Spreadsheet tracking Planned Parenthood patients’ periods ignites firestorm

The revelation that the Missouri state health department had a spreadsheet that tracked the menstrual cycles of Planned Parenthood patients has set off a firestorm in the medical and political arenas Wednesday and led to a call for the dismissal of the department’s director.

Dr. Randall Williams said in sworn testimony Tuesday that the spreadsheet was used to find so-called “failed” abortions, in which Planned Parenthood patients had to return to the St. Louis clinic to complete the procedure.

But on Wednesday medical professionals expressed puzzlement and outrage about the practice, asserting that it served no legitimate purpose.

OBGYN Jennifer Villavicencio, a fellow with the American College of Obstetricians and Gynecologists, said what the state did “defies both logic and ethics” and called it “skin-crawling.”

“I spent some time thinking about how this director would be using this information in any form that would be meaningful medically and I really can’t think of any,” said Villavicencio, a clinical lecturer with the Department of Obstetrics and Gynecology at the University of Michigan.

“I think without the patient’s knowledge that their information was being collected, the fact that it was being collected through an inspector and there was no form the patients signed for release of their information truly defies every practice that I have ever been taught about privacy for patients.

“From an ethical standpoint, it’s frankly bonkers.”

“This whole thing is just a perfect example of how terrible it is when politicians try to practice medicine. And that’s what they’re trying to do,” said Mark Finkelston, an OBGYN for nearly 40 years in Johnson County and at several metro hospitals, now retired.

The existence of the spreadsheet came to light during an administrative hearing in St. Louis to determine if the Planned Parenthood clinic should retain its state license to perform abortions. The document was obtained by Planned Parenthood through legal discovery.

Late Wednesday the state health department in a statement pushed back on the claim that Williams requested the spreadsheet, although it was titled “Director’s Request.” The department also said Williams was never in possession of the spreadsheet.

The statement said the department’s investigator took records of the 3,000 abortions conducted in 2018 and found 67 instances in which the same patient had multiple abortions in the same year. The data was further “narrowed” and the department was able to find a case in which a failed abortion was not reported by Planned Parenthood.

“Without a directive from Dr. Randall Williams, regulators devised a means to efficiently investigate that concern using legally-obtained information which was required by law and which Planned Parenthood routinely submits,” the statement said.

The department’s statement said that Williams had not seen the spreadsheet until he was deposed Oct. 17. The deposition, which is partially cited in the statement, is under seal and cannot be released to the public until the proceeding is over.

The spreadsheet was attached to an email with the subject line “Duplicate ITOPs with last normal menses date” sent by an employee of the Bureau of Vital Statistics, which falls under the health department.

The spreadsheet, which was based on medical records the investigator had access to, also included patient identification numbers, dates of medical procedures and the gestational ages of fetuses. The last column of the spreadsheet included the date of the last menstrual period of each patient. The patient’s names were not included.

The investigation eventually found four patients that had to return to Planned Parenthood more than once to have a successful surgical abortion. The failed abortions led the department to have “grave concerns” that caused it to withhold the St. Louis clinic’s license.

Neither Finkelston nor Villavicencio could think of any medical reason the information about menstrual periods would be useful to the state for its purposes.

“I have no idea,” said Villavicencio, a family clinic specialist with expertise in obstetrics and gynecology, and contraception and abortion. “And I have been racking my brain to think about how tracking someone’s periods would help them understand abortion complications.

“Periods in and around a pregnancy, whether it is a pregnancy that is continued to full-term and delivered, a miscarriage or an abortion, can vary up eight to 12 weeks. They can be irregular, you can [have] incremental spotting, you can have bleeding. So it’s very unclear to me how they would be using just that data point to determine whether or not there was a complication. That suggests to me a complete lack of understanding of how abortion care is delivered, frankly.”

She said OBGYNs, in various scenarios, will ask patients who are having menstrual problems to track their own period. There are apps for that.

“We ask them to do that so we can understand how regular their periods are, how far apart they are, how long they’re lasting, how heavy they are, the characteristics of them,” she said.

“But it is unusual for an office to keep a spreadsheet of one patient’s menstrual period, let alone a spreadsheet that has multiple patients’ information on it. That feels very inappropriate to me.”

And, there’s no guarantee that the information, if it came from the patients themselves, is accurate anyway, Finkelston said.

“For one thing, and Dr. Williams knows this as well as anybody else as an obstetrician, everyone knows that women are half the time incorrect about the first date of last menstrual period,” Finkelston said.

“If there was a reason to gather that information — which is not at all clear to me — one would have to be cognizant of the fact that the data you are collecting was half the time going to be inaccurate.”

Word of the spreadsheet drew harsh criticism across social media. Democratic presidential candidate Cory Booker tweeted: “This news out of Missouri is deeply disturbing. The decision to have an abortion should be between a woman and her health care provider, free from government interference. This abuse of power by Missouri Republicans is dystopian.”

State auditor and Democratic gubernatorial candidate Nicole Galloway called on Gov. Mike Parson, a Republican running for another term, for Williams to be fired immediately.

“This brazen violation of women’s private health information demonstrates how far the Parson administration is willing to go to restrict reproductive healthcare,” Galloway said in a statement.

“Governor Mike Parson has shown his willingness to weaponize his regulatory authority to interfere in gross, weird, and medically unnecessary ways.”

Yamelsie Rodriguez, president and CEO of Reproductive Health Services of Planned Parenthood of the St. Louis Region, said the first time she heard that Williams was tracking menstrual cycles was when he revealed it on Tuesday.

“I think what’s deeply disturbing about that is the fact that Director Randall Williams is using his position of authority and power to push a political agenda in order to try to end access to safe and legal abortion in the state of Missouri,” Rodriguez said.

She said she didn’t know how many women were on the spreadsheet or why they were chosen to be on it.

“We do not have that information other than we know the state has information regarding complications reports for abortion reports and the last menstrual period is listed in the complications reports,” Rodriguez said.

Williams, an OBGYN, was appointed director of the Department of Health and Senior Services by former Gov. Eric Greitens in 2017. Previously, he served in leadership positions with North Carolina’s health department.

He drew national attention earlier this year over a state policy requiring that physicians perform a pelvic exam three days before a woman receives a surgical abortion, even though physicians already do the exam immediately before the procedure.

Planned Parenthood called performing two pelvic exams ‘invasive’ and ‘medically unnecessary,’ and the rule ‘unethical.’ Williams eventually reversed the rule.

The revelation about the spreadsheet brought up issues of privacy, too.

“These patients did not give permission for this information to be released, as far as I know,” Villavicencio said. “So they were trusting that when they went to the clinic their information was going to be secure. And now you have the government coming in and saying ‘I’m going to take this information without your permission and use it how I see fit.’

“That is not how the health care system in this country works and it is completely unethical ... they clearly have a political agenda and they are breaking all the rules they can find and then some to achieve that political agenda and it’s disgusting, frankly.”

Rodriguez said she expects the health department to protect their patients’ privacy, as Planned Parenthood does.

“While the department, or the health department, by law is exempt from federal privacy laws, again what is disturbing in this situation is the director used his authority and power to search for a solution to create a problem,” Rodriguez said.

“I guess our question for Gov. Parson is what is he going to do with this information? He appointed Director Williams and it’s up to the community and citizens to ask questions of its elected officials.”

In her statement, the department said compliance with federal privacy protection law known as HIPAA “was not a factor as no patient data has been released.”

“This information, in fact, was important in the investigative process in ensuring that facilities are safe for patients,” the department said.

Thomas reported from St. Louis.

This story was originally published October 30, 2019 at 8:36 PM.