News Law and Policy

ACLU Accuses Another Catholic Hospital in Michigan of Compromising Patient Care

Jessica Mason Pieklo

Genesys Health System has stopped offering tubal ligations to cesarean section patients because such procedures violate Catholic doctrine, according to a letter sent to to Michigan’s Department of Licensing and Regulatory Affairs by the American Civil Liberties Union.

Doctors and administrators at a Catholic hospital in Grand Blanc, Michigan, are unnecessarily putting pregnant patients at risk by refusing to provide tubal sterilization to cesarean section patients and should be investigated by the state, according to attorneys for the American Civil Liberties Union.

The allegations are set forth in a letter sent this week to Michigan’s Department of Licensing and Regulatory Affairs. The ACLU of Michigan has received multiple complaints about a new hospital policy at Genesys Health System, according to the letter. Genesys, a Catholic hospital that adheres to the Directives for Catholic Health Care Services set out by the United States Conference of Catholic Bishops (USCCB), declared that as of November 1, 2014, its physicians would be forbidden from performing tubal ligations, the surgical sterilization process that involves severing and tying the fallopian tubes.

The USCCB opposes sterilization as a morally unacceptable means of regulating reproduction.

Tubal sterilization is the most common form of permanent birth control in the world. According to the American Congress of Obstetricians and Gynecologists (ACOG), the standard of medical care for pregnant patients who deliver via a c-section is to perform the sterilization procedure immediately following delivery. This is preferable to a patient undergoing a second, additional surgical procedure, per ACOG officials.

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The ACLU claims that since Genesys’ tubal ligation ban has taken effect, patients who deliver via a c-section at Genesys and want their tubes tied are now forced to wait at least six weeks for their uterus to heal from the c-section before undergoing a second surgery, at a different location, to tie their fallopian tubes, exposing them to unnecessary risk and expense.

The ACLU’s letter details the stories of two pregnant Michigan patients, both of whom were denied tubal ligations at Genesys.

As a result of the policy change one patient, who was nine months pregnant and had planned, along with her doctor, to have her fallopian tubes tied immediately following her planned cesarean delivery, was informed 12 days before her surgery that she would be forced to have her tubes tied later in a different facility.

The only other option for Genesys patients who want or need a tubal ligation but cannot afford the expense of an additional procedure or are uneasy about the risk of an additional surgery is to seek an exception from the policy from hospital administration. But according to the ACLU, Genesys’ exemption policy is so impractical it may as well not exist.

Another patient, identified by the ACLU as “Mrs. B,” had scheduled a c-section at Genesys in November 2014 and planned to have a tubal ligation when the hospital notified her it would not honor her request. Mrs. B’s doctor only has admitting privileges at Genesys, which means Mrs. B had to choose between delivering elsewhere without her doctor, delivering at Genesys but without getting her tubes tied, or seeking an exemption from Andrew Kruse, Genesys’ vice president of mission integration. Kruse is not a doctor.

Before Mrs. B was able to contact Kruse, her water broke and she delivered her baby a week early, but without the tubal ligation her doctor was otherwise willing to perform.

The ACLU’s letter claims that as a result of Genesys’ policy change, at least two Genesys doctors have said they will now counsel c-section patients who want a tubal ligation to obtain a non-surgical form of sterilization, called Essure, rather than take the risk that accompanies a second surgical procedure.

That’s despite the fact that there is what the ACLU calls a “serious and ongoing debate” in the medical community about the effectiveness of Essure sterilization and concerns from some about its overall safety.

Essure sterilization includes placing soft, flexible inserts into the fallopian tubes. Over time, tissue forms around the inserts, and the buildup of tissue creates a barrier that prevents sperm from finding eggs, preventing conception.

Genesys’ policy reversal is not the first time Catholic hospitals in Michigan have been accused of prioritizing religious beliefs over patient health.

In 2010, a Catholic hospital in Muskegon failed to provide appropriate treatment and information to a woman named Tamesha Means over concerns treating Means’ miscarriage would be an improper facilitation of an abortion.

The hospital turned Means away three times. During Means’ third visit and after hospital staff had again instructed her to go home, she began to deliver in the waiting room. It was only then that hospital staff began to treat Means.

In December of 2013, the ACLU of Michigan and the ACLU sued the USCCB on behalf of Means.

In 2012, according to the ACLU, a Catholic hospital in Detroit failed to treat a woman who came to the hospital with vaginal bleeding and was diagnosed with an “inevitable abortion.” The patient was forced to leave the hospital in the middle of her miscarriage and seek medical treatment at another facility.

The ACLU demanded state regulators investigate Genesys’ ban on tubal ligation, which they claim violates both state and federal law.

The issue of religious directives interfering with patient health care extends beyond Michigan. Ten of the 25 largest hospital systems in the United States are Catholic-sponsored, and nearly one of nine hospital beds in the country is in a Catholic facility, according to the ACLU.

Analysis Politics

Paul Ryan Uses Falsehoods Behind Texas HB 2 to Push Yet Another Abortion Restriction

Ally Boguhn

In a CNN town hall Tuesday night, Paul Ryan agreed with an audience member's baseless sentiment that the Supreme Court had struck down “commonsense health and safety standards at abortion clinics" in its Whole Woman's Health v. Hellerstedt ruling.

During a CNN town hall on Tuesday night, House Speaker Paul Ryan (R-WI) pushed falsehoods about the anti-abortion provisions at the center of the recent U.S. Supreme Court decision in Whole Woman’s Health v. Hellerstedt being necessary for patient health and safety. Ryan nonsensically then used the decision as a launch point to promote House Republicans’ Conscience Protection Act, which passed in the House Wednesday evening and supposedly shields those who object to abortion from discrimination. The only things Texas’ provisions and the legislation have in common, however, is that they’re all about blocking access to abortion care.

Town hall audience member and executive director of New Jersey Right to Life Marie Tasy claimed during the event Tuesday that the Supreme Court had struck down “commonsense health and safety standards at abortion clinics,” in its landmark ruling against two provisions—the admitting privileges and surgical center requirements—of Texas’ HB 2.

“Absolutely,” Ryan said in response to Tasy’s remarks. “I agree with that.”

But the provisions of the law in question were not about keeping anybody safe. As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

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Despite this, Ryan then used the falsehood at the center of HB 2 as a call to action for yet another anti-choice restriction: the Conscience Protection Act. After fielding the question from Tasy about how anti-choice issues could be advanced in Congress in the wake of the Court’s decision, Ryan pivoted to claim that the government is “forcing people to conduct [abortion] procedures”:

Actually, tomorrow we are bringing a bill that I’ve been working on called the Conscience Protection Act. I’m pro-life. I think you probably know that. And I would like to think we could at least get consensus in this country that taxpayers shouldn’t be funding abortions. That the government shouldn’t be forcing people to conduct procedures, especially health-care workers, against their own conscience.

Our First Amendment is the right of conscience, religious freedom. Yet our own government today, particularly in California, is violating that right and not allowing people to protect their conscience rights, whether they’re Catholic hospitals or doctors or nurses. Tomorrow we’re bringing the Conscience Protection Act to the floor and passing it. It’s Diane Black’s bill. And it is to give those citizens in America who want to protect their conscience rights their ability to defend those rights. That is one thing we’re doing tomorrow to protect the conscience, because I believe we need to cultivate a culture of life. And at the very least, stop the government from violating our conscience rights.

Ryan would go on to make similar remarks the next day while speaking on behalf of the bill on the House floor, though this time he added that the “bill does not ban or restrict abortion in any way …. All it does is protect a person’s conscience.” 

As Rewire‘s Christine Grimaldi previously reported, the Conscience Protection Act would codify and expand on the Weldon Amendment. According to the Department of Health and Human Services (HHS), the amendment prohibits states that receive federal family planning funding from discriminating against any health care entity-including physicians, health-care professionals, hospitals, and insurance plans, “on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.”

The Weldon Amendment currently must be passed each year as part of annual appropriations bills.

Grimaldi noted that the act “would give health-care providers a private right of action to seek civil damages in court, should they face alleged coercion or discrimination stemming from their refusal to assist in abortion care.”

Ryan proposed similar conscience protections as part of his recently released health-care plan, though, as Grimaldi wrote, “the Conscience Protection Act goes a step further, allowing providers to sue not only for threats, but also for perceived threats.”

But those whom Ryan and his colleagues are claiming to defend already have protections that impede access to abortion care, according to critics of the measure.

Ryan, for example, suggested in both his CNN appearance and his House floor speech the next day that California’s requirement that insurance plans must cover elective abortions under “basic health services” violates “religious freedom.” But a June investigation by the HHS Office for Civil Rights into whether California’s requirement violated the Weldon Amendment rejected similar complaints by anti-choice group Alliance Defending Freedom.

“Let’s be very clear—right now, current law says that hospitals, insurers, and doctors may refuse to perform an abortion or provide coverage for abortion, which already greatly limits women’s access to legal procedures,” said Rep. Jan Schakowsky (D-IL) Wednesday, speaking after Ryan on the House floor during remarks before the Conscience Protection Act passed.

“More importantly, when a woman’s health is in danger, providers would not be required to act to protect the health of that mother. This bill would allow them to refuse to … facilitate or make arrangements for abortion if they have a moral objection to it,” continued Schakowsky. “They could also refuse to provide transportation to another hospital if a woman is in distress if that hospital provides abortions.”

Debra L. Ness, president of the National Partnership for Women & Families, explained in a statement following the passage of the legislation in the House that the measure is about blocking access to abortion. “The Conscience Protection Act is dangerous, discriminatory legislation designed to block women’s access to abortion care,” said Ness.

“For example, a hospital could rely on the Conscience Protection Act to turn away a woman in an emergency situation who needs an abortion or refuse to provide a woman information about her treatment options. This legislation is a license for providers to discriminate against women and undermine their access to essential, constitutionally protected health care,” Ness said.

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.