Tag: Catholic health care

The rest of that article on miscarriage management (or the lack thereof) in Catholic hospitals.

Some doctors have decided to take matters into their own hands. In the following case, the refusal of the hospital ethics committee to approve uterine evacuation not only caused significant harm to the patient but compelled a perinatologist, Dr S, now practicing in a nonsectarian academic medical center, to violate protocol and resign from his position in an urban northeastern Catholic-owned hospital.

I’ll never forget this; it was awful—I had one of my partners accept this patient at 19 weeks. The pregnancy was in the vagina. It was over… . And so he takes this patient and transferred her to [our] tertiary medical center, which I was just livid about, and, you know, “we’re going to save the pregnancy.” So of course, I’m on call when she gets septic, and she’s septic to the point that I’m pushing pressors on labor and delivery trying to keep her blood pressure up, and I have her on a cooling blanket because she’s 106 degrees. And I needed to get everything out. And so I put the ultrasound machine on and there was still a heartbeat, and [the ethics committee] wouldn’t let me because there was still a heartbeat. This woman is dying before our eyes. I went in to examine her, and I was able to find the umbilical cord through the membranes and just snapped the umbilical cord and so that I could put the ultrasound—“Oh look. No heartbeat. Let’s go.” She was so sick she was in the [intensive care unit] for about 10 days and very nearly died… . She was in DIC [disseminated intravascular coagulopathy]… . Her bleeding was so bad that the sclera, the white of her eyes, were red, filled with blood… . And I said, “I just can’t do this. I can’t put myself behind this. This is not worth it to me.” That’s why I left.

From Dr S’s perspective, the chances for fetal life were nonexistent given the septic maternal environment. For the ethics committee, however, the present yet waning fetal heart tones were evidence of fetal life that precluded intervention. Rather than struggle longer to convince his committee to make an exception and grant approval for termination of pregnancy, Dr S chose to covertly sever the patient’s umbilical cord so that the fetal heartbeat would cease and evacuation of the uterus could “legitimately” proceed.

How’s that for a horror story?

Dr G also circumvented the ethics committee in her southern Catholic-owned hospital. She opted not to check fetal heart tones or seek ethics committee approval when caring for a miscarrying woman for fear that documentation of fetal heart tones would have caused unnecessary delays. This led to conflict with the nurse assisting her.

She was 14 weeks and the membranes were literally out of the cervix and hanging in the vagina. And so with her I could just take care of it in the [emergency room] but her cervix wasn’t open enough … so we went to the operating room and the nurse kept asking me, “Was there heart tones, was there heart tones?” I said “I don’t know. I don’t know.” Which I kind of knew there would be. But she said, “Well, did you check?” … I said, “I don’t need an ultrasound to tell me that it’s inevitable … you can just put, ‘The heart tones weren’t documented,’ and then they can interpret that however they want to interpret that.” … I said, “Throw it back at me … I’m not going to order an ultrasound. It’s silly.” Because then that’s the thing; it would have muddied the water in this case.

The nurse probably could have gotten her fired for that.

Physicians working in Catholic-owned hospitals in all 4 US regions of our study disclosed experiences of being barred from completing emergency uterine evacuation while fetal heart tones were present, even when medically indicated. As a result, they had to delay care or transfer patients to non–Catholic-owned facilities. Some physicians violated the authority and protocol of the ethics committee to deliver what they considered safe medical care that reflected the standard of care learned in residency. The extent to which this might occur needs to be researched further but may be difficult to assess, because most physicians are not likely to discuss such behavior even in a confidential interview.

It’s one long horror story.

H/t ema.

This should make your hair stand on end:

When There’s a Heartbeat: Miscarriage Management in Catholic-Owned Hospitals. Lori R. Freedman, PhD,corresponding author Uta Landy, PhD, and Jody Steinauer, MD, MAS:

The findings reported here were not the original focus of our research. In the process of conducting a qualitative study about abortion provision in the clinical practice of obstetrician–gynecologists, we interviewed 30 obstetrician–gynecologists around the United States. During the interviews, which were conducted in 2006, 6 physicians working with or within Catholic-owned hospitals revealed that they were constrained by hospital policies in their ability to undertake urgent uterine evacuation. They reported that Catholic doctrine, as interpreted by their hospital administrations, interfered with their medical judgment. For example, some of them were denied permission to perform an abortion when uterine evacuation was medically indicated and fetal heart tones were still present.

The Savita Halappanavar situation. It happens here too.

Catholic-owned institutions and their employees must adhere to medical practice guidelines contained in the “Ethical and Religious Directives for Catholic Health Care Services” (hereafter called “the directives”) written by the Committee on Doctrine of the National Conference of Catholic Bishops.⁸ The directives state that abortion is never permitted. However, regarding emergency care during miscarriage management, the manual used by Catholic-owned hospital ethics committees to interpret the directives states that abortion is acceptable if the purpose is to treat “a life-threatening pathology” in the pregnant woman when the treatment cannot be postponed until the fetus is viable.⁹ The experiences of physicians in our study indicate that uterine evacuation may not be approved during miscarriage by the hospital ethics committee if fetal heart tones are present and the pregnant woman is not yet ill, in effect delaying care until fetal heart tones cease, the pregnant woman becomes ill, or the patient is transported to a non–Catholic-owned facility for the procedure.

Risking the pregnant woman’s life, in other words.

Obstetrician–gynecologists working in Catholic-owned hospitals described cases in which abortion was medically indicated according to their medical judgment but, because of the ethics committee’s ruling, it was delayed until either fetal heartbeats ceased or the patient could be transported to another facility. Dr P, from a midwestern, mid-sized city, said that at her Catholic-owned hospital, approval for termination of pregnancy was rare if a fetal heartbeat was present (even in “people who are bleeding, they’re all the way dilated, and they’re only 17 weeks”) unless “it looks like she’s going to die if we don’t do it.”

In another case, Dr H, from the same Catholic-owned hospital in the Midwest, sent her patient by ambulance 90 miles to the nearest institution where the patient could have an abortion because the ethics committee refused to approve her case.

She was very early, 14 weeks. She came in … and there was a hand sticking out of the cervix. Clearly the membranes had ruptured and she was trying to deliver… . There was a heart rate, and [we called] the ethics committee, and they [said], “Nope, can’t do anything.” So we had to send her to [the university hospital]… . You know, these things don’t happen that often, but from what I understand it, it’s pretty clear. Even if mom is very sick, you know, potentially life threatening, can’t do anything.

That should be malpractice.

In residency, Dr P and Dr H had been taught to perform uterine evacuation or labor induction on patients during inevitable miscarriage whether fetal heart tones were present or not. In their new Catholic-owned hospital environment, such treatment was considered a prohibited abortion by the governing ethics committee because the fetus is still alive and the patient is not yet experiencing “a life-threatening pathology” such as sepsis.

You see what they’re saying there? A situation that will lead to sepsis is not enough, they have to wait until sepsis develops – by which time it may be too late, as it was for Savita Halappanavar.

This should be a crime. The hospitals should be not just sued but prosecuted.

Dr B, an obstetrician–gynecologist working in an academic medical center, described how a Catholic-owned hospital in her western urban area asked her to accept a patient who was already septic. When she received the request, she recommended that the physician from the Catholic-owned hospital perform a uterine aspiration there and not further risk the health of the woman by delaying her care with the transport.

Because the fetus was still alive, they wouldn’t intervene. And she was hemorrhaging, and they called me and wanted to transport her, and I said, “It sounds like she’s unstable, and it sounds like you need to take care of her there.” And I was on a recorded line, I reported them as an EMTALA [Emergency Medical Treatment and Active Labor Act] violation. And the physician [said], “This isn’t something that we can take care of.” And I [said], “Well, if I don’t accept her, what are you going to do with her?” [He answered], “We’ll put her on a floor [i.e., admit her to a bed in the hospital instead of keeping her in the emergency room]; we’ll transfuse her as much as we can, and we’ll just wait till the fetus dies.”

Ultimately, Dr B chose to accept the patient to spare her unnecessary suffering and harm, but she saw this case as a form of “patient dumping,” because the patient was denied treatment and transported while unstable.

And this is all because the hospital is Catholic.

More to come, because I don’t like to make posts too long.

Damn, I missed this – last month a judge dismissed Tamesha Means’s ACLU-backed lawsuit against the US Conference of Catholic Bishops.

The ACLU immediately appealed.

A federal judge in Grand Rapids has dismissed a Muskegon woman’s ACLU-backed lawsuit that claimed Catholic anti-abortion doctrine caused her to receive improper care at Muskegon’s Mercy Health Partners before she miscarried in 2010.

The ACLU immediately filed a notice of appeal to the U.S. Sixth Circuit Court of Appeals.

Catholic anti-abortion doctrine did cause her to receive improper care – she presented with a miscarriage and they told her to go home and wait. That’s not standard of care, it’s Catholic non-care.

The ACLU-drafted lawsuit contended Means “suffered severe, unnecessary, and foreseeable physical and emotional pain and suffering” because of policy directives set by the bishops and enforced at Mercy and other Catholic hospitals.

And risk, wholly unnecessary risk. Remember Savita Halappanavar? That risk.

Catholic hospitals that obey the ERD refuse to terminate miscarriages as long as the fetus still has a pulse.

The lawsuit sought damages and  a declaration that the conference’s actions were negligent, “not only to provide a remedy for the trauma she suffered, but also to prevent other women in her situation from suffering similar harm in the future,” in the words of the legal complaint.

The policies at issue are called Ethical and Religious Directives for Catholic Health Care Services. They prohibit pre-viability pregnancy termination and informing patients that deliberate termination is a medical option.

Even in the case of a pre-viability miscarriage, when the fetus is doomed no matter what. The stinking “Directives” still say the woman has to wait, even if it kills her. It did kill Savita Halappanavar, and it has killed others whose families didn’t make a stink.

On Tuesday, June 30, U.S. District Judge Robert Holmes Bell dismissed the lawsuit without a hearing on the evidence. He based his opinion on written briefs submitted by both sides.

Bell cited two basic reasons for the dismissal:

• Michigan federal courts have no jurisdiction over the bishops’ conference for policy directives issued by the Washington, D.C.-based organization.
• It’s improper for courts to interfere in religious doctrinal decisions, which Bell concluded was behind the anti-abortion policy directives. Considering the Muskegon woman’s negligence claim would “impermissibly intrude upon ecclesiastical matters,” the judge wrote in his opinion.

So churches can run hospitals and they can order the staff to deny life-saving treatment and there’s nothing we can do about it.

Bell noted that Means still had recourse in the courts to sue doctors or hospitals for medical malpractice if she received inadequate medical care – but not, the judge concluded, to sue a religious organization or officials for their religious doctrine.

But suing the hospitals one at a time is useless – it’s the policy and the orders that have to be stopped.

“It is not up to the Court to mandate the larger structural and policy reform to  Catholic hospitals that Plaintiff seeks; that issue is left to the Church and its tribunals,” Bell wrote.

So the Catholic church can go right ahead and keep telling doctors to kill women in their hospitals.

According to the lawsuit, Means was 18 weeks pregnant – a little more than four months — in 2010 when her water broke. She made three visits to a Mercy emergency room within a couple of days with pain and other symptoms and was not informed that pregnancy termination was an option. On the third visit, with an infection-induced fever and while about to be discharged again, she delivered a baby who died within three hours.

The ACLU lawsuit contended that Catholic doctrine incorporated in the bishops’ policy  directives prevented Means from getting appropriate care. The ACLU claims her care was negligent because the policy prevents staff from telling her “that terminating her pregnancy was an option and the safest course for her condition.”

According to the ACLU, Means was in “excruciating pain,” continuing her pregnancy posed “significant risks to her health,” and she suffered “extreme distress” and an infection that can cause infertility.

After Means filed her lawsuit, the bishop conference’s president denied that the conference’s church-based doctrines amount to negligence.

According to that statement, the Catholic Ethical and Religious Directives prohibit abortion but allow operations, treatments and medications for a pregnant woman to treat a “proportionately serious pathological condition,” even if doing so causes the unintentional death of the child.

Termination is the treatment for a miscarriage with PRM – premature rupture of the membrane. That’s the treatment, and the bishops prohibit it – so the president’s statement is lying bullshit.

Congress should do something about this, but it won’t. The Feds should do something about it, but they won’t. They’re either scared of religion or in thrall to it, or maybe both.

Oh well, it’s only women.