News Law and Policy

Court Rules Catholic Hospital Can Refuse Reproductive Health Care

Jessica Mason Pieklo

A California judge ruled a Catholic hospital chain could deny tubal ligation to patients on the grounds of Catholic directives without violating anti-discrimination laws.

A California state court judge has tentatively rejected a lawsuit brought by a California woman against a Catholic hospital that has refused her request for a tubal ligation.

Rebecca Chamorro and Physicians for Reproductive Health sued Dignity Health and Mercy Medical Center in Redding, California in December 2015. Chamorro, who is eight months pregnant and scheduled to give birth at the end of January, wanted a tubal ligation at that time, according to the complaint. But Dignity Health refused Chamorro’s request and told Chamorro’s doctor that he could not perform the procedure, citing religious directives written by the United States Conference of Catholic Bishops.

Those directives state that direct sterilization is “intrinsically evil.”

That refusal, according to the complaint, amounts to sex discrimination because the prohibition against sterilization disproportionately impacts women.

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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.

Chamorro had asked the court for an order declaring that the hospital chain’s refusal violated California civil rights laws, business and professions laws, and the Health and Safety Code, as well as an injunction requiring the hospital allow the procedure.

Superior Court Judge Ernest Goldsmith denied that request in a tentative ruling last week. Chamorro’s discrimination claim is likely to fail because Dignity Health’s sterilization policy “applies equally to men and women,” Goldsmith wrote.

Goldsmith continued: “[p]laintiff can obtain the desired procedure at other hospitals that do not follow defendant’s directive.”

According to Chamorro’s attorneys, their client is still scheduled for a January 28 cesarean section at Mercy Medical, where her doctor will not be allowed to perform the tubal ligation procedure. Despite last week’s order tentatively rejecting Chamorro’s claims, Elizabeth Gill with the ACLU of Northern California said in a statement the rest of their case would move forward.

“We will continue to litigate the case on behalf of Physicians for Reproductive Health,” Gill said. “We believe that the courts will ultimately ensure that government-funded hospitals serving the general public and people of all faiths cannot use religion to discriminate, interfere in the doctor-patient relationship, or deny women basic healthcare.”

News Health Systems

Illinois Bill: Catholic Hospitals Must Inform Patients Where They Can Obtain Denied Care

Nicole Knight Shine

The legislation amends the state Health Care Right of Conscience Act to require religiously affiliated facilities to inform patients in writing about health-care providers "who they reasonably believe" offer procedures that the institutions will not perform.

Religiously affiliated hospitals in Illinois must advise patients where they can find treatments that the institutions won’t offer on religious grounds, under new legislation sitting on the governor’s desk.

The patient information measure, SB 1564, comes at a time when almost about 30 percent of hospital beds in the state—and one in six in the nation—are in Catholic institutions that bar certain reproductive health and end-of-life treatments, according to recent figures from the advocacy group MergerWatch.

The legislation amends the state Health Care Right of Conscience Act to require religiously affiliated facilities to inform patients in writing about health-care providers “who they reasonably believe” offer procedures that the institutions will not perform, or to refer or transfer patients to those alternate providers. Hospitals must do this in response to patient requests for such procedures. The legislation cleared the state house on a 61-54 vote and the senate on a 34-19 vote. Democrats control both chambers.

The office of Illinois Gov. Bruce Rauner (R) did not respond to request for comment on whether he would sign the bill.

Catholic facilities often follow U.S. Conference of Catholic Bishops religious directives  that generally bar treatments such as sterilization, in vitro fertilization, and abortion care. The federal Church Amendment and some state laws protect these faith-based objections.

Even so, growing concerns over facilities that deny treatment that patients want—and that doctors advise—has recently prompted lawmakers in Illinois, Michigan, and Washington state to advance patient information measures.

A Michigan lawsuit now on appeal alleges a Catholic facility caused unnecessary trauma by denying a patient treatment. In 2010, then-18-weeks pregnant Tamesha Means arrived at a Catholic hospital, Mercy Health Partners in Muskegon, Michigan, bleeding and miscarrying. On two occasions, the hospital turned away Means, as Rewire reported. It wasn’t until Means started delivering on her third hospital visit that she received treatment.

The Illinois legislation represents a compromise among the Illinois Catholic Health Association, the Illinois State Medical Society, and the Illinois affiliate of the American Civil Liberties Union (ACLU), representatives from the groups told Rewire.

Lorie Chaiten, director of the ACLU of Illinois’ Reproductive Rights Project, said in an online statement that the legislation “protects patients when health care providers exercise religious refusals.”

Research indicates that patients aren’t always aware that religiously affiliated facilities don’t provide a full spectrum of reproductive health services, according to a 2014 paper published in Contraception.

Patrick Cacchione, executive director of the Illinois Catholic Health Association, said the organization, which represents the state’s 43 Catholic hospitals, opposed an early version of the bill requiring religious health-care facilities to give patients a written list of known medical providers that perform the treatments that the religious institutions oppose.

Cacchione said such a direct referral would have made Catholic hospitals “complicit.”

“We will provide all the information you need, but we will not make a direct referral,” he told Rewire in a phone interview Monday. The new version of the legislation does not require hospitals to confirm that providers perform the treatments; the facilities must only have a “reasonable belief” that they do.

He said Illinois hospitals are already doing what the legislation now requires.

Approximately one in five doctors surveyed at religiously affiliated institutions “had experienced conflict with the institution over religiously based patient care policies,” according to the 2010 paper, “Religious Hospitals and Primary Care Physicians: Conflicts Over Policies for Patient Care,” published in the Journal of General Internal Medicine.

In an emailed statement, Dr. Thomas M. Anderson, a Chicago radiologist and president of the Illinois State Medical Society, told Rewire, “The Society strongly believes physicians should be able to exercise their right of conscience and changes made to SB 1564 protect that right.”

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.