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Persons of Interest


ONE OF THE LAST ABORTION DOCTORS IN INDIANA

Caitlin Bernard is risking her career, and her safety, to care for pregnant
patients.

By Peter Slevin

February 25, 2024
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Photograph by Diana Markosian
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Inside a generic government-office conference room in downtown Indianapolis,
Caitlin Bernard sat before six members of Indiana’s Medical Licensing Board,
whose cases typically involve complaints against physicians who bilked a patient
or drove while drunk. But at this hearing the subject was the intricacies of
patient-privacy rules. In the aftermath of the Supreme Court’s ruling in Dobbs
v. Jackson Women’s Health Organization, a reporter had overheard Bernard tell a
fellow-doctor that a ten-year-old girl from Ohio was coming to Indianapolis for
an abortion. This, Indiana’s Republican attorney general claimed, made the girl
identifiable and violated her right to confidentiality.

For fourteen hours, as Bernard’s white-coated colleagues sat behind her in
solidarity, lawyers tried to prove that Bernard was unfit to practice medicine.
Under close questioning, she insisted that she had not violated privacy rules
and that the case was designed to intimidate her. Any doubt that the hearing had
as much to do with politics as medicine vanished when the deputy attorney
general asked, “Do you have a tattoo of a coat hanger that says ‘Trust Women’ on
your body?”




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Bernard provided a legal medication abortion to the ten-year-old. In the
eighteen months since, she has become the most famous obstetrician-gynecologist
in the country—equal parts hero and warning to abortion providers in
conservative states. Her encounter with the Indiana attorney general made her a
target for Fox News pundits and tarnished her professional record. The criticism
inspired threats and at times made her question how much longer she can do the
work she trained for years to do. As we talked in a clinic between abortion
procedures one day, Bernard offered an assessment of the political moment: “It’s
just insanity, pure insanity.”

The most senior complex-abortion doctor in a state that recently outlawed almost
all abortions, Bernard has struggled to balance her work—which involves
delivering babies, as well as ending pregnancies—with the fraught task of
supporting her patients through medical decisions that increasingly require the
advice of an attorney. “Mostly, it’s just incredibly sad,” she told me. “All of
these absolutely brilliant clinicians have just spent their entire lives
fighting for one basic human right that is literally the easiest procedure that
you’ve ever done in your entire life.”

No one was surprised that it was Bernard who got the call on a June morning in
2022, three days after the Dobbs ruling. “Caitlin is the person in our state who
everybody calls” to handle difficult cases, Tracey Wilkinson, an Indianapolis
pediatrician, told me. “Everyone has her cell-phone number.” Bernard was doing
paperwork in her office when a child-abuse pediatrician in Ohio contacted her
about a ten-year-old girl. The child had been raped and was pregnant. She needed
an abortion but was three days past the six-week deadline for termination that
had been set by Ohio’s Republican-dominated legislature. Bernard recalled
thinking, “Oh, my God, they can’t even take care of this patient?” She agreed to
see the girl and later noted that it was not an unusual request. The girl was
one of fifty-nine patients younger than sixteen to receive an abortion in
Indiana that year, and she was not the youngest patient Bernard had ever
treated.

Unlike many other conservative states, Indiana did not have a trigger law that
allowed abortion restrictions to take effect immediately after the Court
overturned Roe v. Wade. But it was clear in those early days after Dobbs that
the Republican governor and legislature would act quickly. On June 29th, several
hundred doctors, nurses, and medical assistants, shouting slogans and carrying
signs, rallied for abortion access on Indiana University School of Medicine’s
campus. Bernard, wearing light-blue surgical scrubs, hollered into a bullhorn:
“Abortion is health care!”

At the protest, Bernard, who teaches obstetrics and gynecology and trains new
doctors at the medical school, spoke with a resident who was about to start
seeing adolescent patients. She warned him to be prepared to see children who
were travelling from states where abortion laws had been tightened. For example,
she told him, a pregnant ten-year-old from Ohio had been referred to her for
care. Shari Rudavsky, an Indianapolis Star reporter, was standing nearby,
waiting to interview Bernard. She overheard the conversation and asked if the
story was true. Bernard confirmed that it was. The girl and her mother arrived
in Indianapolis, and, after a state-mandated waiting period, Bernard provided
the girl with mifepristone, to block an essential hormone, followed by a dose of
misoprostol, to cause uterine contractions.



On July 1st, the Star published a story about patients travelling for abortions,
with an opening anecdote about the child from Ohio. It mentioned the call to
Bernard and the fact that the ten-year-old’s pregnancy was a few days beyond
Ohio’s new six-week limit. The girl was not further identified, and Rudavsky
quoted Bernard only once, when she referred to the prospect that the Indiana
legislature might pass a law as restrictive as Ohio’s. “It’s hard to imagine
that in just a few short weeks,” Bernard said, in the article, “we will have no
ability to provide that care.”

The story spread quickly. Outlets around the world retold the episode, casting
it as dramatic evidence of what the fall of Roe v. Wade would mean. President
Biden joined in, speaking about Bernard’s patient as he announced an executive
order to protect access to medication abortion and contraception. “Ten years
old, raped, six weeks pregnant. Already traumatized. And was forced to travel to
another state,” he said, wincing. “Imagine being that little girl.”

That was not how everyone saw it. The Wall Street Journal published an editorial
under the headline “An Abortion Story Too Good to Confirm,” suggesting that
Bernard, “a biased source,” had invented the patient. The Republican congressman
Jim Jordan, of Ohio, piled on, tweeting, “Another lie. Anyone surprised?” The
Fox News personality Jesse Watters, whose prime-time show typically attracted
more than two and a half million viewers, questioned why no rape suspect had
been charged. Either “so-called doctors are covering up child rape,” he said, or
the story was a liberal “hoax.”



On July 13th, a man in Columbus—the boyfriend of the girl’s mother—was charged
with raping a ten-year-old, which allowed reporters to discover her identity and
debunked the claim that the story was false. (The man later pleaded guilty and
received a life sentence.) A few hours after the suspect’s court appearance,
Watters targeted Bernard again, incorrectly stating that she had failed to
report the rape. “So, is a criminal charge next? Will she lose her license?” he
asked, as he introduced Indiana’s attorney general, Todd Rokita, who spoke by
video feed. Rokita called Bernard “an abortion activist acting as a doctor,” and
said that the ten-year-old was “politicized for the gain of killing more
babies.” Without providing details, he told the Fox News audience that Bernard
had a history of failing to report abortions: “We’re gathering evidence as we
speak, and we’re going to fight this to the end.”

Even before the Dobbs ruling, Bernard was one of a dwindling number of doctors
willing to provide abortions in conservative states. A 2021 Kaiser Family
Foundation study found that ninety-two per cent of ob-gyns in the Midwest did
not provide abortions. About a third of ob-gyns who do not provide abortions
cited their opposition to the practice, but many expressed concerns about legal
regulations and personal safety. For decades, abortion doctors “navigated a
never-ending barrage of harmful legislation and interference,” Verda J. Hicks, a
Kansas doctor who leads the American College of Obstetricians and Gynecologists,
told me. Colleen McNicholas, a St. Louis Planned Parenthood doctor and a mentor
of Bernard’s, said, “I can’t even tell you the number of complaints that have
been filed to the state licensure board against me by people who I’ve never seen
as my patients.” That, combined with attacks from state legislators and ever
more stringent regulatory restrictions, means that physicians don’t feel safe.

Bernard was born on a communal farm in upstate New York in 1984. “My parents
were hippies,” she said. “This idea of communal living and community,
sustainability, and support—everyone has a role in which we’re all helping each
other.” She accompanied her father, a carpenter and community organizer, on
volunteer trips to Puerto Rico, where he installed septic tanks and built
playgrounds and community centers. Back home, Bernard joined her mother, a
laboratory researcher, at Take Back the Night marches. Bernard knew from an
early age that her mother had had an abortion in college, and that when she
became pregnant with Bernard’s older sister, at twenty-one, with a man who
wanted no role as a father, she chose to have the baby. Bernard said that her
mother was a devoted feminist who taught her “the power of women in their
community—that you don’t need anybody, you can make the decisions for your life.
And that reproduction is key to that.”



After graduating from Binghamton University, in 2006, Bernard interned as a
doula and volunteered at Southern Tier Women’s Health Services, the abortion
clinic where Randall Terry, the founder of the militant anti-abortion group
Operation Rescue, had launched his protests two decades earlier. It was a
tumultuous time to be doing this work. Protesters shouted at patients, and the
1998 assassination of Barnett Slepian, an abortion doctor from Buffalo, was
still fresh. The clinic’s owners felt traumatized, and Bernard saw how the
reproductive-rights community, including her parents, gave them “moral support,
more than anything, showing them that they were protected.” After she finished
medical school, at SUNY Upstate, she started a fellowship at Washington
University in St. Louis, where she learned to perform more complex abortions.
Missouri’s legislature was in the midst of passing increasingly strict abortion
rules, with measures such as a three-day waiting period, limits on
health-insurance coverage, and a requirement to present patients with a sheaf of
material designed to persuade them to change their minds. Coached by McNicholas,
Bernard donned her white lab coat and testified to the legislature. She did the
same later in Indiana, speaking at rallies and becoming a go-to expert witness.

People who work with Bernard talk about her courage. When I asked her where that
came from, she laughed and meandered through an unconvincing riff about how
anyone would do what she does. Then she said, “Maybe part of it is, if you’re
gonna do it, do it—you know, be all in.” To McNicholas, this makes sense. When
you see patients who have needed abortions and have struggled to obtain them,
she said, “you wake up every day, and you remember those names, and you remember
those faces, and you remember those stories of how they were so unnecessarily
harmed.”

In 2019, Indiana’s legislature outlawed dilation and evacuation, or D. & E., a
procedure commonly used by doctors in the second trimester, when some major
genetic or anatomic anomalies can first be detected and other complications may
arise. It is widely acknowledged as the least risky approach to pregnancy
termination in the second trimester, and the easiest for the patient, yet the
new law made it a felony for a doctor to perform it unless the life or health of
the patient is in danger. Bernard, one of the few ob-gyns in Indiana with the
skill and experience to perform a D. & E., testified against the bill. She
described situations in which a patient might want a second-trimester
abortion—after the discovery of a fatal abnormality in the fetus, for
example—and argued that doctors must be able to use their best judgment without
political interference. When the bill passed, the Indiana chapter of the
A.C.L.U. recruited her to help challenge the rule in court. A judge temporarily
stopped the law from taking effect, but he dismissed the case when the Dobbs
decision came out. “We had an injunction. We had won,” Bernard said. “Dobbs
really just, in one fell swoop, took all of that away. That was really, really
difficult.”



While that case was in the court system, the F.B.I. relayed word to Bernard of a
threat to kidnap her infant daughter. She began travelling with security guards,
and she stopped working at a Whole Woman’s Health clinic in South Bend after a
local anti-abortion group posted her name and work location on its Web site
under the heading “Local Abortion Threat.” (That group, Right to Life Michiana,
formerly known as St. Joseph County Right to Life, believes that “abortion is
unacceptable in all cases” and favors the criminalization of doctors who provide
the procedure. In 2006, Justice Amy Coney Barrett, then on the faculty at Notre
Dame Law School, signed an advertisement sponsored by the group that called for
“an end to the barbaric legacy of Roe v. Wade.”) “It was pretty terrifying,”
Bernard told me. “In what other specialty would you be, like, ‘I can’t do this
area because I might get murdered, or my kids are going to have protesters at
their school?’ ” The episode left her wondering whether “doing what I thought
was the right thing was actually putting my family at risk.”

In the weeks after the Ohio girl’s abortion, Todd Rokita, Indiana’s attorney
general, continued his public attacks on Bernard. He released a letter that he
had written to Eric Holcomb, the state’s Republican governor, demanding that
officials “immediately” confirm whether Bernard had filed the required
Terminated Pregnancy Report and alerted Indiana’s Department of Child Services.
The next day, using a simple public-records request, reporters obtained the
report, which showed that Bernard had filed the paperwork properly. Indiana
University Health also released a statement affirming that she had complied with
privacy laws. A friend of Bernard’s published an op-ed in the Times, saying that
she was a “target of a national smear campaign.”

Bernard put the attention to use. She said in an MSNBC interview that doctors
“need to be able to provide this care for everyone, for every single person that
we get a call about, from any state all over the country.” In a column for the
Washington Post, she wrote that she felt “anguished, desperate, and angry . . .
I don’t want to have to accept that a particular religious ideology eclipses my
duty as a physician.” Vice-President Kamala Harris called to thank her for her
leadership, and twenty-two doctors launched a GoFundMe for her legal defense,
ultimately raising more than seven hundred thousand dollars. “None of this
should have happened in a sane world,” she told me. “The problem is that I
didn’t realize we weren’t operating in a sane world.”

Five months after the girl returned to Ohio, Rokita filed a five-count
administrative complaint against Bernard with the state’s medical-licensing
board. He charged that Bernard knowingly violated federal and state privacy laws
by revealing the girl’s age and home state. He also said that she failed to
report the girl’s rape quickly enough to Indiana child-protection authorities,
even though the crime had occurred in Ohio. As Bernard saw it, the most powerful
law-enforcement official in Indiana was trying to silence her and send a warning
to other providers. “On one hand, it was, like, This is ridiculous. There’s no
way he can win this,” she told me. “And then there was the fear of, well, if he
does win, am I going to lose my license?”




The hearing was held before six members of the board—five doctors and a
lawyer—all appointed or reappointed by a strongly anti-abortion Republican
governor. “No physician has been as brazen in pursuit of their own agenda,” Cory
Voight, an attorney on Rokita’s staff, said, of Bernard. To suggest that she was
motivated by self-interest, he showed the board that Time magazine had recently
named her as one of its Time100 Next rising stars and that Vanity Fair had
portrayed her as the face of abortion rights.

“I have no personal gain from any of this. It’s honestly been incredibly
difficult,” Bernard said, when she was called to testify. Speaking clearly and
precisely, she stated, “I did not release any protected health information,”
adding, “There was no information that I released that led to her being
identified.” Bernard argued that, though her remark made the case public, the
girl became identifiable only at the rapist’s arraignment. Asked by Voight
whether it was true that she would not have been accused if she had not spoken
with the reporter, Bernard replied, “If the attorney general, Todd Rokita, had
not chosen to make this his political stunt, we wouldn’t be here today.”

HIPAA, the federal privacy rules designed to prevent a patient from being
identifiable to outsiders, allows a doctor to describe a patient’s home state,
age, and care, but not her dates of treatment. An expert witness for Bernard
confirmed that she did not violate any of the eighteen identifiers of protected
information. A witness for Rokita’s office testified, however, that she had
violated a catchall category that encompasses “any other unique identifying
number, characteristic, or code” that could allow the girl to be recognized, by
disclosing her age, home state, and roughly when she was treated.

Peter A. Schwartz, a Pennsylvania obstetrician and the chair of the American
Medical Association’s ethics council, was the final witness for Bernard. In his
view, he later explained, a unique identifier is something like a rare tattoo on
someone’s forehead. “Is ‘a ten-year-old pregnant rape victim from Ohio’ a unique
identifier? If I had three young women sitting in the front of this room, could
you pick out the one that was from Ohio that was six weeks pregnant and ten
years old? I don’t think so.”

When the testimony finished, late in the night, the board voted unanimously to
reject Rokita’s claim that Bernard had failed to properly report the case. It
also rejected his assertion that she was unfit to be a doctor. But, by a 5–1
vote, the doctors concluded that she had violated HIPAA. They reprimanded her
and fined her three thousand dollars. Bernard, after an exhausting day, was in
tears, knowing that the result would follow her in headlines and in licensing
databases across the country. “It’s a verdict that I did do something wrong,”
she told me, “whether I believe it or not.”



The next day, I.U. Health issued a statement saying that it believed the board
was wrong. The Indianapolis Star soon printed a letter, signed by more than five
hundred Indiana doctors, who called the outcome a “very dangerous and chilling
precedent.” It accused Rokita of improperly using the licensing board to “police
physician speech” about public health and argued that Bernard had actually
honored the profession’s moral obligations. Their argument was grounded in the
A.M.A.’s code of ethics, which says that a physician, while respecting the law,
has “a responsibility to seek changes in those requirements which are contrary
to the best interests of the patient.” That obligation includes sharing relevant
information with the public. Just days after the Dobbs decision, Schwartz told
me, Bernard “had inherited the poster child of real-life events for the hazards
of banning abortion. She had an obligation to let the world know that this fear
that we all had—that there were going to be these horrendous
situations—actually, truly happened.”

Bernard continued to perform legal abortions in Indiana and Illinois. After she
was fined, she joined colleagues in writing an op-ed critical of the Indiana
Supreme Court’s decision to uphold the state’s new abortion ban, predicting that
patients and doctors would suffer. One day last fall, I tuned in to a Webinar in
which Bernard urged attendees from the Association of American Medical Colleges
to advocate for abortion as a human right. She spoke of doctors who have been
intimidated into silence by abortion foes. “That is not surprising,” she said.
“That is their goal.”

The Indiana Supreme Court’s decision cleared the way for a law that prohibits
nearly all abortions, with exceptions for rape and incest within ten weeks of
fertilization, lethal fetal anomalies before twenty weeks, and serious risks to
the mother’s life and health. It also requires that all abortions be done in
hospitals, which means that the Planned Parenthood clinics in Bloomington and
Indianapolis, where Bernard often worked, could no longer provide them. In late
July, I drove to meet her on her last scheduled day at the Bloomington clinic,
passing a highway billboard that read “If you can get to Illinois, we can get
you safe abortion care.” Outside the clinic, a lone protester walked slowly back
and forth, carrying a sign that read “Pray to End Abortion.”

Inside, past security cameras and through a locked door, Bernard occupied a
windowless office. Medical assistants in scrubs came and went, alerting Bernard
when the next patient was ready. She did sixteen surgical abortions that day,
most taking less than ten minutes, along with six medication abortions. There
was a rhythm to the work. Study a chart on the office desktop, use the pass
dangling from her neck to close the file, raise her mask (because she had a
cold), cross the corridor, perform an abortion, come back. “She is our very calm
doctor,” Katherine Martin, the health-center manager, told me. Bernard said that
she was reading a book called “Sacred Choices,” an examination of the right to
abortion in ten world religions. Several Indiana plaintiffs, including Hoosier
Jews for Choice, were challenging the new law on religious-freedom grounds.

That morning, I.U. Health officials had held a conference call with hospital
staff about the new law. A security guard had asked, “What if there’s a
complaint? Are we going to have to arrest Dr. Bernard?” For the first time, the
possibility seemed real to Bernard. Her husband, a teacher, wondered whether
their bank accounts could be frozen. Would the health system continue to pay her
legal bills? Would she be fired? Would she lose her license? Bernard felt even
more vulnerable than before, because, with the clinics closed, she and her
partner, a doctor named Amy Caldwell, would be providing nearly all the
abortions still permitted in Indiana. She worried about making an error in
documents required by the state, or a medical judgment that a prosecutor would
question. She wondered whether she should leave Indiana. “My husband and I talk
about it every week, ‘What is the last straw?’ ” she asked. “Even my therapist
says, ‘Where’s the line?’ ”




Caldwell said that she, too, has considered leaving. (“I would be lying if I
said it didn’t cross my mind,” she told me.) She does not post her photo on her
workplaces’ Web sites, to make it harder for anyone “with malicious intent” to
find her, and she gives few media interviews. Because abortions, and the doctors
who perform them, are governed by rules and paperwork requirements that do not
apply to other physicians, she feels an “imperative to really be perfect. The
people who oppose what I do—their preference is not only to see me lose my
license but, I think, they’d like to see me in jail.”

Rokita, who refers to abortion-rights supporters as “pro-death advocates,” is
pursuing inquiries into other doctors who have provided abortions and
gender-affirming care, according to several people familiar with the requests,
and he filed a lawsuit against I.U. Health, claiming that its support of Bernard
shows that it cannot be trusted to protect patient privacy. I.U. Health replied
that he was wasting government resources. At the same time, he is facing
disciplinary proceedings of his own. In December, 2022, a county judge found
that, by denouncing Bernard on Fox News, Rokita had “clearly violated Indiana
law,” which prohibits discussing confidential investigations in the media. Last
year, with his license in jeopardy, the Indiana Supreme Court reprimanded him,
saying that his public comments were designed to embarrass Bernard. In an
affidavit, Rokita admitted to the violations. He went on to say, “Now I will
focus even more resources on successfully defending Indiana’s laws, including
our pro-life laws.” Rokita, who is running for reëlection, declined to comment
for this article, but in a recent interview with The Federalist he described
himself as a victim: “The goal is to shut me up.”

The Indiana Department of Health recorded 9,529 terminated pregnancies in 2022,
eighty-one per cent of them for Indiana residents. In the first three months
after the new law took effect, the number was just thirty-nine. Nearly all of
them were performed by Bernard or Caldwell, who found that serious medical
complications come in countless forms that do not neatly fit the exceptions
designed by the legislature. For such dilemmas, I.U. Health created a
“reproductive-health rapid-response team,” comprising doctors, lawyers, and
ethicists, on call around the clock. Bernard told me of a patient whose first
child had a genetic anomaly and died less than a year after birth. Now she was
pregnant again, and doctors had detected the same anomaly. Could she have an
abortion? The team concluded that the law allows an abortion only if a baby is
likely to die within three months. Bernard delivered the news to the patient,
then went home and cried. She said, “I sometimes feel this job is going to take
years off my life.”

Caroline Rouse, a friend of Bernard’s, told me of “the repeated and ongoing
moral injury” experienced by physicians who aren’t allowed to do the jobs they
were trained to do. Rouse is a maternal-fetal-medicine doctor in Indianapolis
who did her fellowship in high-risk obstetrics. Her patients suffer from
hypertension, diabetes, congestive heart failure, and autoimmune diseases—all of
which, she noted, “make pregnancy super, super complicated.” But many are not
eligible for abortions in Indiana. “It sucks,” Rouse said. “I didn’t go into
M.F.M. to not be able to take care of all of my patients, and that is what is
happening.”

Katie McHugh is an ob-gyn who no longer performs abortions in Indiana. “I have
one patient with endometriosis who desperately wants to be pregnant and wants to
be a parent,” she said. “She is so scared about what would happen if she had an
abnormal pregnancy, because she doesn’t know if she would live. She doesn’t know
if she would be able to keep her uterus. She talks about this every time I see
her.” McHugh spoke of what she called her own emotional burden, “knowing what to
do in a situation and not being allowed to do it, knowing that, if I were to
give this person the best medical care, I would be committing multiple crimes.”



Some doctors, uncertain about what the law prohibits and requires, are even more
cautious than they need to be. Bernard recalled that, not long ago, one of her
colleagues called to discuss a very sick patient who, the doctor believed,
needed an abortion. She asked Bernard whether it was even legal to recommend the
procedure in Indiana. (It is.) “She said to me, ‘I have a little kid. I can’t go
to jail,’ ” Bernard recounted.

More than once, Bernard told me that she loves her work, but one day, not long
after Indiana’s law took effect, she was feeling pessimistic. She was working at
a Planned Parenthood clinic in Illinois, where she provides abortions two days
every other week, rotating with Caldwell. Working out of a bare-bones office,
two hours from home, Bernard spoke of the “chronic stress” of the work, the
hundreds of thousands of dollars spent on her legal defense, and the hardship
imposed upon her patients. That day, I also spoke with a woman who had travelled
from Indiana for an abortion: a single mother who was forty-one years old and
fifteen weeks pregnant with a fetus diagnosed with Down syndrome. “I’m just not
prepared to give a certain type of life to a child with Down syndrome,” she told
me. “I would need to not work anymore, and then I would need government
assistance, which for me is not O.K.”

Bernard performed fourteen abortions that day, for patients from six states.
Between procedures, seated at a desktop computer across the hall from a busy
nurses’ station, she thought back to how hopeful she had been before Dobbs. “If
we just did more, if we just spoke out more, if we were just at the statehouse
more,” she recalled thinking, surely legislators would see her patients’ reality
and recognize that doctors should be able to support their choices without fear.
“Right now,” she said, “it does not feel like that at all.” ♦

An earlier version of this article misspelled the name of a South Bend clinic.






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Peter Slevin is a contributing writer to The New Yorker, based in Chicago and
focussing on politics. He teaches at Northwestern University’s Medill School of
Journalism and is the author of “Michelle Obama: A Life.”

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