Proposed Hospital Buyout Could Limit Reproductive, End-of-Life Care

Wendy Norris

The contentious transfer of two Colorado-based Exempla hospitals to a Catholic health care network is likely to further shrink comprehensive health care services for Denver-area patients because they violate church doctrine.

The
contentious transfer of two Colorado-based Exempla hospitals to a
Catholic health care network is likely to further shrink comprehensive
health care services for Denver-area patients because they violate
church doctrine.

Local patients seeking reproductive health care or termination of
invasive life support could soon face health care professionals
invoking conscience clauses, should the transfer of Exempla Lutheran
Hospital in Wheat Ridge and Exempla Good Samaritan Hospital in
Lafayette to the Kansas-based Sisters of Charity of Leavenworth Health
System be approved.

 

As the Denver Business Journal reported over the weekend, an arbitrator blocked the sale of the Exempla hospitals
by the Arvada-based Community First Foundation to the Sisters of
Charity over a legal technicality. But the actual transfer of
operational control of the facilities, which are jointly owned in a
complex membership agreement between the two organizations, continues
to move forward albeit without the $311 million buyout windfall to the
foundation.

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Arbitrator William Meyer ruled Friday in a binding decision that the Sisters of Charity cannot buy the foundation’s stake in the two hospitals
according to the Exempla bylaws that govern the membership agreement
between the two organizations that founded the Exempla system in 1997
from the ashes of two Lutheran hospitals.

The Exempla board filed suit in 2008 to block the sale citing, in
part, concerns over that non-sectarian medical policies would be
discontinued under a Roman Catholic health care system.

Issues of religious doctrinal interference in physician-patient
decision making came to a head in 2007 when Gov. Bill Ritter signed a
law requiring hospitals and pharmacies to provide sexual assault victims information about emergency contraception.
A conscience clause was added to the bill that provides a right for
health care providers who object on moral grounds to opt out. Likewise,
during the 2009 legislative session, Catholic church lobbying forced a more narrow legal definition of contraception
in the state’s landmark Birth Control Protection Act to exclude
mifespristone, also known as RU-486, and other federally approved
pharmaceuticals that induce abortion.

However, none of those safeguards are in place for other
reproductive health services, like sterilization or abortion, or in
end-of-life care procedures that require the removal of feeding tubes
or ventilators.

Currently, Catholic health organizations currently operate 11 hospitals and a dozen skilled nursing, hospice and outpatient facilities in Colorado.

News Human Rights

Lawsuit: Religious Groups Are Denying Abortion Care to Teen Refugees

Nicole Knight Shine

The suit accuses the federal government of paying millions to religious grantees that refuse to provide unaccompanied minors with legally required reproductive health services.

Two years ago, 17-year-old Rosa was raped as she fled north from her home country in Central America to the United States. Placed in a Catholic shelter in Florida, the teen learned she was pregnant, and told shelter officials that if she couldn’t end the pregnancy, she’d kill herself. She was hospitalized for suicidal thoughts. Upon her release, the facility in which she’d been originally placed rejected her because of her desire for an abortion, according to a federal lawsuit filed Friday. So did another. Both, reads the lawsuit, were federal contractors paid to care for unaccompanied minors like Rosa.

Rosa’s story is one in a series sketched out in a 16-page complaint brought by the American Civil Liberties Union (ACLU) against the U.S. Department of Health and Human Services (HHS). The suit accuses the federal government of paying millions to religious grantees—including nearly $20 million over two years to the U.S. Conference of Catholic Bishops (USCCB)—that refuse to provide unaccompanied minors with legally required reproductive health services, including contraception and abortion. The grantees are paid by the federal Office of Refugee Resettlement (ORR) to house and care for young refugees.

The lawsuit, brought in U.S. District Court in San Francisco, amounts to a fresh test of the degree to which Catholic organizations and other faith-based groups can claim exemptions from federal laws and regulations on religious grounds.

“Religious liberties do not include the ability to impose your beliefs on a vulnerable population and deny them legal health care,” said Jennifer Chou, attorney with the ACLU of Northern California, in a phone interview with Rewire. “The government is delegating responsibility … to these religiously affiliated organizations who are then not acting in the best interest of these young people.”

Mark Weber, a spokesperson for the HHS, which includes the ORR, told Rewire via email that the agency cannot comment on pending litigation.

Escaping turmoil and abuse in their home countries, young refugees—predominantly from Central America—are fleeing to the United States, with 33,726 arriving in 2015, down from 57,496 the year before. About one-third are girls. As many as eight in ten girls and women who cross the border are sexually assaulted; it is unknown how many arrive in need of abortion care.

The federal ORR places unaccompanied minors with organizations that are paid to offer temporary shelter and a range of services, including reproductive health care, while the youths’ applications for asylum are pending. But documents the ACLU obtained indicate that some groups are withholding that health care on religious grounds and rejecting youths who request abortion care.

The 1997 “Flores agreement” and ORR’s contracts with grantees, which the ACLU cites in its lawsuit, require referrals to “medical care providers who offer pregnant [unaccompanied immigrant minors] the opportunity to be provided information and counseling regarding prenatal care and delivery; infant care, foster care, or adoption; and pregnancy termination.”

In 2016, the federal government awarded 56 grants to 30 organizations to provide care to unaccompanied minors, including 11 that the ACLU claims impose religious restrictions on reproductive health care.

In one case, ORR officials struggled to find accommodations for 14-year-old Maria, who wanted to end her pregnancy, according to the complaint. An ORR official wrote, according to a document the ACLU obtained, that the agency would have liked to transfer Maria to Florida to be near family, but “both of the shelters in Florida are faith-based and will not take the child to have this procedure,” meaning an abortion.

In another, the complaint reads, 16-year-old Zoe was placed with Youth for Tomorrow, a faith-based shelter in Virginia, where she learned she was pregnant. She asked for abortion counseling, which was delayed nearly two weeks, the complaint says. Learning of her decision to end the pregnancy, Youth for Tomorrow asked to transfer Zoe elsewhere because of its abortion prohibition, even though Zoe said she was happy at the shelter.

For vulnerable youths, such transfers represent a form of “secondary trauma,” according to the ACLU’s Chou.

“These women have already endured so much,” she told Rewire. “The process of transferring these youths from shelter to shelter tears them away from their only existing support system in the U.S.”

Federal officials, according to the complaint, were aware that the religious grantees would withhold abortion referrals. In one case, the Archdiocese of Galveston-Houston was awarded more than $8 million between 2013 and 2016, although it stated in its grant application that rape survivors wouldn’t be offered abortion care, but instead permitted to “process the trauma of the rape while also exploring the decision of whether to keep the baby or plan an adoption.”

The lawsuit also claims that a contract with the U.S. Conference of Catholic Bishops included language requiring unaccompanied minors who were pregnant to be given information and counseling about pregnancy termination, but the ORR removed that language after the USCCB complained.

The USCCB did not respond to Rewire‘s request for comment. But in a letter last year to the ORR, the USCCB and five religious groups, including some ORR grantees, wrote they could not facilitate health-care services for unaccompanied minors that run contrary to their beliefs.

The lawsuit is the second the ACLU has filed recently against the federal government over religious privileges.

Last month, the ACLU filed a Freedom of Information Act suit demanding that the federal Centers for Medicare & Medicaid Services release complaints against federally funded Catholic hospitals, where patients have reported being denied emergency medical care in violation of federal law.

In 2009, the ACLU also sued the federal government for allowing USCCB to impose religious restrictions on a taxpayer-funded reproductive health program for trafficking survivors. In 2012, a district court ruled in the ACLU’s favor, and the government appealed. The First Circuit Court of Appeal later dismissed the case as “moot” because the government did not renew USCCB’s contract.

News Health Systems

ACLU Sues for Complaints Filed Against Catholic Hospitals Denying Reproductive Care

Nicole Knight Shine

A 2012 federal investigation of the Catholic-run St. John Hospital in Detroit found the hospital violated federal law by discharging a miscarrying patient who lost seven pints of blood while the facility refused for six hours to allow an emergency abortion because fetal tones were present.

The American Civil Liberties Union (ACLU) is demanding the federal Centers for Medicare & Medicaid Services (CMS) release complaints against federally funded Catholic hospitals, where patients report being denied emergency medical care in violation of federal law.

In a Freedom of Information Act suit filed Tuesday, the ACLU asked a federal court to force the CMS to hand over complaints alleging violations of the Emergency Medical Treatment and Active Labor Act. CMS is charged with fielding complaints and investigating violations of the law, which requires federally funded hospitals to provide patients with the care required to stabilize a medical condition, such as a miscarriage.

A CMS spokesperson told Rewire in an email the agency does not comment on pending litigation.

Roughly one in six hospital beds are in a Catholic facility, with the top four U.S. Catholic health systems expected to take in more $90 billion from Medicare and Medicaid in 2016, according to the ACLU’s 10-page lawsuit filed in U.S. District Court for the Southern District of New York.

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Catholic hospitals follow religious directives, written by the United States Conference of Catholic Bishops, that forbid doctors at Catholic facilities from performing abortions unless the patient is in grave condition, among other restrictions.

“We’ve heard heartbreaking stories from women who rushed to a Catholic hospital in an emergency but were turned away because the hospital let religious rules written by bishops dictate what medical care could be provided,” said ACLU Senior Staff Attorney Brigitte Amiri in an emailed statement.

ACLU officials believe CMS is privy to a “number of complaints” alleging federal violations, according to the court filing. Amiri told Rewire in an email that the goal of the suit is to find out how many.

The lawsuit cites a series of complaints filed by patients who said they were denied emergency care for miscarriage in Catholic facilities. In one account, the hospital discharged a miscarrying patient, who later underwent emergency abortion care and treatment for major blood loss at another facility.

In another account, a woman miscarried alone on the toilet, after a Catholic hospital gave her Tylenol to treat a potentially deadly pregnancy-related infection and sent her home twice.

“It is crucial,” the court filing states, “that the requested documents are disclosed so that the public can ascertain whether hospitals receiving federal funds are violating federal laws designed to protect patient health and safety.”

ACLU filed its Freedom of Information Act request with CMS in 2014, but said it received no meaningful response. The ACLU requested, in part, five years of documents “relating to allegations of improper care, violations of [EMTALA], and violations of [CMS] regulation related to pregnancy-related treatment, including, but not limited to, treatment for miscarriage, abortion, and sterilization at hospitals receiving federal funds.”

CMS handed over a batch of documents as a response to the ACLU’s request. But the ACLU argues in its filing that the documents included no complaints related to miscarriage or abortion care.

Amiri told Rewire via email that the ACLU knows of specific miscarriage-related complaints that CMS failed to turn over.

In a statement announcing the lawsuit, the ACLU said it has used complaints to take legal action against Catholic providers, including a lawsuit filed against Trinity Health, the second largest Catholic hospital system in the country.

“With one in six hospital beds in facilities that are bound by the Catholic Directives, we expect there are more stories that will come to the surface,” Amiri told Rewire.

CMS in its own investigations has turned up wrongdoing on the part of Catholic hospitals, according to the ACLU court filing.

A 2012 investigation by CMS of the Catholic-run St. John Hospital in Detroit found the hospital violated federal law by discharging a miscarrying patient who lost seven pints of blood while the facility refused for six hours to allow an emergency termination because fetal tones were present. A family member drove the patient to another facility for an emergency abortion.

Responding to the investigation, a St. John Hospital staff member told CMS: “We are a Catholic institution and we do not perform abortions here if there are fetal heart tones.”

The court filing doesn’t say whether the hospital was sanctioned for violating the law.

Tuesday’s lawsuit is one of many the ACLU has filed over Catholic directives.

California’s largest medical association announced last month that it will join an ACLU lawsuit against the the state’s largest hospital system, Dignity Health, for using religious directives to deny basic reproductive health care to patients. A court hearing is expected Wednesday.