denied requests to temporarily block the law, although appeals are pending before U.S. Court of Appeals for the Ninth Circuit.

In April, Rebecca Plevin of the local NPR affiliate KPCC found that six of eight area fake clinics were defying the FACT Act.

Although firm numbers are hard to come by, around 25 fake clinics, or CPCs, operate in Los Angeles County, according to estimates from a representative of NARAL Pro-Choice California. There are upwards of 1,200 CPCs across the country, according to their own accounting.

Last week, Rewire paid visits to the three violators: Harbor Pregnancy Help Center, Los Angeles Pregnancy Services, and Pregnancy Counseling Center.

Christie Kwan, a nurse manager at Pregnancy Counseling Center, declined to discuss the clinic’s noncompliance, but described their opposition to the state law as a “First Amendment concern.”

All three centers referred questions to their legal counsel, Alliance Defending Freedom (ADF), an Arizona-based nonprofit and frequent defender of discriminatory “religious liberty” laws.

Matt Bowman, senior counsel with ADF, said in an email to Rewire that forcing faith-based clinics to “communicate messages or promote ideas they disagree with, especially on life-and-death issues like abortion,” violates their “core beliefs” and threatens their free speech rights.

“The First Amendment protects all Americans, including pro-life people, from being targeted by a government conspiring with pro-abortion activists,” Bowman said.

Rewire found that some clinics are following the law. Claris Health, which was contacted as part of Feuer’s enforcement campaign in May, includes the public notice with patient intake forms, where it’s translated into more than a dozen languages, CEO Talitha Phillips said in an email to Rewire.

Open Arms Pregnancy Center in the San Fernando Valley has posted the public notice in the waiting room.

“To us, it’s a non-issue,” Debi Harvey, the center’s executive director, told Rewire. “We don’t provide abortion, we’re an abortion-alternative organization, we’re very clear on that. But we educate on all options.”

Even so, reports of deceit by 91 percent of fake clinics surveyed by NARAL Pro-Choice California helped spur the passage of the FACT Act last October. Until recently, a person who Googled “abortion clinic” might be directed to a fake clinic, or CPC.

Oakland last week became the second U.S. city to ban false advertising by facilities that city leaders described as “fronts for anti-abortion activists.” San Francisco passed a similar ordinance in 2011.