Anna Nusslock never expected to be denied an emergency abortion by a hospital in California, a state with some of the strongest abortion rights protections.
In February, Nusslock, 36, a chiropractor in Eureka, went to the nearest emergency room, at Providence St. Joseph Hospital, after her water broke just 15 weeks into pregnancy.
Doctors said one of the twins she was carrying would not survive and the other had almost no chance, according to medical records. They said that if the pregnancy was not terminated, she could face infection, hemorrhaging and threats to her future fertility.
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But because fetal heart tones could still be detected, a doctor at the Catholic-affiliated hospital said the institution’s policy prohibited providing abortion unless Nusslock’s life was at risk, according to her medical records.
After several hours, her husband drove her to the next closest hospital, where she arrived hemorrhaging and passing a blood clot the size of an apple. She expelled one fetus and was rushed into the operating room so the other fetus could be removed, records show.
“I thought I would be safe here from things like this,” Nusslock said in an interview, “from people taking away choices from me and leaving me in danger.”
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Similar situations have occurred in states with abortion bans, but California Attorney General Rob Bonta said in an interview that Nusslock’s case shows they can happen “even in California, a place that is very strongly pro-choice.”
On Monday, Bonta filed suit against the company that operates Providence St. Joseph, charging that the hospital violated a California law requiring hospitals with emergency rooms to provide care to prevent not only death, but “serious injury or illness.”
Officials in the attorney general’s office say they believe this to be the first lawsuit California has filed against a hospital under the Emergency Services Law, which says hospitals have to provide care “necessary to relieve or eliminate the emergency medical condition.”
The attorney general said he was doing so partly because of uncertainty about the fate of a similar federal law, the Emergency Medical Treatment and Labor Act or EMTALA, which has become a lightning rod in the national abortion debate.
Since Roe v. Wade was overturned, EMTALA has been challenged by two states with abortion bans. One case, involving Idaho, was heard by the Supreme Court this year. The justices decided to send it back to Idaho’s courts, leaving unclear, for now, how EMTALA can ensure that hospitals provide abortions in medical emergencies.
“There were some written opinions by the conservative wing of the court that were very disturbing about whether abortion care, which is health care, will be provided under EMTALA in emergency situations,” Bonta said, “so unfortunately, EMTALA is not reliable right now, in our view, because of the limbo that is in.” As a result, he said, “states are on their own and need to rely on our own laws.”
In a statement, the hospital said, “Providence is deeply committed to the health and wellness of women and pregnant patients and provides emergency services to all who walk through our doors in accordance with state and federal law. We are heartbroken over Dr. Nusslock’s experience earlier this year. This morning was the first Providence had heard of the California attorney general’s lawsuit, and we are currently reviewing the filings to understand what is being alleged.”
California, which also accuses the hospital of violating state laws concerning civil rights and business conduct, is seeking a preliminary injunction immediately stopping the hospital from following its policy while the case proceeds.
“We do not want another Anna,” Bonta said.
In its injunction motion, the state predicted the hospital might say that changing its policy would violate its religious beliefs. The Emergency Services Law does not mention religious or conscience objections. The state argued that a law intended to ensure equal access to medical care outweighs religious exercise and that in other cases, California’s Supreme Court “has upheld laws that require hospitals to provide medical care, even when doing so is at odds with religious beliefs.”
Nusslock, who said she came forward partly out of concern for “access to care for the other women in my community,” said she and her husband, Daniel, had been desperately trying to have a baby and had lost several previous pregnancies.
After learning she was pregnant with twin girls last November, she made decorations for their nursery and crocheted blankets, sweaters and hats. “I was thrilled, and I was so excited,” she said.
Because of her age, previous losses and other factors, her pregnancy was considered high risk and, in addition to a doctor in Eureka, she worked with maternal-fetal medicine specialists at UC San Francisco, five hours away.
In February, she learned the pregnancy had characteristics that could increase risk. Soon after, “I began experiencing severe cramping, pain, and bleeding,” she wrote in a declaration for the lawsuit.
Following doctors’ advice, she twice visited Providence St. Joseph, which had the best equipped emergency department in her area. “Each time I was told that both fetuses had heart tones and sent home despite the persistence of my own symptoms, including severe pain,” she wrote.
Later that month, as she was making dinner, her water broke. She consulted a doctor, and several hours later went to Providence’s emergency department with “severe cramping and severe bleeding,” she said. Medical records show she was diagnosed with previable preterm premature rupture of membranes (previable PPROM), which can quickly and suddenly lead to infection or hemorrhage. It is one of several pregnancy complications for which abortion is a standard treatment.
One twin’s amniotic sac had broken and lost all fluid, making survival impossible, the records said. Nusslock asked if the other twin could survive. The Providence doctor consulted UCSF’s maternal-fetal medicine unit, which told her that for that twin, there was “an extremely low likelihood of maintaining pregnancy” and “an even lower likelihood” the baby could be “neurologically intact.”
The maternal-fetal medicine specialist said that not terminating the pregnancy would probably cause “significant maternal morbidity,” the Providence doctor wrote, meaning serious risks to Nusslock’s health. The specialist recommended ending the pregnancy by inducing labor or performing a procedure. But the Providence doctor wrote that because of hospital policy, “I cannot offer” pregnancy termination “while the fetuses have a heart rate.”
The Providence doctor recommended Nusslock be transferred by helicopter to UCSF, but that would cost $40,000 that her insurance would not cover, she said. When she asked if they could drive to San Francisco, she said the doctor replied, “If you try to drive, you will hemorrhage and die before you get to a place that can help you.”
They eventually drove 20 minutes to Mad River Community Hospital. When Providence hospital discharged her, Nusslock said a nurse, recognizing that her condition could quickly worsen, gave her a bucket and towels, saying it was “in case something happens in the car.”
The doctor at Mad River wrote in a court declaration that Nusslock was “actively hemorrhaging” and lost considerably more blood than expected during the surgical procedure performed there. Records later said that she most likely had an infection in the placenta and amniotic fluid.
The Mad River doctor wrote that she had treated other patients denied abortions by Providence hospital in similar circumstances. She also noted that Mad River’s labor and delivery unit was closing soon, which would make options even scarcer in the area.
Nusslock has recovered physically but says the strain has caused insomnia and hair loss. “This experience deeply traumatized me, and I have been dealing with tremendous anxiety, grief, and depression ever since,” she wrote.
This article originally appeared in The New York Times.
