The Indiana Medical Licensing Board has disciplined Caitlin Bernard, MD, the doctor of a 10-year-old rape victim from Ohio who traveled to Indiana for abortion care last year, a case that became widely publicized.
The board will fine Bernard the maximum fine of $1,000 for each of the three counts of violating patient privacy laws and will send her a letter of reprimand following an administrative complaint filed by Indiana’s Attorney General Theodore “Todd” Rokita.
Bernard, an assistant professor of clinical ob/gyn at the Indiana University School of Medicine in Indianapolis, was thrust into the national spotlight last July after a story in the Indianapolis Star broke, detailing her experience of terminating the pregnancy of a child rape victim in Indiana after an Ohio abortion ban kept the child from receiving the medical care in her home state.
In her testimony, Bernard said, “I wanted to speak as an abortion provider to be clear about the effects of potential upcoming laws in Indiana and what that would mean for my patients here in Indiana.”
Rokita’s complaint alleged that Bernard revealed sensitive patient information, violating state privacy laws and HIPAA in speaking to the media about her patient. The complaint also alleged that she failed to report child abuse correctly in the aftermath of the case.
Bernard’s defense noted that a HIPAA breach risk assessment by the hospital had found that Bernard was in compliance with privacy laws. Bernard said that she was careful to not reveal personal health information when discussing her patient, and had followed hospital policy in her reporting of the care and the apparent child abuse.
The state’s legal team focused on the widespread national attention the case drew, which they argued endangered the patient’s privacy. Bernard had shared the patient’s age, state of origin, and pregnancy status with another doctor at a reproductive health rally, and was overheard by Shari Rudavsky of the Indianapolis Star. Rudavsky then co-wrote the story that included Bernard’s account of her patient after further conversation with Bernard.
“I was quite surprised by all of the attention,” Bernard testified, adding that she had not been aware when talking to the reporter that her patient’s case would become the focus of the story. “I was surprised that people think that young girls are not, unfortunately, frequently raped and become pregnant,” she said, referring to accusations that she had made the story up.
The state also questioned Bernard’s alleged political agenda. At one point the state’s defense asked her, “Do you have a tattoo of a coat hanger that says ‘trust women’ on your body?” Alice Morical, Bernard’s attorney, objected to the question as immaterial to the proceeding.
“Isn’t it true that if you were quiet about your patient and did not push this narrative about [Indiana’s] special session [regarding abortion] that you wanted to give to the media that we wouldn’t be sitting here today?” state attorney Cory Voight asked Bernard.
“No, I don’t think that’s correct,” Bernard responded. “I think that if the attorney general Todd Rokita had not chosen to make this his political stunt, we wouldn’t be here today.”
Referring to her advocacy for access to reproductive healthcare, Bernard said, “In my estimation, as I think it’s the same for all physicians, abortion is not a political issue. Abortion is part of comprehensive reproductive healthcare and needs to stay squarely in the realm of public health.”
The state’s legal team also dissected child protective and state policies regarding the process of reporting child abuse across state lines, alleging that Bernard should have reported child abuse directly to the Department of Child Services in Indiana.
Per her hospital’s policy, which Bernard and her legal team said were written to comply with state laws, Bernard notified the social worker assigned to the case.
The assigned Indiana University Health social worker, Stephanie Shook, testified that she then reported the suspected abuse to Child Protective Services in Ohio, where it had occurred, and confirmed that that agency and law enforcement in Ohio had already opened a case and were investigating the child abuse.
The state legal team also lingered on the decision to release the child back to her home in the care of her mother in Ohio and implied that Bernard should have assumed more responsibility for the child’s safety following her discharge from the hospital.
“How did this girl get sent back to her home for 5 days?” John Strobel, MD, of the Indiana Medical Licensing Board, asked Bernard.
“I think the challenge is that realistically there are many situations in which people live with their perpetrator long after the abuse occurred,” Bernard said, noting that the decision belonged to the Department of Child Services. “Luckily, that is not a decision that I as a physician have ever had to make. I can’t imagine how difficult that that must be.”
Bernard became tearful when speaking about the suspected perpetrator, who she said she initially thought could have been a brother of the victim. A 27-year-old man was later arrested for the rape, and his address was made public, although two brothers had initially been suspects.
After deliberation, the board ultimately decided that Bernard did violate state privacy laws and HIPAA when discussing the case, partially because of the uniqueness of the case and its wide publicity. “I think protecting the patient’s information is more important than making the point to the media,” said Strobel.
But because the board said the state needed Bernard’s services as one of only a few practitioners accepting Medicaid, and because Bernard did not anticipate the widespread media attention, they determined they would send a letter of reprimand and allow her to continue working — a relatively low-level disciplinary action.
The board also found that Bernard had not violated laws related to reporting the abuse to appropriate authorities.
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