The American Civil Liberties Union filed a lawsuit last week against Dignity Health, claiming that the Catholic hospital network is unlawfully denying women’s access to contraception based on religious doctrine.
The suit is the latest in an ongoing conflict over whether Catholic hospitals, which are growing in number, can prevent doctors from performing certain types of reproductive health services while receiving state and federal funding. The ACLU filed the suit on behalf of Physicians for Reproductive Health, a national nonprofit made up of doctors, and Rebecca Chamorro, a patient at Dignity Health’s Mercy Medical Center Redding in California.
Chamorro is eight months pregnant, and scheduled to give birth by cesarean section at the end of January. Already a mother of two, Chamorro decided she did not want any more children after the birth of her third child. Chamorro, in consultation with her doctor, elected to have a tubal ligation immediately following her c-section, according to the complaint.
Chamorro did not respond to a request for an interview.
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But Dignity Health told Chamorro’s doctor that he could not perform the procedure, citing religious directives written by the United States Conference of Catholic Bishops. The directives state that direct sterilization (along with abortion, euthanasia, and assisted suicide) is “intrinsically evil.”
One of the most popular forms of contraception, tubal ligation (or “getting your tubes tied”) is used by more than 30 percent of married women of reproductive age in the United States, the ACLU noted in court papers. The procedure involves tying and cutting the fallopian tubes so that the egg cannot move into the uterus. The best time to perform the procedure is directly after a woman gives birth. It takes one to two minutes and doesn’t require additional equipment or recovery time.
Redding is a rural town in Northern California, and the closest hospital with a labor and delivery ward that does not follow Catholic directives is 70 miles away.
“This is really about the hospital interrupting the doctor-patient relationship,” Elizabeth Gill, senior attorney with the ACLU of Northern California, told MSNBC host Melissa Harris-Perry. “Really it’s as if the Catholic bishops are standing in the operating room and staying the doctor’s hand, preventing him from providing our client with the care she needs.”
Dignity Health is the fifth-largest health system in the nation and the largest hospital provider in California. Each year it receives millions in government grants, Medicare and Medicaid reimbursements, and government programs, according to recent tax filings.
“In general, it is our practice not to provide sterilization services at Dignity Health’s Catholic facilities in accordance with the Ethical and Religious Directives for Catholic Health Care Services (ERDs) and the medical staff bylaws,” a Dignity Health spokesperson wrote in a statement to Rewire.
“As such, tubal ligations are not performed in Catholic hospitals. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available,” the spokesperson wrote. She added that the company does not comment on matters of pending litigation.
Dignity Health sometimes provides tubal ligations for contraceptive purposes, but ACLU lawyers say the hospital’s criteria for when they will and will not allow the procedure is not clear. In 2015, for instance, the hospital allowed a tubal ligation for another patient at Mercy Medical Center Redding after the ACLU threatened to sue.
Faced with a similar demand letter on behalf of Chamorro at the beginning of December, Dignity Health would not budge.
Chamorro’s OB-GYN, Dr. Samuel Van Kirk, estimated in the complaint that he had at least 50 patients over the past eight years who wanted tubal ligations but were denied them based on Mercy Medical’s sterilization policy or Catholic doctrine, according to court papers. A receptionist at Van Kirk’s office said he had no comment and referred us to the ACLU.
“We have no idea of the scope of this problem nationally because we have no idea of the denominator of how many patients are being denied tubal ligations,” Dr. Pratima Gupta, a Bay Area obstetrician and a reproductive health advocacy fellow with Physicians for Reproductive Health, told Rewire in an interview. She added that many patients don’t realize they will not be able to access comprehensive prenatal and postnatal care at a Catholic hospital; even if they do, in rural areas patients have nowhere else to turn.
Because Chamorro’s due date is approaching, the ACLU also filed an emergency motion asking the court to issue a temporary restraining order that would prevent the hospital from interfering with the ligation. On Tuesday, the judge denied the ACLU’s request, saying he wanted more time to consider the issue, Gill said. The ACLU is re-filing the brief.
“We are pleased by the court’s decision to deny the ACLU’s request for the temporary restraining order which will allow Dignity Health to continue to operate consistent with the Ethical and Religious Directives for Catholic Health Care Services,” Dignity Health said in a statement to Rewire.
If the judge does not grant Chamorro temporary relief, she will not be able to have a tubal ligation after the birth of her child later this month. If she still chooses to pursue sterilization, she will need to have a second surgery under general anesthetic at another hospital, Gill told Rewire.
The ACLU’s lawsuit will proceed as planned even if Chamorro is not able to have the tubal ligation later this month.
“We hope that this case sets a precedent that hospitals that are open to the general public and that receive government funding can’t invoke religious doctrine as an excuse to discriminate,” Gill told Rewire.
A new report from Human Rights Watch (HRW) documents the deaths of 18 migrants in Immigration and Customs Enforcement custody from mid-2012 to mid-2015. In some cases, the deaths were likely preventable and the result of “substandard medical care and violations of applicable detention standards.”
These are notthe only deaths that occurred, however. ICE acknowledges on its website that31 deaths have occurred between May 2012 and mid-June of this year. It is unclear whether ICE intends to release information about the additional 13 deaths that have occurred.
Even so, these new findings add to a growing body of evidenceshowing what HRW calls “egregious violations” of medical care standards in detention centers. A February report found such violations contributed to at least eight in-custody deaths over a two-year period.
The public is just beginning to learn more about the deeply rooted problem, Clara Long, a researcher with Human Rights Watch and the lead researcher on the report, explained to Rewire. Long referenced an ongoing investigation by reporter Seth Freed Wesslerat theNation, which explores the numerous deaths that have occurred inside immigrant-only prisons.
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Though the death reviews released by ICE provide further insight into the conditions inside detention centers, the bigger concern among researchers and advocates is what they don’t know. For example, HRW worked with two independent medical experts to review the 18 death reviews released by ICE. The experts concluded that substandard medical care “probably contributed to the deaths of seven of the 18 detainees, while potentially putting many other detainees in danger as well.” Long told Rewire that the information provided by ICE simply wasn’t enough for their independent medical experts to determine that all 18 deaths were related to inadequate medical care, but that it was “likely.”
So there is the larger, systemic issue of inadequate medical care. Researchers at HRW also don’t know exactly how ICE collects information or why the agency releases information when it does. There’s also the core of the issue, as Long noted to Rewire: that the United States “unnecessarily” detains undocumented immigrants in “disturbing conditions” for prolonged periods of time.
Major Failures Lead to Death
The new HRW report identified two of the most dangerous ways ICE is failing migrants in detention: not following up on symptoms that require assistance and not responding quickly to emergencies. Both failures are illustrated by the case of 34-year-old Manuel Cota-Domingo, who died of heart disease, untreated diabetes, and pneumonia after being detained at the Eloy Detention Center in Eloy, Arizona.
ICE’s death review for Cota-Domingo suggests there was a language barrier and that Cota-Domingo was worried about having to pay for health care, which isn’t surprising given that detention centers make migrants pay for things like phone calls to their attorneys and family members. HRW asked Corrections Corporation of America, the company that runs the Eloy Detention Center, about potential fees for medical care, and it said there are no fees for such services at Eloy. For whatever reason, Cota-Domingo was not aware he had a legal right to access the medical care he needed.
When it became clear to his cellmate that Cota-Domingo was in serious need of medical attention and was having trouble breathing, the cellmate “banged on a wall to get a guard’s attention. His cellmate said he did that for three hours before anyone came to help,” Long said. The researcher told Rewire the death report outlines how investigators checked to see if the banging would have been audible to correctional officers. It was. “Once [the cellmate] got their attention, our medical experts said this was something that should have been followed up on immediately, but the nurse decided to wait several hours before doing anything. All of these sluggish responses went on for eight hours. This is not how you treat an emergency,” Long said.
As Human Rights Watch noted in the report, “When officers finally notified medical providers of his condition, they delayed evaluating him and finally sent him to the hospital in a van instead of an ambulance. Both medical experts concluded that the combination of these delays likely contributed to a potentially treatable condition becoming fatal.”
In other death reviews by ICE, the agency’s own records show “evidence of the misuse of isolation for people with mental disabilities, inadequate mental health evaluation and treatment, and broader medical care failures.” Tiombe Kimana Carlos, Clemente Mponda, and Jose de Jesus Deniz-Sahagun all committed suicide in ICE detention after showing signs of “serious mental health conditions.” HRW’s independent experts determined that “inadequate mental health care or the misuse of isolation may have significantly exacerbated their mental health problems.”
It’s important to note that none of the death reviews released by ICE admit any wrongdoing, and that’s primarily because they don’t seek to examine whether medical negligence was at play. The reports simply present information about the deaths.
“There is no conclusion drawn, really,” Long told Rewire. “There’s one [report] in particular that even goes beyond that; it doesn’t even take into account the quality of care that led to the death, even though it’s clearly an issue of quality of care. That raises the question: What is the report for? ICE doesn’t conclude the cause. If you read [the death reviews], you can see there’s a lot of detailed information included in them that allows someone with expertise in correctional health care and who is familiar with how these systems should work, to make an assessment about whether care contributed to death, but that’s not something ICE does—at least not in the information we are able to access.”
ICE’s Murky Death-Review Process
In a statement to Rewire, ICE explained that when a person dies while in the agency’s custody, their “death triggers an immediate internal inquiry into the circumstances.” The summary document ICE releases to the public is “the result of exhaustive case reviews conducted by ICE’s own Office of Detention Oversight (ODO), which was established in 2009 as part of the agency’s comprehensive detention reforms,” Lori K. Haley, a spokesperson with ICE, told Rewire in a prepared statement.
In fact, the ODO was created as a direct result of a series of reforms from the Obama administration after reports of human rights abuses and deaths in detention centers. The death review it produces includes a mix of findings from ICE’s own investigators and from a Beaumont, Texas-based company called Creative Corrections.
According to its website, Creative Corrections serves “local, state and federal government agencies,” offering “training, advising, professional management and consulting services” in “correctional, law enforcement, rule of law, and judicial systems.” The company contracts include the Department of Homeland Security (DHS).
“From what we can see from the documents, both ICE and Creative Corrections interview various people involved, check records, do what seems to be a pretty robust investigation for the death review,” Long said. “Unfortunately, in the set of death reviews that we used for this investigation, [the public doesn’t] have access to the Creative Corrections reports or any of the exhibits that go along with them.”
As the ICE spokesperson noted, the summary documents are typically written by ICE staff. The documents released to the public do not include medical records, full reports from Creative Corrections, or any exhibits that would provide more insight into the apparent medical neglect resulting in an estimated 161 people dying in ICE custody since October 2003. Six migrants have died in ICE custody since March 2016, two of whom died at two different detention centers in the same week. The causes of these most recent deaths—and whether they can be attributed to medical neglect—is still unknown.
“If we had access to all of the information gathered during these investigations, including the reports from Creative Corrections, they would be very rich sources of information,” Long said.
Long and other researchers are also hoping for more information regarding the deaths that happen just after migrants are released from ICE custody. Teka Gulema, an Ethiopian asylum seeker detained at Etowah County Detention Center in Gadsden, Alabama, was released from ICE custody in November 2015 while in the hospital after becoming paralyzed from a bacterial infection acquired in detention. He died in January.
“One concern we have, and it’s a very big fear, is that there are multiple reports of folks who are released from ICE custody while in critical condition,” Long said. “When they die, they are no longer counted as in-custody deaths [by ICE]. We’re worried that’s a loophole being exploited—and for obvious reasons, we don’t have a number in terms of how often this is happening.”
The researcher said she has “no idea” when or why ICE decides to release information, including death reviews.
ICE did not respond to Rewire‘s request for information about its schedule or process for releasing such information.
“Maybe they released the 18 reports because they were cleared for release. Maybe a congressional office asked for them. Maybe they decided to be transparent. It could have been a [Freedom of Information Act] request from the ACLU. I wish I knew, but we really have no idea who decides—or why they decide—to release information, especially without making anyone aware that it’s been released,” the researcher told Rewire.
In April, ICE posted a series of spreadsheets about the inner workings of the detention system on their website that Long said provided a lot of information about how detention operates. The spreadsheets were removed from the site in a matter of days, too soon for many researchers—including HRW—to download them all.
“It’s a big system. We still don’t totally know how it works, which in itself is a major problem,” Long said. “One of the biggest lessons we’ve learned is to always check the ICE website. You never know what you’ll find.”
Reporting for the Nation, Michelle Chen recently noted that “migrants are warehoused under convoluted partnerships involving private vendors and state, local, and federal agencies. Homeland Security may contract out security duties to, or use facilities owned by, private vendors—dominated by Corrections Corporation of America (CCA) and GEO Group—with preordained headcount distributions ranging from 285 in Newark to more than 2,000 in San Antonio.”
Long told Rewire that 80 percent of migrants currently in detention are in what is considered “mandatory detention,” which, according to the Immigrant Legal Resource Center, means that “non-citizens with certain criminal convictions must be detained by ICE. People who are subject to mandatory detention are not entitled to a bond hearing and must remain in detention while removal proceedings are pending against them.” This also means that those in mandatory detention aren’t allowed to have an individual assessment by ICE of their case, “so they just sit in immigration detention indefinitely,” Long said.
“This system doesn’t work. We’re detaining far too many people for far too long and not determining on an individual level if they should be detained in the first place, taking into account all of the options available,” Long said. Options include being monitored by ICE using telephonic and in-person reporting, curfews, and home visits.
Long joins a long list of undocumented community members, researchers, organizers, activists, and other advocates pushing for the Obama administration—and whoever comes after it—to see detention as a last resort, rather than the only resort.
“We spend a lot of time talking about the disturbing conditions in detention centers—that’s what our report is about. But step one requires taking a step back and rethinking this system and how it’s unnecessary and also abuses vulnerable peoples’ rights,” Long said. “In terms of the legality of treating people this way, under U.S. and international law, people who are detained are entitled to medical treatment. The state has an obligation to provide care to this population. They are failing, and people are dying.”
But the two Republicans also have something else in common: They are brazenly anti-immigrant.
Despite a misleading article from the Daily Beast asserting that Pence has had a “love affair with immigration reform” and has “spent his political career decrying anti-immigrant rhetoric,” the governor’s record on immigration tells a different story.
Let’s take a look at Trump’s “xenophobic” and “racist” campaign thus far, and how closely Pence’s voting aligns with that position.
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Despite being called “racist” by members of his own party, Trump’s immigration plan is largely consistent with what many Republicans have called for: a larger border wall, increasing the number of Immigration and Customs Enforcement (ICE) officers, requiring all U.S. companies to use E-Verify to check the immigration status of employees, increasing the use of detention for those who are undocumented and currently residing in the United States, and ending “birthright citizenship,” which would mean the U.S.-born children of undocumented parents would be denied citizenship.
Again, Trump’s proposed immigration policies align with the Republican Party’s, but it is the way that he routinely spreads false, damaging information about undocumented immigrants that is worrisome. Trump has repeatedly said that economically, undocumented immigrants are “killing us”by “taking our jobs, taking our manufacturing jobs, taking our money.”
Market Watch, a publication focusing on financial news, reported that this falsehood is something that a bulk of Trump supporters believe; two-thirds of Trump supporters surveyed in the primaries said they feel immigration is a burden on our country “because ‘they take our jobs, housing and health care.'” This, despite research that says deporting the 11 million undocumented immigrants who currently call the United States home would result in a “massive economic hit” for Trump’s home state of New York, which receives $793 million in tax revenuefrom undocumented immigrants. A recent report by the Institute on Taxation and Economic Policy also found that at the state and local level, undocumented immigrants nationwide collectively pay an estimated $11.6 billion each year in taxes.
Wendy Feliz, a spokesperson with the American Immigration Council, succinctly summarized Pence’s immigration approach to Rewire, saying on Monday that he “basically falls into a camp of being more restrictive on immigration, someone who looks for more punitive ways to punish immigrants, rather than looking for the positive ways our country can benefit from immigrants.”
After Trump’s announcement that Pence would be his running mate, Immigration Impact, a project of the American Immigration Council, outlined what voters should know about Pence’s immigration record:
Pence’s record shows he used his time in Congress and as the Governor of Indiana to pursue extreme and punitive immigration policies earning him a 100 percent approval rating by the anti-immigration group, Federation for American Immigration Reform.
In 2004 when Pence was a senator, he voted for the “Undocumented Alien Emergency Medical Assistance Amendments.” The bill failed, but it would have required hospitals to gather and report information on undocumented patients before hospitals could be reimbursed for treating them. Even worse, the bill wouldn’t have required hospitals to provide care to undocumented patients if they could be deported to their country of origin without a “significant chance” of their condition getting worse.
Though it’s true that in 2006 Pence championed comprehensive immigration reform, as the Daily Beast reported, the reform came with two caveats: a tightening of border security and undocumented immigrants would have to “self-deport” and come back as guest workers. While calling for undocumented immigrants to self-deport may seem like the more egregious demand, it’s important to contextualize Pence’s call for an increase in border security.
This tactic of calling for more Border Patrol agents is commonly used by politicians to pacify those opposed to any form of immigration reform. President Obama, who has utilized more border security than any other president, announced deferred action for the undocumented in June 2012, while also promising to increase border security. But in 2006 when Pence was calling for an increase in border security, the border enforcement policy known as “Operation Gatekeeper” was still in full swing. According to the American Civil Liberties Union (ACLU), Operation Gatekeeper “concentrated border agents and resources along populated areas, intentionally forcing undocumented immigrants to extreme environments and natural barriers that the government anticipated would increase the likelihood of injury and death.” Pence called for more of this, although the undocumented population expanded significantly even when border enforcement resources escalated. The long-term results, the ACLU reported, were that migrants’ reliance on smugglers to transport themincreased and migrant deaths multiplied.
According to the Office of Refugee Resettlement, “when a child who is not accompanied by a parent or legal guardian is apprehended by immigration authorities, the child is transferred to the care and custody of the Office of Refugee Resettlement (ORR). Federal law requires that ORR feed, shelter, and provide medical care for unaccompanied children until it is able to release them to safe settings with sponsors (usually family members), while they await immigration proceedings.”
While we feel deep compassion for these children, our country must secure its borders and provide for a legal and orderly immigration process …. Failure to expedite the return of unaccompanied children thwarts the rule of law and will only continue to send a distorted message that illegally crossing into America is without consequence.
In the four days since Pence was named Trump’s running mate, he’s also taken a much harsher stance on Muslim immigration. Back in December when Trump called for a “total and complete shutdown of Muslims entering the United States,” Pence tweeted that banning Muslims from entering the United States was “offensive and unconstitutional.” However, on Friday when Pence was officially named Trump’s VP pick, he told Fox News’ Sean Hannity, “I am very supportive of Donald Trump’s call to temporarily suspend immigration from countries where terrorist influence and impact represents a threat to the United States.”
Wendy Feliz of the American Immigration Council told Rewire that while Pence’s rhetoric may not be as inflammatoryas Trump’s, it’s important to look at his record in relation to Trump’s to get a better understanding of what the Republican ticket intends to focus on moving into a possible presidency. Immigration, she said, is one of the most pressing issues of our time and has become a primary focus of the election.
“In a few days, we’ll have a better sense of the particular policies the Republican ticket will be pursuing on immigration. It all appears to point to more of the same, which is punitive, the punishing of immigrants,” Feliz said. “My greatest fear is that this ticket doesn’t seem to realize immigrants are actually an incredible resource that fuels our country. I don’t think Trump and Pence is a ticket that values that. An administration that doesn’t value immigrants, that doesn’t value what’s fueled our country for the past several hundred years, hurts all of us. Not just immigrants themselves, but every single American.”