Anna Nusslock, a Eureka chiropractor who was allegedly denied emergency abortion care at Providence St. Joseph Hospital, watches today’s court proceedings from the front row. | Photo by Sage Alexander.

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An attorney representing St. Joseph Northern California took an aggressive new tack today in defending against a lawsuit from California Attorney General Rob Bonta that accuses Eureka’s St. Joseph Hospital of denying patients emergency abortion care: He argued that the patients in question, Eureka chiropractor Anna Nusslock and the pseudonymous “Jane Roe,” didn’t actually experience medical emergencies while in the hospital’s care. And he accused the state of making false statements in presenting its case.

The deputy attorney general arguing in court today emphatically denied those allegations, and he accused St. Joseph Hospital of putting religious dogma ahead of women’s health.

The case is being heard by Humboldt County Superior Court Judge Timothy Canning.

The state is seeking a preliminary injunction that would compel the hospital to comply with California’s Emergency Services Law (ESL) by providing legally mandated emergency medical care. The hospital’s defense attorneys, meanwhile, argue that doctors and hospital staff did not violate the ESL with these patients, and that the injunction being sought by the state would actually force the hospital to perform elective abortions, which are forbidden by the Catholic religion. (St. Joseph Northern California is owned by the Catholic nonprofit Providence-St. Joseph).

The People’s case today was argued by Deputy AG David Hauska, who began by noting that both Nusslock and Roe arrived at the hospital while suffering from previable premature preterm rupture of membranes (PPROM), a condition that occurs in pregnant patients when the amniotic sac around developing fetus breaks early.

The only definitive treatment in such cases is to terminate the pregnancy, Hauska said, and yet both Nusslock and Roe were denied this necessary care at St. Joseph Hospital.

“Within hours, both were suffering from serious hemorrhages and lost a combined three and a half liters of blood,” he said, though he added that the case ultimately is not about those two women, “because what happened is not a mistake. … It was the result of a deliberate and illegal policy whereby St. Joseph withholds care from women experiencing obstetric emergencies.”

Nusslock, as previously reported, was 15 weeks pregnant with twins when she was allegedly discharged by staff at St. Joseph after doctors refused to perform an emergency abortion, despite the fact that the pregnancy had been deemed no longer viable. Staff allegedly handed Nusslock a bucket and towels on her way out the door “in case something happens in the car” on the way to Mad River Community Hospital, 12 miles north. 

Roe was similarly denied “the only treatment that would actually relieve her condition” (PPROM) and made the trek to UCSF to receive treatment, a trip she described as “the worst moment of her life,” Hauska said. Roe was admitted to St. Joseph Hospital during a subsequent pregnancy and again lost her fetus after being discharged in the midst of a different medical emergency, according to Hauska.

He argued that while the hospital never formally wrote down or codified its policy on emergency abortion care, the policy can be inferred from statements of three separate witnesses, who used “remarkably similar language” to describe the circumstances under which physicians at St. Joe’s are allowed to terminate a pregnancy. 

One doctor testified that the procedure is only allowed when the patient is clinically unstable and maternal life is in jeopardy. Another, Dr. Simon Stampe, testified that it’s only permitted when the patient is “actively dying.” And Nusslock’s own provider during her Feb. 2024 hospital visit wrote that he couldn’t provide an abortion “unless her life is at risk,” according to Hauska.

The deputy AG noted that St. Joseph previously stipulated that it would follow the ESL for the duration of the trial, only to attempt to back out of the agreement when Catholic Bishop who oversees our region, Robert F. Vasa, issued a letter objecting to the agreement on ground that it would violate the Ethical and Religious Directives that govern care at Catholic medical institutions. 

In the letter, Vasa said a hospital may only terminate a pre-viable pregnancy when “the only alternative is certain death of both mother and child,” according to Hauska.

That may be an accurate interpretation of Catholic religious doctrine, he continued, but it doesn’t pass legal muster as a hospital policy. The hospital’s own attorneys said in a previous hearing that they can’t ignore the bishop’s guidance, and medical experts say that allowing pregnant patients to approach death before intervention puts them at risk of septic shock and multiple organ failure. 

“At that point, even an aggressive and active intervention will not be enough,” Hauska said. “The mortality rate of patients who progress to septic shock is estimated at 50 to 60 percent.”

By refusing to provide care until a patient’s life is in the balance, the hospital is “gambling with the health of its patients,” he concluded. “The law does not allow that.”

Back in August, Judge Canning denied the motion from St. Joseph’s attorneys to modify or set aside the stipulated agreement, despite Bishop Vasa’s objections.

Today, Hauska proceeded to walk through the timeline of Nusslock’s care after she was admitted to Mad River Community Hospital, and he sought to poke holes in the defense’s arguments. He said those arguments rely on the federal Emergency Medical Treatment and Labor Act (EMTALA), which is similar to California’s ESL but not identical. And he alleged that medical experts who testified for the defense made fundamental mistakes in their analyses.

Defense attorneys have also pointed to an agreement with the state back in 2015, ahead of the merger of Providence Health & Services with St. Joseph Health. In conditions of consent for the merger, the state’s then-Attorney General agreed and mandated that St. Joseph Hospital would continue to apply the Catholic Ethical and Religious Directives on a case-by-case basis at least through 2027.

But Hauska said the government cannot immunize somebody in advance for illegal conduct.

“There’s no such thing as carte blanche” under the law, he said. 

Defense attorney Harvey Rochman addresses Judge Timothy Canning. | Screenshot of the Zoom feed from today’s hearing.



The defense

Once Hauska had wrapped up, defense attorney Harvey Rochman, with the L.A.-based firm of Manatt, Phelps & Phillips, LLP, stepped to the lectern to present his case. He began by recalling the hospital’s founding by Catholic nuns right before the 1918 flu pandemic. They didn’t know much about medicine, but they dedicated their lives to caring for people. And St. Joseph Hospital is now “one of the best hospitals on the North Coast,” Rochman said.

He argued that it’s been hard on the physicians and employees at St. Joe’s to hear the Attorney General’s accusations and lamented “the terrible fear that has been unnecessarily stirred up.”

The AG’s Office can’t meet the burden of proof, he said, adding that the injunction would force the hospital to perform procedures that are not allowed within the Catholic religion, and which contravene of the Ethical and Religious Directives.

Rochman then launched into the allegations of false statements from Hauska and from the brief provided by the Attorney General’s Office. He reminded Canning that at a previous hearing, the judge had asked Hauska whether emergency abortion services were available at Mad River Community Hospital, and Hauska replied, “Not to The People’s knowledge, Your Honor.”

“In fact,” Rochman said, “that was false.” While the birth center at MRCH has been closed, there are still two physicians on staff who can perform emergency abortions, though he acknowledged that they’re not always working and not on-call while away from the hospital. 

Nusslock herself was sitting in the front row of the audience seats in court chambers, and she shook her head in apparent disapproval at this line of argument. 

Rochman also alleged that prosecutors made false statements in documents submitted regarding Nusslock’s condition. They say she was bleeding at a worryingly high rate when she arrived at MRCH and required an immediate trip to the Operating Room for an abortion.

“And it turns out that that’s not actually true at all,” Rochman said. “It’s not even close to true.” Instead, he said, she was deemed to be in stable condition before being discharged from St. Joe’s, and after a thorough examination at MRCH, she spent hours being “expectantly managed” before undergoing surgery.

“So it turns out that this whole series of events actually is a vindication for St. Joseph Hospital,” Rochman said. 

Nusslock shook her head again.

Rochman put some of Nusslock’s medical records from MRCH on a flatscreen TV in the courtroom and cited a declaration from Dr. Elizabeth A. Micks, an obstetrician-gynecologist at the hospital. He said there’s nothing in the medical record to indicate that Nusslock was unstable. 

“She was fine when she left St. Joseph Hospital to go get the treatment that she wanted at another hospital,” he said. Rochman also argued that Roe was likewise stable when discharged from the hospital, and that she failed to comply with orders to come back if her condition changed. Both patients received the necessary stabilizing treatment, he said, and he cited sources who say PPROM alone is not an emergency medical condition.

“The AG presented a false story throughout this case to drum up emotion in the community; to concern you, Your Honor; to [convince] everybody that that’s what had happened, and it just didn’t happen,” Rochman said.

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During a break in the proceedings, Nusslock spoke with reporters outside the courtroom. She said that a doctor cited as an expert by the defense, Dr. Michael Gardner, is the vice president of Women and Children’s Hospital at University Health in San Antonio, Texas, adding that the hospital recently made news after a 37-year-old mother named Tierra Walker, who was pregnant with twins, died from preeclampsia after being unable to access an emergency abortion.

Nusslock also argued that Rochman had mischaracterized her treatment at MRCH and that her surgery was delayed in part due to low staffing there.

“I was not being managed; I was not being examined,” she said. “I was begging for help still.”

She remarked on the challenge of sitting through the court hearing. 

“It’s really hurtful to listen to them misrepresent my experience,” she said. 

The prosecution’s response

Following a lunch break, Hauska pushed back against the accusations that he’d misled the court and the public about critical facts in the case. And he returned to the matter of Bishop Vasa’s letter. The standard of care spelled out in that letter — that abortion care should only be given when death is otherwise certain — is, in fact, the standard that St. Joseph intends to take forward, he argued.

He cited testimony from the prosecution’s own expert witnesses saying that PPROM, when left untreated, leads to serious medical jeopardy in a significant number of cases. Both Nusslock and Roe were determined to be at high risk of deterioration, he said.

As for the allegation that he’d lied about the availability of emergency abortion care at MRCH, Hauska said, “Emergencies happen 24 hours a day, seven days a week,” so in order for a specific service to be considered “available,” it needs to accessible around the clock. 

Regarding the timeline of Nusslock’s care at MRCH, Hauska said the record does, in fact, show that she was bleeding upon arrival, and Nusslock herself testified as much. He cited testimony in which she said that by the time she was admitted, she had passed an apple-sized blood clot.

In closing, Hauska said, “Your Honor, we’re asking for an injunction that requires them to follow the law.”

Canning said he would take the matter under submission. He has 90 days to deliver a verdict, and he said he may wind up taking the majority of that. The stipulated agreement between the parties — which Bishop Vasa objected to — will remain in effect while Canning considers the case.

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