The Telling Backstory of One Doctor-Plaintiff in the Mifepristone Case

For Tyler Johnson, an emergency room physician from Grabil, Indiana, November 2022 was a pivotal month. Johnson is one of several named plaintiffs in a legal challenge, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, filed that November in an effort to severely restrict, and perhaps ultimately criminalize, the pill that’s used in the most common form of abortion in the United States. But Johnson, a self-described “Christian conservative” who had previously asked the state legislature to impose “criminal penalties” for abortion and supported “personal choice” against Covid-19 vaccine mandates, had more than the lawsuit to contend with. Johnson would spend the few months between the Supreme Court’s decision overturning Roe v. Wade in June and the filing of the mifepristone challenge occupied with something else: his campaign for Indiana state Senate. Johnson was sworn in for his first term in the state legislature just four days after the mifepristone challenge was officially filed in a court in Amarillo, Texas. His crusade against health care he disapproved of was just getting started.

According to Johnson and others who brought the case the Supreme Court heard oral arguments in this week, mifepristone is a dangerous “chemical abortion” drug that has transformed emergency rooms into post-abortion field hospitals; doctors, according to this narrative, have been drafted into serving patients who present with complications that can be indistinguishable from miscarriage. These patients who have complications after taking mifepristone “experience trauma” and may not “understand what the drugs will do to them,” according to Johnson in his sworn declaration in the legal challenge; they may also be lying about having taken mifepristone, he alleged, “unnecessarily presenting in the emergency department,” taking time away “from other patients who need it.”

Mifepristone, in reality, has long been known to be safe and rarely results in serious adverse reactions. But in the world that Johnson and the Alliance for Hippocratic Medicine occupy, people who use mifepristone to self-manage abortion are at once vulnerable innocents and deceitful burdens, all of them abandoned to doctors who, against their conscience, must care for these purported casualties of medical abortion.

In order to argue that they have personal grounds—“standing”—for bringing this case, Johnson and the others doctor-plaintiffs claim mifepristone “harms” not only patients but also physicians. Some of the other named plaintiffs emphasized ethical objections, that they are “opposed to being forced to end the life of a human being in the womb for no medical reason, including by having to complete an incomplete elective chemical abortion.” For his part, Johnson argued that the Food and Drug Administration had “created a culture of chaos for emergency room physicians,” one that “puts us in increasingly high risk situations, which increases our exposure to claims of malpractice and liability.”

At the time he filed this declaration, Johnson himself was in the midst of a malpractice lawsuit involving a patient he treated in March 2018, who arrived in the emergency room in respiratory distress and showing signs of sepsis. Esperanza Umana was 20 with a newborn son. According to court filings, about 20 minutes after Johnson discharged Umana, she collapsed in a pharmacy parking lot. The woman’s mother prevailed before a medical review panel; three emergency room doctors ruled unanimously in March 2022 that Johnson “failed to comply with the appropriate standard of care as charged in the complaint, and the conduct complained of was a factor of the resultant damages.” According to the family’s attorney, it’s a rare finding—typically the board rules against physicians in fewer than 18 percent of complaints.

But Johnson dragged out the case for more than a year, into his first months of elected office. His lawyers (along with lawyers for the hospital) asked for and were granted four extensions, claiming they needed more time to conduct depositions with experts and witnesses. Then Johnson tried to have the case proceedings paused and the court records sealed from the public. “It is clear that various interested parties have publicized this lawsuit, needlessly and unfairly litigating this case in public media,” the motion stated. “Dr. Johnson’s professional and personal reputations have been damaged through these tactics.” Further, he was entitled to temporarily stop the case due to “privileges and immunities afforded to Dr. Johnson as an Indiana state senator.” In May 2023, a judge decided to keep the records public but did pause the malpractice suit until 30 days following the legislative session. The case was at last resolved in July 2023 with an undisclosed settlement. By then, Esperanza Umana’s mother had heard Johnson telling the press on the campaign trail that “you can talk to any physician: Medical malpractice happens.” Her response? “How heartless can you be making that statement. There are families behind this. There’s a child behind this.”

As the malpractice suit dragged on, and the mifepristone case sped its way to the Supreme Court, the recently elected state Senator Johnson was at work, sponsoring legislation that would ban access to hormone therapy, puberty blockers, and surgery for trans youth in Indiana. Johnson called such treatment, which meets the current standards of care for trans youth, “irreversible, unproven and life-altering procedures.” In January 2023, he introduced Senate Bill 480, which allowed for civil penalties against health care providers who offered anyone under the age of 18 that treatment or who “aided and abetted” another practitioner to do the same. Gender-affirming health care for minors, under S.B. 480, would be considered itself a violation of the standards of medical practice, subject to discipline by the board regulating that provider.

In February, Matt Sharp, an attorney for the Christian-right legal outfit Alliance Defending Freedom, came to the Indiana state legislature to testify in support of Johnson’s legislation. That’s not unusual; ADF has led efforts to pass such bills across the United States. But ADF was also then representing Johnson and the other plaintiffs in the mifepristone case. Sharp said ADF simply wanted to be a “resource” for legislators like Johnson. But he also noted the larger impact of such “resource” sharing: “States are the laboratories of democracy. It’s where a lot of ideas start then eventually bubble their way up to Congress.” In April, S.B. 480 became law. ADF has since filed a brief defending the ban in a legal challenge. (Johnson and ADF did not respond by publication to questions sent by email.)

That ADF and Johnson’s legal paths cross like this isn’t a conflict of interest so much as a perfect alignment of purpose: one in which people must surrender their own health and well-being, their gender and their sexuality, or risk the penalty as set by the likes of these groups. There is no truth to Johnson and ADF’s claims about the safety of mifepristone or hormones and puberty blockers. In fact, there is no outcome in this case that would make mifepristone any safer; it’s hard to believe that safety was ever the point. What these groups seek is the world that Johnson and others describe in their sworn declarations: These doctors want the control they feel has been taken away from them.