A Code of Misconduct
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Mr. Chief Justice, may it please the court. It's an old joke, but when a man argues against two beautiful ladies like this, they're going to have the last word. She spoke, not elegantly, but with unmistakable clarity. She said, I ask no favor for my sex. All I ask of our brethren is that they take their feet off our necks.

Welcome back to Strict Scrutiny, your podcast about the Supreme Court and the legal culture that surrounds it. We're your hosts. I'm Kate Shaw. I'm Alyssa Murray. And I'm Leah Littman. And the court is dark this week, so we are taking the opportunity to bring you a deep dive into some very important post-ops litigation. But while we were recording that episode, some news broke. So we're going to cover that first.

So for some very good – okay, it's not really very good news. I think it sort of falls in the vein of news that was engineered to make you think it was really good news, but in fact, it's not really good news at all. And so with that lead up, I will just say it. The Supreme Court adopted a kind of ethics code. And again, I'm using – They adopted a document captioned ethics code. Yes.

An ethics-like code. An ethics-adjacent code. Yes, yes. Yeah. An anti-ethics code. A code of misconduct. A code of misconduct. Yeah. Yes. Yes. So we're going to break this all down for you and –

We'll start off with the good news, and then, of course, we will proceed to the bad, and then, of course, the ugly. So good news first. You know, this is a step. The fact that the court felt compelled to do this because of public scrutiny is...

Kind of a big deal. I mean, I do want to give a hat off to ProPublica, who's reporting made this happen, and to the public for staying on this issue, which also helped make this happen. You know, they got the court to do something, which is not nothing. And just because we will be shredding the code in a bit, I don't want that to undermine this. Like, this is a huge testament to ProPublica's reporting and to sustained public attention, right? It really does suggest that that kind of stuff can actually move the needle.

Because the Supreme Court and Republicans were saying this wasn't necessary. But the country, great ethical journalists, like, made this happen. And that's kind of a big deal. Shit.

Shout out to the Senate Democrats who were like, we're going to bring Harlan Crowe and Leonard Leo up in here to talk to us. We're going to subpoena them. And suddenly things started moving. Amazing. Yes. Two things can be true. It can be really important that the Supreme Court was moved to do something exclusively because of this investigative journalism and public pressure and pressure from the Hill. And that matters. And

And it can also be true that the thing they did was laughably insufficient and deserves to be excoriated, which we will proceed to do momentarily. And so keep on them, I think, is the lesson. If you go to the doctor and she's like, you have high cholesterol. And you're like, you know what? I need to do something about my high cholesterol. I am going to go on a diet. But the diet consists of hamburgers from Shake Shack. Like that's what this is like.

You've recognized a problem. There's a problem that has been identified, it has been named, and you have done something. You didn't do something that's actually going to happen. Should have taken a cross-door. But you did do something. So that I think is a good pivot to maybe evaluating what the court actually did in this ethics code slash anti-ethics code slash code of misconduct. So let's walk through some general thoughts on why this code is so insufficient, why it just doesn't cut it. Well,

We'll start with the opening, which is the prologue slash statement the justices included to introduce the code.

In that prologue, which is one of the most defensive pieces of prose I have ever read, the justices say, recent public concern over their conduct is merely a misunderstanding and the code is being put in place to dispel that misunderstanding. Meanwhile, ProPublica is like, we didn't misunderstand shit. This was actual misconduct. Right.

Completely. But certainly the message in the framing is that the justices are trying to convince the readers that the reporting and the concerns are a big nothing. Like the public has been misled into thinking there's a problem. In fact, there is actually not a problem. And somehow this document is supposed to convince everyone that in fact there is not a problem. And let's just say it's wildly unsuccessful in that project. Yeah.

Isn't this a bit like someone offends you and then they apologize to you and the apology is like, I'm sorry that you were offended. Yeah. Like, I'm sorry that you took this the wrong way. Well, it's like that. It also called to mind the energy from the Rahimi argument where the justices were unwilling to actually admit they made a mistake in Bruin. And instead, we're just going to kind of

clarify things and like what they meant in Bruun. It's just extremely strong, Brodus energy. We can do no wrong, right? You can't criticize us and you just don't understand if you think something is wrong.

This doesn't exactly suggest the court is going to be fixing the problem since sort of from the outset, they make clear they don't think there is one. So not a very promising start. And if anything, it goes downhill from there. Yeah. So another part of the prologue is that the prologue says the new ethics rules are for the most part, not new and largely represent a codification of principles the court already follows. So

So, you know, just to put that in plain English, like the court is saying these rules make all or most or many of the things the justices have been doing perfectly valid and consistent with this code of misconduct. Like they seem to think they're doing great and they wanted to write down these awesome principles that are guiding their behavior and have been guiding their behavior because why? I just don't know. Yeah.

Basically, it's a codification of misconduct. We decided to make official all the bullshit we've been doing. Like it's an actual a code of bullshit. Amazing. Another reason why this so-called ethics code is a big nothing burger is there's no apparent enforcement mechanism here. Like none, zero, like nothing.

If the justices violate this quote unquote code, you can do the same thing that you can do now if they act unethically, which is nothing. Right. You don't do anything. You just scream into the void like that is the mechanism. Right. Like there's no enforcement. It is literally riddled with should do this, could do this, but no musts, no will, no police officers going to show up at your house and demand that you turn over the boarding school tuition like none of this.

Like, it's just the same old, same old. Now, in addition to all of those big picture problems, there are some real granular issues here. So one thing the code seems to do is to affirmatively give the justices permission to do things that they shouldn't be doing, right? This is why we're calling it a code of misconduct.

One provision says that, quote, a justice may engage in extrajudicial activities, including law-related pursuits and civic, charitable, educational, religious, social, financial, fiduciary, and government activities, and may speak, write, lecture, and teach on both law-related and non-legal subjects. I'm just going to call this the FedSoc codicil. Okay.

All the FedSoc-ing is fine. And there are more, more of those provisions kind of sprinkled throughout the code. The most concrete parts, this is one example and we'll talk about others, but the most concrete parts of this document are ones that don't disallow but affirmatively sanction certain kinds of conduct. So where there may have been some ambiguity previously, justices did attend FedSoc and other events and some people

thought they shouldn't. And obviously, the justices concluded otherwise, but there was, I think, at least a degree of ambiguity. This purports to totally put that to rest and says, it is fine. It is great. You go to all those dinners. And the parts that suggest actually ratcheting up ethics guidelines are, you know, hortatory and vague in general. And the parts that actually allow activity that actually is pretty suspect in certain circumstances are much more concrete. So it feels like that might get a little

backwards. Yeah, and just to give one example of that, it says, quote, a justice may attend a fundraising event of law-related or other non-profit organizations. Yikes. Amazing. The Koch brothers caught us all. Amazing. Right. The Federalist Society is a law-related non-profit organization, and the Koch brothers have 501c3, right? Non-profit organizations. There is...

There is, I think, a little bit of a boundary here. So they can't be the headliner for a fundraising event, but they can participate if they are sort of billed with the same billing as other participants. So it's basically fine to have a justice. You just can't.

just have a justice. So you've got to like sprinkle other people around them. Yeah. So the provision I think that you're referring to is the one that says, quote, a justice should not knowingly be a speaker, a guest of honor, or featured on the program of such event,

And then it defines a fundraising event as something where the proceeds from the event exceed its costs or if donations are solicited. But again, there are just real questions what this means. Like, does it permit a keynote address at the Federalist Society or at one of these 501c3 other organization things? Like, could it if that event doesn't solicit donations or if the event is structured to break even? Or what if they told the justice, we're giving you an award?

the Robert Bork, Roger Taney Freedom Medal, right? And it's not a keynote. And the justice didn't like knowingly go in being a speaker. Like there are some aspects of the code that suggest it might allow this. Like the fact that the court says this is a codification of existing principles and the Republican justice's keynote that feds out Gala every single year. I mean, we just don't know. And they're going to be the ones that are deciding this. And they might never ever explain like why they've concluded their conduct is consistent with whatever this is.

And it totally rewards them for just being oblivious. Yes. To not find out anything. Don't know. Don't know. Knowingly does a lot of work here. Yeah. And that seems quite deliberate. It's also not clear how that provision you were just talking about, Leah, intersects with a part of the code that

seems to create a caveat to the prohibition, if there even is a prohibition. So there's a part that says, except in unusual circumstances, no such appearance, meaning of partiality, will be created when a justice speaks to a group of students or any other group associated with an educational institution, a bar group, a religious group, or a nonpartisan scholarly or cultural group. Okay, so actually it's fine to talk to those groups. And nonpartisan scholarly group is 100% how FedSoc describes itself. So

Maybe that part of the code says it's all fine anyway. Again, we haven't even scratched the surface because there are other ways in which some of these alleged prohibitions in the code are worded in a way that actually seems to license an awful lot of misconduct. So, for example, one provision says, quote,

End quote. So...

they can continue to do closed-door FedSoc, Koch Brothers Network talks. Or like the informational aspect of it. Like does that mean Sam Alito can talk to David Rifkin? Because like he's doing his informational slash journalist hat? Or it's just ridiculous. And he's just sharing the facts of the case and not the merits. But it's like it feels again like this is actually granting affirmative permission to do things that even under existing practice prior to the promulgation of this code were—

They were not, you know, some were, Melita was, but the rest of them weren't. And maybe this is like an invitation for them to do more of that. It feels like it. There's another one. So this provision says, quote, end quote.

Seems like a good prohibition. Don't use the prestige of your office for fundraising. But then they put the knowingly on it. So what if you don't know that the prestige is being used? So like when Justice Thomas opens up the Supreme Court to the Horatio Alger Association or society, whatever it is.

For donor events, is that knowingly permitting the court's prestige to be used for fundraising or his office to be used for fundraising? Can Ginny Thomas do something? I mean, like the stuff on spouses and partners and family members is super vague. So again, this all seems to be like –

Be as oblivious as possible, ostrich yourself as much as possible, and it'll all be fine. Yeah. And there are other concerning walkbacks and caveats in the code, like this one that says, quote, the rule of necessity may override the rule of disqualification. So what that means is if they need a justice or justices to participate, that's more important than disqualification. So if all of the FedSoc bros and Amy are at

Arlen Crowe's parties or the FedSoc gala, then it's fine because they've all violated the rules. And they need to get a quorum. And so, like, no harm, no foul. Everybody can just sit. Right. Okay. So that's the stuff the code affirmatively permits.

The code also has some very narrow prohibitions on what the justices can't do that we know some justices are going to read in the narrowest possible fashion. So, for example, there is this, quote, "...a justice should disqualify himself or herself in a proceeding in which the justice's impartiality might reasonably be questioned, that is, where an unbiased and reasonable person who is aware of all relevant circumstances would doubt that the justice could fairly discharge his or her duties."

The reasonable person who is aware of all relevant circumstances is the most audacious burden shifting that I have ever seen in this kind of code. It is insane. Well, I mean, like, would the justice say, like, all relevant circumstances includes the fact that the justices think they're being principled or that the justices would, like, describe themselves as being driven by principles? It's just insane. And just to offer some evidence of how the justices have applied this standard, that is, all of the things they've said...

wouldn't lead a reasonable person to question their impartiality. We know Sam Alito doesn't think his hours-long interview with David Rifkin, the lawyer in the tax clause challenge and Wall Street journalist, he doesn't think that raised questions about his impartiality. We know he doesn't think his trip with Paul Singer raised questions. We know Thomas doesn't think his relationship with

Crowe raised questions. We know Leonard Leo also thinks none of this reporting has raised questions about the justice's partiality, so it doesn't seem great. It's like this is a no ethics, just vibes code, which makes some sense in that ethics derived from ethos, which is kind of a vibe, and it's just- It's definitely ancient Greek for vibe. Right. Yeah. Yeah.

For sure. 100%. It's also worth noting that the standard that the court has now imposed upon itself, and impose is a very strong word, is actually less demanding than the standard that exists for lower court judges. And that was always the case, but now they've actually codified it as such. Right.

I guess that's great. It's explicit. But the code for U.S. judges prescribes that, quote, when reasonable minds with knowledge of all the relevant circumstances disclosed by a reasonable inquiry, blah, blah, blah,

So, again, it's much more rigorous for lower court judges. And again, it's not just for lower court judges.

again, we want to acknowledge it is different. They are a nine-member court, and there's not a deep bench to pull people from, and we get that. But you're basically making it okay to hold yourself to a lesser standard while promoting this as some kind of huge reform. Yeah. And the code is less demanding than the one applicable to lower court judges in other ways as well, including the provisions governing outside influence. So on outside influence, the Supreme Court's

Code slash whatever this is. Vibe. Vibe says a justice should not allow family, social, political, financial, or other relationships to influence official conduct or judgment. And a justice should neither knowingly lend the prestige of judicial office to advance the private interests of the justice or others, nor knowingly convey or permit others to convey the impression that they are in a special position to influence the justice. Okay.

That's less demanding than the standard for lower courts. The SCOTUS code requires it to be knowing the standard applicable to lower courts does not. And again, we know how these guys and Amy have applied this standard. They don't think their relationships with people like Leonard Leo, Harlan Crowe and whatnot influence their official conduct. They think that's all just driven by their neutral principles of interpretation. It's a very, very, very vibes based ethics code with no real boundaries.

Speaking of the whole question of outside influence, I mean, I think this runs in two different directions here, Leah. So I want to call out this provision that says, quote, a justice should not be swayed by partisan interests, public clamor, or fear of criticism, end quote. So this is basically like we are now codifying that whole FedSoc vibe where we like stiffen the resolve of our favorite conservative justices. It's basically an apologia for Dobbs.

Like when Justice Alito was like, you know, I will not be swayed by your hysterical screaming, ladies. Like I'm even more convinced of the rightness of my position. It basically makes it part of the ethics vibe. Yes. To feel that way. Yeah. And that same provision also says, quote, a justice should be patient, dignified, respectful and courteous to all individuals with whom the justice deals in an official capacity.

I feel some impeachments coming on. Credit where credit is due. Read seriously, this could disqualify Sam Alito and Neil Gorsuch from participating in oral arguments or the Supreme Court period. So, you know, I guess at a minimum, it seems that the justices have prohibited themselves from challenging advocates to fights during arguments. And you think that's meaningless. We would remind you of what happened in the Senate last week.

week with Senator Mark Wayne Mullen challenging a witness to a fight before Senator Bernie Sanders told him to sit down and shut up and the witness had the best response. We're playing that in full here. Quit the tough guy act and these Senate hearings. You know where to find me. Any place, any time, cowboy.

Sir, this is a time, this is a place. If you want to run your mouth, we can be two consenting adults. We can finish it here. Okay, that's fine. Perfect. You want to do it now? I'd love to do it right now. Well, stand your butt up then. You stand your butt up. Oh, hold on. Oh, stop it. Is that your solution? No, no, sit down. Sit down. You're a United States senator. Act it. Sit down, please. Can I respond? Hold it. Hold it.

I've been listening to this on a loop and just laughing all day. And it's apparently no longer allowed at the Supreme Court. That might be good. Right. But is dueling allowed? Dueling might be part of the vibe. Yeah, for sure. I don't know that it's expressly prohibited in this code, so probably fine. You can't knowingly engage in a duel. You suddenly find yourself... Those accidental duels. I know.

Beyond the scope of the code. You stumble upon one. Absolutely. There is an addenda to the code that says neither the filing of a brief amicus curiae nor the participation of counsel for amicus curiae requires a justice's disqualification. That's fine. In a way, actually, this is one of the only provisions that I had some sympathy for because they don't want to incentivize people filing amicus briefs in order to specifically oust individual justices. Obviously, that could be

really dangerous. In terms of recusals, it provides a lower standard than the statute governing recusals contains. So the code says a justice should disqualify himself or herself in a proceeding in which the justice's impartiality might reasonably be questioned. The statute says a justice shall recuse. I'm no textualist, but even I can see that those two are not the same standard. Those words are different and they mean different things and the statute is mandatory. And

And the code contains a suggestion. Laws are optional. With no enforcement. Right? No laws, just ethics vibes. Yep. I mean, like, these guys, we don't know how this thing is going to work or who would enforce it. It did call to mind the scene from Parks and Rec where Ron Swanson says, like, not to worry, I have a permit. And then he shows the person a piece of paper that says, I do what I want, Ron. So, you know, it...

That was their inspiration, clearly. Yeah. So big takeaways. This is a wildly disappointing document, and yet it really is important proof positive that the pressure matters, the attention matters, and we all have to keep it up. Is that the big takeaway? I think that's the huge takeaway. I think there's a takeaway for Congress. Like, keep –

going. This is like basically you came home from school with a 50% on a test where you were scored out of 100. Like there are 50 more points you could get. So keep going. There's more for Congress to do. There's more for the public to do. Like this is not an invitation to put the whole ethics question to bed. Like

All done. We handled it. It's handled. This is not an Olivia Pope moment. No, it's not been handled. Let's take a quick break. When we come back, we will be talking to one of the lawyers in the Zoroski case out of Texas. So please don't go away. But again, reminder, some of this content may be very sensitive to certain listeners. So make your own judgments about how you proceed. Thank you. Strict Scrutiny is brought to you by IXL Learning.

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This show is sponsored by BetterHelp. It's the end of the Supreme Court term, which means it's time for a self-care refresher. What are your self-care non-negotiables? Maybe you never skip leg day or therapy day. When your schedule is packed with kids' activities, big work projects, and more, it's easy to let your priorities slip.

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What's the one thing most history books all over the world have in common that they're seriously lacking in the melanin department? What's the one thing that they're seriously lacking in the melanin department?

Wondery's podcast Black History for Real introduces you to the most overlooked Black history makers you should already know about. In recent episodes, they've told the story of the women of the Black Panther Party, like Assata Shakur, who's still a fugitive in exile, and Elaine Brown, the first female chairperson of the party. And there's so much more, like why a young Samuel L. Jackson got expelled from Morehouse College, and why country keeps trying to keep Beyonce out.

Follow Black History for Real wherever you get your podcasts. Discover more to the story with Wondery's other top history podcasts, including American History, Tellers, Legacy, and even The Royals. It's been a year and a half since the court decided Dobbs v. Jackson Women's Health Organization, which overturned Roe v. Wade and withdrew a right that American women had enjoyed for nearly a half century.

Dobbs was and is a travesty of a decision, and the long, hard work of responding to it will be a project that consumes many years of our national life. And despite some bright spots, like the Ohio ballot initiative that recently enshrined abortion protections in that state's constitution, the situation on the ground remains horrifying in many places.

Two states where that is especially true are Texas and Tennessee. And we're very fortunate to be joined today by two people who are doing some of the most important work on the ground, challenging state abortion restrictions on various theories, which we're going to talk about today. For our first guest, we are delighted to be joined by Molly Duane.

Molly is a senior staff attorney at the Center for Reproductive Rights, where she has been litigating cases since 2015, including the challenge to SB8, the Texas bounty hunter law that in many ways really laid the groundwork for Dobbs. She was lead trial counsel in Zyrowski v. Texas, a challenge to Texas's implementation of the medical exception to its abortion ban. Molly will also be arguing that case before the Texas Supreme Court at the end of this month. Molly, welcome to Trick Scrutiny. We're so happy to have you with us. Thanks for having me.

And later in this episode, we're going to be joined by Ashley Cofield. Ashley is the CEO of Planned Parenthood of Tennessee and Northern Mississippi, and she's going to get us up to speed on everything that's been happening in that region, which has really been starved for abortion access since Dobbs. So let's start off with Molly and the great state of Texas, or, well...

The kind of okay state of Texas. So, Molly, we've highlighted Amanda Zyrowski on the show a number of times, and she's one of the plaintiffs in the lawsuit that you've brought against Texas regarding the actual operation of their medical exception to the abortion ban. Can you talk us through in very general terms the nature of the challenge that you all are bringing against the state?

Sure, Melissa. And I'll just note that Amanda's husband is a huge strict scrutiny fan. So this is going to be very exciting. All the best men are, just going to say. All the best men are. My husband was also very excited, but not as excited as Josh. So let me talk a little bit about the case. And it really starts, as you said, with SB8, because since September of 2021, when SB8 went into effect, physicians

physicians and other medical professionals throughout the state of Texas have been grappling with who, if anyone in Texas, should still be getting abortions under the state's only exception, which is for medical reasons. So politicians are always touting these exceptions as don't worry about it. People are still getting abortions. But how do those exceptions actually work in practice? And do they work in practice? Well, spoiler alert, they do not.

So what does the exception say? We always have to start with the text, right? And the exception says that people can still get abortions if they have a life-threatening condition that poses a risk of, quote, death. Okay, sure. Or poses a serious risk of substantial impairment of a major bodily function. So the problem is no one knows what that means.

What makes a risk serious? What's the difference between a substantial and an insubstantial risk? What about a major bodily function versus a minor bodily function? And I think most importantly, what physicians really don't understand is how close to death does a patient need to be.

And when you're talking about penalties of really the most extreme, lifetime in prison, loss of their licensure, and if you combine SB-8 and the trigger ban, we're talking about hundreds of thousands of dollars in civil fines. Physicians are obviously unwilling to take some risks here.

So, in Amanda's case, as you all have talked about on the podcast, she was diagnosed with, it's called an incompetent cervix, which, I mean, maybe we should pause in thinking about the naming of that diagnosis. It's a little bit cervix-blaming, but I think it sort of sets up the whole issue that we're dealing with here. The state of Texas is okay with that. We'll get to in a second when we get to the transcript. Yeah.

Blaming the cervixes. It's definitely their fault.

but that physicians just felt they didn't know what to do. They didn't know if or when they could intervene. And so they told her to go home and wait until she developed signs of infection. Well, after several days, she quite suddenly developed the very serious symptoms that her doctors told her to be looking out for. She was freezing, even though it was 100 degrees outside. She couldn't tell whether 1 or 10 was higher. And her husband rushed her to the emergency room, and she was indeed in sepsis.

And after that, she spent about three days in the ICU. She was finally given an abortion at that point, but it took a blood transfusion, multiple surgeries to reconstruct her uterus before she was able to leave. And at this point, based on the scar tissue that developed on her uterus, she was able to leave.

One of her fallopian tubes is permanently closed. So two fallopian tubes, that's 50% of her fertility slashed right there because directly because she was unable to get an abortion. So I know you often talk about facial versus as applied relief on this podcast. And I want to pause on that for a moment because this is an as applied challenge and it's just on behalf of patients like Amanda and

And so what we are seeking is really quite narrow in many ways. We're just seeking an interpretation from the court, from the state court, who's empowered to do this, telling us what the exception actually means.

And then to the extent that it doesn't cover medical conditions like Amanda's, we have filed an as-applied constitutional challenge under the state constitution's right to life, liberty, and equality. So that's the lawsuit in a nutshell. This is so interesting, Molly, and just sort of a random historical point to bring in.

It's amazing that it's the physicians sort of leading the charge to challenge these laws on vagueness grounds today because in the 1960s, it was physicians that really were at the forefront of the effort to repeal or liberalize the 19th century abortion laws that were such a point of consternation during that period and were on the books in most states. And the physicians in the 1960s were making a lot of the same arguments today.

Thank you.

only moderately successful in their efforts to repeal or liberalize laws. The reform effort ultimately stalled in large part due to the influence of the Catholic lobby in a lot of states. And it sort of stayed that way until the court intervened in 1973 to decide Roe. Yeah. So I am...

We joke it at my office because I am a science person. I'll talk about an incompetent cervix all day long. I am not a history major, right? But I have learned a ton about history because we're all students of history and tradition now, aren't we? But what's so interesting about our legal arguments in this case is that history and tradition is very much on our side.

Because for the vast majority of history, I mean, for centuries, right, physicians had judgment to provide abortion care to their patients when it was medically necessary. Even under the pre-Roe abortion ban in Texas, this was the case. In fact, we attached to our appellate brief in the Texas Supreme Court several journal articles. I'm not kidding. Several medical journals from the 1800s talking about the medical conditions that our clients are suffering from.

and how physicians in the 1800s always provided those procedures to their patients because it was medically required. As you say, there was a shift in the 50s and 60s where some of the judgment started to be taken away from physicians, but that is really an aberration. And our argument here is that the two years since SB8 are similarly an aberration, right? If you look across the expanse of history,

It has, for most of Texas's history, been the case that physicians were able to exercise their good faith judgment and not force their patients to get sick before they could provide medical care. So really, we're just trying to go back to that time in history and argue, like, even at the time when women were basically chattel, you couldn't just kill them off or take their fertility willy-nilly.

So that's a great kind of historical and high-level conceptual framing of the challenge that you brought. And you talked about the facts of Amanda and her husband and their experience in Texas. You have a number of other plaintiffs, each of whom has a really distinct story about what happened to them. And in July, you went to trial with these stories and these legal arguments. And in a summer episode, listeners may remember, we actually played a couple of excerpts from that trial. Yeah.

At the time, we didn't have the full transcript of the trial, and we actually now do. And there is just so much in there that we want to talk to you about. Could you talk a little bit about how you would characterize the nature of the state's arguments just broadly in defense of its law? Well, I'm glad you read the transcript because sitting there in the courtroom, it was hard to believe what was happening. And I just want more people to understand just how insane what happened in the courtroom was. So

I suppose if you're asking me to articulate in a few words, mostly cruel, but also just incomprehensible. It is really difficult to understand what they're arguing here. As I said, they've never provided their own interpretation of the law. They just keep saying that the law is clear. I mean, it's a completely circular argument. And at the same time, as I think you've covered on your show, Texas has challenged federal guidance.

The guidance says that emergency rooms must provide stabilizing care to pregnant people, even if that includes abortion. And the state of Texas has challenged that, saying that emergency rooms can't be walk-in abortion clinics. Well, that's a fun rhetorical point for them, but pretty clearly it is causing physicians to be scared to rely on EMTALA or any other law to provide medically necessary care.

But I think most staggeringly, their main argument is that we don't have standing. So let's break that down. We have OBGYNs in the case who have had to turn away patients because they weren't sick enough. We have patients like Amanda who suffered pretty catastrophic harm under the law and their future fertility is impacted now because of what they went through.

We have plaintiffs in the case who are currently pregnant. One of the plaintiffs who testified during the temporary injunction hearing was currently pregnant while she was on the stand. And the state is saying none of those people have standing. So, I mean, you compare this...

to the Mifepristone case and you've got aesthetic injury is totally cognizable for standing purposes, but a currently pregnant person who's afraid to be pregnant because of what she went through in a prior pregnancy doesn't have standing. It's pretty confounding to me. And as I said in the hearing and

I'll say again to the Texas Supreme Court, it appears that what the state is saying is that only a woman who has blood or amniotic fluid dripping down her leg would have standing to challenge these laws. And neither Article III nor the Texas jurisprudence has ever required so much for standing. It's interesting that they're requiring so much of you all to show standing and show an actual injury. And I'm just reminded of the Fifth Circuit's ruling on standing in the Mipha-Pristone case, which suggested that

Those physicians, the Hippocratic Alliance for Medicine, need only show that they had an interest, an aesthetic interest, in seeing babies born. And that was enough to support standing. I mean, it was.

Do you want to comment on just sort of what appears to be very different standing doctrines, depending on whether you're supporting abortion rights or against them? Yes. I mean, obviously, that case was in my mind the whole time we were hearing these arguments. I mean, OK, one is in the Texas Supreme Court. One is in the Fifth Circuit. Like, technically, there are different regimes. But actually, Texas does follow Article 3. And the idea that we could be held to such an insane standard when those who oppose abortion are not...

It should be shocking, but it actually isn't because as someone who's been litigating in reproductive rights for about a decade, this is something that I'm very well used to. We will always be held to a higher standard. I mean, you want to talk about abortion exceptionalism. That's what's exceptional is what we're constantly forced to do.

Let's underscore a little bit how exactly this insistence on the Texas attorney's part that basically nothing that happened to these plaintiffs was traceable to any conduct on the part of any Texas state official. And there was no sufficiently certain possibility of recurrence that standing should be found. So it almost sounds too outlandish to be believed, but that really is, if you read the transcript, what is being argued.

So maybe let's start by listening to this excerpt from the transcript. And as mentioned, you know, we have a copy of the written transcript, but not the actual audio recordings from the trial. So our producer Melody has asked a couple of folks from Crooked to help us out by reading those excerpts from the transcript. So we're going to play the first one here.

Similarly, plaintiffs will not and cannot provide any evidence of any medical provider in the state of Texas being prosecuted or otherwise penalized for performance of an abortion using the emergency medical exception. Their alleged fear of persecution is baseless. No medical exception adopted by this court will redress plaintiffs' injuries, either alleged past or hypothetical future.

The doctors, who knows? Who knows why the doctors have been deterred in their willingness to supply medically necessary and urgent care? Nothing to do with this law. So that was an argument made repeatedly by the Texas lawyers. And it wasn't just made in opening, closing type statements. It was made in what really felt to us like a pretty sadistic way in the context of the examination of some of the witnesses you put on, Molly. So maybe let's...

play an example of one of those exchanges here. Ms. Zyrowski, at any time, did Attorney General Paxton tell you you couldn't receive an abortion? I never spoke to Attorney General Ken Paxton directly, no. Okay. Did anyone in their capacity as a representative of the state of Texas directly tell you you could not have an abortion? I didn't speak to any representatives from the state of Texas, no. Okay.

At any time, did Executive Director Carlton tell you that you couldn't receive an abortion? No. Did anyone at the Texas Medical Board tell you that you couldn't receive an abortion? No. Ms. Brandt.

At any time, did Attorney General Paxton tell you that you couldn't receive a selective fetal reduction? Not directly, no. Did anyone in their capacity as a representative of the state of Texas tell you that you couldn't receive a selective fetal reduction? No. Did Executive Director Brent Carlton tell you? No. Did anyone at the Texas Medical Board tell you? No.

No. So who was it exactly that told you you could not receive a selective fetal reduction in the state of Texas? My maternal fetal medicine doctor in state and every doctor that I spoke to or a nurse or a facility out of state. Why were out-of-state medical providers providing you guidance on Texas law?

I mean, this is absolute gaslighting. Like, did Ken Paxton personally call you and tell you you could not have an abortion because otherwise you don't have an injury here? I mean, like, Ken Paxton was trying to not get impeached for much of last year. Like, he wasn't calling anybody, but this law still existed. And everyone understood how it impacted or at least shadowed the provision of medical care or the effort to obtain abortion care.

It was actually worse than that because in person, my experience of it was worse than that because they started every examination objecting to the relevance of each plaintiff's testimony. So maybe let's play an example. Again, not the actual audio from the trial, but a reading of the transcript. That's an example of one of those exchanges here.

Your Honor, at this point, the defendants are going to object to all of this information about past medical issues based on relevance. Your Honor, I think that plaintiffs' experience living under the Texas abortion law and being denied care under the abortion law could not be more relevant to the issues involved in this case. Plaintiffs will be presenting testimony from various patients who will tell similar stories and all of them will explain personally that what happened to them was a result of the Texas abortion laws.

And so I truly don't know why we're here doing this if the state doesn't think those issues are relevant. The objection is overruled. So that's at the during the opening, I think. So they basically re-raise this objection at the beginning of every witness's testimony. None of this is relevant. Yes, every single time they insisted upon reasserting this objection before every patient plaintiff testified. And by the time we got to Dr. Denard, who was both

both an OBGYN herself and someone who had to travel out of state for a medically indicated abortion and who happened to be currently pregnant while she was on the stand. By the time we got to her, she and she was asked, did Attorney General Paxton personally tell you you couldn't have an abortion? Her response was, I don't even think he knew I was pregnant. And what proceeded from there was.

was queen. Iconic. It was pretty iconic. I have to say we were very proud of her. But what happened from there is that the state's attorney then tried to badger her into answering and to force the judge to give a yes or no answer, which the judge declined to do. I'm so reminded of that Robert Cover article, Violence and the Word in NOMOS. Like this is, you know, one of these articles, sort of a classic of jurisprudence.

And it's basically this idea that legal process itself can be a form of violence. And this is so clear here that just the way these litigants were treated was as bad as the injury they actually suffered at the hands of the law. The process itself is part of the punishment, the dehumanizing aspect of it, constantly being gaslighted and being made to feel like

The injury that you suffered, whether it was a pregnancy loss or, you know, having to wait to bleed out before you could get the care you needed, it's just not that big a deal. And did someone actually tell you you couldn't get an abortion? Well, no, then get out of court. Yeah. I mean, when Amanda got off the stand, she said, I think to a reporter that she almost lost her life being denied an abortion. And this experience of testifying wasn't that much less traumatic.

So this had real echoes of SBA, the state suggesting that the private bounty hunter law, like that law, you know, the law governing medical exceptions, it's not directly enforced by the state. And so nothing that happens under that law is attributable to the state at all.

as Kris Jenner said on Keeping Up with the Kardashians, this is a case for the FBI. Why could these people not get abortions and medically needed abortions? Who is to say? But the arguments come up differently here. It's not about whether the court has jurisdiction, but whether the injury to these plaintiffs was caused by or traceable to anything the state has done. But is that kind of a through line in these cases?

Well, I didn't I'm not familiar with the Kardashian reference, so you may have to unpack that for me later. But, yeah, I think it definitely is. I mean, as a abortion litigator who's you know, I've I've done so many, maybe six or seven cases in Texas.

And this is the case that they have been asking us to file, right? In every lawsuit they file, they say you can't file pre-enforcement. You have to wait until the law goes into effect. We don't really know what's going to happen. Let's wait and see. Then you can't seek facial relief. You have to seek as applied relief.

In some circumstances, the law is totally OK. So just bring an as-applied challenge. Oh, and don't have doctors sue. Really, you should be able to come here with patients. So here we are in state court with patients as plaintiffs filing an as-applied challenge. And still they're saying, nope, it's not good enough. We're not responsible. You don't have standing sovereign immunity, blah, blah, blah. Frankly, it's offensive, but it also just isn't right as a matter of law.

In none of the prior lawsuits involving SB 8 was the state of Texas as an entity sued in state court, which is what we've done here.

In a very, as I said, narrow as applied challenge, anyone who is a claimant in an SB8 lawsuit is necessarily exercising state power under SB8. And so an injunction would apply to them. And yet still, it's not enough. So, you know, as Molly, you're framing the incompetent cervix argument kind of teed up, it seemed like at various points, Texas was extremely keen to blame everyone except for the state of Texas for what is happening. And in their zeal to do that, it felt like the

Texas office was sometimes blaming the plaintiffs themselves.

So, you know, Texas was very keen to tell the plaintiffs that they were maybe too old when they got pregnant and therefore brought the risks on themselves. Were you ever told that your pregnancy was considered geriatric? No. Okay. Were you ever told that your pregnancy was categorized as high risk? No. Okay. Was it ever recommended to you to attend weekly ultrasounds and or appointments with a maternal fetal medicine specialist because of your age? No. Okay.

And this was, in fact, a recurring theme. So when the Texas lawyer was cross-examining Dr. Denard, she again, you know, brought up this concept of, well, you know, did you have a geriatric pregnancy that therefore like brought this on yourself? Would a pregnancy of a 37-year-old female be considered geriatric? Well, that's a nice word. I apologize. Geriatric is not a medical term.

I'm not really sure what to say. I mean, we were shocked. I don't know what I expected on cross-examination, but it certainly wasn't what I saw in front of me. And it happened once, right? Amanda was the first person we put on the stand, and we sort of looked at each other and thought, no.

That didn't go well for them. Surely they're not going to repeat that with every single plaintiff. And then they did. And I'll just say that none of this appears in the appellate briefing, which says to me that it was just straight up harassment. That was the purpose. There was no legal argument they were trying to construct through these lines of questioning. Not that I could see anyway. Yeah.

pure sadism. Yeah, it does read like that in the transcript. There is a kind of social argument being made that, like, you know, if you really want to have a successful pregnancy, you should be younger. Like, that's when women should be having children, not, you know, prosecuting careers. Don't go to college. Don't have jobs. Yeah. Right? Like, have children. And

Motherhood is a vibe. Get on it. And if you have a geriatric pregnancy, if you're 30, 35, having a baby, that's on you. And Texas, it's going to Texas. In the general vein of ridiculous statements and vomitous conduct, it's worth recalling for our listeners that during her testimony, one of your litigants actually became physically ill and vomited on the stand. Right.

What impact did that have in the courtroom? And what did she have to say about her experience in Texas and how the state's treatment of her both before and after this lawsuit has impacted her? Yeah, I'm glad that you asked me that question because it gives me some pain to see how sensationalized that one moment in the hearing was. I will say without waiving attorney-client privilege in any way that this is something she and I had talked about at great length.

Essentially, for your listeners' benefit, the plaintiff who this happened to, her name is Samantha Cassiano, and she has several children already, was excited to learn that she was pregnant again. Her and her family were hoping for a girl, and at the same appointment that she learned she was having a girl, she also learned that her daughter was never going to survive the pregnancy or much farther beyond it.

So her baby had a fatal fetal diagnosis known as anencephaly, where the head does not really develop above the neck. And she was scared to leave the state. She did not have the money to leave the state. And she actually reached out to us after the lawsuit was filed when she was still currently pregnant, saying, this is happening to me right now.

So what ended up happening is that she was forced to carry that pregnancy to term and just the process of going through that pregnancy, the delivery, and then what happened afterwards was so traumatic that during her pregnancy, she developed not only depression and post-traumatic stress, but a physical reaction to the trauma that she was experiencing that resulted in her vomiting pretty continuously. So, yeah.

you know, as she was testifying about the four short hours of her daughter's life. And she, um,

regarding how traumatic it was to watch her daughter gasp for air and her eyes bleed as she lost her life. And so talking about the trauma that that not only inflicted on her and her daughter, but her partner and her older children. I mean, that's the thing that I always think about as a mother. What impact does this have on your toddlers who you can't explain this to? But

As she was recounting that, she became physically ill. And what happened in the courtroom is that I and the judge rushed to her first, and then her partner was next, and he was intercepted by a marshal. But the judge was very kind and called a break. And it was entirely Samantha's decision to get back on the stand after the break. Because I just have to say, like her, and she has said this many times, her experience of going through this

What the state of Texas forced her to do has made her even more resilient about making people know what happened. She wants to tell her story. But it is very hard as an attorney to watch your client going through that and feel like you're the one putting them through it.

But so, so brave of her to do it and then to continue testifying after that. And I'll just mention one more thing. While this was happening, the attorney for the attorney general who was standing, you know, sitting in his chair behind me as I was examining her was weeping. And I just wanted... Is that Jonathan Stone? Yes. I just wanted to turn around and say, why are we here? There's another story that maybe we could share and then we'll move on that one of the plaintiffs in the lawsuit told Molly, which is that...

you know, differ somewhat in its particulars from the stories we've talked about already. So this individual was pregnant with twins and one of them had a condition, you know, I think it was the same condition that you just alluded to, 100% fatality rate. The recommendation here, because the woman was pregnant with twins, was what's known as a selective fetal reduction where an abortion is performed

to end the non-viable pregnancy, but the woman can continue to carry the healthy twin as a single pregnancy. And there is a huge risk if you don't do that, that early labor will happen before the healthy twin is viable, meaning that neither twin survives. So this woman did travel out of state. She had the selective fetal reduction procedure. She returned. She was initially really scared to go to the hospital in Texas when she had some leaking and bleeding, but she ultimately was able to carry the healthy pregnancy to term. And so we wanted to play that here.

So if I had not gone out of state and had just done what was legal in Texas, my daughter, Marley, would most likely be in the NICU because she would have been born before 37 weeks. All of my ultrasounds leading up to labor, I would have had to watch twin A, Isla, deteriorate more and more every ultrasound. So I would have had to give birth to an identical version of my daughter without a skull and without a brain, and I would have had to hold her until she died.

And then I would have had to sign a death certificate and plan a funeral and decide if we wanted to bury her or cremate her. It would have just been a really, really heartbreaking experience. But instead, I got to just give birth to my healthy daughter. Instead of crying from heartbreak that day, I was crying tears of joy and relief.

And then here's her talking about the impact of the experience on her and on her willingness to have another child to get pregnant again in the state of Texas. Ms. Brandt, after this experience, have you thought about having more children? No, I don't feel safe to have children in Texas anymore. I know that it was very clear that my health didn't really matter, that my daughter's health didn't really matter. And that's heartbreaking.

I also know that since I've had one pregnancy impacted by a neural tube defect, that I'm at a slightly increased risk of having another. And I just wouldn't feel safe carrying that type of pregnancy in this state. So after my daughter was born, my husband actually got a vasectomy. And we're just going to take our two healthy kids and be grateful. Overruled. Yeah, I mean, I just thought it was so poignant to hear her talk about

Yeah.

seemed to consider that the danger posed to the one viable twin just didn't matter because the sort of maximalist enforcement of this prohibition was the only thing in the minds of policymakers. So I just thought that was an incredibly powerful story to share as well.

Yeah, that's exactly right. Actually, two of our plaintiffs were in this situation. So the one you're talking about, her name is Ashley Brandt. Lauren Miller is another one of the plaintiffs. And in both of their cases, they were pregnant with twins. And to protect both their own life

and the life of the surviving twin, this was the health care that they needed. And lucky for both of them that they were able to travel out of state. But the experience of doing that was itself extremely traumatic. And I think we play that down a lot. Oh, you can just travel. Well, first of all, most people cannot. But even the ones that can, the experience of that, of needing health care, of having to, you know,

go through a serious medical procedure in a hotel room. This is not how our health care system is supposed to work, and it's certainly not pro-life. What was the outcome in this case after the

this trial with this testimony? So what happened is that we had this two-day hearing and the district court had before it both our request for a temporary injunction and the state's request to dismiss the case in Texas state court. That's called a plea to the jurisdiction. And what happened is that the district court denied their jurisdictional motion, granted our temporary injunction motion. And so for three short hours, we had a temporary injunction in place. I...

This is a whole other story, but it was a Friday night and I was frantically trying to get a court staffer to come back and let me pay the $100 bond so that the injunction could go into effect immediately. And when I woke up in the morning, the state had filed their appeal, which in Texas state court means that the injunction has automatically stayed. So that is where we have been for the past few months. To Texas's credit, you can actually get a pretty

quick hearing up to the Texas Supreme Court. So our briefs are all completed. Amicus briefs are being written now. And we are set to present argument before the Texas Supreme Court the Tuesday after Thanksgiving. What's your hope going into that oral argument in this appeal? Well, obviously, I'm hoping to win, Melissa. But well, I mean, fair enough. Like what kind of reception do you think you'll get at the Texas Supreme Court? Yeah, I really don't know.

It's kind of interesting because in some sense, this puts the usual abortion politics before the justices. But in another sense, this is something that a lot of people have gone through, some people quite quietly, right? Infertility and issues getting pregnant and everything.

You know, wanting a child and having difficulty having one is is a pretty shared human experience in a lot of places. And so I'm really not sure. But but what I can say is that Texas is not going to be the first. And I hope that that gives them some comfort, although, you know, sometimes they like to be cowboys out there. I'm from New Mexico, so I'm allowed to say that.

But courts in North Dakota and Oklahoma and Indiana, which are not really bastions of liberalism, have all said that you do not have to wait until a patient is on the brink of death before they can be offered an abortion. And as I said, the history and tradition of Texas law works in our favor. So we're optimistic and hopeful that this will happen.

result in real people being able to access abortion care again in Texas. And obviously, it's going to be a long fight. But even if the court rules against us, my position all along has been say it to our faces. And a lot of the plaintiffs are going to be sitting in the courtroom. And I want the justices to see them when they consider whether or not, for example, none of them have standing. Yeah.

I know that CRR has other suits like this one pending in other jurisdictions. We'll talk later about the suit in Tennessee, and I believe there's also a suit that's been filed in Oklahoma and one in Idaho. Can I ask just like a broader question? I mean, these are incredibly sympathetic plaintiffs, women who did want these pregnancies and had

really tragic experiences of pregnancy loss or difficult choices that they had to make in the course of their pregnancy. Has there been any discussion about maybe taking cases where the plaintiffs are perhaps

less sympathetic to those who might have pro-life sensibilities? For example, women who are just like, I don't want to be a mother. This is not my choice. Any sort of thoughts about curating plaintiffs for these kinds of cases and the kinds of litigation that you bring? Yeah, that's a very fair question. And it's something I think about all the time. And obviously these cases

cases that we've filed in Texas and Idaho and Tennessee have caught the public's attention and have gotten a lot of press. But I want to emphasize that this is not the answer. This is not everything that we are doing. This is a very narrow slice of abortion seekers. And I truly, truly do not want our plaintiffs to suck up all the air in the room because the

Not wanting to be pregnant is also a completely fine reason to seek an abortion. Those are the abortions that my grandmother and my mother received, and I support them 100%. So I see this case as...

part of our strategy, but not all of it. You know, the Center for Reproductive Rights is a global organization. So we have talked a lot with our colleagues in other countries about, you know, how do you start a decriminalization effort, a campaign? And our colleagues in places like Ireland and Colombia and Mexico and Kenya, they all emphasized that sometimes this is how it starts. So those who are familiar with the story of Savita

Hala Panavar will know that Amanda's story sounds really similar, except that Savita died, but it was her death that helped spark a revolution in Ireland to transform its abortion laws. So part of what we're doing here is just normalizing abortion and

But we work really hard not to stigmatize the vast majority of abortion seekers who are not our plaintiffs in this lawsuit. And I, to be perfectly honest, have really enjoyed in a strange way representing individual people. It is different from what my practice was before Dobbs. But I am, you know, I get phone calls all the time. Call me, email me. I am ready and willing to help anyone who wants to tell their story. I have to just recognize, you know, organizations like We Testify, they're

have been doing this work for many, many years and have recognized the importance of abortion storytelling to destigmatizing abortion and miscarriage care. So we don't seek to replace those efforts. Rather, we are trying to work alongside them and say to the public, "Look,

you think you support an abortion ban, this is what it actually looks like in practice. And the thing that I keep hearing from sometimes the plaintiff themselves, but also their families and their friends, is that, wow, they were opposed to abortion until they found out what happened to, you know, this person. And now they're thinking, well, maybe you

maybe you should just leave this to doctors and their patients, right? It's not the response is not, oh, well, these are the only abortions that should be happening. It's maybe government shouldn't get involved in this in the first place. So I find that hopeful. So maybe we should end on that hopeful note. Molly Duane, thanks so much for making the time to talk to us today. We will be keeping a close eye on this argument at the end of the month in the Texas Supreme Court and thinking of you and wishing the best for you and your clients.

Well, thank you all for having me and thank you for the good vibes. We need some good vibes in the ether as well. And some good law. We've got to take one more quick break. And after that, we're going to turn our attention to eastern Tennessee and northern Mississippi to hear about the realities of a post-Dobbs world on the ground there.

Hi, I'm Stacey Abrams, host of the brand new Crooked podcast, Assembly Required with Stacey Abrams. Each week, we'll work together to better understand one of those big issues that seems insurmountable. Whether it's the Electoral College, America's loneliness epidemic, or the future of Hollywood post-strikes, I'll challenge you to dig in and ask, how do we get here? What obstacles lie ahead? And what can we do to get good done? Are you in?

Episodes of Assembly Required with Stacey Abrams are available starting August 15th. Head to your favorite audio platform and subscribe now so you never miss an episode. Okay, listeners, as we previewed at the beginning of the show, we're not just going to focus on Texas. We're also going to focus on another T-State with an equally terrible record on reproductive rights. So joining us now is Ashley Cofield, the CEO of Planned Parenthood of Tennessee and Northern Mississippi.

Thank you.

They have referred patients to other states for this kind of care. And notably, they have expanded their family paling services to include, wait for it, vasectomies, because men have reproductive rights too, and maybe they should exercise them. Ashley, we're so excited to have you here to talk about what's going on in Tennessee and northern Mississippi. Welcome to Strict Scrutiny. Thank you for having me. I love the show.

So as our listeners know, the Dobbs decision leaked in early May, about 50 days before the final decision was announced. And in 2019, the Tennessee legislature enacted the Human Life Protection Act of 2019, a trigger law that would take effect 30 days after a judgment overruling Roe. Given that, Ashley, you were on notice that Roe was likely to be overruled, what did Planned Parenthood do to prepare for the impending change in the legal landscape for abortion care? Well,

Well, it was a long time coming because, you know, the trigger ban was in 2019 in Tennessee, which was an if-then ban.

than a total ban. And then in 2021, there was a six-week ban. And then in 2022 came the decision. It was just this kind of horrible buildup. And the six-week ban hit us harder because it felt more real, even though that's not what ultimately got us. It was the trigger ban that did. But the six-week ban was a real gut punch. So it was a couple of years of knowing that it was coming. And let me give you a little more context.

Six months before the Dobbs decision, one of our health centers was burned down by a domestic terrorist. So we were...

dealing with a really violent act against our affiliate. That was the first time in our history that we had been face-to-face with violence like that. The way that we did prepare in that context of kind of hell that we were in was really thinking about primarily how we were going to navigate people out of the state to get abortion care in other states. So we were, you know, hiring social workers, preparing them with resources in order to help people with logistics like, you know, travel,

We were thinking about the additional family planning services that we could offer, like vasectomy, which we recently launched. And we were thinking about how to return reproductive health care to East Tennessee, where we had our health center burned down. And we had thousands of patients there who counted on us, not just for abortion, but for gender affirming care and for family planning. So there was a lot going on at the time of the ban.

So that's essentially the kind of lead up to Dobbs. Can you now give us a sense of what things have been like on the ground in Tennessee and northern Mississippi since the Dobbs decision was actually issued? Well, I feel like we've been tasked with dramatically ramping up our ability to care for people who need us now more than ever. And

One thing that's really surprised us is how few people, the relatively low number of people that have reached out for us for help to navigate to other states compared to the number of people who reached out to us for abortions when abortion was legal. You know, we thought that the numbers would be somewhat comparable. You know, that the people who need abortions would also come back to us and trust us to help them with navigation. And that's not been the case. And I think it's because the climate of fear has

around the abortion law and the confusion about the law. And people think that they might be breaking the law, you know, if they want to talk to us or if they want to travel out of state to get an abortion, which is not true. They're not breaking the law by doing that. But I do think there's a real climate of fear. And one thing we've learned through helping people travel is that a lot of people in Tennessee who may have been able to get to us in a brick-and-mortar health center to get an abortion have

have a lot of trouble with this travel for all the reasons that we thought, you know, that how difficult it is to travel out of state. They've never been out of state. They don't have proper transportation, time off work and all those kinds of things. But a lot of people don't have internet access and they don't have good devices to use or take with them when they're traveling. And so just the fact of them reaching out to us and us helping them with logistics is huge because they just don't have all of those resources to manage something that complicated and then to

you know, manage a trip like that without somebody really holding their hand through the process. So as we noted in the introduction, your offices are no longer providing medication or surgical abortions in Tennessee, but you have pivoted to begin providing vasectomies for men. So,

What was the thinking behind focusing on reproductive care for men? And what did your office have to do to get teched up to be able to provide those services? Had you always provided men's reproductive health services or was there special training that your providers had to get to be able to provide vasectomies? Well...

Melissa, it was surprisingly easy to stand up vasectomy services compared to abortion services because there's no laws restricting access. Wait, wait. There's very few restrictions. There are no laws restricting vasectomies? No. If a patient is a Medicaid patient, there's a waiting period. There's a required consult and a waiting period. But...

Other than that, there's really... Wait, let's think. What could be different between... Those seeking abortions. And those seeking vasectomies? What could be different about these kinds of reproductive healthcare? Nothing comes to mind. I don't know. Okay. Yeah. I mean, it's almost like men have greater reproductive freedom than do women. And what's interesting, you know, we trained our medical director who's an OBGYN to do it. And she went down to a

vasectomy provider in Florida, he calls himself the vasectomy king. You can Google him. And I'm going to start calling Sam Alito the vasectomy king or like the vasectomy prince, right? It hits. It hits. Yeah. And, you know, the thing that men face, to be fair, the thing that men or people with penises face about this decision for them is providers can be

Some providers can be judgmental about their decision and they can say, well, you're too young to make this decision or you've not had kids, so I'm not going to do it. And, you know, we've made the decision that if you're an adult and you've been through the consenting process and you know the risks and the cost of reversal and the issues with reversal and you still want to do it, that's your decision. You can do it. So what we're seeing are younger people coming in for vasectomy and people who've been turned down by other providers. Right.

Are there any other plans to provide other kinds of primary care services? Everyone knows that. Well, I don't know if everyone knows this, but we know that Planned Parenthoods are often a place where you not only can seek abortion care, or at least you could seek abortion care, but you can also get other basic kinds of health care, like mammograms. Are there...

Other plans for you all to provide other kinds of services like prenatal care to those who are pregnant? We are talking about prenatal care. We want to be a good partner in the community and think about where we fit in to that service. What we've started with is...

primary care services like hypertension screening and diabetes management and those types of services there's disparities with cardiovascular disease and hypertension and diabetes among black women and that causes pregnancy complications and it's one reason for the disparities in pregnancy outcomes and birthing outcomes so we decided to focus on some primary care services that we had not previously had the bandwidth to focus on while we were trying to manage the

the abortion landscape that we were in that was very complicated and difficult. So we're really excited about adding those services and hoping that we take better care of our patients that way, because we've seen this over the last decade. They're presenting with these issues at younger and younger ages. So you already mentioned this, Amanda, how Black women, you know, in Mississippi and Tennessee and Memphis in particular have some of the highest rates of maternal mortality and morbidity in the country. You know, have the legislatures in either state taken action to deal with this in the

I guess I can answer that no. But, you know, how is Planned Parenthood attempting to address this, you know, in light of the state's inattention to it? You know, it's so hard. I'm sure you all know that Tennessee passed a law in 2021 prohibiting. It's called the prohibitive concepts law, you know, that stops schools from talking about structural racism. And the law didn't call it structural racism. Right.

But if you know anything about white supremacy, you know what it's actually saying, because it said that you can't talk about the United States being fundamentally sexist or racist. Well, what does fundamentally mean? You know, it's a really vague. It probably means you can't talk about structural racism. So in talking with them about disparities, it's impossible to talk about disparities without talking about structural racism, right?

And so there's not even a conversation about it. And, you know, our state has decided not to expand Medicaid, which is itself a policy of structural racism, even though many, many white people in Tennessee would benefit from that. That's exactly what it is. And they have no shame in that policy. They have absolutely no shame. So without that shame, there won't be any action on it anytime soon. So we're at a log jam right now.

you know, the gun safety issue that was so in the news recently in Tennessee when the shooting at the Covenant School in Nashville happened, the three legislators that were expelled, democratically elected legislators that were expelled at

from the General Assembly for standing up for the 5,000 kids who are standing outside the General Assembly and being ignored. You know, gun safety is also an issue of structural racism, and it has disparate impacts on Black and brown people, and they wouldn't even acknowledge the people who were there to talk with them about it. So we have...

We're not dealing with a real democratic institution that's there to listen to everybody's concerns and have a real conversation about policy. That's not where we are right now. The abortion ban, which was enacted in 2019, was actually amended in 2023. And it does have an exception that permits abortion if it's necessary to, one, prevent the death of the pregnant person, or two, in circumstances where there's a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant person.

But interestingly, the 2023 amendments specifically foreclose applying those exceptions and circumstances where the woman is threatening self-harm or for any reason that relates to her mental health. I just want to note that's a really different sort of

posture to be in. I mean, because like, at least in the period preceding Roe versus Wade, one of the ways that doctors were able to authorize abortions was by adverting to the fact that a woman was suicidal or her mental health was impaired by the prospect of having to deliver a child. And, you know, have you seen the

the sort of confluence of mental health crises or suicidal ideation among the pregnant population in Tennessee as a result of these amendments? I think any patient who is being denied an abortion when they need one is having a mental health crisis on some level. And I think hundreds, if not thousands, of mental health professionals across Tennessee would be happy to help a person in that situation. And our opposition knows it. And that's why the law was written that way.

But it is chilling when you read that a suicide is not an exception. We also wanted to ask you about another lawsuit, one that directly implicates Planned Parenthood of Tennessee and Northern Mississippi. And the Tennessee Attorney General filed suit against the Federal Department of Health and Human Services, challenging HHS's decision to withhold Title X funds, that's a family planning program, those funds from Tennessee. Can you get us up to speed on that case and how it impacts

Planned Parenthood's work? Yeah, absolutely. Well, the state of Tennessee refused to comply with a Title 10 regulation that they provide non-directive counseling to pregnant people, meaning that if the

pregnant person that comes to a Title X clinic asks for information about abortion services, that those resources are provided. Just like if they ask for information about accessing prenatal care or if they ask about information about adoption, those resources would need to be provided. And they unpragmatically, you know, made the decision not to comply, even though my understanding is that they were warned that they would be removed from the Title X program and

And they did it anyway. And this is in the context of them walking away from our HIV prevention money a few months before that. They did that voluntarily rather than give any of that money to Planned Parenthood. So they made the decision not to comply. And the Office of Population Affairs at the U.S. Department of Health and Human Services made the decision to remove them from the program as of April 1st.

And we knew that about this compliance issue because there are Planned Parenthood affiliates that are Title X grantees that were, you know, having to comply. I knew that the state wouldn't comply. I knew that they would be unpragmatic about it. It's just like Medicaid expansion. You know, I'm not going to do it. I'm just not going to do it. I'm not going to do what you say. I'm not going to participate in this.

I'm going to live here on my Christian commune in Tennessee and just ignore what everybody else is doing and slowly dismantle the sexual and reproductive health care protections that we've built up over decades. So they decided to leave the program. We knew that it would be the easiest thing for the federal government to get the money back to Tennessee if a direct grantee, somebody who was already a direct grantee in the program, asked to expand their program to include Tennessee. So I worked with the Virginia League for Planned Parenthood, who

that is a direct grantee and asked them if they would be willing to expand their grant to include the state of Tennessee and if we could apply together. And they graciously did so. And so a big part of the money went to the Virginia League for Planned Parenthood, which is now subcontracted with our affiliate so that we got half the money back to Tennessee. And then another nonprofit in Mississippi,

Had the same idea and got the other half of the money back to Tennessee. And together, we'll be able to build a Title 10 network outside of the state of Tennessee. So then what did they do? Even though they voluntarily did not comply with the program, they've decided to sue the U.S. Department of Health and Human Services, you know, with the argument that the non-directive counseling requirement is not something that they should have to comply with.

Sounds like a good way to end things. Thank you so much for coming in today, Ashley, and helping us understand what's going on in the Rocky Top State and in northern Mississippi as well. We salute you and all of your colleagues at Planned Parenthood of Tennessee and northern Mississippi. Thanks for being here. Thanks so much for having me. Appreciate y'all. A couple of notes for you before you go.

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