In 2010, a group of anti-choice activists sent several complaints to Iowa’s medical board, demanding the agency end a popular telemedicine abortion program. Run by Planned Parenthood of the Heartland, the program helped patients in rural clinics access safe medication for ending their pregnancies without traveling hours to a city. The anti-choice activists claimed, inaccurately, that not having a doctor physically present to hand people the pills was a threat to patients’ safety. At the time, the medical board wasn’t swayed. It closed the complaints without taking disciplinary action against Planned Parenthood’s physicians.
But that changed after Republican Terry Branstad, an abortion foe, reclaimed the Iowa governorship that November. In Iowa, as in many other states, medical board members are appointed by the governor and confirmed by the state Senate. Over the next couple of years, Branstad nominated replacements for all 10 members, installing an anti-abortion doctor who became board chair. Another Branstad appointee, a Catholic priest, had campaigned against the Planned Parenthood program, once arguing in a board meeting that the medical board ought to “uphold the fundamental value of human life from the moment of conception.” In 2013, with the board full of Branstad’s picks, the anti-choice activists revived their old cause. This time, the medical board banned telemedicine abortion everywhere in the state.
Planned Parenthood’s program in Iowa was ultimately allowed to continue after the organization sued the state medical board. But the episode showed how easily these boards can be weaponized for anti-abortion causes.
Medical boards, which issue licenses to doctors and discipline those who break state laws, are “seen and assumed to be nonpartisan,” says Mai Fleming, a California-based family physician who holds licenses in 17 states. “The hope is that they look at a person’s medical application with unbiased eyes and really evaluate the merit of the provider.”
But a closer look reveals boards that are stacked with Republican political donors in states that have recently tightened restrictions on abortion. Across the 12 states with total or near-total abortion bans as of July 31, more than half of medical board seats were held by people who had given at least $1,000 apiece to Republican campaigns, according to campaign finance data accessed through the National Institute on Money in Politics analyzed by Mother Jones. An estimated 70 percent are men.
In the post–Roe v. Wade reality, boards long seen as doctors’ allies are being recast as something to fear: panels of political appointees armed with wide-reaching abortion bans and the power to strip doctors of their licenses. “The more zealous people you get on the board who have extreme views, the more likely it is that the state medical board is going to more tightly aligned with the other arms of the government and go after physicians,” says Adarsh Krishen, chief medical officer for Planned Parenthood of Greater Ohio. It’s already happening: In Texas, which is ruled by an anti-choice governor and attorney general, Operation Rescue—an anti-choice activist group known for its militant tactics—filed a complaint last September going after the license of Dr. Alan Braid, who publicly defied the state’s six-week abortion ban. While prosecutors in states with criminal abortion laws must convince juries “beyond a reasonable doubt” to convict a doctor, medical boards can typically use a lower standard of proof to take away a physician’s credentials.
“You get a little bit more nervous and anxious when you start to see the state passing regulations restricting medical care,” Krishen says. “Then what’s the next step? The medical board saying, ‘Did you comply?’ And if not, now it’s going to come for your license.”
In some states, medical boards are being used as the muscle behind new restrictions: Mississippi Gov. Tate Reeves has said that enforcement of his state’s abortion ban would be “done by the State Board of Medical Licensure.” Even though some local prosecutors have pledged not to file criminal charges against those providing abortions, the prospect of medical board discipline alone may be enough to scare doctors away from delivering much-needed care.
State medical boards have existed since the mid-1800s, when the market for doctors was crowded with healers, midwives, and quacks. Physicians lobbied to create a government-run medical licensing system that would set them apart from those they considered frauds—protecting patient safety, at least in theory, while padding doctors’ pockets.
Today, members are typically physicians themselves, along with a handful of non-doctors tasked with representing consumer interests. Almost universally, the board members are appointed by governors—a system that has turned some seats into plum awards for campaign supporters and ideological allies.
Look no further than Ohio, where 8 in 12 medical board members have given money to Republican politicians. A decade ago, pain doctor Amol Soin gifted $5,000 to Republican John Kasich during his 2010 run for governor. When Kasich won, he appointed Soin to the state’s medical board, where he remains today. Soin has given about $40,000 to current Republican Gov. Mike DeWine and his lieutenant, Jon Husted.
While in office, Kasich acquired a reputation for appointing anti-abortion figures to high-ranking positions in state leadership, including in the Department of Health. One anti-abortion holdover from the Kasich era is Mike Gonidakis, a 48-year-old lobbyist who for 10 years has served simultaneously as the president of Ohio Right to Life and a state medical board member.
Gonidakis has long tried to swat away claims that his advocacy creates a conflict of interests on the medical board. Like other anti-abortion groups all over the country, Ohio Right to Life is involved in filing official complaints against abortion-providing doctors and clinics. In 2016, when Gonidakis was chairing the board, an Ohio Right to Life affiliate in Dayton complained about three Ohio doctors, claiming they had forced an abortion on an incapacitated patient. Ohio Right to Life publicized the allegations, and at first, Gonidakis told journalists he did not plan to recuse himself from hearing the case. After liberal groups complained, he relented. (The medical board reportedly closed the case without discipline for the doctors involved, and the Ohio Ethics Commission found Gonidakis had acted within the bounds of the law.)
Catherine Romanos, a family doctor who has been providing abortion care in Ohio since 2013, says Gonidakis’ presence on the board creates an “environment of fear” among providers and sends physicians the message that the medical board is “not an unbiased licensure organization.” (Gonidikas did not respond to a request for comment.) While Krishen says he’s yet to see the Ohio medical board discriminate against abortion providers, he adds that doctors are loath to voice complaints due to the medical boards’ power.
“The physicians who provide abortion care in Ohio are already targeted in a variety of ways for doing our job,” Romanos says. “To feel like you’re working really hard to make sure you’re following the law perfectly, but the body that supplies your license maybe is biased in this way, or has board members who are clearly not neutral? It’s unsettling.”
Last month, DeWine announced he would be reappointing Gonidakis to the board for another five-year term—a decision that sparked outcry not only for Gonidakis’ anti-abortion activism but also for his vocal skepticism about public health precautions during the Covid-19 pandemic. “This nomination is dangerous and puts lives at risk,” Iris Harvey, CEO of Planned Parenthood Advocates of Ohio, said in statement after DeWine’s announcement.
Currently, Ohio law bans abortion after six weeks—recently leading a pediatrician to refer a pregnant 10-year-old who had survived rape to neighboring Indiana to get an abortion. Gonidakis has already indicated his willingness to go after doctors’ licenses for violating the state’s abortion bans. “The state medical board does not need the county prosecutor or a prosecution to revoke a doctor’s license,” he recently told the Columbus Dispatch. “If a prosecutor refuses to prosecute, the medical board can still take action on the license.”
That possibility is enough to send a chill through the medical community. “Doctors are rule followers,” says Romanos, in Columbus, Ohio. “When we don’t know what the rules are, we back off.” These days, she’s seeing a tenth of the patients she otherwise would, due to the state restriction banning abortion after fetal cardiac activity is detectable, around the six-week mark of pregnancy.
Even when faced with patients with ectopic pregnancies—which are never viable and always require treatment—some doctors are afraid to provide appropriate care in case they are accused of breaking the abortion law by accident, Romanos says. Recently, the clinic where she works received calls from two patients with ectopic pregnancies who said their doctors had declined to treat them and sent them to her clinic instead. “They know that we know the laws better than anyone,” she says. “It gets so confusing when you criminalize routine care. Even really well-meaning doctors are just scared.”
Though medical board discipline happens state by state, it’s designed to follow a doctor throughout her career. Malpractice insurers and prospective employers must be informed of it, along with medical boards in other states where she holds a medical license. Those other boards can then open their own investigations, and impose their own discipline.
That policy makes sense for stopping abusive or incompetent doctors from hopping from state to state, but now raises the possibility that abortion providers will face blowback even in states where abortion is legal, according to Fleming. Last year, after Texas implemented a six-week abortion ban, Fleming stopped her monthly trips to work at an abortion clinic there for fear of facing penalties that could affect her whole practice. The ban, she says, “forced me to be in a position where I felt I was abandoning a cohort of my patients, in order to continue to be able to serve other patients.”
Some left-leaning states are starting to take steps to limit the damage medical boards can do to doctors across states. In Colorado, Gov. Jared Polis issued an executive order telling the Colorado medical board not cooperate with investigations into doctors accused of breaking another state’s abortion law, as long as doctors’ actions followed Colorado medical standards. In California, a similar bill is making its way through the state legislature. And there are other steps boards could theoretically take—like using their discretion to avoid pursuing some abortion-related complaints. (In Indiana, which passed a sweeping abortion ban on Friday, lawmakers were apparently concerned about this possibility: Part of their new law explicitly requires the board to revoke licenses from doctors found likely to have illegally provided an abortion.)
Another way medical boards could wield their power is by defending—or opting not to defend—the way licensed doctors practice medicine in a state. Last month, the Texas Medical Association sent a letter to the state medical board requesting that it protect doctors’ ability to provide medically necessary treatment, including abortion, to patients with severe pregnancy complications. (Texas abortion laws contain narrow exceptions to save a pregnant patient’s life or prevent “substantial impairment of major bodily function,” as the Texas Tribune explains.) The medical association’s letter, first reported by the Dallas Morning News, said it had received complaints of hospital lawyers and administrators stopping doctors from providing appropriate treatment to some pregnant patients. It asked the Texas board to “swiftly act to prevent any wrongful intrusion into the practice of medicine.” According to Tim Weitz, a former general counsel for the Texas Medical Board who now represents doctors in disciplinary proceedings, the board could potentially protect these doctors by issuing cease-and-desist orders to the lawyers and administrators for practicing medicine without a license.
But will they? The board has yet to make any public statement on the question of interfering with doctors during medical emergencies—or on abortion in general—since the Supreme Court’s Dobbs decision. But it’s not hard to speculate on its likely stance, given its members’ close ties to Gov. Greg Abbott. (Abbott has been fighting federal guidance that ensures emergency room patients get the medical treatment they need, including abortions). Forty percent of medical board members in Texas have gifted Abbott at least $10,000 for his various campaigns—including textile CEO Arun Agarwal, who gave Abbott $132,000 before being appointed in 2019 and has given him over $63,000 since then. “A lot of the board members will have been donors for the governor, and that’s how they got there,” Weitz says. As KXAN reporter Matt Walsh has documented, Abbott has not removed one board member, Dr. Satish Nayak, despite the board citing him for failing to keep adequate medical records; Nayak has given Abbott $32,920. As Abbott continues his campaign to make Texas as hostile as possible to those seeking to terminate pregnancies, he can likely count the state medical board as an ally.
Fleming, who ended her practice in Texas, today provides abortion pills through a telehealth service to patients in states where remotely prescribing the medicine is legal. In April, she started the lengthy and expensive process of applying for her eighteenth medical license, in Oklahoma. (The Oklahoma board, which is 90 percent male, includes a Chevrolet dealership owner who’s donated nearly $100,000 to Republicans.) Fleming says her application was in the final stages of review when the Supreme Court overturned Roe v. Wade. Soon, the Oklahoma Medical Board asked her to appear before them in-person—an unusual request that Fleming fears might have something to do with her area of practice. “There’s no way for me to know what their reasoning is, and it’s perfectly in their rights to do this,” she says. “But I worry about the degree of scrutiny that has come up, and whether or not that it has to do with the fact that it is known, based on my CV, that I am an abortion provider.”
If her application is denied, it could have ripple effects on her insurance and employment prospects. But she’s continuing the process, she says, out of hope—“to have the availability and opportunity to have that license if something changes in the future.”