October 2, 2015 — The American Civil Liberties Union on Thursday filed a federal lawsuit against a Catholic health system for denying appropriate emergency care to patients experiencing incomplete miscarriages, USA Today reports (Szabo, USA Today, 10/1).
According to Al Jazeera America, the case draws attention to the Ethical and Religious Directives for Catholic Health Care Services (Hayoun, Al Jazeera America, 10/1). The directives ban Catholic facilities from performing sterilizations, abortions and certain other procedures. Since the early 2000s, when the Vatican sought stricter enforcement of the directives, the number of Catholic hospitals in the U.S. has grown, in part because of mergers with secular facilities. The number of Catholic hospitals increased by 16% from 2001 to 2011 (Women's Health Policy Report, 1/6).
According to ACLU attorney Alexa Kolbi-Molinas, ten of the largest U.S. hospital systems have a Catholic affiliation, and about one in every nine hospital beds in the U.S. resides in a Catholic facility. ACLU's lawsuit addresses one such health system, Trinity Health Corporation, which is one of the largest Catholic hospital groups in the country (USA Today, 10/1). It includes more than 80 hospitals located across 21 states.
In July, a federal judge dismissed another ACLU lawsuit involving one of Trinity Health's subsidiaries, Mercy Health Partners, in a case that involved a woman who was repeatedly turned away from the hospital while miscarrying (Al Jazeera America, 10/1). The judge ruled that federal courts in Michigan do not have control over policy mandates made by the U.S. Conference of Catholic Bishops. ACLU is appealing the case (Women's Health Policy Report, 7/7).
ACLU in the latest lawsuit alleges that Trinity Health violated the Emergency Medical Treatment and Active Labor Act by refusing to provide "appropriate emergency care to women suffering pregnancy complications, including miscarriages." Under EMTALA, providers must "provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to occur during the transfer of the individual from a facility" (Al Jazeera America, 10/1).
Specifically, ACLU states that the health system denied emergency abortions to at least five women who had miscarriages at one of the health system's hospitals. The women had all "suffered a preterm, premature rupture of membranes," a condition that almost always results in fetal death and which can endanger the woman's life if not treated appropriately, USA Today reports. According to the complaint, the women who were denied emergency abortions suffered complications such as hemorrhaging, life-threatening infections and severe pain.
Sarah Prager -- an associate professor of obstetrics and gynecology at the University of Washington, who is not involved in the case -- explained that abortion is the standard of care in these situations because women with the complication are at a high risk of infection and bleeding. "If you delay action until there is no longer a fetal heartbeat, that can often put the mother’s life at risk or risk her future fertility," she said (USA Today, 10/1).
Kolbi-Molinas said, "Patient welfare must be the No. 1 concern of health care professionals ... Every pregnant woman who enters an emergency room should be guaranteed that she will get the care she needs, and should not have to worry that she won't get appropriate care because of the hospital's religious affiliation" (USA Today, 10/1).
Separately, Washington state abortion-rights advocate Mary Kay Barbieri said, "Women are told, 'There's nothing we can do for your miscarriage, go home,' and think they are getting medical advice but in fact are getting religious advice." She added, "We're now beginning to understand how seriously the Catholic doctrine is affecting women in life or death issues or decisions on when to have a child" (Al Jazeera America, 10/1).
Similarly, Arthur Caplan, director of medical ethics at NYU Langone Medical Center, said hospitals need to let patients know if they will decline a certain medical procedure, noting, "If you don't state the limit of what you will or will not do, you are violating informed consent" (USA Today, 10/1).