250 Massachusetts Ave NW, Suite 400 | Washington, DC 20001

October 4, 2024

VIA ELECTRONIC MAIL

Alan Chatman & Mike Jones

WCJB-TV
6220 NW 43rd Street
Gainesville FL 32653
alan.chatman@wcjb.com
mike.jones@graymedia.com

Re: Floridians Protecting Freedom Advertisement

To Whom It May Concern:

We write as counsel to Floridians Protecting Freedom (the “Campaign”) in response to a

letter (“Letter”) from the Florida Department of Health (“Department”) regarding the
Campaign’s television advertisement entitled “Caroline” (the “Advertisement”). First, and most
importantly, this Letter raises serious First Amendment concerns – indeed, it reflects an
unconstitutional attempt to coerce the station into censoring protected speech. Second, the
Advertisement is true – the Letter provides no evidence to the contrary. The Advertisement must
continue to air on your station.

This is not simply an instance where your station has received a baseless cease-and-desist
letter in the context of a heated political campaign. We are sure the station is more than familiar
with such letters, and how to dispose of them. Here, the Department is threatening the station
with criminal prosecution if it does not cease running the Advertisement. This is not just an
unfounded request, it is unconstitutional state action. The Letter is a textbook example of
government coercion that violates the First Amendment.

It is well-established that the First Amendment “forbids a public official to attempt to

suppress the protected speech of private persons by threatening that legal sanctions will at [their]
urging be imposed unless there is compliance with [their] demands.” Backpage.com, LLC v.
Dart, 807 F.3d 229, 231 (7th Cir. 2015) (collecting cases). Simply put, “a public official who
tries to shut down an avenue of expression of ideas and opinions through ‘actual or threatened
imposition of government power or sanction’ is violating the First Amendment.” Id. (quoting
American Family Association, Inc. v. City & County of San Francisco, 277 F.3d 1114, 1125 (9th
Cir. 2002)); see also Weaver v. Bonner, 309 F.3d 1312, 1323 (11th Cir. 2002) (holding that the
issuance of a “cease and desist request” that prohibited a candidate “from engaging in certain
speech is an impermissible prior restraint on protected expression”).

The Department, indeed, acknowledges that your station “enjoys the right to broadcast
political advertisements under the First Amendment of the United States Constitution and Article
I, section 4 of the Florida Constitution.” The Advertisement is a political advertisement. It is, as
explained below, true. The Advertisement consists of Caroline telling viewers about her own
medical experience. The Department does not even attempt to explain how Caroline’s recount of
her own experience is “false.” Simply put, the State of Florida cannot bar political
advertisements that do not agree with the State’s own preferred narratives and characterizations.
The State simply cannot use “intimidation and threat of prosecution” and vague insinuations of
illegality to deter the distribution of protected speech with which it disagrees. Bantam Books,
Inc. v. Sullivan, 372 U.S. 58, 63–64 (1963).

The Department cannot criminalize media outlets running political advertisements with
which it disagrees. Such advertisements are not a “sanitary nuisance.” They do not expose the
stations running the advertisements to criminal sanction. Speech criticizing the government in
the context of a political campaign is the lifeblood of democracy and lies at the very heart of the
First Amendment’s protections. The Department’s letter is a flagrant abuse of power, and it
should be rejected out of hand.

Second, the Advertisement is true. The Letter vaguely outlines the limited instances where
abortions are allowed in Florida but fails to provide any evidence showing that Caroline’s
statements are false. In fact, Caroline’s statements are true: “The doctors knew if I did not end
my pregnancy, I would lose my baby, I would lose my life, and my daughter would lose her
mom. Florida has now banned abortion even in cases like mine.” Caroline was diagnosed with
stage four brain cancer when she was 20 weeks pregnant; the diagnosis was terminal.

Under Florida law, abortions may only be performed after six weeks gestation if “[t]wo
physicians certify in writing that, in reasonable medical judgment, the termination of the pregnancy is
necessary to save the pregnant woman’s life or avert a serious risk of substantial and irreversible
physical impairment of a major bodily function of the pregnant woman other than a psychological
condition.” Fla. Stat. § 390.0111(1)(a). And, Florida regulations provide very limited guidance
regarding the exceptions and the only instances where the Agency for Health Care
Administration has provided guidance that abortions are permitted after six-weeks’ gestation are
when there is an immediate threat to the pregnant person’s life: Preterm premature rupture of
membranes (PPROM), ectopic pregnancy, and molar pregnancy Fla. Dept. of Health R.
59AER24-2. None of these enumerated exceptions would have applied in Caroline’s case.

Moreover, Caroline’s diagnosis was terminal. Practically, that means that an abortion would
not have saved her life, only extended it. Florida law would not allow an abortion in this instance
because the abortion would not have “save[d] the pregnant woman’s life,” only extended her life.
See Dr. Tien Declaration.

The Department may or may not honestly believe that its restrictions on reproductive healthcare
are sufficient to protect women’s health. But that is not the lived experience of pregnant patients
and doctors in states with abortion bans like Florida. Pregnant patients who have cancer
generally cannot undergo chemotherapy. And because the cancer is not immediately life
threatening, an abortion is not permitted. See The Court’s Big Abortion Decisions Are Out. What
Now?, Tradeoffs (June 28, 2024), https://tradeoffs.org/2024/06/28/supreme-court-abortion-
idaho-mifepristone/. This means that the pregnant person will either need to delay or forego
treatment, jeopardizing their life, or travel out of state to obtain an abortion. In any event, women
and their medical providers face the untenable reality that they do not know if they will face state
prosecution or sanction if government officials second guess their actions. See Dr. Tien
Declaration.

The Department’s letter is a flagrant abuse of power and must be rejected. Moreover, there is no
genuine dispute as to the accuracy of the statements in this Advertisement. Your decision to
accept the Advertisement must remain undisturbed. Please contact us promptly at 202-968-4554
before the Advertisement’s schedule on your station changes in any way.

Best Regards,

Ezra Reese
Ben Stafford
Emma Olson Sharkey
Elias Law Group

Counsel to Floridians Protecting Freedom

Dr. Tien Declaration
 Exhibit A

Shelly Hsiao-Ying Tien, M.D./M.P.H.

shtien@gmail.com
312-810-3833

Genesis Maternal-Fetal Medicine, Tucson, Arizona

04/2022 – current, physician

Planned Parenthood – South, East and North Florida

03/2021 – current, physician

Trust Women, Oklahoma and Kansas

02/2021 – 05/2024, physician

Planned Parenthood – Southeast, Alabama

12/2021 – 5/2022, physician

NorthShore University Health System/University of Chicago

07/2015 – 12/2020, physician

Fellowship, Maternal-Fetal Medicine

University of Minnesota, Minneapolis
07/2012 – 06/2015

Residency, Obstetrics and Gynecology

Advocate Illinois Masonic Medical Center, Chicago, Illinois
07/2008 – 06/2012

Medical Education
Tufts University School of Medicine, Boston, Massachusetts
08/2003 - 05/2008
M.D./M.P.H.

Education
Undergraduate - University of Illinois, Champaign/Urbana
Biology
08/1999 - 06/2003
B.S.

Board certification
Maternal-Fetal Medicine 2018
Obstetrics and Gynecology 2013

Memberships
Society for Maternal-Fetal Medicine
2012 – current
American College of Obstetricians and Gynecologists
2008 – current
Society of Family Planning
2022 – current

Medical Expert Witness cases

Gainesville Woman Care, LLC, et al., vs. State of Florida, et al., in the 24 hour Mandated Delay
• January 2022 - Medical expert witness on behalf of the ACLU.

Planned Parenthood of Southwest and Central Florida, et al., vs. State of Florida, et al., in the 15
week abortion ban
• June 2022 - Medical expert witness and plaintiff on behalf of the ACLU and PPFA.

Committees

Northshore University Health System Obstetric Practice Committee - Chair, 2016 – 2020
• Educational committee that creates physician guidelines and nursing protocols for
obstetric care for Evanston and Highland Park hospitals.

Northshore University Health System Epic Physician builder, 2018 – 2020

• Developed and implemented obstetric clinical workflows for our Epic electronic medical
record system.

Illinois Perinatal Quality Collaborative (ILPQC) - Clinical lead for the Immediate
Postpartum Long-Acting Reversible Contraception initiative, 2018 – 2020
• Implementation of immediate postpartum LARCs for patients at Evanston and Highland
Park hospitals.
• Provision of educational support for other birthing hospitals in the state.

Maternal-Fetal Medicine Clinical Competency Committee, 2018 - 2020

• Biannual meeting and evaluation of educational progress for maternal-fetal medicine
fellows.
Volunteer Experience

Medical Students for Choice (MSFC), Massachusetts, 09/2003-04/2008

Student coordinator
• Facilitated multiple lectures and workshops on reproductive education and contraception.
• Organized the 2005 regional student conference for MSFC.

Cross Cultural Solutions, Ghana, 06/2003-07/2003

Medical Volunteer
• Volunteered through the organization Cross Cultural Solutions.
• Provided immunizations to children, assisted in the local health center pharmacy, and
taught women's health education in the maternity ward.

Provena Mental Health, Illinois, 04/2001-05/2002

Suicide Hotline Volunteer
• Volunteer counselor on the suicide hotline.
• Provided mental health interventions to clients in crisis, and general health resources and
information for family members and support persons.

Rape Crisis Services, Illinois, 05/2000-05/2003

Medical Advocate and Hotline Volunteer
• Hotline volunteer providing counseling, support and resources to survivors of sexual
violence.
• Medical advocate for patients – provided education and support during the emergency
room visits for patients who presented after an assault.

Publications

Tien SH, Crabtree JN, Gray HL, Peterson EJ. Immunologic response to vaccine challenge in
pregnant PTPN22 R620W carriers and non-carriers. PLoS One. 2017 Jul 19;12(7):e0181338.

Tien S and Yamamura Y. Cervical ectopic pregnancy: persistence despite a serologically

negative ß-hCG. J Reprod Med 2015;60(5-6):257-60.

Tien S, Villines D, Parilla B. Gestational Weight Gain in Obese Patients and Adverse Pregnancy
Events. Health 2014;6:1420-1428.

Grimes K, Schulz M, Cohen S, Mullin B, Lehar S, Tien S. Pursuing Cost-Effectiveness in

Mental Health Service Delivery for Youth with Complex Needs. J Ment Health Policy Econ
2011;14:73-86.
Publications, non-peer reviewed

Rugino A, Tien SH. Strip of the Month: Complete Heart Block Masquerading as a Reactive
Nonstress Test. NeoReviews November 2018, Volume 19/Issue 11.

Rodriguez-Kovacs J, Tien SH, Plunkett BA. Selective Serotonin Reuptake Inhibitor Use in
Pregnancy: Repercussions on the Oblivious Passenger. NeoReviews March 2018, Volume
19/Issue 3.

Cockrum RH, Tien SH. Strip of the Month: August 2016. NeoReviews August 2016, Volume
17/Issue 8.

Schneider P, Tien SH. Strip of the Month: February 2016. NeoReviews February 2016, Volume
17/Issue 2.

Presentations

Tien S, Crabtree J, Gray H, Peterson E. (2015, February). “Immunologic response to vaccine

challenge in PTPN22 gene variants in pregnancy.” Poster presentation at: the Society for
Maternal-Fetal Medicine, San Diego, CA.

Tien S, Aguilera M. (2014, October). “Monochorionic Monoamniotic Twin Gestation: A review

of antenatal management at three tertiary care centers.” Poster presentation at: Central
Association of Obstetricians and Gynecologists, Albuquerque, NM.

Tien S, Gray H, Jacobs K, Giacobbe L, Wagner W, Aguilera M. (2013, October). “A review of

ten years’ experience with placenta accreta at a single tertiary care center.” Poster presentation
at: Central Association of Obstetricians and Gynecologists, Napa Valley, CA.

Tien S, Gray H, Jacobs K, Giacobbe L, Swartout J, Aguilera M. (2013, October). “Spinal

anesthesia converted to general anesthesia for cesarean hysterectomy is associated with
improved neonatal Apgar scores versus general anesthesia alone.” Poster presentation at: Central
Association of Obstetricians and Gynecologists, Napa Valley, CA.

Tien S, Casserly K, Rauk P. (2013, April). “A right atrial thrombus in the setting of puerperal
coagulopathy.” Poster presentation at: Society for Obstetric Anesthesia and Perinatology, San
Juan, Puerto Rico.

Tien S, Gray H, Jacobs K, Giacobbe L, Swartout J, Aguilera M. (2013, April). “Maternal obesity
associated with clinically increased blood loss and postoperative hospital stay in patients
undergoing peripartum hysterectomy.” Poster presentation at: Society for Obstetric Anesthesia
and Perinatology, San Juan, Puerto Rico.
Tien S, August C, Fernandez C, Dini M. (2012, October). “Metastatic colon cancer presenting as
an adnexal mass.” Poster presentation at: the Advocate Research Forum, Advocate Illinois
Masonic Medical Center, Chicago, IL.

Tien S, Villines D, Parilla B. (2012, October). “Gestational Weight Gain in Obese Patients and
Adverse Pregnancy Events.” Oral presentation at: Central Association of Obstetricians and
Gynecologists, Chicago, IL.

Tien S, Popper F. (2009, October). “A Retrospective Review of Misoprostol Efficacy for the
Treatment of Early Pregnancy Failure.” Poster presentation at: Central Association of
Obstetricians and Gynecologists, Maui, HI.

Grimes K, Mullin B, Lehar S, Schulz M, Creeden M, Tien S. (2008, February). “Strength in

Numbers: Using Concurrent Measurement to Guide Quality.” Poster presentation at: Research
and Training Center for Children's Mental Health, Tampa, FL.
 Exhibit B
Ron DeSantis
Mission: Governor
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts. Joseph A. Ladapo, MD, PhD
State Surgeon General

Vision: To be the Healthiest State in the Nation

October 3, 2024

Alan Chatman & Mike Jones

WCJB-TV
6220 NW 43rd Street
Gainesville FL 32653
alan.chatman@wcjb.com
mike.jones@graymedia.com

Dear Mr. Chatman & Mr. Jones:

The Florida Department of Health has been notified that your company is disseminating a political
advertisement claiming that current Florida law does not allow physicians to perform abortions necessary
to preserve the lives and health of pregnant women. 1

This claim is categorically false. Florida’s Heartbeat Protection Act does not prohibit abortion if a
physician determines the gestational age of the fetus is less than 6 weeks. § 390.0111(1), Fla. Stat. After
6 weeks, an abortion may be performed if “[t]wo physicians certify in writing that, in reasonable medical
judgment, the termination of the pregnancy is necessary to save the pregnant woman’s life or avert a
serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant
woman other than a psychological condition.” § 390.0111(1)(a), Fla. Stat. The two-physician requirement
is waived in the case of an emergency medical procedure. § 390.0111(1)(b), Fla. Stat. And while
physicians must exercise professional skill, care, and diligence to preserve the life and health of a fetus in
the third trimester, “if preserving the life and health of the fetus conflicts with preserving the life and
health of the pregnant woman, the physician must consider preserving the woman’s life and health the
overriding and superior concern.” § 390.0111(4), Fla. Stat.

The advertisement is not only false; it is dangerous. Women faced with pregnancy complications posing
a serious risk of death or substantial and irreversible physical impairment may and should seek medical
treatment in Florida. However, if they are led to believe that such treatment is unavailable under Florida
law, such women could foreseeably travel out of state to seek emergency medical care, seek emergency
medical care from unlicensed providers in Florida, or not seek emergency medical care at all. Such actions
would threaten or impair the health and lives of these women.

Under section 386.01, Florida Statutes, “the commission of any act, by an individual, municipality,
organization, or corporation . . . by which the health or life of an individual, or the health or lives of
individuals, may be threatened or impaired” constitutes a “sanitary nuisance.” The Department of Health,

1
The advertisement is displayed on the home page of the Amendment sponsor’s website under the title “Caroline.”
See https://floridiansprotectingfreedom.com/. The woman featured in the advertisement states: “The doctors knew
if I did not end my pregnancy, I would lose my baby, I would lose my life, and my daughter would lose her mom.
Florida has now banned abortion even in cases like mine.”

Florida Department of Health

Office of the General Counsel Accredited Health Department
4052 Bald Cypress Way, Bin A-02 • Tallahassee, FL 32399-1701 Public Health Accreditation Board
PHONE: 850/245-4444 • FAX: 850/245-4790
FloridaHealth.gov
 STATE OF FLORIDA
DEPARTMENT OF HEALTH

upon determining the existence of such nuisance, must notify the person or persons committing the
nuisance “to remove or cause to be removed the same within 24 hours.” § 386.03(1), Fla. Stat. If the
nuisance is not removed within the time prescribed, the Department is authorized to institute legal
proceedings under section 381.0012, Florida Statutes, to obtain an injunction. § 386.03(2)(c), Fla. Stat.
The Department is further authorized to “[i]nstitute criminal proceedings in the county court in the
jurisdiction of which the condition exists against all persons failing to comply with notices to correct
sanitary nuisance conditions.” § 386.03(2)(b), Fla. Stat. Creating, keeping, or maintaining a nuisance
injurious to health is a second-degree misdemeanor. § 386.051, Fla. Stat.

While your company enjoys the right to broadcast political advertisements under the First Amendment of
the United States Constitution and Article I, section 4 of the Florida Constitution, that right does not
include free rein to disseminate false advertisements which, if believed, would likely have a detrimental
effect on the lives and health of pregnant women in Florida.

/s/ John Wilson

John Wilson
General Counsel
Florida Department of Health