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PREVIOUSLY

• Attorney General Sues St. Joseph Hospital for Denying a Woman Emergency Abortion Care
• A Local Doctor Urged St. Joseph Hospital to Change Its Anti-Abortion Policies Long Before State Lawsuit, According to Court Declaration
• St. Joseph Hospital Denies Allegations in State Abortion Care Lawsuit But Agrees to Follow State Health Care Laws as the Case Proceeds
• Judge Signs Order Committing St. Joseph Hospital to Providing Emergency Abortions, At Least For the Duration of AG Lawsuit
• Citing Religious Freedom and Catholic Doctrine, St. Joseph Health Challenges State’s Emergency Abortion Care Lawsuit on a Variety of Grounds

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The California Attorney General’s Office this week filed arguments and supporting documents that push back against a recent request from the Catholic owners of St. Joseph Hospital to have Humboldt County Superior Court Judge Timothy Canning dismiss a state lawsuit that accuses the hospital of refusing to provide medically necessary emergency abortion services. 

In a series of filings submitted to the court on Tuesday, the Attorney General’s Office says St. Joseph Health Northern California, LLC, (SJH), a subsidiary of Providence Health & Services, openly admits that its religion-based hospital policies contradict California’s Emergency Services Law (the “ESL”), which requires hospitals to provide abortion care when needed to treat a medical emergency.

“The stakes of this could not be clearer,” the state’s latest filing says. “[H]aving acknowledged that they have, and will continue to, violate a law which requires them to adequately care for patients experiencing life threatening medical emergencies, SJH now asks this Court to condone their conduct by dismissing this action.”

Last month, an attorney representing SJH filed a series of demurrers arguing that the case should be thrown out based on a variety of procedural, jurisdictional and legal grounds, including the hospital’s constitutional rights to free exercise of religion and free expression. While neither denying nor admitting to any of the factual allegations in the state’s case, the attorney said the matter should be handled by the California Department of Public Health, rather than the courts. And he insisted that the patient in question had been discharged for medical reasons, which is allowable by law.

The case centers on the experience of Eureka chiropractor Anna Nusslock, who was pregnant with twins and bleeding heavily when she arrived at the hospital last February. Just 15 weeks pregnant, her water had broken prematurely, and doctors in St. Joseph Hospital’s emergency department told her that one of the twins would not survive and the other had almost no chance, according to medical records.

The doctors also warned Nusslock that if her pregnancy was not terminated, she could face infection, hemorrhaging and threats to her future fertility. But Providence, a not-for-profit Catholic health care system, requires staff to follow a set of “Ethical and Religious Directives” that “bars doctors from providing life-saving or stabilizing emergency treatment when doing so would terminate a pregnancy, even when the pregnancy is not viable,” according to the state’s initial complaint.

Instead of providing the necessary emergency services, St. Joseph staff discharged a still-hemorrhaging Nusslock with instructions to drive herself to Mad River Community Hospital. “On the way out the door, Providence handed Nusslock a bucket and towels ‘in case something happens in the car,’” the AG’s Office said in a news release.

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In its response to the SJH’s demurrer filing, the Attorney General’s Office says SJH intentionally discriminates against pregnant patients in violation of the state’s Unruh Civil Rights Act, and while the California Department of Public Health (CDPH) plays a role in enforcing the Emergency Services Law (ESL), that authority doesn’t preclude the AG from filing a lawsuit.

“The ESL represents a basic promise to all Californians: if you experience a medical emergency, a hospital will provide the care you need without regard to your ability to pay or other characteristics … ,” the AG filing states. “Yet, SJH refuses, as a matter of hospital policy, to adequately care for pregnant patients experiencing obstetric emergencies.”

The filing goes on to say that the hospital’s policy “has harmed numerous patients and threatens future patients.”

Regarding the argument that this dispute should be left to the CDPH to investigate, Bonta’s office notes that this litigation will involve issues of preemption and constitutional rights, which aren’t areas of expertise for that department.

While SJH has argued that it transferred Nusslock to Mad River Community Hospital for medical reasons, Bonta’s office says that argument “conveniently ignores” multiple paragraphs of the state’s complaint explaining that she was discharged for non-medical reasons. 

“The People … affirmatively allege that, medically speaking, SJH was fully capable of providing the treatment Anna needed,” the filing says. Turning to the matter of civil rights, Bonta’s office continues: “Put bluntly: as a matter of SJH policy, SJH denies pregnant patients, and pregnant patients alone, the recognized standard of care in medical emergencies.”

Bonta’s office also argues that neither the First Amendment nor federal conscience legislation preempt the Emergency Services Law.

“[A] law remains generally applicable so long as it does not “prohibit religious conduct while permitting secular conduct that undermines the government’s asserted interests in a similar way,” the AG’s filing says. (Emphasis in the original.)

By way of comparison, the state cites a recent Ninth Circuit case in which a public school student in San Diego challenged the district’s vaccine mandate, which allowed medical exemptions but not religious ones. The court rejected the argument that this mandate amounted to religious discrimination, explaining that “the medical exemption … serves the primary interest for imposing the mandate — protecting student ‘health and safety’ — and so does not undermine the District’s interests as a religious exemption would.”

Likewise, in this case, the ESL allows exemptions when a hospital lacks appropriate facilities and qualified personnel “while providing no comparable exemption for religious reasons,” Bonta’s office says.

The filing, which you can download below, offers more arguments against SJH’s request for dismissal while reiterating that the organization’s conduct “endangers the safety of its patients.”

A hearing to consider the demurrer is scheduled for Valentine’s Day, Feb. 14, at 10:30 a.m. in the Humboldt County Courthouse.

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DOCUMENTS:

• Memorandum of Points and Authorities in Support of Plaintiff the People of the State of California’s Opposition to Defendant’s Demurrer
• Plaintiff the People of the State of California’s Opposition to Defendant’s Request for Judicial Notice
• Plaintiff the People of the State of California’s Request for Judicial Notice in Support of Opposition to Defendant’s Demurrer