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.
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.
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.
But the science behind abortion pill reversal is thin.
A 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.