When Anna Nusslock showed up at the local hospital 15 weeks pregnant and in severe pain earlier this year, she said, a doctor gave her devastating news: The twins she and her husband had wanted so desperately were not viable. Furthermore, her own health was in danger and she needed an emergency abortion to prevent bleeding and infection.
Providence St. Joseph Hospital in the small Northern California coastal town of Eureka refused to give him the care he needed because doctors could detect fetal “heart tones,” Nusslock said at a news conference Monday. California Attorney General Rob Bonta filed a lawsuit against the Catholic hospital detailing Nusslock’s dangerous ordeal and alleging that the hospital violated multiple state laws when it discharged Nusslock, with an offer of a bucket and towels, to go. to another location to receive what he described as standard medical care.
Bonta also filed a motion for a preliminary injunction in Humboldt County Superior Court, asking it to require Providence to treat anyone with an emergency medical condition. “The need for immediate relief is about to intensify,” the motion said. That’s because Mad River Community Hospital, where Nusslock ultimately received care 12 miles up the road, is scheduled to close its birthing center this month.
Providence will be the only hospital in a roughly 85-mile radius that will offer labor and delivery, according to a KFF Health News analysis. When care is more than an hour away, academic researchers often define the area as a hospital desert.
“It begs the question: What will happen the next time someone in Anna’s situation shows up in Providence? There will be no Mad River for them to go to,” Bonta said at a news conference. “With a severe lack of services, even here in California, and an influx of patients from states that ban abortion, we need hospitals to follow the law.”
The case illustrates how even in California, where the right to abortion is enshrined in state law, there is a glaring loophole. Catholic hospitals, which restrict reproductive health care because they follow the church’s “ethical and religious guidelines,” are aggressively expanding nationally by acquiring secular hospitals. In areas of the country, including parts of Northern California, they are the only option. At the same time, maternity wards are rapidly closing, leaving more patients to deal with religious directives rather than accepted medical standards.
California’s lawsuit also comes amid uncertainty that arose after the Supreme Court in 2022 struck down the constitutional right to abortion: whether federal law requires hospitals to provide abortions as emergency medical care even in states that have the procedure is prohibited. The high court took up the issue this summer. The Biden administration reaffirmed its policy that the Emergency Medical Treatment and Labor Act requires hospitals to stabilize or treat any patient who presents to an emergency room. Texas is suing the administration over the policy.
The issue also arises in presidential elections. During the Oct. 1 vice presidential debate, Minnesota Democratic Gov. Tim Walz noted that a Georgia woman died because a hospital delayed care. Sen. JD Vance (R-Ohio) responded, in part, by asking Walz if she wanted to force Catholic hospitals to perform abortions against her religious beliefs, saying that “Kamala Harris has supported suing Catholic nuns.”
With federal protections in limbo, Bonta said California must rely on its state laws to protect patients. Specifically, Bonta, who is expected to run for governor, alleges that Providence violated a California law requiring hospitals to provide care “necessary to alleviate or eliminate the emergency medical condition.”
Nusslock’s case is not an isolated incident, according to the lawsuit. “One or two women per year receive abortion care in Mad River, after being denied care at Providence Hospital,” the lawsuit says. “These people, like Anna Nusslock, had been discharged from Providence Hospital with instructions to go elsewhere.” Bonta said his office is investigating how widespread cases are in California, where Catholic hospitals account for 15% of hospital beds.
In an Oct. 1 letter to employees obtained by KFF Health News, Providence Northern California service area CEO Garry Olney said the hospital is “heartbroken” by Nusslock’s experience, which “failed to meet our high standards of safety, quality and compassion. Be careful.” He added that the hospital is reviewing its training, education and escalation processes to ensure it doesn’t happen again.
Providence spokesman Bryan Kawasaki said its 51 hospitals comply with applicable federal and state laws, including EMTALA. Kawasaki declined to comment specifically on Nusslock’s case.
More women face barriers to care as Catholic health systems have gained market power, according to research from KFF Health News. Four of the 10 largest hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality.
Many Americans have no choice: Ambulances can take patients to a health system run by Catholics without giving them a say. Non-Catholic hospitals may be outside your insurance networks or too far to reach in an emergency. In the United States, nearly 800,000 people have Catholic or Catholic-affiliated maternity hospitals within an hour’s drive, including parts of Northern California.
Research shows that pregnant women who must drive further distances to a birth center are at greater risk of harm to themselves or their fetus.
“It’s really concerning, especially in a state like California, where people expect to have comprehensive access to care,” said Debra Stulberg, a family medicine physician at the University of Chicago. “The growth of Catholic hospitals, especially in this post-Catholic eradobbs era, continues to limit the quality of care people receive.”
Directives guiding care in Catholic health systems are issued by the United States Conference of Catholic Bishops. They claim that abortions are “intrinsically evil” and “never permitted.”
The document offers this guidance as an exception: Treatments that could cure “a proportionally serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the fetus is viable, even if they will result in the death of the fetus.” child.”
“I would say the church helps Catholic hospitals apply some of our deepest beliefs and moral principles to very, very complex situations,” said John Brehany, executive vice president of the National Catholic Bioethics Center, an ethics authority for institutions. Catholic health care. . “And one of those beliefs is that you can never directly attempt to end the life of a developing human being.”
Brehany would not comment on Nusslock’s case, but gave the example that if a woman needed cancer treatment, the church would allow her to continue treatment even if it “results in the death of a fetus.” He added that some situations are “more debatable” than others.
As Catholic systems have consolidated and acquired more medical facilities, their denials of care have been compounded by other hospitals closing their delivery rooms at an alarming rate across the country. In California, 56 hospitals have closed their maternity wards in the past 12 years, according to CalMatters research. Nationally, at least 267 hospitals closed labor and delivery units between 2011 and 2021, representing about 5% of the country’s hospitals, according to Chartis, a healthcare consulting and analytics firm.
With each closure, patients could lose options for abortion care, contraceptives, tubal ligations and gender-affirming care, said Mona Shah, senior director of policy and strategy at Community Catalyst, a national health equity organization.
Nusslock’s 12-mile trip to receive care in Mad River cost her, according to the lawsuit and her public statement. He had passed a “blood clot the size of an apple” and was bleeding with “blinding pain,” he said, when he arrived at the operating room. In the lawsuit, Nusslock said her doctor later told her that her test results showed she most likely had an infection.
It’s a trip that Bonta described as “unloading patients” and that Nusslock should never have made.
Seven months later, Nusslock said, she has trouble sleeping and remembers how Providence sent her away.
“I’ll never forget looking at my doctor, tears streaming down my face, my heart shattered into a million pieces, and just begging him, ‘Don’t let me die,’” she said.
KFF Health News data editor Holly K. Hacker contributed to this article.
This article was produced by KFF Health Newswho publishes California Healthlinean editorially independent service California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF, an independent source of research, polling and health policy journalism. Learn more about KFF.
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