by Tia Will
For the following article, I will continue to use the format of my previous two articles. I have referenced the time of the statement on the tape, the speaker, when the tape is incomplete, inaudible, or a cut away inserted, and finally have separated my interpretation with an asterisk. I have included my conclusions regarding the credibility of the charges at the end of the article.
For anyone desiring to follow along, this tape is entitled :
“Human Capital – Episode 2 “
One further point before beginning the tape. Contrary to claims that the tapes are unedited, this tape has been highly edited. The tape does not start at the beginning of a conversation, but clearly joins an ongoing exchange. There are only the comments of Holly although there is clearly someone asking questions whose voice is not heard. There are also frequent voice overs in which you see scenes from the Fresno PP interspersed with the tape of Holly, and frequent breaks in her responses with cuts to responses to a different question. One poster suggested that this is reasonable since no one would want to take the time to view the entire tapes. My view is that arriving at the truth frequently requires an expenditure of time. Viewing the full footage is the way to arrive at an unbiased conclusion but that is not provided.
Joining an already existing conversation without reference to the question asked, Holly O’Donnell ( a former employee of StemExpress, not PP) states :
“ she told me, its not an option, it’s a demand. That’s what your job is.”
She is referencing the harvesting of donated fetal tissue for transportation to researchers.
*This is a true statement. That is the job description. And there is nothing illegal about this activity. There is no statement of who is being referenced by the word “she. ”
“and these mothers don’t know and there is no way they would know”
in reference to tissue donation.
- This statement is refuted by PP. PP officials have addressed this issue directly, stating exactly when in the process the mothers are consented. This point was essentially conceded by the male interviewer in his conversation with Dr. Nucatola when he misstates her comment about the timing of the order of the consents and is corrected by her. So which is the claim? Is the claim that consents are being obtained prior to the procedural consent, or there are no consents being obtained? Without proof, this is a baseless allegation made by a tissue technician who would have no way of knowing what consent process was used and in most cases would not have even been in the facility at the time of the consents since they are often done the day before the procedure.
Holly is narrating what happens when the StemExpress technician goes to Planned Parenthood to obtain a specimen. Part of the audio is accompanied by a supposed PP employee walking down a hallway interspersed with a voice over of Holly speaking. She states that different technicians had different assigned PP affiliates so that a good working relationship could be established and maintained. Holly was assigned to Stockton and Fresno.
Holly describes the location of the Fresno affiliate as “on an alley.” From the pictures presented it would appear that the facility does abut an alley on one side.
*I would like to point out that many, many businesses of all types abut alleys on one side. This says nothing about the legality or merits of their activities although the clear intent here is to invoke “back alley” images.
Holly goes on to state “in areas like Fresno where it is dirt cheap and the area not good, there are so many, so many. I would work for eight hours and there would be 40 something patients, it really wore me down.”
- This is doubtless a true statement. But Holly’s emotional suitability for the job is not the issue. What we are not being shown are the reactions of the men and women who have dedicated their professional lives to the provision of health care services for their patients. It is this other perspective that I am hoping to provide even though I have never been affiliated with Planned Parenthood.
1:23 Holly continues: “The environment is morbid….like you can feel it.”
* I do not doubt the truth of this feeling for Holly. I do however dispute its objectivity. I have met many patients who consider all clinics and hospitals as morbid situations to be avoided. I do not share their sentiment. This does not make either opinion right or wrong and certainly says nothing at all about the legality, morality, or desirability of the activities of the clinic.
1:33 “You can hear screaming, you can hear crying”
- This also is doubtless true. And the same could be said of any ER, pediatric clinic, gynecologist’s office or Labor and Delivery unit. This certainly does not mean that we should shut down all of these health care venues.
1:58 Holly continues stating that when they go into a clinic they are given a list of the women who are coming in for US or for their procedures and then states “ if we have time, we consent them. We take them in the room or meet them in the chair. Some women come in, take a test, are pregnant and then you can consent them. So it is just taking advantage of the opportunity.
- What Holly has omitted is what happens prior to or in between her receiving the list of patients that she is to consent. Dr. Nucatola made it clear that the tissue donation consent always follows the consent for procedure. I do not know whether this is a willful or inadvertent omission by Holly who would have no way of knowing what information had been obtained or consents completed prior to her patient interview unless of course she has maintained lists of patients who are willing to corroborate her story or better yet had obtained their permission to review their medical records. If she herself had reviewed their records without their written consent, this is a clear violation of HIPPA and would subject her to whatever penalty the breaking of HIPPA violations would pertain to her position.
Between 2:00 to 3:28
Holly provides what appears to be a factual presentation of the patient and tissue log for any given day, the manner of entry into the computer for identification of desired tissue, intended recipient, and the obtaining technician. All is very standard documentation for tissue transfer.
* I would like to make one clarification at this point. There is on one sheet of the documentation a list of the “prices for fetal tissue”. This is important because it is the sheet utilized by StemExpresses for their costs. This is not, repeat not a Planned Parenthood document. It is not a list of sales prices. This is not made clear by Holly or by the Daleiden group.
Holly has been describing the consent form used by the patient which includes her acknowledgement that this is a donation, that she is aware that she will receive no compensation for the donation, that she understands that the purpose of the donation is for research …. And that she has already been consented for the abortion.
- This would appear to be in direct contradiction to her statement that “these mothers don’t know, nor is there anyway that they would know….”
She then states “No, it doesn’t happen all the time. Some of these women don’t know that they are going to get an abortion”
- If this is true, and a breach in protocol is detected, it is the responsibility of the person detecting the error to notify the appropriate personnel to take care of the problem immediately. In this case, the responsible individual would be Holly. This is not at all unusual and is the reason that we have instituted an elaborate and repetitive set of checks in our system.
- I will give you an example from my clinic last week. A patient presents for an IUD placement after having been counseled by a nurse over the phone. Somehow, a vital piece of information (the assurance that there was no reasonable possibility of pregnancy) had been omitted.
The clinic assistant working with me that day (a float) also missed this crucial bit of information. I caught it, but not before the patient was undressed in the room and anticipating her procedure. The patient wasclearly surprised but very understanding when I explained the situation to her, called off the procedure for that day and rescheduled her at a time when I could attest to the safety of the procedure. This happens on occasion by human error, but may not be clear to Holly.
4:18 Holly begins a description of Dr. Berman
“There were actually comments about him going “viciously fast””
“Like if we didn’t watch him, we would lose our specimens, he was that fast.”
“If there wasn’t a girl in the room, he would get mad. He would pace the hallways, if there wasn’t something to do.”
“Its almost like he wanted to do it.”
“What I imagined was him literally going into the room, lifting the covers, going in grabbing and walking out. Like that’s how fast it is. Its ridiculous.”
- Hard to know where to start. All of this is either :
- second hand ( aka gossip),
- to be anticipated since ancillary staff are supposed to be aware of the progress of a procedure so as to perform their duty in a timely fashion.,
- an expectation by the doctor that ancillary staff will be performing their duties in a timely manner so that neither the doctor nor the patients have to experience delays.
- imposing her emotional bias onto the presumed thought process of the doctor ( when doctors go to work, most of us “want” to do our job).
- purely a figment of her imagination as she freely states when she describes what she “imagines” to happen when he walks in the procedure room.
While it is completely true that some providers are more personable and have a better bedside manner than others, there is nothing here to even suggest that Dr. Berman does anything medically inappropriate and some might say that he is a good patient advocate for attempting to prevent unnecessary delays in patient care.
Holly continues after obvious editing.
“I was the clinic’s only ( inaudible credential initials) licensed phlebotomist. But the other individuals were drawing blood. “
- Doubtless true. What she does not state is that many other job categories including medical assistants, physician assistants, nurse practitioners, certified nurse midwives, clinically trained medical students and physicians are fully trained and certified to draw blood. It is unclear from the tape whether Holly is not aware of this, or does not choose to acknowledge it, or whether it has been edited out of her comments.
Holly continues after obvious editing:
“The coworkers I had, they would not consent the donors. If there was a higher gestation, and the technicians needed it, there were times when they would just take what they wanted. And these mothers don’t know and there is no way they would know.”
* If this is true, and if Holly had knowledge of it, the time for her to report it would be immediately to a Planned Parenthood supervisor on site or to her immediate supervisor in StemExpress .
This is clearly illegal. The action that she is describing breaches the Patient Bill of Rights which applies in California. This is not a breach by Planned Parenthood if they are not informed. It would be a breach of policy by the individual technicians which is likely severe enough to cost the technicians their jobs. But if Holly knew of this and did not inform either her supervisor or the Planned Parenthood official on site of her concern, then she is clearly complicit.
Holly continues after obvious editing to provide a specific example in which a technician named “Jessica,” a StemExpress employee, not a PP employee obtained tissue without consent.
- With the withholding of this information until revealed on the Daleiden tapes, Holly has clearly implicated herself in a known illegal activity, or at least been responsible for the failure to report it to the appropriate supervisorial staff as soon as she became aware.
After obvious edit, Holly continues (paraphrased):
There were times when a girl would approach me and ask me “should I be doing this?”
I am very pro-life and I would tell them like “run,” “go”… “like they will figure something out.”
- In medicine, there is a well defined protocol for what to do if a patient expresses ambivalence or concern to a member of the staff who is not a licensed provider for the advice being sought. This is not it. The protocol is to inform a licensed clinical provider so that they can come and appropriately evaluate the patient. I have had this happen many times under many different circumstances. Patients have ambivalent feelings about all kinds of procedures. I have had patients taken off the operating room table when they have expressed ambivalence at the last moment prior to an elective procedure. Just this week, I had a patient decline a recommended biopsy only to return later the same day having decided she wanted it done after all.
In my view, what Holly has just done is admitted to practicing medicine without a license.
“I am not going to tell a girl to kill her baby just so I can get money. And that is what this company does.”
- The first part of Holly’s statement is completely appropriate. It is not within her scope of practice to “tell a girl to kill her baby”. It is equally not within her scope of practice to tell a girl to leave the clinic. She has no responsibility and no authority to give any medical advice whatsoever. Her responsibility is to convey the patient’s comments to a provider whose scope of practice does include giving such advice.
- The second part of her statement is unsupported. Dr. Nucatola clearly stated that the consent to procedure precedes the consent for tissue donation. If this order is adhered to per Planned Parenthood protocols, then this would not be a true statement. If Holly had evidence to the contrary, she had the obligation to present that information to a Planned Parenthood supervisor at the time she became aware of it.
Holly continues ( paraphrased) :
In describing her end of day duties she states, I would put the specimen in a FedEX box. I would have to drive it to FedEx. And the sad thing is, if someone asked what was in the box, I wouldn’t know what to say. “There are dead baby parts in there.”
The tape then ends and the following written copy appears :
Hold Planned Parenthood accountable for their illegal sale of baby parts.
My impressions of this tape are as follows:
- There is no evidence presented that any fetal tissue is made available for sale by Planned Parenthood.
- There is no evidence that any medical protocols have been breached by any employee of Planned Parenthood.
- There is no evidence that any Planned Parenthood provider is acting outside their scope of practice.
- There are unsubstantiated allegations that some technicians of StemExpress have acted outside the parameters of their scope of practice, but no evidence that Holly, when aware of these breaches, took any steps to report them to any individual with responsibility.
- There is evidence in her own words that Holly herself choose to practice outside her own scope of practice.
Based on the above, I have another concern about the activities of the Daleiden group. Holly would appear to be an emotionally driven and naïve young woman. I have a great deal of empathy for her because I myself have been in morally ambivalent situations in which I have experienced great and long lasting emotional disturbance by the choices that I have made and helped patients to make under extreme duress. My concern is that she has been exploited by the Daleiden group and has been placed by them at significant legal risk through her own words describing her actions.
Based on my 30 + years in medicine, I would offer her this advice as I would to anyone who finds themselves being asked to step outside their scope of practice:
- Do not give in to the temptation to share your opinion on medical matters. This can be interpreted as practicing medicine without a license. It can cost you your job, as I have seen happen. It can lead to legal complications.
- If you observe a coworker engaging in activity that you believe is illegal or immoral, your obligation is to correct them directly if you believe that they are acting in good faith but in error, or to report them immediately to a supervisor if you believe that their actions are intentional or deliberate. I have seen people disciplined for failure to report coworkers for breaching protocol.
- Regardless of her personal convictions, the mandated approach to reporting of suspected medical malfeasance is escalation through appropriate channels within the involved companies. Some people do not do this because they fear work place retaliation or loss of job. I understand this fear, but guarantee that this is a less onerous course than risking retaliation, loss of job and legal prosecution should you yourself have broken any laws.