California’s law sought to punish doctors who give patients false information about Covid-19.SAN FRANCISCO — A federal judge in California has temporarily blocked enforcement of a new state law allowing regulators to punish doctors for spreading false or misleading information about Covid-19 vaccinations and treatments to their patients.The law, signed by Gov. Gavin Newsom last year, had been intended to address the waves of misinformation that have churned through the course of the pandemic.Though the wording of the law had been narrowly tailored, the judge, William B. Shubb of the U.S. District Court for the Eastern District of California, ruled on Wednesday that its definitions of misinformation and the uncertainty about its enforcement were “unconstitutionally vague.”The case is one of two legal challenges facing the law, the first of its kind in the nation to try to address a problem that the U.S. Surgeon General, the American Medical Association and others have said has cost unnecessary illnesses and lives.In December, another judge in the Central District of California denied an injunction in a similar case. The split verdicts raises the likelihood that the law’s fate could ultimately be decided at the U.S. Court of Appeals for the Ninth Circuit in San Francisco.“I think the judge saw the law for what it was: an attempt to silence doctors who disagree” with recommendations of the Centers for Disease Control and Prevention or other regulatory bodies, said Jenin Younes, a lawyer with the New Civil Liberties Alliance in Washington who represented five doctors who brought the lawsuit.Judge Shubb, who was appointed by President George H.W. Bush in 1990, wrote in his ruling that he did not consider the question of whether the law violates First Amendment protections of free speech. Instead, he found that the law’s provisions violated the plaintiffs’ rights of due process under the 14th Amendment.The law expanded the authority of the Medical Board of California, which licenses doctors, to designate spreading false or misleading medical information to patients as “unprofessional conduct.” That could lead to a suspension or revocation of a doctor’s license to practice in the state.Judge Shubb ruled that the definition of misinformation — “false information that is contradicted by contemporary scientific consensus contrary to the standard of care” — could have a chilling effect on doctors’ interactions with their patients. He granted a preliminary injunction to block the law, pending a full hearing of the complaint.One of the plaintiffs, Aaron Kheriaty, a psychiatrist who has challenged many government policies that emerged during the pandemic, said in an interview on Thursday that the law was too rigid, especially given the evolving understanding of how best to address a pandemic like this one.“Today’s quote-unquote misinformation is tomorrow’s standard of care,” he said.Governor Newsom’s office did not immediately respond to a request for comment.

When Gov. Gavin Newsom signed into law a bill that would punish California doctors for spreading false information about Covid-19 vaccines and treatments, he pledged that it would apply only in the most “egregious instances” of misleading patients.It may never have the chance.Even before the law, the nation’s first of its kind, takes effect on Jan. 1, it faces two legal challenges seeking to declare it an unconstitutional infringement of free speech. The plaintiffs include doctors who have spoken out against government and expert recommendations during the pandemic, as well as legal organizations from both sides of the political spectrum.“Our system opts toward a presumption that speech is protected,” said Hannah Kieschnick, a lawyer for the Northern California branch of the American Civil Liberties Union, which submitted a friend-of-the-court brief in favor of one of the challenges, filed last month in U.S. District Court for the Central District of California.That lawsuit and another, filed this month in the Eastern District of California, have become an extension of the broader cultural battle over the Covid-19 pandemic, which continues to divide Americans along stark partisan lines.They could also more broadly test what steps — if any — the government can take to combat the scourge of misinformation and disinformation, even in cases where it affects personal and public health.Gov. Gavin Newsom said a California law that would punish doctors for spreading false Covid-19 information was narrowly focused on malicious intent.Jim Wilson/The New York TimesThe law, narrowly written in hopes of avoiding First Amendment entanglements, would designate the spread of false or misleading information to patients as “unprofessional conduct,” subject to punishment by the agency that regulates the profession, the Medical Board of California. That could result in fines, or a suspension or revocation of a doctor’s license to practice in the state.The California Medical Association, which represents nearly 50,000 physicians in the state, sponsored the legislation, but the doctors involved in the two lawsuits argue that the law’s provisions remain both vague and excessively intrusive.They warn that the law’s definition of misinformation as falsehoods that violate “contemporary scientific consensus” would stifle doctors’ abilities to advise patients honestly about the pros and cons of Covid-19 treatment and practices.Republican-controlled states have gone in the opposite direction. Texas has adopted a law to allow citizens or the state’s attorney general to sue social media companies for removing posts because of political points of view. Legal challenges to it — and another in Florida involving candidates for elected office — have swung back and forth and could reach the Supreme Court.The Spread of Misinformation and FalsehoodsCovid Myths: Experts say the spread of coronavirus misinformation — particularly on far-right platforms like Gab — is likely to be a lasting legacy of the pandemic. And there are no easy solutions.Midterms Misinformation: Social media platforms struggled to combat false narratives during the 2022 U.S. midterm elections, but it appeared most efforts to stoke doubt about the results did not spread widely.A ‘War for Talent’: Seeing misinformation as a possibly expensive liability, several companies are angling to hire former Twitter employees with the expertise to keep it in check. A New Misinformation Hub?: Misleading edits, fake news stories and deepfake images of politicians are starting to warp reality on TikTok.The plaintiffs in California have sought injunctions to block the law even before it goes into effect, arguing that it was intended to silence dissenting views.Dr. Tracy Hoeg said the law would “cause this very broad self-censorship and self-silencing from physicians with their patients.”Anne Chadwick Williams for The New York TimesOne of them, Dr. Tracy Hoeg, a physician and epidemiologist who works in Grass Valley, near Sacramento, has written peer-reviewed studies since the pandemic began that questioned some aspects of government policies adopted to halt the spread of Covid-19.Those studies, on the efficacy of masks for schoolchildren and the side effects of vaccines on young men, exposed her to vehement criticism on social media, she said, partly because they fell outside the scientific consensus of the moment.She noted that the medical understanding of the coronavirus continues to evolve, and that doctors should be open to following new evidence about treatment and prevention.“It’s going to cause this very broad self-censorship and self-silencing from physicians with their patients because it’s not clear what we are and aren’t allowed to say,” said Dr. Hoeg, one of five doctors who filed a challenge in the Eastern District. “We have no way of knowing if some new information or some new studies that come out are accepted by the California Medical Board as consensus yet.”The lawsuits highlight the legal hurdles facing states that have sought to curb misinformation or disinformation, especially online. While states controlled by Democrats have sought to compel the social media giants to do more to stop the spread of conspiracy theories around the Covid-19 pandemic, Republican states have moved to punish the companies for removing accounts based on political points of view.Ethan W. Blevins, a lawyer for the Pacific Legal Foundation, a conservative legal organization that has criticized the law but is not involved in either challenge, said the state would have a burden to prove that medical disinformation created actual harm and that it was spread deliberately.“The Supreme Court has already said many times that false information is still protected under the First Amendment,” he said.In a statement issued when he approved the law on Sept. 30, Governor Newsom, a Democrat, acknowledged the challenge of protecting doctors’ freedom of speech but said the law narrowly focused on malicious intent and clear deviations from established standards of care.“I am concerned about the chilling effect other potential laws may have on physicians and surgeons who need to be able to effectively talk to patients about the risks and benefits of treatments for a disease that appeared in just the last few years,” he wrote. “However, I am confident that discussing emerging ideas or treatments including the subsequent risks and benefits does not constitute misinformation or disinformation under this bill’s criteria.”The law’s supporters argue that it was needed to protect patients from doctors who had fueled skepticism about vaccines and mask mandates or encouraged the use of drugs like ivermectin and hydroxychloroquine, which have not proved to be effective against the coronavirus.A protest against mandated Covid-19 vaccines outside City Hall in Los Angeles last year.Etienne Laurent/EPA, via ShutterstockEven so, lawmakers narrowed the legislation’s scope to include only direct conversations with patients. Posts on social media, opinion articles or other public statements doctors might make are not subject to the law.The American Medical Association has blamed disinformation for worsening the pandemic’s toll. In June, it adopted a policy that, among other things, called for empowering state licensing boards to discipline doctors who spread it in their capacity as health professionals.Dr. Jeff Barke, a physician who has treated Covid patients at his office in Newport Beach in Southern California, said the law was an attempt by the state to impose a rigid orthodoxy on the profession that would rule out experimental or untested treatments.Those include treatments with ivermectin and hydroxychloroquine that he said he had found to be effective at treating the coronavirus, despite studies suggesting otherwise. “Who determines what false information is?” he said.Dr. Barke joined another outspoken doctor, Mark McDonald, in filing the challenge in the Central District Court last month, represented by two conservative legal groups, Advocates for Faith and Freedom, and the Liberty Justice Center. He said they were defending patients from a “huge medical bureaucracy,” dominated by pharmaceutical lobbies and the state.“What comes next?” he said. “How I talk to patients about cancer? How I talk to patients about obesity or diabetes or asthma or any other illnesses? When they have a standard of care that they think is appropriate and they don’t want me going against their narrative, then they’ll say Barke’s spreading misinformation.”Judge Fred W. Slaughter, who was appointed by President Biden and confirmed by the Senate in March, held a hearing on Dr. Barke’s case this month. He questioned lawyers on both sides about whether the plaintiffs had standing in the case and whether the new law could regulate misinformation as a matter of professional conduct, as opposed to speech.“The statute is clear, especially to trained medical professionals who know what the standard of care is,” Kristin Liska, deputy attorney general for the state’s Department of Justice, told the judge.The challenge in the Eastern District is scheduled to be heard in December by Senior Judge William B. Shubb, who was appointed by President George H.W. Bush in 1990.Richard J. Baron, who heads the American Board of Internal Medicine, said the fight over medical misinformation and disinformation reflected a deeper erosion of trust in society.Certain types of information were undoubtedly harmful, Dr. Baron argued, and doctors have an obligation to protect patients from them, regardless of their political views about public health policies.“It’s the state that gives you a license, and it’s the state that assures that that license gives you a lot of ability that people who don’t have that license don’t have,” he said. “And with that comes the responsibilities of fidelity to the community of experts that generate things like the standard of care that patients are entitled to.”

Weighing into the fierce national debate over Covid-19 prevention and treatments, the state would be the first to try a legal remedy for vaccine disinformation.Trying to strike a balance between free speech and public health, California’s Legislature on Monday approved a bill that would allow regulators to punish doctors for spreading false information about Covid-19 vaccinations and treatments.The legislation, if signed by Gov. Gavin Newsom, would make the state the first to try to legislate a remedy to a problem that the American Medical Association, among other medical groups and experts, says has worsened the impact of the pandemic, resulting in thousands of unnecessary hospitalizations and deaths.The law would designate spreading false or misleading medical information to patients as “unprofessional conduct,” subject to punishment by the agency that licenses doctors, the Medical Board of California. That could include suspending or revoking a doctor’s license to practice medicine in the state.While the legislation has raised concerns over freedom of speech, the bill’s sponsors said the extensive harm caused by false information required holding incompetent or ill-intentioned doctors accountable.“In order for a patient to give informed consent, they have to be well informed,” said State Senator Richard Pan, a Democrat from Sacramento and a co-author of the bill. A pediatrician himself and a prominent proponent of stronger vaccination requirements, he said the law was intended to address “the most egregious cases” of deliberately misleading patients.More on Misinformation and FalsehoodsA Web of Lies: Researchers looked at thousands of spider news stories to study how sensationalized information spreads. Their findings could be broadly applicable.A Familiar Playbook: As another U.S. election approaches, social media companies are readying a series of anti-misinformation strategies that resemble those used in 2020.TikTok’s Struggles: The platform is becoming a primary incubator of election misinformation because the qualities that allow TikTok to fuel dance fads can also make inaccurate claims difficult to contain.Russian Propaganda: Social media giants have taken steps to curb the Kremlin’s reach. But misinformation on Ukraine still spreads in Spanish, Arabic and other languages.California’s legislation reflects the growing political and regional divisions that have dogged the pandemic from the beginning. Other states have gone in the other direction, seeking to protect doctors from punishment by regulatory boards, including for advocating treatments involving hydroxychloroquine, ivermectin and other medications that the American Medical Association says remain unproven.If enacted, the law could face a legal challenge. Governor Newsom, who has three weeks to sign the legislation, has not yet taken a public position on it.While other nations have criminalized the spread of vaccine misinformation — and have higher vaccination rates — the response by states and the U.S. government has largely been limited to combating misconceptions with accurate information, said Michelle M. Mello, a professor of law and health policy at Stanford University.She noted that even laws that cited a “compelling interest,” like public health and safety, to police disinformation ran the risk of having a chilling effect, a First Amendment standard for many courts.“Initiatives like this will be challenged in court and will be hard to sustain,” she said in an interview. “That doesn’t mean it’s not a good idea.”California’s response follows a warning last year by the national Federation of State Medical Boards that licensing boards should do more to discipline doctors who share false claims. The American Medical Association has also warned that spreading disinformation violates the code of ethics that licensed doctors agree to follow.The measure was among a flurry of Covid-related bills proposed by a legislative working group that drew fierce opposition from lawmakers and voters. Some of the most contentious bills have stalled or died, including one that would have required all California schoolchildren to be vaccinated.As the legislation moved through the Legislature, its sponsors narrowed its scope to deal directly with doctors’ direct interaction with patients. It does not address comments online or on television, though those have been the cause of some of the most impactful instances of Covid misinformation and disinformation.“Inaccurate information spread by physicians can have pernicious influences on individuals with widespread negative impact, especially through the ubiquity of smartphones and other internet-connected devises on wrists, desktops and laptops reaching across thousands of miles to other individuals in an instant,” the Federation of State Medical Boards wrote in a report in April. “Physicians’ status and titles lend credence to their claims.”The legislation would not require the suspension or revocation of a doctor’s license, leaving such determinations to the Medical Board of California. It is intended to make the dissemination of false information about Covid-19 subject to the same rules as other kinds of “unprofessional conduct” taken up by the board.The legislation defines disinformation as falsehoods “deliberately disseminated with malicious intent or an intent to mislead.” Treading into the at times contentious debates over alternative, often unproven Covid treatments, the bill defines misinformation as spreading information “that is contradicted by contemporary scientific consensus contrary to the standard of care.”It says doctors have “a duty to provide their patients with accurate, science-based information.” That would include the use of approved vaccines, which have been subject to fierce debates and political activism across the country, though there is broad agreement among medical professionals about their effectiveness.A group called Physicians for Informed Consent opposed the legislation, saying it would silence doctors. The group filed a lawsuit this month to seek an injunction preventing the Medical Board of California from disciplining doctors based on accusations of disinformation. In its lawsuit, it called the legislation’s definition of misinformation “hopelessly vague.”In a recent letter to Surgeon General Vivek H. Murthy, James L. Madara, chief executive of the American Medical Association, said disinformation swirling around vaccines had contributed to ignorance among the public that had worsened the pandemic’s impact.“The most unfortunate result of this has been significant vaccine hesitancy and refusal among certain communities and within certain demographics, ultimately resulting in continued higher rates of severe illness, hospitalization and death due to Covid-19 in these populations — outcomes largely preventable with vaccination,” he wrote.