The Hill: Anti-Choice bill does imperil women’s lives

Last week’s vote on the anti-abortion measure, H.R. 358, was a disappointing new low for the House.  The heated debate occasioned dueling letters by Rep.’s Jan Schakowsky (D.-Ill.) and the bill’s author, Rep. Joseph Pitts (R.-Penn.), about whether the bill would allow institutions and doctors to refuse to provide care even in life-threatening emergencies. At issue are patient protections from an anti-“patient dumping” law, the Emergency Medical Treatment and Active Labor Act (EMTALA). Schakowsky’s letter noted that the “bill would, in effect, strip EMTALA of its power to ensure that women in emergency situations receive abortion care at hospitals by making their right to health care secondary to the hospital’s ability to refuse to provide abortion care.” Pitts, on the other hand, claimed that because EMTALA refers to “unborn child,”  “EMTALA currently recognizes both lives.” Who’s right? Schakowsky is, by a mile.  EMTALA uses “unborn child” in three places, all make clear that a hospital seeking to transfer a woman in “active labor” must assess health risks from the transfer for both the woman in labor and the child she will deliver.  The law does not confer a freestanding interest in the health of an “unborn child” that allows hospitals to deny care to a woman experiencing a miscarriage.  If it did, the Pitts bill would be superfluous. In fact, in an American Journal of Public Health article by Lori Freedman, a religiously-affiliated hospital that refused to complete a miscarriage, essentially risking a woman’s health, was reported for an EMTALA violation:

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 [suffering from infection]. 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.

[From the doctor:] “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 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.’’ This shocking delay in care is caused by hospitals’ adherence to Religious Directives from the U.S. Conference of Catholic Bishops – including those cases that clearly conflict with medical standards.  The Directives require doctors to wait until the fetal heartbeat stops before completing a miscarriage, even if the pregnancy is no longer viable.  In the meantime, women risk a life-threatening form of infection.

One loophole highlighted by this story is that EMTALA does not apply if a patient is admitted to the hospital.  In addition, if no one transfers a patient, courts have been clear that EMTALA does not create a standard for medical negligence. But if nobody tries to transfer a patient to a hospital that will provide care, patients may fall through the cracks.   The Pitts bill would allow institutions to insist on policies that deny patients care, trumping doctors’ professional judgment and training.  Freedman’s report tells one such story: a doctor appalled at the denial of care to a woman having a miscarriage – a woman so ill that her eyes filled with blood from the infection caused by the delay – subsequently quit his job in disgust. Nationally, one-sixth of hospital visits are to religiously-affiliated hospitals. The notion that care would differ so drastically from one emergency room to another is out-of-step with public health needs and the beliefs of religious adherents, who, polls indicate, agree that medical care should not be restricted by religion. Only physicians, not institutions, have a conscience. Granting institutions a right of refusal merely guarantees that doctors who choose to provide care consistent with their own beliefs and training won’t be able to do so. Chillingly, the Pitts bill would ensure that hospitals’ institutional dictates, including those at odds with medical science, could override the doctors’ consciences, even when those dictates risk women’s lives. Read and comment on this story on The Hill’s Congress Blog >,