The Humboldt County Courthouse. | File photo.

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Attorneys for the State of California and St. Joseph of Northern California went head to head for the first time this morning, making their initial oral arguments in a case that asks whether Catholic religious beliefs are a valid legal reason to limit emergency abortion access in the state. 

Today’s hearing, which took place in a standing-room-only courtroom at the Humboldt County Courthouse, concerned a demurrer, or request to dismiss the case, filed by attorneys for St. Joseph. One of them argued that, before this complicated issue comes before a judge, it should first be investigated by the California Department of Public Health (CDPH). He also argued that care providers at Catholic hospitals are protected in such cases by the Free Exercise Clause of the First Amendment.

Attorney General Rob Bonta’s office sued St. Joseph of Northern California (a subsidiary of Providence Health & Services) this past September, accusing Eureka’s St. Joseph Hospital of violating multiple state laws when it refused to provide emergency abortion care to people experiencing obstetric emergencies.

The case focuses largely, though not exclusively, on the experiences of Anna Nusslock, a local chiropractor who was allegedly turned away from St. Joseph Hospital last February while suffering a medical emergency. Fifteen weeks pregnant with twins, Nusslock was diagnosed onsite with Preterm Premature Rupture of Membranes (PPROM) and told her twins wouldn’t survive. 

According to state prosecutors, St. Joseph’s medical staff then refused to treat her, citing a policy that prohibits staff from providing the necessary procedure when a fetus has a detectable heartbeat. Instead, the suit alleges, hospital staff sent Nusslock to Mad River Community Hospital with a bucket and towels, “in case something happens in the car.” 

The case alleges that other women have had their health similarly jeopardized by this policy, which is based on the Ethical and Religious Directives for Catholic Health Care Services, a document issued by the United States Conference of Catholic Bishops.

At today’s hearing, attorney Harvey Rochman, with the L.A.-based firm of Manatt, Phelps & Phillips, LLP, argued on behalf of St. Joseph of Northern California. Appearing before Humboldt County Superior Court Judge Timothy Canning, he said the court should allow the “subject matter experts” at CDPH to investigate and determine whether there has been a violation of the state’s Emergency Services Law (ESL). 

That agency has “primary responsibility” to investigate and determine whether there have been such violations, Rochman said.

He also argued that Nusslock was transferred to Mad River Community Hospital for medical reasons, saying she “was unable to get a procedure that she wanted” at St. Joseph Hospital so she went to a hospital where she could obtain that procedure.

Transfers made for medical reasons are permitted under the ESL, and Rochman argued that Nusslock’s case was analogous to a patient being turned away because a hospital lacked the personnel and equipment to preform a procedure — like when a hospital’s only neurosurgeon is away on vacation.

Regarding the state’s allegation that St. Joseph Hospital violated the state’s Unruh Civil Rights Act by discriminating against pregnant people,  Rochman said that can’t be true because the hospital treats “hundreds of pregnant patients all the time.”

What distinguishes the patient in this case, he said, is the need for a specific procedure, namely, an abortion when there’s a fetus with a heartbeat.

Rochman went on to outline defenses based on the U.S. Constitution, saying courts have recently shown a “significant conservative trend” in terms of how to evaluate claims under the Free Exercise Clause of the First Amendment. He said that forcing a Catholic hospital to perform abortions would be subject to “strict scrutiny,” a rigorous judicial standard for evaluating the constitutionality of any laws that limit free speech.

It would be inconsistent, he argued, to give a secular hospital a pass when it lacks the personnel and equipment necessary to perform a procedure while not giving a pass to religious hospitals unable to perform the procedure because it conflicts with their conscience and beliefs. 

When Rochman wrapped up, the arguments were turned over to the three deputy attorneys general seated at the opposite table: Martine D’Agostino, Katelyn Wallace and David Hauska.

D’Agostino went first, and she sought to put the case into a larger context. “This is a case about emergency health care,” she said, and she alleged that the women of Humboldt County have been denied adequate care at St. Joseph Hospital, “at great risk to their lives.”

The “harrowing experiences” of women who’ve been turned away from the emergency department are the result of a longstanding policy to refuse emergency abortion care when a fetal heartbeat is present, D’Agostino said. 

Regarding the argument that the matter should be handled by CDPH, she said the Emergency Services Law contains an express provision preserving the Attorney General’s right to enforce the statute. Furthermore, even if CDPH did investigate Nusslock’s case, its findings would be specific to her situation, not the broader policy or the similar experiences of other patients, she argued.

D’Agostino said that handing this matter off to that agency first would delay a resolution, presenting “a grave risk to the very lives of the women of Humboldt County.”

Next up was Wallace, who tackled the reasoning behind Nusslock’s transfer to Mad River Community Hospital. She said that one argument put forward by St. Joe’s attorneys — that state law only prevents non-medical transfers when they’re done due to a patient’s inability to pay — would undermine the entire point of the statute.

She said that the staff at St. Joseph refused to serve Nusslock based on “an ideological line” that had “nothing to do with medical needs.” The state’s case contends that she was transferred for non-medical reasons.

Going third, Hauska said that several California court cases offer relevant precedents on the issues at play here — namely, religious challenges to providing medical care. In all such cases the courts found that the laws are enforceable, he said.

He also pushed back on the defense attorney’s civil rights defense, saying it’s not enough for the hospital to say it treats hundreds of pregnant women; the point is that they must treat all pregnant women access to the privileges, facilities and services offered to everyone else. Most patients can expect that if their doctor recommends something, the hospital can provide it and the patient wants it, then they’ll receive that care.

“But for pregnant patients alone there’s a wrinkle,” Hauska said. At St. Joseph Hospital, they see their care “micromanaged and potentially vetoed by hospital administrators.” He described this as a straightforward case of intentionally discriminating against one protected group — pregnant women.

Offered one last chance to argue his case for dismissal, Rochman said the case is not, in fact, about pregnant people. It’s about patients with “a very complex medical issue” that happens when there’s a fetal heartbeat. 

The rule in question is “procedure focused, not pregnancy focused,” he said.

Judge Canning said he’ll take both sides’ arguments under submission and issue his ruling on the demurrer some time in the next 90 days.

While we were working on this story, Providence issued a press release that says, in part, that there are circumstances “in which certain medical procedures that could result in fetal death may be allowed in a Catholic hospital.” And it says the organization recently “enhanced our training, education and escalation protocols to further ensure the best possible care.”

The release can be found at the bottom of this post from earlier today.

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