California Spent 6 Weeks in Court, Can’t Find One Woman Hurt by Abortion Pill Reversal
Attorneys for Heartbeat International and RealOptions Obria Medical Clinics are hopeful for a good outcome in the first Abortion Pill Reversal case to reach trial in the United States. That hope comes following a three-year legal battle, a six-week bench trial, and three-and-a-half hours of closing arguments on September 17.
The People of the State of California v. Heartbeat International, Inc. and RealOptions concerns whether women may receive information about continuing their pregnancy after they start a chemical abortion and change their mind. The case has implications for pregnancy help and non-profits beyond California as the ruling could set a first-of-its-kind precedent for using consumer protection law against a nonprofit’s religiously based speech.
California Attorney General Rob Bonta is accusing Heartbeat International, the largest network of pregnancy help organizations in the U.S. and globally, and RealOptions, a network of faith-based medical clinics that provides both men’s and women’s health services through four licensed medical clinics in the San Francisco Bay Area, of misleading women about Abortion Pill Reversal.
Get the latest pro-life news and information on X (Twitter). Follow @LifeNewsHQ
Heartbeat and RealOptions are represented by legal non-profit Thomas More Society and special counsel from the LiMandri & Jonna law firm.
Abortion Pill Reversal (APR) is an updated application of a treatment used since the 1950s to combat miscarriage. It entails prescribing bioidentical progesterone to counter the effects of mifepristone, the first of two drugs in a chemical abortion. Mifepristone works by blocking progesterone, the natural hormone in a pregnancy woman’s system necessary to sustain pregnancy.
Heartbeat manages the Abortion Pill Rescue Network, a network of nearly 1,500 healthcare professionals, pregnancy centers, and hospitals worldwide that administer the APR protocol. RealOptions is a Heartbeat affiliate and a member of the APRN.
Statistics show that to date more than 8,000 lives and counting have been saved thanks to Abortion Pill Reversal.
After six weeks of trial, testimony from 25 witnesses, and nearly 200 exhibits, the State identified no woman harmed by APR and no consumer complaint against APR, Heartbeat International, or RealOptions.
In fact, three APR moms testified in court in support of APR, and more than 200 women signed a letter of support conveying thanks for the care, information, and the hope they received from the APRN. More than 40 those women were from California.
Heartbeat and RealOptions contend that no woman should be forced to complete and abortion she no longer wants.
A key moment in the trial came when the State’s own expert could not say APR does not work.
Dr. Mitchell Creinin, one of the Attorney General’s principal expert witnesses and a vocal critic of APR, was questioned directly about the safety and effectiveness of APR. Under oath, Creinin could not say that APR does not work nor that it is unsafe. Meanwhile, Heartbeat presented a considerable body of medical evidence supporting APR as safe and effective.
Another watershed moment centered around the American College of Obstetricians and Gynecologists (ACOG). While ACOG is the leading professional association for obstetricians and gynecologists (OB/GYNs) in the U.S., it supports abortion, and is critical of APR. Because of its prominence ACOG is regularly cited as an authority to say that APR does not work, and the Attorney General’s office uses ACOG’s scientific consensus to support its claims that Heartbeat International and RealOptions engage in false and misleading advertising about APR.
At trial, an ACOG representative acknowledged that its APR guidance came – not through its established clinical-guidance process – but from its government relations department, so a non-medical opinion and no formal clinical finding that APR is ineffective.
Bonta’s office claims there is no scientific evidence that Abortion Pill Reversal works, criticizing the limitations of the available studies. But defendants argue that scientific limitations are not evidence that APR is ineffective – the difference between “not conclusively proven” and “proven false.” The Attorney General also acknowledged that observational evidence can be used in medicine.
Heartbeat International does not promise women that APR will work, rather cites a 64–68% APR success rate based upon a published, peer-reviewed study of specific progesterone protocols. That study also showed there was no increase in birth defects with APR as well as a lower preterm delivery rate than the general population.
Along with the areas of science and safety, Heartbeat and RealOptions’ marketing and communications were intensely scrutinized in the trial, the defense arguing that the AG has failed to show any statement that was false or misleading.
Heartbeat International and RealOptions share information about APR at no cost to women who pursue it. Their attorneys argue that California’s advertising law does not govern the speech of the two religious, pro-life non-profits because their speech about APR is non-commercial and protected by the First Amendment.
Bonta seeks more than $20M in penalties and to bar Heartbeat and RealOptions from presenting APR as safe and effective. He is calculating maximum cumulative penalties by counting a woman’s visit to the APR website, hotline conversations, and the consent form to proceed with APR as separate violations under two different statutes. The State’s post-trial calculations allege at least 5,131 violations of each statute by Heartbeat.
Along with the implications for free speech for non-profits in California and beyond, a ruling in the AG’s favor would have significant negative impact on both pregnancy help organizations’ ability to continue serving women and families.
Given that providing women with information on the possibility of trying and reverse their unwanted chemical abortions would foster their reproductive freedom, and California law recognizes the right to choose to bear a child, protecting those who assist women in exercising pregnancy-related decisions, the question some ask is whether bias is at the heart of the AG’s case.
This is also because though the lawsuit did not begin with a harmed woman or any consumer complaint, it did originate after a government effort to find a case against pregnancy help.
Following the 2022 Dobbs decision overturning Roe v. Wade, Bonta created the California Reproductive Rights Task Force to protect and expand abortion access.
Task force meeting minutes show participants discussing possible false-advertising lawsuits against pregnancy centers and specifically broaching Abortion Pill Reversal as a potential target, though a participant noted there was no evidence at that time that pregnancy centers were violating California’s False Advertising Law.
Bonta’s office issued investigative subpoenas and interrogatories to Heartbeat International and RealOptions concerning their HIPAA and privacy practices. His investigation did not identify wrongdoing related to those practices.
Nine months after the task force discussion, Bonta filed the lawsuit against Heartbeat and RealOptions over their APR communications.
Throughout his time in office, Bonta has publicly advocated abortion access, defended California’s abortion laws, opposed abortion restrictions in other states, and promoted California as a safe haven for abortion providers and those seeking abortions.
Counsel for the Attorney General began closing arguments claiming that Heartbeat and RealOptions target women who are amid emotional turmoil, touting false hope, and luring them toward their services. The remainder of the plaintiff arguments followed in likewise fashion discordant to Heartbeat and RealOptions’ case and arguments.
Attorneys for the defendants responded following closing arguments.
“I was mind blown to hear their closing,” said Special Counsel Paul Jonna. “It was like we were in a different world.”
“We have so much evidence to defend against these claims … you don’t where to start,” Jonna said.
“We discredited their lead expert,” said Peter Breen, executive vice president and head of Litigation at Thomas More Society. “They had no evidence at all that Abortion Pill Reversal is unsafe or ineffective, they just said, ‘well we’re criticizing them a bit.’”
“That argument is not consistent,” Breen said. “You cannot have the argument telling you what’s true or false in a disputed issue of scientific fact, and especially a highly contentious one, and so we’re very hopeful for a good result.”
Jonna remarked that the court asked tough questions of both sides during closing argument, and the hope is of course for the judge to rule in favor of Heartbeat and RealOptions.
“But it’s just clear to me they’ve got no case,” he said. “They’ve not met their burden of proof. They’re trying to silence and sensor their opponents and it’s a very dangerous escalation of government overreach.”
“They presented no actual victims,” Breen added. “They presented no evidence that Abortion Pill Reversal doesn’t work, and in fact, they were arguing that they didn’t have to.”
“Regardless of what the trial court does we are going to vindicate their (Heartbeat and RealOptions) rights,” said Jonna.
“There are thousands of women who have babies who are happy with Abortion Pill Reversal,” Breen said. “Our hope long-term; we don’t just win this, we also establish that this standard of care, this is how medicine will be practiced in the future so that women have a real choice.”
The judge in the case has 90 days under California law to issue a decision.
Case resources are listed below.
Defendants’ closing trial brief in the case is available HERE.
The open letter in support of the Abortion Pill Rescue Network is available HERE.
Heartbeat International People of the State of California v. Heartbeat International & RealOptions case page.
Thomas More Society Case Details & Documents
Thomas More Society APR Page
State of California’s Complaint against Heartbeat International & RealOptions
Abortion Pill Reversal 101
LifeNews Note: Lisa Bourne is Managing Editor of Pregnancy Help News and Content Writer for Heartbeat International. This originally appeared at Pregnancy Help News.
