Denied treatment for a miscarriage or ectopic pregnancy? We want to know.

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Here at the National Women’s Law Center we are trying to identify instances where this practice may have occurred. What happens when women with pregnancy complications go to the emergency room for treatment? If you or someone you know has experienced a delay or denial of treatment, we want to know. Help us bring this hidden issue out from the shadows: share your story with us.

Last month, the National Women’s Law Center released a new report – Below the Radar: Health Care Providers’ Religious Refusals Can Endanger Pregnant Women’s Lives and Health. This report looks at a disturbing trend: women seeking care at Catholic hospitals for miscarriages and ectopic pregnancies (where the pregnancy is developing outside of the uterus) are sometimes denied appropriate care, suffer delays in treatment, or are not given full information on their treatment options. 

Some institutions and individuals allow religious doctrine, and not evidence based medical care, to dictate the kind of treatment that pregnant women can receive. This is because these health care providers consider any intervention that ends the pregnancy to be an abortion; even in cases where there is no medical treatment that would allow the pregnancy to continue, and the woman could suffer serious harm if she does not get treatment quickly.

Here at the National Women’s Law Center we are trying to identify instances where this practice may have occurred. What happens when women with pregnancy complications go to the emergency room for treatment? If you or someone you know has experienced a delay or denial of treatment, we want to know. Help us bring this hidden issue out from the shadows: share your story with us.

If you went to an emergency room with symptoms of miscarriage or ectopic pregnancy, even if you were not treated there, we still want to hear from you. We understand that this survey touches on a sensitive matter, and all responses will be kept strictly confidential.

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If you want to learn more about this issue, please visit our website. Thank you in advance for sharing your stories with us.

Analysis Law and Policy

Michigan Woman Sues Catholic Bishops for Negligence After Miscarriage

Jessica Mason Pieklo

Tamesha Means is suing the U.S. Conference of Catholic Bishops, claiming the bishops' anti-choice directives are negligently affecting the medical care delivered at Catholic-owned and -sponsored hospitals.

A Michigan woman is suing the U.S. Conference of Catholic Bishops (USCCB), claiming the bishops’ anti-choice directives are negligently affecting the medical care delivered at Catholic-owned and -sponsored hospitals.

Filed by the American Civil Liberties Union (ACLU), the lawsuit, believed to be the first of its kind, argues that patients’ lives are put at risk by unnecessarily denying pregnant women in crisis proper medical care.

In 2010, a then-18 weeks pregnant Tamesha Means showed up at Mercy Health Partners in Muskegon, Michigan, in the middle of having a miscarriage. Her water had broken and she was experiencing severe cramping. Mercy Health, a Catholic-sponsored facility, told Means there was nothing it could do for her and sent her home. Means came back the next day, this time in more pain and bleeding and was again told the course of action was to wait and see.

It wasn’t until Means, a mother of three, returned to Mercy Health a third time, this time suffering from a significant infection as her miscarriage persisted untreated. In response, the hospital gave Means some aspirin to treat her fever and prepared to send her home. Before the hospital discharged Means for a third time, she started to deliver. It wasn’t until then that the hospital decided to admit Means and to treat her condition. Means eventually delivered a baby who died within hours of birth.

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Mercy Health is required to adhere to the “Ethical and Religious Directives,” a set of rules created by the USCCB that govern the delivery of medical care at Catholic-run hospitals. The directives prohibit a pre-viability pregnancy termination, even in cases when there is little or no chance that the fetus will survive, and the life or health of a patient is at risk. The rules also direct health-care providers not to inform patients about alternatives inconsistent with the directives, even when those alternatives are the best option for the patient’s health.

According to the ACLU, that is exactly what happened to Means at Mercy Health, where attorneys claim the directives are put above medical standards of care. According to the complaint, at no point in the three times Means showed up at the hospital did anyone tell her that she had little chance of a successful pregnancy. The ACLU also alleges that the hospital, as a direct result of the bishops’ directives, failed to tell Means that her health and life were at risk if she tried to continue the pregnancy, and that the safest course of care for her was to end it. “They never offered me any options,” said Means in a statement. “They didn’t tell me what was happening to my body. Whatever was going on with me, they discussed it amongst themselves. I was just left to wonder, ‘What’s going to happen to me?'”

The lawsuit alleges that because she received neither the information nor the care appropriate for her condition, Means was unable to direct her course of treatment, and suffered unnecessarily. “A pregnant woman who goes to the hospital seeking medical care has the right to expect that the hospital’s first priority will be to provide her appropriate care,” ACLU Deputy Legal Director Louise Melling said in a press call. “Medical decisions should not be hamstrung by religious directives.”

According to the ACLU, Means’ story is not unique. In support of their complaint, attorneys representing Means point to research showing that other patients have been denied information and appropriate care at hospitals bound by the bishops’ directives. “The best interests of the patient must always come first, and this fundamental ethic is central to the medical profession,” Kary Moss, executive director of the ACLU of Michigan, said on the call. “In this case, a young woman in a crisis situation was put at risk because religious directives were allowed to interfere with her medical care. Patients should not be forced to suffer because of a hospital’s religious affiliation.”

But, according to the ACLU, patient care does suffer, significantly. The group’s research shows that over half of OB-GYNs working in Catholic-sponsored hospitals have run into conflicts with the directives. In one example, a doctor describes a miscarrying patient who was gravely ill and who was carrying a fetus that had no chance of surviving. Even though this patient had sepsis and a 106-degree fever, the hospital’s policy would not allow the doctor to treat the patient by terminating the pregnancy until the fetal heartbeat ceased on its own. In another example cited by the ACLU, a cardiologist was reprimanded for telling a patient with signs of a potentially fatal condition that if it worsened, the American College of Cardiology and the American Heart Association would recommend terminating the pregnancy in order to save her life.

Because this lawsuit is believed to be the first of its kind, there are a lot of unanswered questions, like whether or not the bishops can be sued for negligence in this way, and the effect, if any, a ruling on the issue would have for other Catholic-owned and -sponsored hospitals.

More importantly, though, the lawsuit forces a look at the question of what role, if any, religious doctrine should play in the delivery of medical care. And it does so in the venue of negligence and malpractice claims, which is far more patient-centered than any intellectualized debate about medical ethics, religious faith, and the First Amendment. Notably, Means’ attorneys don’t claim that her constitutional rights were infringed on in any way. Instead, they argue the bishops are negligent in putting forward directives they know will endanger patients’ health and conflict with professional standards of care. In some ways, it’s a much more straightforward claim to make, and one that, presuming the lawsuit is allowed to move ahead, will require the bishops to defend the directives on the merits and against claims they violate the standard of care for pregnant patients. With Catholic-owned or -sponsored institutions making up a significant percentage of health-care providers in this country, these are questions that need answers.

News Contraception

Anti-Choicers Gear Up To Fight Guidelines on Preventive Care for Women

Jodi Jacobson

The Institute of Medicine recommended that insurance plans cover contraceptive care with no co-pays and alarm bells start ringing in anti-choice offices across the land.  So get ready for the smear campaign to come.

All articles included in Rewire’s coverage of the IOM Report can be found here.  This article was edited at 7:11 am Thursday, July 21st to include a paragraph (under the heading Misleading Argument #3) that was in advertantly left out of the original published draft.

It’s a predictable routine. 

Medical experts review clinical and public health data and evidence on a set of issues.  They make recommendations on the best way to improve individual and public health, save lives, and lower health care costs for individuals, businesses and the nation writ- large.

If those recommendations include, anywhere, the words “Women,” “Reproductive,” “Health,” and “Care,” alarm bells go off in the hallways of anti-choice group offices everywhere. 

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And then the flood of lies begins.

So it was with the release of today’s Institute of Medicine Report on Preventive Health Care for Women.

The IOM report (the Executive Summary of which can be found here) recommends, among other things, that the Department of Health and Human Services (HHS) include in its final guidelines on women’s preventive health care that insurance companies cover the “full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”

And, oh boy, did those alarm bells start ringing, from the United States Conference of Catholic Bishops to the Family Research Council to the Americans United for Life and all those other rejectors of research and common sense.

First let’s do the evidence thing.  The IOM recommendations make eminent sense, whether you are concerned about individual rights, public health, or financial responsibility.

Why?

As the IOM report points out, reducing unintended pregnancies improves women’s health and the outcomes of later wanted pregnancies, enables women to plan their families effectively, and reduces the need for abortion. The full IOM report goes into significant detail on the rationale for contraceptive coverage and is worth reading on its own.

Nearly half of all pregnancies in the United States are unintended.  While some women and couples can and do decide to carry an unintended pregnancy to term, other women facing such pregnancies find them untenable and so resort to abortion. Approximately seven in 10 women of reproductive age (43 million women) are sexually active and do not want to become pregnant, but could become pregnant if they and their partners fail to use a contraceptive method. The typical U.S. woman wants only two children. To achieve this goal, she must use contraceptives for roughly three decades.  So even if all you care about is reducing the number of abortions, then the first step is to reduce the number of unintended pregnancies.  Making contraception more affordable and accessible does that.

Unintended pregnancy costs U.S. taxpayers roughly $11 billion each year.  A study by Adam Sonfield and colleagues at the Guttmacher Institute found that two-thirds of births resulting from unintended pregnancies—more than one million births—are publicly funded, and the proportion tops 80 percent in a couple of states. The cost of those births, and the potential gross saving from helping women to avert them, is estimated at $11.1 billion. 

“Investing in publicly funded family planning to help women avoid unintended pregnancy has a proven track record, says Sonfield. “In the absence of the services provided at publicly funded family planning centers, the costs of unintended pregnancy would be 60 percent higher than they are today.”  In a similar study, Emily Monea and Adam Thomas of the Brookings Institution found that:

The estimates of the cost to taxpayers of providing medical services to women who experience unintended pregnancies and to the infants who are born as a result of such pregnancies range between $9.6 and $12.6 billion per year, and average $11.3 billion. The estimates of the public savings that would result if these unintended pregnancies were prevented range from $4.7 billion to $6.2 billion per year, and average $5.6 billion.

“Like Sonfield and colleagues,” stated Thomas and Monea, “we find that the potential public savings from preventing unintended pregnancy are enormous.”

“Our results suggest that if unintended pregnancies could be eliminated altogether, the resulting savings on taxpayer-financed medical care alone would approach the amount that the federal government spends on Head Start each year. Policymakers should protect and even increase investments in such proven cost-saving strategies as publicly subsidized family planning services and evidence-based teen pregnancy prevention programs.”

Remember: We are talking here about assisting women in avoiding pregnancies which they do not intend, do not want, and/or for which they are not prepared in the first place. 

In its findings, the IOM not only rigorously considers the evidence, it also cites numerous other reports recommending the same:

The IOM Committee on Women’s Health Research recently identified unintended pregnancy to be a health condition of women for which little progress in prevention has been made, despite the availability of safe and effective preventive methods (IOM, 2010b). This report also found that progress in reducing the rate of unintended pregnancy would be possible by “making contraceptives more available, accessible, and acceptable through improved services (IOM, 2010b). Another IOM report on unintended pregnancy recommended that “all pregnancies should be intended” at the time of conception and set a goal to increase access to contraception in the United States (IOM, 1995). Healthy People 2020 (HHS, 2011a), which sets health goals for the United States, includes a national objective of increasing the proportion of pregnancies that are intended from 51 to 56 percent. In addition, Healthy People 2020 Effective Interventions sets goals to increase the number of insurance plans that offer contraceptive supplies and services, to reduce the proportion of pregnancies conceived within 18 months of a previous birth, and to increase the proportion of females or their partners at risk of unintended pregnancy who used contraception during the most recent sexual intercourse (HHS, 2011a).

Medical and scientific evidence is, alas, not sufficient for the anti-choice community, which would clearly prefer women get pregnant intentionally or not–whether in consensual sexual relationships or through rape or incest, whether or not their own health and well-being will be put at stake–and then force them to carry said pregnancies to term.  And in keeping with that, they must reject all evidence that undermines their agenda.

So in response to the IOM evidence, they are deploying the three most-frequently repeated and misleading arguments to rally their troops.

Misleading Argument #1: Health-care Reform Will Fund Abortion.

A central strategy of the anti-choice movement is to constantly redefine and confuse issues. And one of the most prevalent tactics is to repeat, endlessly, the lie that contraceptives cause abortion.  Today, the Family Research Council did just that when it  bemoaned the possibility that contraceptives might be included with no co-pay.

An FRC release stated that health care reform “also requires that “preventive care services for women,” without any co-pay from patients, be covered by all insurance plans based on Department of Health and Human Services (HHS) recommendations.”  (This is actually not true, as HHS has as yet not adopted the IOM recommendations, but I suppose FRC figures that when if they are going to lie, they might as well go full bore.)

FRC then went on to state that: “health plans will be required to cover drugs that can prevent implantation, such as Plan B, and even the new drug, ella, that, chemically like RU-486, can destroy implanted embryos.”  As noted by medical experts on the IOM panel during a press call today, and as clear from abundant evidence from any number of actual medical organizations, there is simply no evidence that emergency contraceptive methods “destroy implanted embryos,” that is not their mode of action, and as per medical definitions, a fertilized egg that has not implanted does not constitute a pregnancy in any case. In fact, there are no tests to confirm “fertilization,” and roughly half of all fertilized eggs do not implant in the first place and are flushed out during menstruation.

Misleading Argument #2: It Violates My Conscience!

FRC’s Director of its Center for Human Dignity, Jeanne Monahan, stated today on National Public Radio and in other press outreach that inclusion of birth control will “undermine the conscience rights of many Americans.”

I’m at a loss as to what group the statement “many Americans” includes, since more than 99 percent of all women ages 15 to 44 who have ever had sexual intercourse have used at least one contraceptive method. Overall, 62 percent of the 62 million women ages 15 to 44 are currently using a method of contraception. So the vast majority of women in the United States, whether Catholic, Protestant, Evangelical, Jewish, Muslim, Atheist, Agnostic or of other faith traditions use contraception. I believe that FRC staff may be living in another country, or perhaps, as they say, on another planet.

What FRC doesn’t want you to know is that polling proves them wrong. A national poll conducted in May of this year, found that 88 percent of voters, including four in five Republicans, support women’s access to contraception. Most Americans–using common sense–agree that improving women’s access to contraception is a more effective way to reduce the number of abortions than enacting more restrictive abortion laws.

Moreover, we don’t need any more “conscience” clauses and I sincerely hope that advocacy groups and others will push hard on HHS against yet another gratuitous conscience provision.  We have more than enough provisions that now enable professionals who trained for and accepted the role of physician or pharmacist to beg off doing the job for which they signed up whenever it comes to providing reproductive health care to women. We don’t need any more.  Suffice it to say it not only violates medical ethics, but it also violates the consciences and rights of all women who depend on the medical system to… deliver medical care.

Misleading Argument #3: Inclusion of Contraception Requires “Others” to Foot the Bill.

Most insurance plans today already cover contraceptive supplies to some degree.  The change is not that coverage will be included for the first time ever. It is that contraceptive supplies will become more affordable and therefore both more accessible and more reliable because unaffordable co-pays will be eliminated. A 2010 Planned Parenthood survey found that one in three women voters have struggled to pay for prescription birth control at some point, and have used it inconsistently as a result.

In fact, as pointed out today in a New York Times op-ed authored by Vanessa Cullins, vice president of medical affairs at Planned Parenthood Federation of America, “When the federal government offered full coverage of birth control to all federal employees in 1998, it experienced no increase in costs. In fact, by some estimates it costs employers more not to provide contraceptive coverage in employee health plans.”

More to the point, we are talking about plans into which people are paying premiums with their own funds. I pay a premium each month for my health insurance policy.  I don’t remember FRC offering to pay it for me. What they want to do is lay the (untruthful) groundwork for the same misleading arguments they make regarding abortion care, i.e. that if there is any government money anywhere in the system subsidizing even one single person’s insurance coverage, it “taints” the entire insurance pool.  It’s a ridiculous argument for abortion care and a ridiculous argument for contraceptive care and deserves to be ignored as the baseless claim that it is.

What others do foot the bill for, as illustrated above, is the high cost of unintended pregnancies that result from current contraceptive costs that are too high especially for low-income women at risk of unintended pregnancy.  But since those costs are borne first and most dearly, in isolation, by women who are in effect forced to carry unintended and untenable pregnancies to term, and then by all of us across the population as “hidden” costs, it is easier to mislead by saying that suddenly a burden will be laid at the feet of the apparently less than one-half of one percent of the population FRC and others purport to represent.

Our country, our health, and our rights are best served when legitimate evidence is used as a basis for sane policy.  It’s time to end the ideological was on women’s health care, starting with ensuring HHS adopts the IOM recommendations.  In full.

Various organizations are circulating petitions to HHS in support of the IOM recommendations, including:

Planned Parenthood Federation of America: No co-pay birth control for millions of women in America is within reach. Right now, the Dept. of Health and Human Services is deciding whether or not to require new insurance plans to cover birth control with no co-pays. We’re almost there — add your name to Planned Parenthood’s petition: http://ppact.org/iomfb

The National Women’s Law Center

and

NARAL Pro-Choice America