Religion and state

1. Denial of Reproductive Health Care
at Catholic Hospitals
NAF member webinar
April 6, 2015
Brigitte Amiri, JD, Senior Staff Attorney
ACLU Reproductive Freedom Project
Lois Uttley, MPP, Director
MergerWatch Project

2. Our focus on Catholic hospitals
• Catholic hospitals are governed by the
Ethical and Religious Directives
(ERDs), issued by U.S. Catholic
Bishops.
• ERDs prohibit the provision of
abortions, contraception, sterilizations,
infertility services.
• Reports of failure to appropriately treat
reproductive emergencies at Catholic
hospitals. (Freedman, AJPH, 2008)
• When Catholic hospitals merge with
non-Catholic hospitals, there usually is
a demand that the merged entity
eliminate reproductive care that
violates the ERDs.

3. Number of Catholic hospitals is growing

4. Catholic health systems are expanding

5. When patients have a choice of
hospitals, the problem isn’t so acute

6. Some communities have only one
hospital, and it’s Catholic
• 26 communities across
the U.S. have a “sole
provider” acute care
hospital that is Catholic-
affiliated.
• These 26 hospitals had
more than 900,000
emergency room visits
in 2011.

7. Case example: Tamesha Means
• Rushed to Mercy Health Partners in
Muskegon, Michigan, when her water broke
at 18 weeks.
• Based on the bishops’ religious directives,
the hospital sent her home twice even
though Means was in excruciating pain.
• Never told her that terminating her
pregnancy was an option and the safest
course for her condition.
• When Means returned to the hospital a third
time she began to deliver. Only then did the
hospital begin tending to Means’
miscarriage.

8. Case example: Sierra Vista, Arizona
• Local secular hospital
joins a Catholic
health system,
Carondelet (part of
the giant Ascension
Health System).
• Hospital agrees to
follow Catholic rules.
• Patients, doctors
worry about care.

9. Woman suffering miscarriage
is denied care
• Woman loses one twin at home,
goes to the hospital ER.
• Physician determines no chance
remaining twin will survive. Risk
of infection for the woman if
pregnancy is not ended.
“We were advised to send her 80 miles away to another
hospital because there was a fetal heartbeat, and that was
a very difficult situation for me to manage.”
--- Dr. Robert Holder, board certified ob-gyn

10. MergerWatch: Protecting patients’ rights and
access to reproductive health care
• We’ve worked with community
activists, physicians, nurses on
more than 110 Catholic/secular
hospital merger cases in 38 states.
• Our approaches include public
education, community organizing,
putting pressure on hospital
executives and using state hospital
oversight laws to advocate for
preservation of reproductive care.
www.MergerWatch.org

11. Taking action to protect women
and their doctors
• Raising public awareness – getting stories out there
• Lawsuits – Means v. USCCB
• Legislation
• Administrative agency complaints at state and
federal level

12. Hospitals’ accountability to the public
1. Must be licensed by states and meet state regulatory
oversight requirements, which vary from state to state.
2. If tax-exempt, must meet certain requirements.
3. If owned or sponsored by a county, municipality or
local hospital taxing district, accountable to a taxing
district board and/or local public officials.
4. To receive Medicare and Medicaid reimbursements,
must agree to meet “Conditions of Participation.”

13. Catholic hospitals depend on Medicare
and Medicaid funding
• In 2011, Catholic hospitals
billed Medicare and
Medicaid $115 billion and
received $27 billion.
• In some parts of the
country, publicly-owned
hospitals financed with
local tax dollars are joining
Catholic systems.

14. COPs that should protect patients’
rights and access to reproductive care
Hospitals should ensure that:
• “The patient has the right to participate in the
development and implementation of her plan of care.”
• The patient is “being informed of his or her health
status, being involved in care planning and treatment,
and being able to request or refuse treatment.”
• The facility “meets the emergency needs of patients in
accordance with acceptable standards of practice.”
• The facility does not discriminate, including on the basis
of sex.

15. CMS case example: Poor pregnancy
emergency care at Detroit Catholic hospital
• St. John Hospital and Medical Center is a part of Ascension
Health, a large Catholic health system.
• A woman who was 17 to 23 weeks pregnant arrived at the
hospital at 4 a.m. in October 2012 with vaginal bleeding and
tachycardia. She was diagnosed with “inevitable abortion.”
• The hospital told her she had to go to another hospital
because as a Catholic health ministry, St. John could not
terminate a pregnancy when fetal heart tones were present.
• After 6 hours at St. John’s, the woman was discharged and
driven in a private vehicle to another hospital. She required
emergency surgery and 7 units of blood.

16. CSM investigates and takes action
• CMS investigated a complaint and found St. John’s did not
document amount of her bleeding or her emotional state. Her blood
pressure was only taken twice.
• Hospital staff told CMS the patient was “crying and upset.” She
“wanted to have the abortion completed because she knew the
baby would not make it.”
• In December of 2012, CMS found that the hospital violated
EMTALA for failure to stabilize a patient and transfer her via
ambulance.
• “Plan of Correction” required policy and posted guidelines for
admission and discharge for patients presenting to St. John’s
birthing center. Hospital was subject to monthly audits until it was
in 100% compliance for four consecutive months.

17. One of our goals: Get more complaints
filed with CMS
• Citing the Tamesha Means case and evidence of
problems at other Catholic hospitals, we asked CMS to
issue a bulletin setting standards for hospital
emergency reproductive care.
• CMS officials declined, saying they need more
evidence of a pattern of problems. They challenged us
to get more complaints filed.

18. CMS Complaints
• We are happy to help with the form
• Can be anonymous – patient and doctor
• Will trigger an investigation (hopefully)

19. How we can help
• The ACLU and MergerWatch are ready to work with
physicians to spotlight cases of hospitals interfering
with reproductive health care delivery.
• If you have a story, contact us:
– ACLU: 212-519-7897 or bamiri@aclu.org
– MergerWatch: 212-870-2010 or info@mergerwatch.org

20. Questions?
• Thank you for your attention.
• We will take any questions you may have.