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As the nation marks the 48th anniversary of Roe v. Wade and President Trump’s term has come to an end, questions remain about how the former administration had addressed congressional concerns surrounding Planned Parenthood Federation of America’s (PPFA) fetal-tissue practices and its lack of action that ultimately prompted criticism from conservatives.

Roughly a week before Trump left office, the Department of Health and Human Services (HHS) proposed a rule that would purportedly strengthen requirements for informed consent from mothers, as well as prevent fetal-tissue trafficking in federally funded studies -- issues raised after HHS terminated in 2018 its contract with a tissue procurer that worked with PPFA.

But while HHS has taken on those and other measures, the federal government hasn’t followed up on key issues flagged in 2016 by a House select panel that started in response to David Daleiden’s explosive undercover videos released in 2015. News of a DOJ inquiry surfaced in 2017 and the former administration remained mum on the controversial allegations up through President Biden’s inauguration on Wednesday. 

Daleiden’s videos and depositions from his civil trial with the abortion provider prompted accusations that PPFA had violated federal law by altering abortions in order to sell fetal tissue -- something it vehemently denies. Congressional investigators also sent referrals to HHS for potential violations of the Health Insurance Portability and Accountability Act (HIPAA), but it’s unclear how the department proceeded.

"Under the Trump administration, the Department of Justice was right to start an investigation into Planned Parenthood selling body parts from aborted babies," Sen. Marco Rubio, R-Fla., told Fox News in December. "This practice is abhorrent, and the Department of Justice should finish what it started back in 2017." 

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A national leader in the pro-life movement told Fox News: "Planned Parenthood was caught red-handed, on film, illegally trafficking in baby body parts. A select House committee investigation referred to DOJ specific evidence years ago and yet not one federal prosecutor had the guts to bring a case. Disgusting!" DOJ did not respond to Fox News' request for comment, and it's unclear whether they considered the publicly available information in any investigation.

Daleiden also issued multiple statements criticizing the administration as a medical study caught attention at the end of last year for grafting fetal scalps onto rodents. The scalps, which the research paper described as containing "full-thickness human skin," came from the Health Sciences Tissue Bank at the University of Pittsburgh. That entity, now known as the Pitt Biospecimen Core, obtains tissue from the University of Pittsburgh Medical Center (UPMC), which has received federal funding and worked with Planned Parenthood. Both UPMC and the University of Pittsburgh have denied wrongdoing.

Daleiden said it was "outrageous that the same week we learn more about the depraved experiments at the University of Pittsburgh, the best DOJ leadership can do at an event with the vice president is to announce a conscience lawsuit in Vermont."

As he noted, former Vice President Pence gave a "Life is Winning" speech last month that was attended by prominent leaders in the movement. Under him and President Trump, the administration has pursued a series of controversial decisions that led some conservatives to label Trump the "most pro-life president" in U.S. history.

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Pro-life leaders have praised Trump for, among other things, defunding PPFA through Title X, becoming the first president to speak at the March for Life, moving to grant conscience exemptions for medical workers who don't want to perform the procedure, moving to restrict fetal tissue research, and pushing a 20-week ban that was ultimately rejected by the Senate.

But now Vice President Kamala Harris, who prosecuted Daleiden in an unprecedented criminal case as California's attorney general, has taken office. Her replacement in California was Xavier Becerra, who also participated in Daleiden's prosecution and has opposed pro-life efforts pushed by the department (HHS) he's been tapped to lead under President Biden.

Pence's office and the Justice Department did not respond to Fox News' requests for comment. When contacted, the Trump White House didn't comment either.

In the midst of the dispute over fetal-tissue research, Planned Parenthood brought a civil lawsuit against Daleiden and other parties alleging that workers at PPFA clinics had been secretly recorded in violation of federal and state laws. In 2019, a federal jury ordered Daleiden and other defendants to pay nearly $2.3 million in damages. Recently, a federal judge ordered Daleiden and his associates to pay $13.6 million in legal fees to the plaintiff. While that case has already been decided, Justice Department findings could theoretically impact other legal proceedings surrounding Daleiden's challenges to PPFA. 

Questions remain years after the release of controversial undercover videos of Planned Parenthood officials

Five years after the release of Daleiden's videos, their impact continues to ripple through the legal system and fuel debate about how aborted baby body parts are used in research. But despite the centrality of their role in conservatives' criticism, advocates note the Trump administration’s lack of follow up on major allegations.

"We are incredibly grateful for their work," former PPFA director and current pro-life advocate Abby Johnson said last month, referring to the Trump administration. "There are several loose ends. ... We urge President Trump and his administration to swiftly act to protect those most vulnerable among us and deliver justice to the oppressed."

Sen. Ben Sasse, R-Neb., told Fox News: "There isn’t any gray here: trafficking baby body parts is abhorrent and Planned Parenthood should have faced legal consequences."

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PPFA has defended itself by citing the lack of public evidence, in addition to findings from multiple state-level investigations, while arguing that Daleiden's videos were heavily edited -- criticism that a federal judge disputed in 2019. Since then, Daleiden has released testimony and invoices that purportedly corroborate some of the most troubling claims in his videos; namely, that PPFA officials altered abortions in order to obtain intact or "usable" fetal tissue.

Invoices unsealed from his civil trial showed a California affiliate charging tissue procurer StemExpress $55 per "POC," or products of conception -- another term for fetal remains -- and $10 per sample of blood. Three invoices -- dated Aug. 2, Sept. 5, and Sept. 28 of 2012 -- show the abortion provider charging a total of $24,940, along with more than 200 POCs.

PPFA has contended that its charges related to transportation and time spent by staff, apparently claiming the type of reimbursements that are allowed under federal anti-trafficking law. The invoices don't mention either of those, however, nor do they contain the word "reimbursement." Holly O'Donnell, a former Stem Express employee, previously told Daleiden her employer handled transportation for PPFA while a Republican-led congressional panel has similarly accused the abortion provider of double-counting costs. 

The dollar amounts assigned to fetal organs have been as high as $1,600 for a liver, thymus pair -- an offer that a company, Biomax, set up by Daleiden made and was entertained by at least one affiliate of PPFA. Although the abortion provider ended in 2015 its practice of receiving reimbursements as part of tissue transfers, questions remain as to how it used those funds prior to that.

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O'Donnell previously told Daleiden that Stem Express employees coordinated closely with PPFA to fill what she likened to a "grocery list" of fetal body parts. Management, she said, heavily pressured employees and incentivized them to obtain fetal organs, which internal emails showed with dollar amounts assigned to them. Both Stem Express and Planned Parenthood have denied similar allegations O’Donnell leveled in Daleiden's initial video with her.

PPFA has also pointed out that one of their doctors said on camera that she isn’t interested in profiting off tissue and that another also said, "We’re not in it for the money."

Erica Sackin, senior director of communications and culture at PPFA, previously told Fox News: "The truth is that the Center for Medical Progress broke the law to try and prevent Planned Parenthood from serving the patients who depend on us, and to shut down a provider of critical sexual and reproductive health care, including cancer screenings, STI testing, birth control and abortion care. They still face criminal charges, and were ordered to pay millions of dollars in damages as a result."

Fierce criticism has also come from StemExpress founder Cate Dyer, who lambasted Republicans' investigation as a "witch hunt" and praised fetal tissue research for its role in producing vaccines for diseases like polio. In a July 7, 2016, statement, she added that fetal-tissue research was "essential" for developing a vaccine against the Zika virus, which was making news headlines around that time.

Since that statement, the issue has gained renewed attention with coronavirus vaccines emerging from studies utilizing fetal cell lines. And it could grow with research like the one involving fetal scalps grafted onto rodents, as well as a recently published study on tracking the development of cells extracted from 15 fetal organs. Released in November, the paper on that study said it involved "121 human fetal samples ranging from 72 to 129 days in postconceptual age." It claims "aspects" of the project were funded by the National Institutes of Health (NIH) and the Chan Zuckerberg Initiative, a joint project between Facebook CEO Mark Zuckerberg and his wife Priscilla Chan.

The co-author of Dyer's statement was California-based doctor Eugene Gu, who has acquired Twitter fame while issuing morally indignant posts about President Trump. CBS News previously reported on the ethical debate that emerged from Gu’s company Ganogen, which has received StemExpress tissue, attempting to grow fetal kidneys in rats that could later be implanted in adults. Ganogen also experimented with placing fetal hearts in lab rats and posted a video of a fetal heart beating inside of a rodent. That video has since been removed, but traces of it remain on an Internet archive. Daleiden claims he alerted DOJ to these instances, and Gu did not respond to Fox News' request for comment. The House select panel, which subpoenaed Ganogen, reported that Gu’s company paid thousands of dollars to StemExpress between 2013 and 2014.

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University of Pittsburgh faces renewed attention with fetal scalp study

Both Daleiden's and Johnson's work has suggested some kind of organized system for transferring fetal body parts on a mass scale.

In a PureFlix interview with Johnson last year, former university employee Lori Kelly alleged a federally funded project with researchers seeking to collect bladders and kidneys from babies as late as 24 weeks into pregnancy. Kelly added that as project manager, she worked to develop "a pull-down menu of baby body parts for researchers to choose from to submit to the tissue bank, so that we could send the body parts to them."

"And these researchers were all across the United States," she said, "from Florida to California." When asked, the University of Pittsburgh did not respond to Kelly's allegations, and Kelly declined an interview request through a representative of Johnson’s organization. 

Regardless, publicly available evidence does not prove that the university violated anti-trafficking law. A 2015 review by the state's Democratic administration also found no evidence that PPFA was involved in fetal-tissue donation in the state, and its health secretary there was "no evidence that any Planned Parenthood site in this Commonwealth is involved in the buying or selling of fetal tissue."

But pro-life advocates argue the issue is far from over given Planned Parenthood's relationships with the university and the University of Pittsburgh Medical Center (UPMC). For example, the university hosted a residency program in which participants improved abortion techniques and engaged in other activities while working in UPMC facilities and a Planned Parenthood of Western Pennsylvania (PPWP) clinic.

The 2019 annual report for the university’s Department of Obstetrics, Gynecology, and Reproductive Sciences lists Dr. Beatrice Chen, who has been listed as PPWP’s medical director, under "outreach/contracted care," along with three other doctors for that affiliate. It also identified the UMPC Magee-Women’s hospital as its "main clinical location" and lists activities of university professors practicing medicine there.

Beyond any relation to the abortion provider, the recently surfaced study on fetal scalps will likely refocus attention as Pennsylvania state legislators, like Rep. Paul Schemmel, a Republican who chairs the Pennsylvania House's subcommittee on health care, return to work this month. "I suspect there will be investigations through multiple committees," said Schemmel, who added he was "horrified" by the study. 

In an email obtained by Fox News, the University of Pittsburgh told lawmakers in December that it meets legal requirements for research and was unaware of any FBI investigation into its fetal-tissue practices. 

"The University of Pittsburgh complies with rigorous regulatory and ethical oversight of fetal tissue research," Paul Supowitz, the university's vice chancellor, told lawmakers. "The researchers in this matter followed all applicable federal and state guidelines and regulations (with Pennsylvania having one of the most restrictive set of requirements in the nation), as well as strict protocols approved by the University. The University’s Institutional Review Board approved the acquisition of stem cells."

The FBI’s Pittsburgh office told Fox News it wouldn’t confirm or deny the existence of investigations.

UPMC also denied it was under FBI investigation and PPWP did not respond to multiple requests for comment. The university further clarified to Fox News that it and UPMC were separate entities and said that PPFA did not supply the fetal scalps used in the controversial study highlighted by Daleiden and others.

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"There is no procurement relationship for tissue with Planned Parenthood," read a statement from the university.

However, one of Daleiden's videos purported to show a 2014 exchange with Dr. Audrey Lance, who said university patients were offered the opportunity to donate to the tissue bank. Based on photos from Linkedin and other sources, Daleiden appeared to be correct in identifying the doctor as Lance, who, like Chen, was also listed as PPWP "outreach/contracted care." Daleiden also provided Fox News a photo of a business card he said he received from Lance. It contains Lance’s name, email address with a "magee" email, and the UPMC logo. UPMC did not immediately respond when asked about this.

UPMC denied procuring tissue from Planned Parenthood and denied the organization’s doctors were involved in abortions that resulted in fetal tissue being transferred to the university’s tissue bank. 

In a statement to Fox News on Tuesday, UPMC said that Lance was part of another entity known as the University of Pittsburgh Physicians.

"University of Pittsburgh Physicians (UPP), an affiliate and subsidiary of UPMC, has numerous professional agreements with a variety of organizations across western Pennsylvania and beyond to provide specialty and subspecialty services," a statement read. "UPP serves as an independent contractor in these agreements and does not have management responsibility over these organizations. Dr. Audrey Lance left UPP in 2018."

Beating hearts, intact fetuses and questionable techniques

Although federal law allows fetal-tissue research, the NIH restricts how medical personnel can obtain that tissue.

Questions surrounding organ extraction intensified when video testimony surfaced with PPFA officials discussing fetal viability after abortions -- raising questions about potential violations of the Born Alive Infant Protection Act, which guarantees abortion survivors the same rights as others. At the time, then Sen. Kelly Loeffler, R-Ga., led a group of senators in requesting an update from DOJ.

"Following new videos of Planned Parenthood officials admitting to sickening criminal behavior including infanticide and fetal-tissue trafficking, I requested an update on action the Department of Justice has taken to stop this appalling behavior," Loeffler told Fox News. She added that while she was "disappointed" she hadn't heard back on her August inquiry, she hoped the DOJ "investigation leads to real action against Planned Parenthood." 

PPFA did not respond to Fox News’ for comment, but it has vehemently denied selling fetal tissue and has offered various answers on whether it let infants die in its care. In a statement from 2013, the organization appeared to clarify that it offered "appropriate care" to infants and their mothers.

And in 2018, its Kentucky affiliate flatly denied that physicians committed infanticide. The national office also condemned a bill that year that would impose criminal penalties on doctors who didn't provide abortion survivors with lifesaving care. "Medical guidelines and ethics already compel physicians facing life-threatening circumstances to respond," the group said.

At least one Planned Parenthood official, Jon Dunn, has acknowledged that their affiliate saw an infant born alive after an abortion. "I know they kept it warm and comfortable for the very brief period that it was alive," he stated as part of a sworn deposition in Daleiden's civil trial.

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Dr. Deborah Nucatola, a medical director for Planned Parenthood, told Daleiden's attorney she was "sure" she'd seen nonviable fetuses exit the uterus. By nonviable, she meant "not capable of survival." Nucatola added she didn't recall seeing various signs of life in these cases (movement, indication of breathing and a beating heart).

Both Nucatola and Dr. Mary Gatter -- two of the PPFA officials in Daleiden's videos -- have denied altering their abortion "procedure," instead claiming only the "technique" was altered while obtaining fetal tissue. Critics have argued, however, that is a distinction without a difference when analyzing whether they might have violated federal law in obtaining fetal tissue.

A tissue procurement manager for Advanced Bioscience Resources (ABR), which worked with PPFA, similarly acknowledged in deposition testimony that she knew of fetuses leaving the mother, sometimes "intact" or with closed abdomens. 

Perrin Larton, the ABR manager, maintained that the fetuses weren't alive and that those types of incidents generally occurred "once every couple of months." In those cases, she said, ABR would perform a dissection to obtain the desired tissue. Although ABR has worked with PPFA for years, Larton claimed she'd never heard of deliveries like that happening at the abortion provider.

In 2018, HHS terminated ABR’s contract with the Food and Drug Administration (FDA) and initiated a "comprehensive review of all research involving fetal tissue to ensure consistency with statutes and regulations governing such research." While it’s unclear what exactly HHS found in its audit, it appeared to prompt -- two years later -- last week’s proposed rule on informed consent.

In announcing ABR’s termination, HHS said in 2018 that it was "not sufficiently assured that the contract included the appropriate protections applicable to fetal tissue research or met all other procurement requirements." 

O’Donnell, a former StemExpress employee, previously alleged that PPFA and her employer breached patients’ privacy and attempted to collect fetal tissue without their consent. Despite receiving HIPAA referrals years ago, HHS hasn’t publicly disclosed any investigation into the issue. 

StemExpress previously told the Fresno Bee: "Ensuring that patients have provided consent for blood or tissue donation to support medical research, education, or treatments is a threshold issue that is non-negotiable for StemExpress."

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Questions remain as to why the HIPAA referral and certain aspects of Trump’s agenda seemed to lag within the HHS Office of Civil Rights. 

Former administration officials previously alleged to Fox News that the department’s Office of General Counsel had generally stalled OCR’s efforts on abortion and religious liberty through attorneys with liberal backgrounds. With President Biden entering office, it appeared even less likely the department would fulfill conservatives’ vision on those issues.