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California Sues Catholic Hospital for Denying Emergency Abortion Care

“We have a hospital implementing a policy that’s reminiscent of heartbeat laws in extremist red states.”

Nina Martin

Many Californians are proud of their state’s strong protections for abortion and reproductive rights—safeguards that have become even more important in the post–Roe v. Wade era. But a new lawsuit filed Monday by Attorney General Rob Bonta’s office highlights the risks that blue states face from a vital sector of the health care system that has long considered itself exempt from laws protecting abortion access: Catholic hospitals.

Bonta’s office announced that it was suing the owners of Providence St. Joseph Hospital in Eureka, a small coastal city in the north of the state, for violating various state laws in its treatment of Anna Nusslock, a 36-year-old chiropractor pregnant with twins. This past February, Nusslock’s water broke at 15 weeks—far too early for the fetuses to survive—leaving her in excruciating pain and at high risk of developing a severe infection if treatment was delayed. According to the American College of Obstetricians and Gynecologists, the standard of care in such cases is to remove the fetuses in a procedure akin to an emergency abortion. One of the twins had already died. But medical staff at the Catholic hospital allegedly told Nusslock that because the other twin still had a detectable heartbeat, Catholic ethical rules prevented them from ending the pregnancy until Nusslock’s life was in danger. 

After several hours of waiting, Nusslock’s husband drove her 20 minutes away to the nearest hospital in the even smaller city of Arcata, “where she arrived hemorrhaging and passing a blood clot the size of an apple,” according to an account in the New York Times. “She expelled one fetus and was rushed into the operating room so the other fetus could be removed.” The Arcata doctor who treated Nusslock wrote that she had treated other patients denied abortions by Providence St. Joseph in similar circumstances, the Times reported.

Nusslock told the Times that, six months later, she has recovered physically but still feels the emotional toll. “This experience deeply traumatized me,” she said, “and I have been dealing with tremendous anxiety, grief, and depression ever since.”

“The next person in Anna’s situation will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene.” 

This is exactly the kind of scenario that many pregnant patients with life-threatening complications have been facing in states that imposed onerous abortion restrictions and bans in the aftermath of the US Supreme Court’s Dobbs decision in 2022. Despite the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to provide stabilizing emergency care to anyone who needs it for any reason, doctors and hospitals in abortion-ban states have been unwilling to provide abortion care for fear of losing their licenses, facing punishing fines, or even being prosecuted and thrown in jail.

After lawsuits in Idaho and Texas, the Supreme Court essentially punted on the EMTALA issue last June, although litigation continues. Meanwhile, the death of Georgia mother Amber Thurman from a catastrophic infection in 2022 shows just how dangerous the medical landscape has become as doctors and hospitals have delayed treating emergencies that require abortion care.

But as I wrote for Mother Jones earlier this year, the same kinds of scenarios have long been common in Catholic healthcare systems. And this reality presents an especially thorny challenge in the post-Roe era, even in blue states that have tried to strengthen their abortion protections.

[Catholic] hospitals—as well as their clinics, pharmacies, and physician practices—follow the Ethical and Religious Directives for Catholic Health Care Services, issued by the US Conference of Catholic Bishops, which ban or limit abortion, contraception, sterilization, fertility treatments, trans care, and physician-assisted suicide. Under the ERDs, Catholic hospitals—even in liberal parts of the country—have long treated pregnancy emergencies in ways that have become chillingly familiar in abortion-ban states. For decades, Catholic hospitals have been “doing as a norm what has now become the post-Dobbs landscape,” Georgetown Law professor and reproductive justice scholar Michele Bratcher Goodwin told my Mother Jones colleague Pema Levy. […]

Under the ERDs, Catholic providers are not allowed to terminate the pregnancy as long as the fetus is alive—even if it has no possibility of surviving—until the woman’s life is in danger, says Lori Freedman, a professor and researcher at the University of California, San Francisco, whose 2023 book, Bishops and Bodies: Reproductive Care in American Catholic Hospitals, is based on interviews with dozens of medical practitioners and patients. “They cannot treat her [with medications or procedures that will terminate the pregnancy], but watch her and wait for signs of infection to develop,” she says. “They have this requirement—if there is a fetal heartbeat, wait till there’s a threat to the mother’s life. Then they have to save her life. That is a low standard of care.”

Making the picture even more complex, Catholic hospitals comprise a huge part of the American healthcare infrastructure—they’re the largest group of nonprofit providers in the country. According to the watchdog group Community Catalyst, about 16 percent of acute-care hospitals around the US are Catholic, caring for one in seven hospital patients every day and accounting for 17.5 million emergency room visits a year. In California, they have about the same percentage of the market. But in some states, Catholic providers account for a much bigger share, including in such reproductive safe havens as Washington (almost 50 percent), Colorado (around 40 percent), and Oregon and Illinois (about 30 percent each). As I wrote, those hospitals have been able to skirt reproductive protections:

Religious providers are protected by what are known as “conscience” clauses sprinkled throughout numerous state and federal laws. The ACLU has sued Catholic hospitals at least three times in the past decade over their treatment of pregnant patients under the ERDs—and lost.

Bonta—whose job is the one Kamala Harris held before she became a senator in 2016, then vice president—told the Times he was filing the case partly because of uncertainty about the fate of EMTALA after the Supreme Court’s landmark (not in a good way) 2023–2024 session. “There were some written opinions by the conservative wing of the court that were very disturbing about whether abortion care, which is health care, will be provided under EMTALA in emergency situations,” Bonta said, “so unfortunately, EMTALA is not reliable right now, in our view, because of the limbo that [it] is in.” As a result, he said, “states are on their own and need to rely on our own laws.” 

The Nusslock suit alleges that the Eureka hospital, owned by St. Joseph Health Northern California, which also operates a second hospital in the area, violated three state statutes: the Emergency Services Law, the Unruh Civil Rights Act, and the Unfair Competition Law. According to the Times, the case is believed to be the first filed by California officials against a hospital under the Emergency Services Law, which says hospitals have to provide care “necessary to relieve or eliminate the emergency medical condition.”

In addition to filing the complaint, the attorney general’s office is moving immediately for a preliminary injunction to force Providence to provide timely emergency care, including abortions. “California is the beacon of hope for so many Americans across this country trying to access abortion services since the Dobbs decision,” Bonta’s office said in a statement. “It is damning that here in California, where abortion care is a constitutional right, we have a hospital implementing a policy that’s reminiscent of heartbeat laws in extremist red states.” 

Bonta’s office said the suit was especially urgent because Mad River Community Hospital, where Nusslock eventually received treatment, is scheduled to close its labor and delivery unit in October due to a steep decline in the number of pregnant patients in recent years. “In a month, Providence will be left as the only hospital with an L&D unit in all of Humboldt County,” the AG’s press release said. “The next person in Anna’s situation will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene.”