A Florida administrative law judge has recommended disciplinary action against a registered nurse who posted a TikTok video wishing a severe birth injury on White House Press Secretary Karoline Leavitt while she was pregnant. Judge Robert S. Cohen issued the recommended order Sept. 1, proposing a reprimand, $250 fine, and social media training for Alexis Backer Lawler, a labor and delivery nurse at Baptist Health Boca Raton Regional Hospital. The case now goes to the Board of Nursing for a final ruling.
The Florida Department of Health filed an administrative complaint against Lawler on Feb. 20 after she posted the video on Jan. 22. In the video, Lawler identified herself as a labor and delivery nurse and directed graphic, profane language at Leavitt, wishing her a fourth-degree tear. The injury was described at hearing as the most severe that can occur during childbirth, requiring surgery under anesthesia and potentially additional procedures. "As a labor and delivery nurse, it gives me great joy to wish Karoline Leavitt a fourth-degree tear," Lawler said in the video.
A final hearing was held July 14 in Tallahassee. The case centered on whether Lawler's TikTok post constituted unprofessional conduct under Florida Administrative Code Rule 64B9-8.005(14), which prohibits nurses from using abusive, threatening or foul language in front of a patient or directing such language toward a patient. Lawler argued the video was protected political speech made on her personal time, away from her workplace, and not directed at any patient.
Cohen rejected that argument after two Baptist Health labor and delivery patients testified that they had seen the video before or around the time of their own deliveries at the hospital. Patient E.G. testified that she had been assigned Lawler as her nurse during her Jan. 5–6 delivery and later saw the video shared by her husband. She described her reaction as shock and disgust.
"It was just inappropriate, specifically coming from someone whose job is to take care of you at one of your most vulnerable moments," E.G. testified. Another patient testified that she saw the video a few days before her own admission to Baptist Health on Jan. 24 and overheard nurses at the hospital discussing it during her stay. She said she did not have Lawler as her nurse and that her decision to deliver at Baptist Health was not changed by having seen the video. Neither patient filed or planned to file a lawsuit against the hospital or Lawler.
Cohen found that Lawler had not taken steps to restrict her TikTok audience before posting the video and did not appear to have a clear understanding of which of her accounts were public or private. "By posting the video on TikTok, with some clearly provocative language aimed at a pregnant mom who happens to be a public figure, on a popular public social media platform, she should have known there was a risk of the posting going viral," Cohen wrote. He also noted that Lawler had identified herself as a labor and delivery nurse in the video, which he said lent specific weight to the nature of the injury she was wishing on Leavitt.
Shortly after the video circulated, Lawler was fired from Baptist Health Boca Raton Regional Hospital. A hospital spokesperson confirmed her termination, stating that the comments made in the social media video do not reflect the hospital's values or the standards expected of healthcare professionals. Lawler's TikTok account was public at the time of the posting, and a group called Libs of TikTok reposted the video along with Lawler's place of employment, causing it to spread widely.
Lawler testified that she subsequently received death threats and tightened her social media privacy settings. Her TikTok account has since been banned.
The recommended order also references a separate incident from September 2025, in which Baptist Health received complaints from employees and members of the public about social media posts Lawler made related to the death of conservative commentator Charlie Kirk. Human resources records show Lawler met with hospital management, reviewed the hospital's social media policy and acknowledged the guidance.
No formal discipline was issued at that time. Lawler was also noted to have worn a pin reading "no uterus, no opinion" while working in the labor and delivery unit. One patient testified that she found the pin off-putting in that setting.
In weighing the penalty, Cohen cited several mitigating factors: Lawler has been licensed for approximately 14 years with no prior disciplinary history, the two patients who testified suffered no physical harm and pursued no legal action, and Lawler lost her job at Baptist Health as a result of the incident. "The mitigating factors in this case outweigh any potential aggravating factors which were not proven to exist," Cohen wrote.
Cohen also recommended the board assess costs related to the investigation and prosecution of the case. The Board of Nursing is not required to follow the judge's recommendation.