California District Court Joins other Federal Courts in Vacating the Trump Administration’s “Denial of Care” Rule in Full

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(PRESS RELEASE) Today, a California federal judge became the third judge in the U.S. to strike down the Trump Administration’s Denial of Care rule in its entirety. U.S. District Judge William Alsup also upheld the third party standing of reproductive rights physicians to bring cases on behalf of their patients and applied that doctrine to cover physicians bringing claims on behalf of LGBTQ patients, explaining that the rights of physicians and plaintiffs in these contexts are closely intertwined.  

The vacated rule would empower an immensely broad array of healthcare workers, including receptionists and ambulance drivers, to turn away and refuse to serve patients based on moral or religious grounds. Patients seeking services like contraception, abortion, or gender affirming care would be most impacted by the rule. The lawsuit was filed by the County of Santa Clara, the Center for Reproductive Rights, Lambda Legal, Americans United for Separation of Church and State, and Mayer Brown LLP.

In his ruling, Judge Alsup wrote: 

“The New Rule sets forth new definitions of statutory terms that conflict with the statutes themselves—expansive definitions that would upset the balance drawn by Congress between protecting conscientious objectors versus facilitating the uninterrupted provision of health care to Americans.”

“Under the rule, a clerk scheduling surgeries for an operating room could refuse to reserve slots for abortions and sterilizations. So could an employee who merely sterilizes and places surgical instruments or ensures that the supply cabinets in the operating room are fully stocked in preparation for an abortion. For the reasons already stated, the Church Amendment was never intended to apply to those who have no role in the actual performance of the abortion or sterilization. Neither those who schedule abortions nor those who prepare an operating room assist in the performance of such a procedure under the Church Amendment.”

“Doctors and their patients have a confidential relationship, especially when it comes to asserting rights related to invasive procedures and treatments. Furthermore, most of the medical procedures at issue here such as abortions, gender-affirming surgery, and HIV treatments cannot be safely secured without the aid of a physician.  The rights of the individual physician plaintiffs and their patients here are thus closely intertwined.” 

“For the foregoing reasons, this order holds the rule is “not in accordance with law,” by reason of conflict with the underlying statutes and is in conflict with the balance struck by Congress in harmonizing protection of conscience objections vis-a-vis the uninterrupted flow of health care to Americans. When a rule is so saturated with error, as here, there is no point in trying to sever the problematic provisions. The whole rule must go.”

Earlier this month, federal judges in New York and Washington also vacated the entire rule in separate cases. Dozens of states, municipalities, providers, and advocacy groups have challenged the rule through various lawsuits around the country. The lawsuits emphasize that this confusing policy would incentivize health care providers to eliminate reproductive healthcare and LGBTQ care altogether, leaving millions across the country without access to critical health care, including in regions that might otherwise prioritize maintaining access to this essential care.  The Rule is especially dangerous because it has no emergency exception.

“We are grateful the Court recognized the unchecked discrimination against women and LGBTQ patients that could occur under this rule, even in medical emergencies,” said Genevieve Scott, Senior Staff Attorney at the Center for Reproductive Rights. “Discrimination in any context is egregious, but allowing someone’s religious or moral views to effectively veto a patient’s medical choice could have deadly consequences. It is out of line with any reasonable understanding of law or medical ethics that a receptionist, who is not directly involved in providing medical care, could turn away patients, or that an EMT could refuse to transport a patient with a life-threatening ectopic pregnancy.”

The Denial of Care Rule was issued in May by the U.S. Department of Health and Human Services, and it applies to virtually every kind of healthcare provider.  Health care facilities risk losing all federal funding if they do not grant employees carte blanche to deny information and services.   Because the Rule is infeasible to implement, if allowed to go into effect, it would coerce many health care facilities to eliminate reproductive healthcare and LGBTQ healthcare, leaving millions across the United States without access to critical healthcare.

Plaintiffs in the case include the County of Santa Clara, which runs an extensive health and hospital system that serves as a safety-net provider for the county’s 1.9 million residents; the health providers Bradbury-Sullivan LGBT Community Center in Allentown, Pa., Center on Halsted in Chicago, Hartford GYN in Connecticut, Los Angeles LGBT Center, Mazzoni Center in Philadelphia, Trust Women Seattle and Whitman-Walker Health in Washington, D.C.; the associations AGLP, GLMA and Medical Students for Choice; and five doctors.