'A Nightmare on Replay'

A second local woman has filed a lawsuit alleging Providence St. Joseph Hospital caused her undue suffering and put her life at risk when it denied her necessary emergency medical care in the form of an abortion, because the unviable fetus she was carrying still had a detectable heartbeat.

The allegations in the suit filed Dec. 12, on behalf of an anonymous woman referred to as “Jane Roe,” mirror those in a lawsuit the California Attorney General’s Office filed against the hospital Sept. 30, alleging it endangered Anna Nusslock’s life in February by refusing to abort a non-viable pregnancy.

Together, the suits and accompanying declarations illustrate an alleged pattern of practice at St. Joseph Hospital, with the hospital denying women emergency abortion services on at least four occasions despite immediate health risks to the mother and doctors having determined the fetuses could not be saved.

The fresh allegations come after Mad River Community Hospital’s labor and delivery unit closed in October, leaving St. Joseph Hospital as the only hospital birthing option locally and putting a renewed spotlight on the hospital’s adherence to the Ethical and Religious Directives for Catholic Health Care Services created by the United States Conference of Catholic Bishops. Those directives prohibit elective termination of pregnancies, but state law requires that hospital emergency rooms provide care — including abortions — necessary to prevent not only maternal death, but serious injury or illness.

While denying wrongdoing in the suit, Providence entered into a stipulation with the Attorney General’s Office in October, under which the hospital pledged its care staff will follow the state’s Emergency Services Law by allowing physicians to terminate a patient’s pregnancy when necessary to protect a mother’s health.

Nonetheless, Jane Roe’s lawsuit and allegations seem to have heightened concerns among state and local officials, with North Coast State Sen. Mike McGuire pledging to meet with the hospital officials in the coming days to discuss his concerns.

“Denying a patient medically-urgent abortion care is egregious, unacceptable and against the law here in California,” McGuire said in a statement emailed to the Journal. “I’ll be calling in the leadership team of Providence in the days to come, and I’ll make clear that the state will use every legal measure necessary to enforce the letter of the law.”

Providence spokesperson Chamia Chambers, meanwhile, said in a statement that it was “truly saddened by the experience described” in Jane Roe’s complaint and is reviewing the allegations.

“Providence recently rolled out enhanced education and training for our medical staff and caregivers to reaffirm our provision of emergency services for all patients, including those who are pregnant,” Chambers said. “Safe, high compassionate care is always our top priority, and we want to reassure the Humboldt County community that they can count on us when they need us most as they have for more than 100 years.”

‘A Nightmare on Replay’

Jane Roe was 17 weeks into what the complaint describes as “a very wanted pregnancy” when on Dec. 12, 2022, she felt her water break and immediately rushed to St. Joseph hospital’s emergency room, “hoping to save her baby.” Once there, doctors confirmed she was in active labor and diagnosed her with previable preterm premature rupture of membranes (known as previable PPROM, which is the same condition that brought Nusslock to the same ER in February, according to the AG’s filing.)

Jane Roe’s complaint says doctors informed her this was a serious medical condition given her other risk factors and delivered “the tragic news that her baby would not survive.” Roe had been here before, according to the complaint, having twice lost pregnancies to previable PPROM at around 17 weeks gestation, both at St. Joseph Hospital, which the complaint alleges had refused to terminate her pregnancy — the standard of care in such situations — on both occasions.

“With no chance of survival for her baby, and with her risk of developing an infection or suffering another near fatal hemorrhage increasing by the minute, [Roe] needed an emergency abortion to protect her life and health,” the complaint says. “But [Roe’s] doctors were forbidden from providing this necessary care so long as there was still a detectable fetal heartbeat — a prohibition imposed by hospital policy, not medical judgement. This was a nightmare on replay. [Roe] had sought treatment at Providence St. Joseph during both of her prior miscarriages and both times had been turned away and denied medically necessary care.”

In Roe’s first miscarriage, the complaint alleges that when she was refused necessary care at St. Joseph, she traveled more than five hours by car to San Francisco while in active labor to be treated at a hospital there. The second time, the complaint alleges, she was discharged and sent home “without an obstetrician ever evaluating her” and delivered the next morning in her obstetrician’s office “and nearly hemorrhaged to death,” later requiring a double blood transfusion.

“This third time was no different,” the complaint says. “[Roe] suffered in limbo — actively laboring and in pain, grieving her loss, and terrified that she might hemorrhage again and even die. After 19 hours of agony, [Roe] spontaneously delivered her deceased baby in a hospital toilet.

“Providence St. Joseph’s treatment of [Roe] on these three occasions was shocking and inhumane,” the complaint continues. “It was also illegal.”

Roe, the complaint says, continues to suffer post-traumatic stress disorder, anxiety, depression and fear or hospital settings.

Similarly, Nusslock, a local chiropractor, was 15 weeks pregnant with twin girls when her water broke, and she arrived at St. Joseph Hospital bleeding and in severe pain on Feb. 23, according to a sworn declaration. After an ultrasound, Nusslock said Sarah McGraw, the doctor on call that night at St. Joseph, diagnosed her with previable PPROM and told her that while both fetuses still had detectible heart tones, one had no chance of survival and the other had “essentially no chance,” and that attempting to continue the pregnancy carried “significant maternal morbidity and mortality” risks.

A specialist recommended immediate abortion care, but McGraw told Nusslock she was not “permitted” to provide it under St. Joseph policy and that she could not do anything for Nusslock so long as her twins had heart tones, according to the declaration. The doctor conceded the situation was “horrible” and recommended Nusslock be flown to University of California, San Francisco Medical Center, Nusslock alleges. When Nusslock expressed concern the $40,000 flight wouldn’t be covered by insurance and asked if she could drive, she alleged she was told: “You will hemorrhage and die before you get to a place that can help you.” Ultimately, Nusslock says St. Joseph agreed to discharge her so she could be driven to Mad River Community Hospital, which had agreed to take her. She alleges a nurse gave her a bucket and some towels, “in case something happens in the car,” and she was sent on her way.

By the time Nusslock was admitted to the now shuttered labor and delivery unit at Mad River, she says she’d passed “an apple-sized blood clot” and was bleeding heavily. The doctor who treated her there, Elizabeth Micks, said in a declaration that Nusslock was “not clinically stable” when she arrived and “appeared to be deteriorating.” She was moved to the operating room “on an emergency basis” for the procedure.

“Though Ms. Nusslock was able to physically recover, I do not believe this was a foregone conclusion,” Micks said in the declaration. “There is never a guarantee that doctors will be able to address and reverse the damage once a patient begins to deteriorate. Moreover, one complication can rapidly beget others: An infection can prevent a uterus from properly contracting, which can cause hemorrhage, and subsequent blood loss can both weaken the body’s ability to fight the infection and create other complications. This is why the standard of care is to offer early intervention, and why care delayed may ultimately be care denied.”

Micks’ declaration goes on to state that based on her personal experience, she would estimate that one to two women per year receive abortion services at Mad River after being denied care at St. Joseph, though it’s rare to see cases as “emergency” as Nusslock’s.

Kim Ervin, a physician who recently retired after practicing obstetrics and gynecology in Humboldt for 35 years, practicing at both St. Joseph and Mad River, says she believes the experiences detailed by Roe and Nusslock are not unique.

“I’m sure it’s happened and been happening for years,” she says, noting that what she believes is different this time is it happened to someone like Nusslock, a professional with means who knew the law and was willing and able to take a public stance in the wake of a personal tragedy.

‘Deeply Concerning’

With these two cases having come into public view as St. Joseph became the only hospital delivery option for expectant families, the uneasy question for many is, what now?

The first lawsuit spurred Ellie Titus into action. She says conversations with friends quickly grew to the creation of a Facebook group and email list, followed by the launch of the website humboldtmutualaid.org. She says the group is now almost 150 members strong, focused on “organizing to protect abortion access in Humboldt County.”

But she says exactly what that will look like long-term remains to be seen. The group hosted a forum for candidates running for city council seats in Fortuna and Ferndale in the lead-up to the election to put them on record on the topic of abortion access, among other things. It has also served as a conduit, connecting “more than one” local with a story to tell to the Attorney General’s Office, though she declined to go into detail about that.

She says the group will likely host additional events in the new year and is revamping its website and researching nonprofit status or some other legal structure.

In the meantime, she says the group has volunteers ready to help people in immediate need. The group is distributing fliers advising pregnant women of the rights with a hotline — (707) 234-5558 — for people to call or text if they need an advocate, or even just a ride.

“There are people who want to help,” Titus says.

But the larger vision is to advocate for a more lasting change to ensure expectant families on the North Coast have access to the full spectrum of healthcare services they may need, she says, and a first step is going to be pushing elected officials to make that a priority.

“We have one labor and delivery unit in Humboldt County, where the doctors are bound by what the bishops tell them, and that seems totally untenable to me for Humboldt County’s economic future, not to mention I think it’s morally outrageous,” she says. “But just from an economic standpoint, this isn’t a situation that’s going to attract investment or make it easy for people who are from here to stay and grow here. I would really like to see some urgency and outrage from our elected leaders out there who I know are allies.”

The Journal reached out to Humboldt County’s state representatives, and asked if they could comment on the lawsuits’ allegations or their efforts to ensure St. Joseph provides necessary emergency services to pregnant mothers who need them.

McGuire, one of the state’s top officials as the Senate’s president pro tempore, reminded that access to a full spectrum of reproductive healthcare is not just a fundamental right but “enshrined in the state Constitution,” before pledging to talk to Providence’s leadership in the coming days.

Newly elected Second District Assemblymember Chris Rogers, meanwhile, noted Providence has committed to making changes but said “it is very apparent” its policies have failed patients.

“During what I can only imagine is the worst moment in these women’s lives, their medical professional’s hands were tied by hospital policies that denied them vital care and put their lives at risk,” he said in an emailed statement.

The Journal also reached out to all five members of the Humboldt County Board of Supervisors, asking what they could do in their capacity to help ensure women suffering medical emergencies during pregnancy can get the care they need. Only two responded, First District Supervisor Rex Bohn and Fourth District Supervisor Natalie Arroyo.

Bohn said he’s talked with Providence and been told “their doors are open for all patients needing emergency services, including those who are pregnant, and they are providing staff with enhanced caregiver training.”

Arroyo offered a more personal response, saying the situation is “deeply concerning” and she’s grateful to those who have come forward to share their experiences.

“My partner and I very much want to start a family ourselves and we find ourselves in that higher risk category, so it’s personal for me, in addition to having a professional and community duty to care,” she wrote in an email. “I have been working for many months to interview people involved in local medical care provision and build relationships with medical leaders in Humboldt. Part of this is asking how local government can help address our challenges with recruiting and retaining providers, building up our institutions, addressing civic needs, providing more preventative care and other actions to improve the health of our residents.”

If there’s a silver lining to all this, Ervin says she suspects it will be that Providence St. Joseph will do all it can, at least in the short term, to make sure it’s following the law to avoid more lawsuits or further action from the state. She noted that the hospital has sent out a memo to providers saying it would not interfere with the judgement of a physician who deems an emergency procedure necessary.

“If a woman comes in to the emergency room and she’s bleeding, and she’s early pregnancy or pre-viability … I don’t think there’s going to be any kind of interference,” she says, adding the question is whether that will continue after the lawsuits resolve or media attention wanes. “But Providence owns a ton of hospitals, so I’m sure they were really freaked about by all that attention, so I think they’re going to be really good for a while.”

Longer term, she says there’s no escaping the fact that Humboldt County’s medical institutions are in trouble, with St. Joseph subject to a corporate model and the directives of a bishop in Santa Rosa, and Mad River struggling to maintain services, as evidenced by the recent closure of its labor and delivery unit. Healthcare, she says, is “looking pretty bleak.”

Providence St. Joseph was due to file a response to the Attorney General’s Office lawsuit by the end of November, but had not yet done so on Nov. 16, before the Journal went to press. A spokesperson for the California Department of Justice, meanwhile, declined to comment on Roe’s lawsuit but said the attorney general will continue to enforce the law.

“Abortion care is healthcare; and in California, access to abortion care is a constitutionally protected right,” they said in an emailed statement. “The attorney general will always defend reproductive rights, and will continue to use the full force of his office to hold accountable those who break the law. Our office strongly encourages any individual(s) that were denied an abortion in a medical emergency, or denied any other emergency medical care to contact abortion.access@doj.ca.gov.”

Thadeus Greenson (he/him) is the Journal’s news editor. Reach him at (707) 442-1400, extension 321, or thad@northcoastjournal.com.