Humboldt County Superior Court Judge Timothy Canning has rejected Providence St. Joseph Hospital’s request to dismiss a landmark lawsuit brought by the California Attorney General’s Office alleging it violated state law when it refused to provide a medically necessary abortion in February 2024, putting the mother’s life at risk.
Attorneys representing the hospital filed for a demurrer in December, asking the case be dismissed, or at least delayed, and arguing that state law requires the California Department of Public Health to review alleged violations of the state’s Emergency Services Law and that requiring religious hospitals to provide abortion services when there is a detectable fetal heartbeat would amount to a violation of its religious protections under the First Amendment.
In a ruling filed Monday, Canning rejects those arguments — as well as several others put forward by Providence — allowing the case to proceed.
Filed in September, the lawsuit alleges the hospital violated state law requiring hospital emergency rooms to provide care to prevent not only maternal death but also “serious injury or illness” when it reportedly denied care to Anna Nusslock due to policies set in accordance with the Ethical and Religious Directives for Catholica Health Care Services created by the United States Conference of Bishops.
The suit alleges that 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 Feb. 23. After an ultrasound, Nusslock said Sarah McGraw, the doctor on call that night at St. Joseph, diagnosed her with preterm premature rupture of membranes and told her that while one of her fetuses still had detectible heart tones, both were nonviable and would not survive. Attempting to continue the pregnancy, the doctor said, carried “significant maternal morbidity and mortality” risks, according to the suit.
The suit alleges specialists at the University of California, San Francisco Medical Center recommended immediate abortion care, and McGraw agreed, though the Providence doctor then told Nusslock she was not “permitted to provide” the procedure so long as either of the fetuses had detectable heart tones.
Ultimately, McGraw informed Nusslock that Mad River Community Hospital was willing to take her, according to the suit, and she was discharged for her husband to drive her the 12 miles north, with a nurse allegedly giving her a bucket and some towels “in case something happens in the car.”
When Nusslock arrived at Mad River, the suit alleges she’d “passed an apple-sized blood clot,” was bleeding heavily and “appeared to be deteriorating.” She was rushed into emergency surgery.
While Providence St. Joseph Hospital has denied it violated the law, it entered an agreement with the state in October, pledging its care staff will follow the Emergency Services Law by allowing physicians to terminate a patient’s pregnancy when necessary to protect a mother’s health. A footnote in a filing weeks later, however, indicated the hospital intended to keep following the religious directives for care, saying it has a “connotational right” to do so.
In arguing the AG’s case should be dismissed, an attorney representing Providence said the “elephant in the room” is that the Attorney General’s Office does not have a single case it can point to setting the precedent of a court requiring a Catholic hospital to provide abortion services against its policy.
Further, attorneys representing Providence argued that the ESL grants the California Department of Public Health primary jurisdiction to investigate alleged violations of its provisions, so the court should dismiss or delay the case until the department has a chance to investigate and issue its findings. They also argue the ESL allows patients to be transferred “for medical reasons” to receive care at other hospitals, and that the AG’s lawsuit incorrectly applies a civil rights law — the Unruh Civil Rights Act — when it alleges Nusslock was denied full and equal accommodations because she was pregnant.
In his ruling, Canning says while the ESL does give the public health department primary jurisdiction, it also gives individuals harmed by violations of the law authorization to bring civil actions. Further, Canning dismissed Providence’s arguments that the public health department would be better suited than the court to grasp the complexities of the law and this case.
“Providence urges this court to exercise its discretion and dismiss or abate this action until CDPH weighs in, contending that the ESL is a complicated statute with highly technical definitions which may be beyond this court’s ability to comprehend,” Canning’s ruling reads. “However, to the extent that specialized knowledge or expertise is needed to resolve the issues raised by the complaint, the parties can proffer expert testimony to assist the court. The court overrules the demurrer on this ground.”
As to whether Nusslock was transferred from Providence for medical reasons — the AG claims she was transferred for religious reasons, while Providence argued she ultimately received care at Mad River Community Hospital so it is indisputable she was transferred for medical reasons — Canning said there are facts in dispute that can’t be reconciled at this stage in the proceedings.
Canning also found that the AG’s complaint alleges facts that, if true, would meet the requirements for a claim under the Unruh Civil Rights Act, denying Providence’s request that section of the suit be dismissed.
Much of Canning’s ruling, however, is spent addressing the religious freedom defense pushed by Providence’s attorneys, who argued that forcing the hospital to perform abortions unconstitutionally interferes with Providence’s free exercise of religion. Canning explains in his ruling that laws that burden religious exercise must be neutral and generally applicable — meaning they don’t target a specific religion and apply generally to all people and intuitions — or pass a strict scrutiny analysis.
“The ESL requires California hospitals with emergency rooms to provide emergency services to whoever needs them,” Canning wrote. “The legislative purposes behind the statue are ‘the provision of emergency medical care is a vital public service of great benefit to Californians.’”
Canning notes that the law does not require hospitals to provide emergency services they do not have appropriate facilities or qualified personnel available to provide, but draws a distinction between that exemption and what’s alleged in this case. Canning writes that the complaint alleges Providence does have appropriate facilities and qualified personnel to perform an emergency abortion but chose not to because of “religious doctrine.”
“The court finds that the ESL is neutral as to religion and is a statute of general applicability, and the exemptions contained in the ESL are also religion-neutral and narrowly tailored to accomplish the purposes of the ESL,” Canning writes. “There is a rational and logical connection between requiring a hospital to provide emergency services unless that hospital does not have trained physicians to perform the service, or does not have the necessary equipment to perform the emergency procedure. Ensuring hospitals only perform emergency treatments that their staff are qualified to perform with necessary medical equipment promotes patient welfare. Further, allowing a hospital that is fully able to care for a patient to choose not to do so due to its religious doctrine would undermine the purposes of the ESL. Finally, there is nothing in the ESL or legislative history that is based on secular beliefs, or that prioritizes secular beliefs above religious beliefs. Instead, the ESL addresses public policy concerns as found by the Legislature, acting well within its constitutional powers.”
But even under a strict scrutiny standard, Canning finds the ESL holds up, saying it serves the specific and compelling government interest of providing a high quality system of emergency medical services to promote the health and safety of Californians.
“Assuming the facts as alleged in the complaint are true, the Court concludes that the ESL does not unconstitutionally infringe on Providence’s religious right to free expression,” Canning’s ruling concludes.
Providence now has 30 days to file an answer to the AG’s Office’s initial complaint in the case.
Since the filing of the AG’s suit, Nusslock herself and another woman identified in court filings as Jane Doe have filed lawsuits against the hospital alleging they suffered personal harm when the hospital illegally denied them abortion care during medical emergencies.
This article appears in From Garden to Table in the Hall.