Women's Health and Lives at Risk Due to Religious Restrictions at Hospitals, New Center Study Shows
National Women's Law Center Files Complaint with Department of Health and Human ServicesJanuary 20, 2011
(Washington, D.C.) The National Women’s Law Center (NWLC) released two reports today that reveal that certain religiously affiliated hospitals put women’s health and lives at risk by restricting doctors’ ability to provide the best medical care to pregnant women experiencing miscarriages and ectopic pregnancies. The Center also filed a complaint with the U.S. Department of Human and Health Services’ Centers for Medicare and Medicaid Services urging immediate action to ensure that laws designed to protect patients’ health are properly applied and enforced.
The Center’s report, Below the Radar: Ibis Study Shows that Health Care Providers’ Religious Refusals Can Endanger Pregnant Women’s Lives and Health, demonstrates that certain hospitals, because of their religious beliefs, deny emergency care, the standard of care and adequate information to make treatment decisions to patients experiencing miscarriages and ectopic pregnancies. The study and report focused on cases where no medical intervention was possible that would allow the patient to continue her pregnancy and where delaying treatment would endanger the woman’s health or even life. These hospital treatment practices violate federal laws and regulations that are intended to protect patients and ensure the delivery of quality health care services at hospitals receiving Medicare funds. The Center’s report also presents a legal analysis of the implications of a study it commissioned from Ibis Reproductive Health, a clinical and social science research organization, Assessing hospital policies & practices regarding ectopic pregnancy & miscarriage management: Results of a national qualitative study, that it also released today. While the study concentrates on Catholic-affiliated hospitals’ treatment of pregnancy complications, the Center’s findings, legal analysis and demand for corrective action apply to any institution or individual delaying or denying treatment based on religious beliefs rather than medical considerations.
“Most women assume that when they go to a hospital they will be offered the best medical treatment options for their diagnosis,” said NWLC Co-President Marcia D. Greenberger. “But this report paints a chilling picture of women with ectopic pregnancies or suffering miscarriages who are not offered the full spectrum of medically appropriate treatment options because they have gone to a hospital whose religious affiliation conflicts with the provision of those options. To make matters worse, women denied certain medical options may never even be told that these options could, for example, improve their chances of having a healthy pregnancy in the future. Women who fail to receive appropriate treatment or to be informed that preferable options would be provided in another hospital can suffer serious harm with long-term adverse consequences to their lives and health.”
The reports highlight stark cases where doctors noted a discrepancy between the medically-accepted standard of care for miscarriage and ectopic pregnancy and the treatment provided by hospitals due to their religious affiliation. For example, while the standard of care for certain ectopic pregnancies requires patients to receive the medication methotrexate, doctors in the study reported that their hospitals forbade the use of the drug. Instead, patients were either transferred to another hospital or required to undergo unnecessary and invasive surgery to resolve their condition, thereby being denied the standard of care.
One doctor in the study reported several instances of potentially fatal tubal ruptures in patients with ectopic pregnancies at her Catholic-affiliated hospital. She said that her hospital subjected patients with ectopic pregnancies to unnecessary delays in treatment, despite patients’ exhibiting serious symptoms indicating that a tubal rupture was possible. These patients, therefore, were denied emergency care to which they were legally entitled.
In some of the miscarriage cases described in the Ibis Study, the standard of care also required immediate treatment. Yet doctors practicing at Catholic-affiliated hospitals were forced to delay treatment while performing medically unnecessary tests. Even though these miscarriages were inevitable, and no medical treatment was available to save the fetus, some patients were transferred because doctors were required to wait until there was no longer a fetal heartbeat to provide the needed medical care. This delay subjected these patients to further risks of hemorrhage and infection and could have violated their right to receive emergency medical treatment under federal law.
The Center’s complaint to the Centers for Medicare and Medicaid Services identifies the violations of health care provider obligations under the Medicare Conditions of Participation (CoPs) resulting from these practices. The complaint urges HHS to issue a notification reminding hospitals that they are bound by all CoPs; to require hospitals to institute policies and procedures to protect patients’ legally enforceable rights; to investigate the failure of hospitals to provide standard of care and informed consent, and to take corrective action to prevent further violations.
“Religious dictates do not trump bedrock legal protections that entitle patients to the standard of care and informed consent in the American medical system,” said Jill Morrison, NWLC Senior Counsel and an author of Below the Radar. “But for too long some hospitals have been allowed to disregard the obligation to prioritize women’s health and lives. It’s time to shine a light on these serious violations and make hospitals accountable to protect the lives and health of the patients they serve.”
Some doctors at religiously affiliated hospitals are speaking out. Dr. Robert B. Holder, an ob-gyn at Sierra Vista Regional Health Center, a Catholic–affiliated hospital in Sierra Vista, Arizona told the Center: “A couple came into the ER after the wife had miscarried one of her twins at home. When I determined that the remaining twin was in a hopeless situation, this couple faced a tragic, heart-wrenching decision. After helping them make the medically appropriate decision to complete the miscarriage, I contacted the hospital’s administration to seek permission to perform a uterine evacuation. I wasn’t granted permission and I was told to inform this already traumatized couple that their decision was seen as “unethical” per the Directives.
“I was ashamed and angered when I transferred this patient by ambulance to a secular hospital in Tucson, 80 miles away to get proper care,” he added. “This patient was successfully treated in the end, but ultimately she didn’t receive the treatment she was entitled to in her local community hospital.”
A doctor who works at a nonsectarian hospital in New York City and who asked to remain anonymous, told the Center about a woman in her 20s who came into the emergency room after having been diagnosed with an ectopic pregnancy the day before at a religiously-affiliated hospital. “The doctor [at the religious hospital] told her that the embryo wasn’t viable but since there was a fetal heart beat they would need to delay treatment,” she explained, adding that the woman was told to go home and return if she felt pain, started bleeding or developed a fever. “A day later the woman began to worry why nothing had been done to treat her and decided to come to our hospital. I examined her and confirmed that she had an ectopic pregnancy. I had been trained that you never let the sun set on this condition. I explained all of the treatment options and recommended that we go with methotrexate. She agreed. Things turned out okay for her, but I was haunted by her situation. What if she had waited too long to go to a second hospital? What if she had done nothing and woke up some night with a ruptured fallopian tube? I haven’t been able to get over all the ‘what ifs.’ ”
“There have been no studies quantifying how many women are harmed each year by limited treatments or by never even being told which treatments are being denied them because of hospitals’ adherence to religious dictates,” said Greenberger. “But this report demonstrates the devastating consequences that could flow from the failures of hospitals around the country to ensure appropriate treatment and informed consent, even when dealing with the dangerous conditions of ectopic pregnancies and miscarriages when women’s health and lives are on the line. We call on the Department of Health and Human Services to investigate these serious lapses and order immediate corrective action where violations are found. We also call upon religious and nonsectarian hospitals alike to ensure that their practices comply with federal law and to serve the patients’ health needs.”