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Report: Application of Catholic directives put five patients in danger

Feb. 22, 2016 — A Catholic hospital's refusal to administer abortion care endangered the lives of five pregnant women over the course of a 17-month period, according to a report released to The Guardian (Redden, The Guardian, 2/18).

Background

Catholic hospitals operate under the Ethical and Religious Directives (ERDs) for Catholic Health Care Services, which ban Catholic facilities from performing abortion, sterilizations and certain other procedures (Women's Health Policy Report, 10/27/15). According to The Guardian, it is not considered a violation of the directives to administer lifesaving care to a pregnant woman that indirectly results in the termination of pregnancy (The Guardian, 2/18).

The number of Catholic hospitals in the United States increased by 16 percent from 2001 to 2011 (Women's Health Policy Report, 10/27/15).

Report details

The report was written by a former Muskegon County, Michigan, health official, Faith Groesbeck. According to Becker's Hospital Review, at the time she wrote the report, Groesbeck was working on a project to lower infant and fetal mortality, which granted her access to certain confidential medical information (Rosin, Becker's Hospital Review, 2/19).

The report states the hospital made "unilateral healthcare choices for the five women without their knowledge or their consent," according to The Guardian. In addition, The Guardian reports that the "report details some of the ... most systematic collisions of religion and medicine ever to surface in public" (The Guardian, 2/18).

Key findings

The report found that the application of the ERDs by Mercy Health Partners, a Catholic hospital in Muskegon, subjected five pregnant women to prolonged miscarriages that could have been life-threatening, Becker's Hospital Review reports. The incidents occurred between August 2009 and December 2010.

The five women each experienced a pregnancy complication involving the premature rupture of membranes surrounding the fetus, a condition that can cause miscarriage when it occurs prior to fetal viability. All of the women were less than 20 weeks pregnant at the time they presented symptoms at the hospital (Becker's Hospital Review, 2/19).

The report stated that all five women presented with symptoms indicating immediate delivery would be the safest option (The Guardian, 2/18). Specifically, the report found that all of the women presented with symptoms of infection, including elevated temperature or heart rate. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) state that in such cases, most physicians would induce labor (Becker's Hospital Review, 2/19).

According to the report, the hospital did not tell the women that they could opt for immediate delivery rather than wait for a natural miscarriage, nor did it tell them that immediate delivery was the most appropriate medical care in instances of infection. One of the women included in the report said she asked the hospital for immediate delivery, but they denied her request.

While at least one hospital official said it is Mercy Health's policy to inform patients when there is a procedure the hospital will not provide, the report found that the hospital officials did not seem to be aware of what the five women had been told regarding their health care options. Further, the report stated that Mercy Health CEO Joseph O'Meara acknowledged that the hospital lacked clear guidelines to determine whether a pregnant woman's life was endangered (The Guardian, 2/18).

According to the report, all five women delivered. Two had stillbirths, and the three other women gave birth to infants who died shortly after delivery (Hausman, MLive, 2/19). The report noted that several of the women experienced infection or emotional trauma, or required surgery that otherwise would have been unnecessary (The Guardian, 2/18).

Internal Review

A Mercy Health physician who conducted an internal review of the five women's experiences questioned Groesbeck's assertion that all five women showed signs of infection.

He said the hospital had acted appropriately in four of the five cases. In one of the cases, he said doctors reportedly allowed a woman to develop signs of infections. The physician said doctors should have presented the woman with the option to be transferred to a non-Catholic hospital where doctors could induce labor. However, the physician maintained that was not clear to the physicians that the woman developed sepsis (MLive, 2/19).

Investigations

Groesbeck initially voiced her concerns about the situation to Mercy Health, but leaders at the hospital affirmed the policies (The Guardian, 2/18). In 2013, Groesbeck reported Mercy Health to HHS, claiming the hospital had violated the Emergency Medical Treatment and Labor Act of 1986 (EMTALA) (PL 99-272) (Becker's Hospital Review, 2/19). Under EMTALA, Medicare-participating hospitals with emergency departments are required to provide stabilizing treatment to patients with emergency medical conditions (Women's Health Policy Report, 10/27/15).

According to Becker's Hospital Review, Groesbeck's report spurred federal officials to investigate Mercy. The investigation, which closed in March 2014, only cited the hospital for a minor infraction, according to Becker's Hospital Review (Becker's Hospital Review, 2/19).

Separately, one of the women, Tamesha Means, took legal action against the hospital. According to the lawsuit, filed by the American Civil Liberties Union (ACLU) in 2013, 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. 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 2015 (Women's Health Policy Report, 10/27/15).

Conclusions

The report concluded, "In each incident, (Mercy Health Partners) withheld medically indicated treatment and information from pregnant women experiencing emergency situations." It added, "These practices not only risk life-threatening infection, infertility, and health problems, they subject women to unnecessary physical and psychological suffering" (The Guardian, 2/18).

The report cited an ACOG physician who characterized the hospital's actions as a "pattern of substandard care." The physician noted, "It's not too strong to say that any one of these women could have suffered fatal consequences" (Becker's Hospital Review, 2/19).