Crisis pregnancy centres warned off ectopic scans

A lawsuit settlement in Massachusetts over alleged medical harm at a crisis pregnancy centre is prompting new legal guidance for faith-based clinics across the US.

Crisis pregnancy centres are now being advised not to perform ultrasounds on women with suspected ectopic pregnancies – a potentially life-threatening condition where an embryo implants outside the womb – and instead refer them to emergency care.

The advice was shared during a panel discussion hosted by the National Institute of Family and Life Advocates (NIFLA), a group that provides legal and medical support to crisis pregnancy centres.

Lawyers urged centres to avoid scanning women reporting symptoms.

One lawyer said during the recorded session: “Just as I’m walking down here I had a call from a centre.

“They had a woman come in who was cramping, and she said on a scale of 1 to 10, it was just below a 6. And I’m like, yikes, like, I wouldn’t scan her.”

The lawyer said the appropriate response in such cases is to send the client directly to the emergency department.

NIFLA has previously issued similar guidance.

A 2018 document states that “if a patient has symptoms of an ectopic pregnancy or miscarriage, she will not be offered an ultrasound exam and is advised, verbally and in writing, to immediately obtain medical care.”

Although NIFLA did not represent Clearway Clinic in the Massachusetts case, the centre was listed as a NIFLA member in 2023.

NIFLA has previously represented crisis pregnancy centres in high-profile cases, including a 2018 US Supreme Court case in California that resulted in a First Amendment ruling in their favour.

Crisis pregnancy centres are religiously affiliated organisations that provide free pregnancy tests and ultrasounds, typically with the aim of discouraging abortion, according to the American College of Obstetricians and Gynaecologists.

They have been criticised for presenting themselves as comprehensive reproductive health clinics while following an ideological rather than clinical model of care, according to a paper in the American Medical Association Journal of Ethics.

During the NIFLA panel, lawyers and a participating doctor advised against scanning women with symptoms of possible ectopic pregnancy, particularly in cases involving low levels of human chorionic gonadotropin (HCG) – a hormone produced by the placenta in early pregnancy.

Low or slowly rising HCG levels may indicate miscarriage or ectopic pregnancy.

The doctor said: “I’m not scanning. If you’ve got a level that’s low like that, it could be early pregnancy, but that is one of the cardinal signs of ectopic and one of the cardinal signs of miscarriage, slowly rising HCG.

“Please do not. She’s already got a provider. Dump it back on them.”

“She should be going back to her provider,” a legal representative added.

Andrea Swartzendruber, a researcher who studies crisis pregnancy centres, described the advice as a significant shift.

She said: “That seems like a very marked change, especially given that so many CPCs are using fear around ectopic pregnancy as a reason to come in and get scanned.”

The panel also addressed privacy concerns.

While many centres claim to be “HIPAA-compliant”, they are not legally bound by the US Health Insurance Portability and Accountability Act (HIPAA), which applies only to specific healthcare entities.

One lawyer said: “There’s this movement not to say HIPAA, and I just finally got everybody to spell it right. So I’m kind of upset.

“We want you to abide by those policies, but don’t advertise yourself as HIPAA-compliant.”

Debra Rosen, executive director of Reproductive Health and Freedom Watch, said this approach can be misleading.

Rosen said: “Unregulated pregnancy clinics masquerade as medical facilities, are not covered entities under HIPAA, and for decades have vigorously pushed back against even the most basic forms of accountability.

“Women nationwide face real harms as these fringe clinics trap them between illusions of confidentiality and the actual legal protections they receive.

“This dangerous gap demands legislative action.”