California nursing regulators have again given the green light to a class teaching nurses about unproven abortion pill “reversal,” marking the third time the oversight agency has reversed course on the continuing ed class.

Dr. Joseph Morris, the chief of the nursing board, issued the approval in a December 19 letter to an attorney for Heartbeat International, an Ohio-based anti-choice nonprofit that offers the class to nurses from around the United States.

So-called abortion pill reversal is an experimental treatment advanced by abortion rights foes absent rigorous peer-reviewed research. The treatment purports to stop the effects of a pill-induced abortion with a large dose of the hormone progesterone after the first abortion pill. A pill-induced, or medication abortion, requires two medications to be effective.

The board reinstated Heartbeat International’s ability to teach so-called abortion pill reversal for continuing ed credit, “having considered the information provided during the informal conference December 11, 2017, with representatives of Heartbeat International,” according to a letter signed by Morris.

The California Board of Registered Nursing has for months flip-flopped over the class. Emails obtained by Rewire suggest board officials fear denying the class will prompt a lawsuit from anti-choice groups. In one email, Morris, the chief of the nursing board, warned two board members, Donna Gerber and Trande Phillips, the “issue has the potential to go viral.”

A board spokesperson told Rewire the board’s recent decision was “based on the course satisfying the Board’s regulatory requirements for continuing education and not on a threat of a lawsuit.”

The controversy came to a head last summer when the nursing board said the abortion pill “reversal” class met scientific standards, but reversed course less than two months later, when Morris issued a cease-and-desist letter to stop the class. Heartbeat International appealed the decision.

Best known for its network of anti-abortion crisis pregnancy centers, or fake clinics, Heartbeat International has been a board-approved continuing education provider since 2012, and has taught abortion pill “reversal” for years. Rewire’s reporting first brought the class to the board’s attention in 2016.

A spokesperson for Heartbeat International said it will offer the newly re-approved class at a national conference in Anaheim in April.

The course has become a political hot potato in the state capitol, according to documents Rewire obtained through a public records request that included emails from top officials. In recent months, legislative aides, attorneys, and nursing board officials debated whether the board had grounds to prohibit the abortion pill “reversal” class amid dueling legal opinions. 

In emails last fall, nursing officials circulated a Facebook post in which Heartbeat International threatened to sue the board. In one email exchange, a state senate aide shared a legal opinion suggesting the board and staff would be “safe” in the event of a lawsuit.

“Thanks! I was asked this question several times today,” replied Morris, the board chief.

In another, the aide told Morris, “Yes the board would be exposed to litigation, but it would win. Is the board completely risk adverse to the extent of not defending any standards?”

The American Congress of Obstetricians and Gynecologists has condemned abortion pill “reversal,” saying it is “not supported by the body of scientific evidence.” A Heartbeat International nursing instructor, Martha Shuping, has acknowledged abortion pill “reversal” is “not actually an accepted procedure.”

Emails Rewire obtained among staff for Assemblyman Jim Patterson (R-Fresno) and the head of the nursing board also suggest the lawmaker met with Morris and others on behalf of Heartbeat International after the board ordered the organization to stop teaching abortion pill “reversal.”

Patterson’s office did not respond to repeated requests for comment about the meetings. Patterson consistently opposes pro-choice positions, according to voting scorecard from the California Pro-Life Council.

State code requires nursing courses to be related to “scientific knowledge” or patient care. But documents Rewire obtained show that attorneys diverged on the legal standard for prohibiting the class and ousting Heartbeat International as a continuing ed provider.

Spencer Walker, attorney for the state Department of Consumer Affairs, the umbrella agency for the nursing board, wrote in an August 2017 memo that the abortion “reversal” course met state standards and was “clearly science-based.”

But in an earlier opinion in February 2017, state Legislative Counsel Diane Boyer-Vine wrote the nursing board could apply a different standard—where the yardstick was whether the course was “relevant to the practice of nursing.” Boyer-Vine held the board could withhold approval on that basis.

The nursing board is expected to consider revising regulations of continuing ed courses that teach “new and experimental healthcare treatments” at an upcoming meeting, a board spokesperson told Rewire.

Jay Hobbs, spokesman for Heartbeat International, commended the board for “resisting an overtly political attack that strips women of the right to choose against abortion,” in an email to Rewire.

The abortion pill “reversal” course is among several continuing-ed classes that first came to the board’s attention through Rewire’s reporting in 2016. Rewire revealed how Heartbeat International and other national anti-choice groups capitalized on a loophole in state law to teach unproven notions to nurses for state credit. Care Net and National Institute of Family and Life Advocates also taught anti-choice classes for state nursing credit.

Soon after, state Sen. Jerry Hill (D-San Mateo) introduced legislation to require continuing education courses to be based on science and the nursing board to routinely audit continuing ed providers. The law, approved by California’s governor in September 2016, went into effect in January 2017. That same month, a state nursing auditor warned Heartbeat International not to offer abortion pill “reversal” instruction as a California-approved provider. Susan Engle, a registered nurse and auditor, wrote: