Nearly a dozen state-funded fake clinics in Texas have not received required annual inspections since September 2016, as inspections of these fake clinics revealed dozens of discrepancies, including violations of basic safety protocols, according to documents reviewed by Rewire.News.

Republicans in the Texas legislature have created burdensome regulations for abortion clinics, while lawmakers have funneled millions of taxpayer dollars to so-called crisis pregnancy centers, fake clinics that deploy anti-choice propaganda.

Alexa Garcia-Ditta, communications director at NARAL Pro-Choice Texas, told Rewire.News that the documents revealed predictable results from a program with no measurable goals or oversight.

“It is shameful that Texas continues to pour millions of taxpayer dollars into fake women’s health centers that operate with no accountability or oversight,” Garcia-Ditta said. “In shutting down licensed abortion clinics and instead legitimizing crisis pregnancy centers, Texas officials have made it clear that they do not truly care about the health and safety of pregnant Texans.”

The Alternative to Abortion services program, created by the GOP-held state legislature in 2005, has distributed $54.9 million organizations that oppose abortion rights and purport to provide support services to pregnant people and adoptive parents.

Texas Health and Human Services overseas the Alternatives to Abortion service program, and during the 2017 legislative session state lawmakers dramatically increased the funding of the program to $38.3 million.

The funds are distributed through the Texas Pregnancy Care Network (TPCN), a nonprofit organization awarded a contract to distribute the funds to more than 50 subcontractors with 121 locations. The subcontractors include social services organizations, adoption agencies, and maternity homes, however, fake clinics are the largest single category of subcontractors with 51 locations.

A Rewire.News investigation found most of the funding distributed by TPCN to fake clinics was not used for concrete assistance or services.

TPCN during the first six months of the current fiscal year has distributed more than $4 million to subcontractor providers, and nearly $2 million has gone to fake clinics. Since 2015, TPCN has funneled more than $10 million to fake clinics. 

John McNamara, executive director of the Texas Pregnancy Care Network, told Rewire.News that monitoring occurs at least once a year for all providers. Facilities tours occur when a provider changes location, opens a new facility, makes significant changes, or remodels a facility.

“In addition, extensive monitoring of providers is done on a daily, weekly, and monthly basis remotely from TPCN’s offices,” McNamara said. “Facilities tours occur as needed to ensure that new or altered facilities comply with program standards.”

A review of the quarterly reports submitted to HHSC found there were 11 fake clinics that did not receive an onsite annual monitoring or facility tour between September 2016 and February 2018, and 33 other provider locations also did not receive an onsite annual monitoring or facility tour.

Thirty-seven of the 51 fake clinics received annual monitoring during that 18-month stretch. Three more fake clinic locations received a facility tour.

When asked why more than a third of subcontractors had not been the subject of an onsite inspection, McNamara said that “all providers were annual monitored last fiscal year, and all will be annual monitored this fiscal year.”

Metroplex Women’s Clinics provide limited pregnancy support services at four locations and a mobile pregnancy clinic. The organization has been a subcontractor provider for TPCN since 2016, and has received more than $442,000 in state funding.

TPCN’s program compliance manager on April 4, 2017 conducted an onsite annual monitoring of Metroplex Women’s Clinic Southeast location in Arlington, and no discrepancies were recorded. Metroplex Women’s Clinic’s other three locations and mobile clinic have not received an onsite annual monitoring or facility tour, according to documents dating back to September 2016.

State law requires abortion clinics receive onsite inspection at least once every year, and abortion providers must follow more than 120 pages of regulations. Texas does not license or regulate fake clinics.

Fatimah Gifford, vice president of marketing and public relations at Whole Woman’s Health, confirmed in an email to Rewire.News that each of the organization’s four clinics had been inspected by officials from the Department of State Health Services (DSHS).

“All of our [Texas] sites have had DSHS inspections this year and annually every year without exception,” Gifford said. “And sometimes we are inspected more than once.”

TPCN personnel conducted onsite annual monitoring or facility tours of 22 fake clinics during the current fiscal year, and at 17 subcontractor provider locations recorded an average of 3.9 discrepancies. The discrepancies recorded included “smoke detectors were not installed” and “one or more procedures were not in substantial compliance with program rules relating to separation of spiritual activities/materials.”

Foundation for Life is a nonprofit organization that offers “positive alternatives to young women considering abortion” in an office in northwest Houston.

TPCN conducted a facility tour in June 2017 of the Foundation for Life. The report shows discrepancies, including that the facility was missing a fire extinguisher and “No Smoking” sign and that “spiritual materials were not labeled and separated from the non-spiritual materials.” An annual monitoring was conducted by TPCN on February 8, and the report once again shows discrepancies, including that “educational materials were not in compliance with program rules relating to storage” and “access to client files needed to be better secured.”

Foundation for Life, which as received $27,383 in state funding during the first six months of the 2018 fiscal year, has gotten $29,963 in state funding during since becoming a TPCN subcontractor provider.

TPCN subcontractor providers usually have two weeks to resolve discrepancies. The average subcontractor provider takes two weeks or less to remedy discrepancies. “TPCN verifies corrective action by email, photo, by video call, or in-person as needed,” McNamara said.

If a subcontractor provider has repeat deficiencies, the TPCN program director conducts specific training and oversight with the subcontractor provider to ensure standards are met. “Depending on the severity, repeat deficiencies may result in contract suspension, termination, or non-renewal,” McNamara said.

Garcia-Ditta said fake clinics use scare tactics and and provide medically inaccurate information to manipulate pregnant people, and are “ultimately dangerous to the health and safety of pregnant Texans seeking health care.”

“By funding these fake clinics and allowing them to stay open with no mechanism for oversight, the Texas Legislature is directly supporting lies, deception, and coercion,” Garcia-Ditta said. “Texas must stop playing politics with people’s health and fund legitimate providers who offer comprehensive and accurate medical services.”