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.
Heartbeat International, and other abortion opponents, have treated the notion of abortion pill reversal, or undoing a pill-induced abortion, as a medical fact.
But the science behind abortion pill reversal is scanty, at best.
A 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.
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.