October 27, 2015 — The American Civil Liberties Union has filed several different types of legal challenges against Catholic hospitals that have applied the U.S. Conference of Catholic Bishops' religious directives when treating pregnant patients, Modern Healthcare reports (Schencker, Modern Healthcare, 10/24).
In the early 2000s, the Vatican sought stricter enforcement of the Ethical and Religious Directives for Catholic Health Care Services, which ban Catholic facilities from performing sterilizations, abortions and certain other procedures. Meanwhile, the number of Catholic hospitals in the U.S. increased by 16% from 2001 to 2011 (Women's Health Policy Report, 10/23).
Brigitte Amiri, a senior staff attorney at ACLU, said the organization is pursuing several different legal strategies to protect women affected by the directives. "We're still at the beginning wave of these attempts to try to get the law enforced," she said.
Violation of Federal Law
In a recent lawsuit, ACLU alleges that Trinity Health is violating various federal laws, including the Emergency Medical Treatment and Labor Act (PL 99-272), by refusing to provide certain health care services to pregnant women who are experiencing complications.
Under EMTALA, Medicare-participating hospitals with emergency departments are required to provide stabilizing treatment to patients with emergency medical conditions. According to the ACLU, abortion is necessary to stabilize patients in certain circumstances.
Douglas Laycock, a professor of law at the University of Virginia, said such an argument could prevail in the courts. "In the true emergency cases where withholding care does real harm to the patient, I think the courts are going to be inclined to view that EMTALA trumps, but it's too early to know for sure," he said, adding that the courts will have to determine how to apply EMTALA alongside other laws that permit providers to refuse to provide abortion services.
Sex Discrimination and Corporate Practice of Medicine Laws
ACLU also threatened a lawsuit over a California hospital's decision to deny a patient's request for tubal ligation while she was undergoing a C-section (Modern Healthcare, 10/24).
Mercy Medical Center Redding, which is owned by Dignity Health of San Francisco, initially refused to perform the procedure on a patient, Rachel Miller, who had sought to have the procedure after her scheduled delivery. The hospital cited the religious directives as the reason for its refusal. However, the hospital eventually revised its decision, following a notice from ACLU that it would file suit for sex discrimination unless Miller was offered the procedure (Women's Health Policy Report, 8/26).
According to the ACLU, the hospital did not allow the female patient to receive services that meet the standard of care, which it alleges amounts to sex discrimination. ACLU also alleges that the hospital inserted its corporate parent's religious beliefs into a treatment decision, which could violate California's corporate practice of medicine law (Modern Healthcare, 10/24).
Relatedly, ACLU of Michigan also filed a complaint against Genesys Regional Medical Center, a Catholic hospital that similarly denied a pregnant patient a tubal ligation at the time of her delivery. In that case, Jessica Mann, who was pregnant with her third child, was diagnosed 10 years prior with a certain type of brain tumor that can cause blindness, paralysis and other problems. She was advised by her doctor to undergo a tubal ligation after the birth because of her condition. Genesys refused to provide the procedure, citing the directives, and Mann went to another hospital to deliver and undergo the procedure (Women's Health Policy Report, 10/23).
Meanwhile, ACLU also has filed a lawsuit against USCCB alleging negligence for how one of Trinity's hospitals in Michigan treated a pregnant women, Tamesha Means, when she sought out emergency care (Modern Healthcare, 10/24).
ACLU filed the suit in 2013 on behalf of Means, who in 2010 was rushed to the nearest hospital -- Mercy Health Partners in Muskegon, Mich. -- after her water broke when she was 18 weeks pregnant. The fetus had virtually no chance of surviving, and doctors in such a situation typically induce labor or surgically remove the fetus to reduce the woman's chance of infection. According to the lawsuit, the doctors at Mercy Health did not admit Means for observation or inform her that the fetus was in danger and her own health could be at risk.
Means also alleges that she was in "excruciating pain" but was sent home twice without being offered appropriate medical treatment or informed of her options. She returned a third time, at which point she had developed an infection, and began to miscarry as the hospital was preparing her discharge paperwork. The baby was pronounced dead two-and-a-half hours after delivery.
The lawsuit was dismissed by a federal judge because federal courts in Michigan do not have control over policy mandates made by the Washington, D.C.-based bishops' conference. Immediately following the decision, the ACLU filed a notice of appeal to the 6th U.S. Circuit Court of Appeals in July (Women's Health Policy Report, 7/7).