Threats to health care sector targets likely to stay 'elevated' amid cultural wars: DHS

Threats to health care locations and those who work there are surging and are likely to stay "elevated," as a result of cultural and divisive issues like abortion, gender-related care and a hangover from debates caused by the COVID-19 pandemic, federal intelligence analysts said.

The brew of hot-button socio-medical issues litigated both in the public square and in the courts will "amplify the health care sector's visibility as a potential target for attack" by domestic extremists, according to a new briefing memo issued by the Department of Homeland Security on Feb. 26.

The confidential analysis, obtained by ABC News, describes a diverse array of dangers these mounting threats could pose: from harm to patients through compromised care, to causing a chilling effect on clinicians through harassment and intimidation, to ideologically motivated cyber attacks targeting health care providers and networks.

"Violent extremist threats against the health care and public health sector have diversified since the height of the COVID-19 pandemic in 2021, and will likely remain elevated in the post-pandemic era due to the expansion of medical-related ideological grievances," the DHS bulletin said.

A recent "escalation in threats of violence targeting health care facilities and personnel" has included "hoax bomb threats against hospitals, attempts to incite violence through doxing [public release of personal information like addresses and phone numbers] and calls to execute particular physicians, public officials, or pharmaceutical executives," the bulletin said.

The "surge" in threats aligns with an increase in public dialogue surrounding medical issues that have been amplified by legislation and debate, according to the bulletin.

Since the pandemic upended life, the threat spectrum has "expanded" to "other ideological grievances, as highlighted by an increase in abortion or gender-affirming care-related threats" that are "explicitly based on narratives and conspiracy theories popular with violent extremists" keying in on those divisive issues, the bulletin said.

"Our society is very angry and very polarized -- an increasing number of people in the US have come to believe that those who disagree are the enemy, and, that violence is an acceptable way to express their disagreement," said John Cohen, the former intelligence chief at DHS and now an ABC News contributor.

For those who would seek to exploit societal fractures in America, an us-versus-them mentality is applied to the most contentious wedge issues and provides a handy crowbar, experts say.

"Violent extremists, terror groups, foreign intelligence services have purposely sought to exploit public policy issues being debated in the U.S. that are the most polarizing, that they believe will inspire a volatile reaction – and hopefully violent acts," Cohen added.

Threats of violence have not remained hypothetical as real attacks have been directed at perceived epicenters of extremists' grievances.

Last week, a California man pleaded guilty to firebombing a Planned Parenthood clinic with a Molotov cocktail in March 2022. It followed guilty pleas from others involved in the firebombing, which forced the clinic to temporarily close and reschedule roughly 30 patient appointments.

The defendant sought to "scare pregnant women away from obtaining abortions; deter doctors, staff, and employees at the clinic from providing abortions; and intimidate the clinic's patients," according to the Department of Justice. Following the Supreme Court decision overturning Roe v. Wade in June 2022, he and co-conspirators "planned to use a second Molotov cocktail to attack another Planned Parenthood clinic." A year later, they were arrested two days before an LGBTQ "Pride Night" at Dodger Stadium, which they had planned to attack, the DOJ said.

It's one among a growing list of criminal plots in recent years: from swatting calls and death threats on health officials and hospitals to assaults on clinic escorts, to vandalism and facility damage.

"If abortions aren't safe th[e]n neither are you" has been graffitied on pregnancy resource centers -- and abortion alternative advocacy group headquarters -- across multiple states, surrounding the overturn of Roe. In May 2022, an "incendiary device" was used to start a fire at a "pro-life organization's building" in Oregon.

In September 2023, a Massachusetts woman pleaded guilty to calling in a false bomb threat against Boston Children's Hospital – which, among the wide range of health care services it provides, is home to a health care program focused on gender-diverse and transgender adolescents.

"There is a bomb on the way to the hospital, you better evacuate everybody you sickos," the woman had threatened on the call, according to DOJ -- prompting a bomb squad to be dispatched and forcing the hospital and the surrounding area to go into lockdown.

"It was obviously scary. This is not the kind of thing you want to have in a health system," said John Brownstein, chief innovation officer at Boston Children's Hospital and an ABC News contributor -- adding that he was on the hospital campus that day.

"Part of the issue is there's a ton of misinformation," Brownstein said. "When someone takes it beyond just commentary -- and makes an attempt to turn an internet-based conversation into a real-world threat."

That health care has become a target poses a uniquely troubling concern, experts say: it directly attacks citizens' well-being -- and creates a ripple effect of bodily harm.

These threats have "compromised patient care and medical services across a broader cross-section of health care systems and other medical providers" since the pandemic era, the DHS bulletin said. Those "recurring threats" could "likely reduce the ability of clinicians and facilities to provide care," the bulletin said.

The worst may be yet to come, the bulletin suggests: In a year of the first presidential election since the pandemic and the Jan. 6 attack on the U.S. Capitol, leading candidates are running on some of the most divisive issues -- from reproductive rights to gender and culture wars, to immigration at the Southern border, to the multiple wars abroad -- which authorities have said could prove to be flashpoints.

"Government action in the health care sector over the coming year, including in response to public health crises, and public discourse involving controversial medical issues may escalate threats of violence to acts of violence," the DHS bulletin said, adding court decisions on "mail order access to abortion medication and state legislation prohibiting the provision of gender-affirming treatments to minors are especially likely to heighten the potential for violence against the sector."

And for adversaries seeking to undermine U.S. societal stability -- chipping away at a crucial bedrock like health care presents an appealing means.

"It's the goal of U.S. adversaries to not only destabilize our society but to have people lose confidence in government," Cohen said. "In the election process, in critical infrastructure -- our power grid, financial institutions and our health care systems -- those are the fundamental things that people rely on each and every day to live their lives."

In the wake of a pandemic that further fueled division, "the environment here in the U.S. has become more fertile for our adversaries," Cohen said. "We anticipate this high level of threat-related activity is only going to increase as we get closer to the election."

With the exponential power and pervasiveness of artificial intelligence and the internet -- and as society relies more on both -- the threat gets even more complex, even as online social media provides a platform for conspiracy theories and extremist thought.

"Ideologically-motivated cyber actors increasingly target health care entities during periods when socio-politically divisive topics are prevalent in public discourse," the bulletin said.

Even “absent attacks, recurring threats of violence may still have a chilling effect” on providers, “resulting in more acute or widespread barriers to patient care,” the bulletin said.

"If the people engaging in these activities are successful, it will interrupt the ability of people to receive appropriate health care or protect themselves and their community from public health hazards. And when that occurs, people die," Cohen said.