What The Hell America!

A groundbreaking lawsuit and new state law expose the dangerous practices of crisis pregnancy centers and mark a turning point in the fight for reproductive healthcare accountability.

Antiabortion crisis pregnancy centers (CPCs) across the United States receive state and federal funds but have operated with little or no government oversight. CPCs use unsterilized transvaginal ultrasounds wands inside of patients, delay access to lifesaving care by misdiagnosing serious medical conditions and steal patient data from real medical clinics, according to investigative reporting and lawsuits filed against them. Advocates have been stymied in their efforts to obtain any sort of CPC accountability. But that may be changing.

Last year, a Massachusetts woman brought a first-of-its-kind class-action lawsuit against a CPC for deceptive trade practices and failure to operate under medical standards of care, resulting in misdiagnosis of her ectopic pregnancy and a life-threatening emergency. After the woman won a favorable lower court decision, the CPC, Clearway Clinic, settled the case.

“These unregulated pregnancy centers claim to offer reproductive healthcare, but they operate with almost no medical oversight and a mission that puts personal ideology above patient well-being,” said Jenifer McKenna, senior advisor at Reproductive Health and Freedom Watch. “This chilling case against Clearway Clinic revealed that CPCs may limit access to lifesaving health treatments that don’t align with their views.”

In the wake of the case, Massachusetts legislators passed a first-of-its-kind law requiring licensed medical professionals who provide medical care for pregnant patients as part of their scope of practice to supervise the provision of pregnancy ultrasound services in the state. These strategies offer new promise for holding the CPC industry accountable for some of the ways they threaten the health of people seeking reproductive care.

Jane Doe v. Clearway Clinic, Inc.

On June 22, 2023, the plaintiff—who went by Jane Doe in the case—filed a class-action lawsuit against the Clearway Clinic, Inc., alleging that a nurse at their Worcester, Mass., center failed to diagnose her ectopic pregnancy, leaving her to suffer a life-threatening emergency.

The plaintiff’s complaint alleged two violations of state law:

1. Clearway engaged in deceptive advertising because it “does not make clear that its true goal is to dissuade women from terminating their pregnancies, rather than providing them with the range of medically appropriate options.”
2. The complaint maintained Clearway failed to adhere to accepted standards of medical care, resulting in a “missed diagnosis of an ectopic pregnancy, which ended up rupturing.” The plaintiff alleged that “Clearway’s failure to adhere to accepted standards of medical care constitutes medical malpractice.”

The complaint asserted that the nurse who administered the plaintiff’s ultrasound did not undertake sufficient medical measures to ensure that her pregnancy was in utero. “The nurses making these diagnoses are not licensed to diagnose viable pregnancies, as they are neither licensed to practice medicine nor are they advanced practice registered nurses,” according to the complaint.

Moreover, while the appropriate medical action was an immediate termination of the pregnancy, the plaintiff further alleged that Clearway would not have done this or even made a referral for this lifesaving procedure because of the organization’s antiabortion beliefs.

She thought it was a place where she could go and get actual medical care help and confirm her pregnancy.

Shannon Liss-Riordan

Rather than diagnosing the ectopic pregnancy, the complaint asserts that Clearway was instead “focused on encouraging plaintiff to continue her pregnancy.”

As a result, Clearway “missed a life-threatening condition that caused grave harm and distress to plaintiff.” The rupture of the plaintiff’s ectopic pregnancy caused massive internal bleeding and necessitated emergency surgery. As a result, the plaintiff lost her fallopian tube.

“We know these clinics lure women in under the pretext of being actual, real medical centers, but they’re not,” said Boston-based attorney who brought the case, Shannon Liss-Riordan, whom Forbes magazine named to its 2024 list of 200 Best Lawyers in America. “The goal is, of course, to dissuade women from terminating their pregnancies and seeking or obtaining actual medical care.”

After a positive home pregnancy test, the plaintiff wanted to confirm the result with a medical provider. When she searched the internet, a Google advertisement directed her to Clearway Clinic.

“It appeared to her from the ad that it was an actual medical center, and she thought it was a place where she could go and get actual medical care help and confirm her pregnancy,” said Liss-Riordan.

The plaintiff contacted Clearway and went right into their Worcester center to see a nurse in October 2022. After administering an ultrasound, the nurse told the plaintiff she had a viable in utero pregnancy. The plaintiff left the clinic believing that her pregnancy was fine.

“She found it a little odd that after the visit, the staff at the clinic kept following up with her, wanting to know if everything was okay, and just making sure she was planning to continue with the pregnancy,” said Liss-Riordan, noting that the plaintiff had no intention of ending the pregnancy. “She was just seeking medical care.”

Instead, “she was given horrific care because she did not have a viable in utero pregnancy. She had an ectopic pregnancy,” said Liss-Riordan. “She found that out when she was rushed to the hospital not that long after because her ectopic pregnancy exploded. It was a near life-threatening experience for her.”

The plaintiff later learned that the Clearway nurse who diagnosed her with a viable in utero pregnancy was not licensed to make that diagnosis. “We had an expert witness who was prepared to say that the standard of care was such that someone who had looked at this ultrasound picture should have been able to know that,” said Liss-Riordan.

In response to the lawsuit, Clearway Clinic filed a motion to dismiss the case, claiming it was not subject to the Massachusetts law against unfair and deceptive trade practices because it is a nonprofit organization that does not charge for services. Like many state consumer protection statutes, the Massachusetts law prohibiting deceptive advertising applies to businesses engaged in commercial trade or commerce, specifically the “sale, rent or lease … of any services.”

The plaintiff countered that Clearway should be subject to the state consumer protection law because she didn’t realize that Clearway wasn’t an actual medical center, and she was planning to pay for the services she received.

According to Liss-Riordan, Clearway should be subject to the law because it operated in a commercial context and competed with other businesses. “Their entire purpose was to compete with actual lawful health centers, and their goal was to take business away from those lawful health centers, so that itself made it a commercial enterprise.”

“Clearway has inserted itself into the marketplace in a way that makes it only proper that it be subject to rules of ethical behavior and fair play,” said Liss-Riordan, noting that Clearway likely benefitted financially from providing ultrasounds because they directly solicit donations for these services.

“Clearway’s motivation is not to aid women, but rather to destroy or damage abortion providers,” said Liss-Riordan, arguing that Clearway’s motivation in entering the market was to “damage and destroy other (legitimate) healthcare providers” by “deceptively masquerading as a medical clinic providing standard care in order to manipulate the healthcare marketplace to divert women away from its (for-profit) competitors.”

Clearway’s mission, said Liss-Riordan, is “not to provide genuine reproductive healthcare,” but to “encourage women to continue their pregnancies and dissuade them from ending pregnancies, regardless of the medical circumstances.”

When CPCs present the appearance of medical legitimacy without actual accountability, real harm follows.

Jenifer McKenna

After a “feisty hearing,” a Massachusetts superior court judge denied Clearway’s motion to dismiss.

Shortly after the ruling, Clearway settled the medical malpractice claim with the plaintiff. “The matter has been resolved to the satisfaction of the parties,” said Liss-Riordan.

“I consider this to be a victory because it’s a chink in the armor for these CPCs trying to claim that they’re not subject to the laws in Massachusetts,” said Liss-Riordan. “I think the decision that we got should open the door toward more of this litigation going forward.”

“If others will step forward to bring such challenges, we can use the legal system to fight this deception by CPCs,” said the attorney.

New Massachusetts Law Regulating CPCs

In response to the lawsuit, Massachusetts activists have challenged the state’s Department of Public Health for licensing Clearway as a community clinic while providing no oversight of its provision of ultrasound services.  And the extensive state and national coverage of the case shined new light on the need for state action to protect Massachusetts patients.

In 2023, state Sen. Becca Rausch introduced a bill that would regulate provision of obstetric ultrasounds under Massachusetts law, stating:

A person shall not provide ultrasound services pertaining to a possible or actual pregnancy except under the supervision of a provider or other licensed health care professional who, acting within their scope of practice, provides medical care for people who are pregnant or may become pregnant.

In July 2024, the legislature passed the provision as part of a comprehensive maternal health bill. It was signed by Gov. Maura Healy in August 2024—for the first time regulating the provision of ultrasounds, including by antiabortion crisis pregnancy centers. Advocates are now working with the Massachusetts Department of Public Health and the attorney general’s office to ensure that the new law is enforced.

Recent research has revealed that 91 percent of CPCs in the country advertise medical services and the majority (77 percent) now advertise ultrasounds.

“People seeking reproductive healthcare around the country are being steered—often unknowingly—into these unregulated pregnancy clinics where science takes a back seat to belief,” said McKenna. “When CPCs present the appearance of medical legitimacy without actual accountability, real harm follows.”

The Massachusetts class-action lawsuit offers a new strategy for holding CPCs accountable for the some of the harm they cause and the Massachusetts law is a model for how to prevent future harms.

“State legislators around the country must fulfill their responsibility to protect constituents by following Massachusetts’ lead and ensure that pregnancy care is based on medical standards rather than the personal beliefs of those providing it,” said McKenna.