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At a Catholic Hospital, a Dispute Over What a Doctor Can Do – and Say

The ACLU has filed a complaint in Colorado asserting a doctor was disciplined by a Catholic hospital simply for talking about an abortion.

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The ACLU has filed a complaint in Colorado asserting a doctor was disciplined by a Catholic hospital simply for talking about an abortion. (File, Brendan Smialowski/AFP/GettyImages)

Nov. 19: This story has been corrected.
Nov. 14: This story has been updated with comment from Dr. Demos.

A dispute between a Colorado cardiologist and the hospital he works for has highlighted a growing area of concern among patient advocates and civil libertarians: gag rules imposed on doctors and nurses by Catholic health-care providers.

In a complaint filed Wednesday, ACLU of Colorado accused Mercy Regional Medical Center in Durango, in the remote southwest corner of the state, of illegally telling doctors and other employees that they cannot discuss abortion with patients, even if a pregnancy threatens a woman’s life. The complaint was filed with the Colorado Department of Public Health and Environment, which oversees the state’s hospitals.

“Mercy Regional’s moral objection to abortion does not exempt the hospital from complying with [state and federal] laws,” the ACLU’s Sara Rich wrote to the health department, “and the hospital cannot invoke its religious status to jeopardize the health and lives of pregnant women seeking medical care.”

In a statement, hospital spokesman David Bruzzese said the complaint was “based on inaccurate information.” He said Mercy takes “very seriously the care we provide to our patients.”

The hospital chose not to respond to specific allegations in the complaint.

The case involves Dr. Michael Demos, a cardiologist for 36 years, and a female patient with a family history of Marfan syndrome, an inherited disorder of the connective tissues that has been called “one of the most feared cardiovascular complications associated with pregnancy.”

In women with the condition, the strains on the body brought on by pregnancy can cause the aorta to rupture, almost always killing the mother. Thus the American College of Cardiology and American Heart Association recommend that if a patient’s aorta becomes enlarged beyond a certain point, her pregnancy should be terminated.

According to the complaint, Demos met with the patient, who was eight weeks pregnant and displayed signs of having the disorder, in early 2012. As he tells it, he recommended follow-up testing and discussed the treatment options — including abortion — should the results indicate that her life was in danger. Fortunately, an echocardiogram showed that the patient’s blood vessels were normal, Marfan syndrome was ruled out, and she went on to have a healthy baby. “I never saw her again,” Demos said.

But more than a year later, the woman complained to hospital officials that Demos and others on Mercy Regional’s staff had recommended that, based on “a presumptive diagnosis of Marfan syndrome” (the ACLU’s words), she should end her pregnancy. “It was a misunderstanding on her part,” Demos said in an interview, adding that there was “no harm done. Usually in these cases, there’s harm.”

But Demos seems to have been caught up in another misunderstanding, too. A Brooklyn native who has lived in Durango since 2008, he said he became a Mercy employee in July 2011, when his private practice group was bought out by another group that eventually became part of Mercy. He can’t recall whether he knew what Mercy’s policies were on abortion: “Perhaps I should have known, but I didn’t.” And he had more than the usual reason to be cautious about a patient who might have Marfan: Many years ago, he said, he treated another pregnant woman with the condition who died. Not to have discussed the option of abortion with someone who might suffer from the disorder “would have been malpractice,” he said.

But hospital officials apparently saw it differently. Demos was reprimanded and told (in the words of the complaint) that he was “not permitted to recommend an abortion, nor is he permitted to even discuss the possibility of terminating a pregnancy with a Mercy Regional patient, regardless of the circumstances.”

Later, Mercy Regional’s chief medical officer, John Boyd, assured the patient in writing that the hospital would “provide education to all our employed providers, reminding them that they should not recommend abortion — even to patients who may have serious illnesses,” the ACLU’s complaint says, quoting his letters. Boyd also reaffirmed that under The Ethical and Religious Directives for Catholic Health Care Services, Mercy Regional’s staff was “precluded … from providing or recommending abortion.”

The ERDs, a set of 72 guidelines issued by the U.S. Conference of Catholic Bishops, restrict a range of reproductive health options that conflict with church teachings — abortion, birth control, sterilization, fertility treatments — as well as certain end-of-life care possibilities and stem cell research. The directives also have been interpreted by many hospitals to prohibit emergency abortions for miscarriages and ectopic pregnancies as well as emergency contraception after sexual assault (which now generally works by preventing ovulation).

The directives have long been controversial with women’s health advocates and civil libertarians, and the Colorado episode, they say, underscores why. The guidelines don’t just restrict what doctors and nurses at Catholic providers may do; they can even limit what health professionals are allowed to say.

Mercy’s policy “prevents physicians from fulfilling their ethical obligations” to patients and “interferes with patients’ rights to make informed decisions regarding their medical care,” the complaint said. The policy also violates patient safeguards under Medicare and Medicaid as well as a Colorado law protecting physicians’ autonomy, the ACLU said.

Mark Silverstein, ACLU of Colorado’s legal director, said that by barring doctors from informing patients about all possible treatment options, Mercy Regional poses “a potential threat to the health, safety and even the lives of its patients.”

The potential risk to patients is especially grave in communities like Durango, where a Catholic hospital is the only one for miles around, added Sheila Reynertson of MergerWatch, a New York–based nonprofit that tracks Catholic hospital consolidations and their impact. She noted that so-called “sole provider” hospitals — there are 30 of them in mostly isolated parts of the country — receive additional federal funds to serve the needs of their communities, as well as Medicare, Medicaid and other tax breaks.

Reynertson said that gag policies like Mercy’s are “absolutely” common — and are becoming more so as Catholic health-care systems gobble up other providers in a merger boom touched off by health-care reform. “What’s unusual about this case is that you have it in writing,” Reynertson said. “Usually, the policies are not so clear cut.”

But vague gag rules may be just as problematic, Reynertson added, especially at secular hospitals and practices, like Demos’s, that find themselves under Catholic control. “People tend to overreact to keep their jobs. This is what we’ve heard many times — the nurse in the emergency room who is suddenly very nervous about that pregnancy emergency because there’s a heart beat. Doctors become nervous, hospital administrators become nervous. It’s a chilling effect.”

Also unusual is that Demos is a heart specialist, suggesting that the gag rules can have a broader reach than many people realize. “Usually you would expect to see this kind of thing happening to an OB/GYN” — the doctors who have historically been most likely to come into conflict with the ERDs, Silverstein said.

In his statement, spokesman David Bruzzese acknowledged that, as a faith-based hospital, Mercy is committed to carrying out its mission and ministry “in a manner that is consistent with our religious and ethical directives.”

But, he added, patients and physicians “are free to use all information in the medical literature to make appropriate medical decisions.”

The ACLU, meanwhile, urged state health department officials to intervene to stop Mercy Regional from enforcing its gag policy and from “inappropriately interfering with its physicians’ practice of medicine.” It has requested a response from the state by the end of the month.

For his part, Demos — who remains a Mercy employee — said that he had only good intentions in bringing the complaint. “I love Durango. I’m not going away. I really want this hospital to thrive — someday I will be a consumer [here] too. I always try to do my best, and I want my hospital to be the best, too. I want to practice the best we can practice. If you’re looking for a motive, that’s it.”

Correction: This story originally said that emergency contraception generally works by preventing implantation of a fertilized egg. It actually works by preventing ovulation.

Stephen Booser

Nov. 14, 2013, 5:08 p.m.

Even though I don’t approve, I concede the indirect government subsidy religious establishments receive by virtue of their tax-free status. This tradition was begun by the Roman Emperor Constantine and is too well ensconced to be done away with.

However, if had a magic wand, I would wave it and any institution, organization, and especially health care provider receiving subsidy of any kind, indirect or direct, from municipal, state, or federal government in addition to tax-free status would have a choice: Provide the comprehensive services offered that are legally permitted and mandated to everyone equally without regard for religious ethics and tenets. 

The key here is subsidy with public money no matter how fractional an individual’s share may be. For example, some fractional part of the taxes I pay provides for, say, indirect subsidy to a Catholic hospital which has tax-free status. In my opinion, it is impermissible for the Catholic hospital to receive any more of my money as additional subsidy if on religious grounds it refuses treatment and consultation, such as regards abortion, based on religious grounds. This constitutes a violation of the establishment clause.

If a Catholic hospital receives, say, a grant from a governmental agency or receives a grant from an agency that itself enjoys tax-free status, it means that if such a hospital refuses treatment and consultation because of religious prohibitions. then public money is being given to a religious establishment in addition to tax-free status. And this, in my opinion is a no-no on constitutional grounds.

Taking this approach avoids getting embroiled in arguments about religion which will lead nowhere.

Now, let’s see… Where did I put my magic wand?

I want religion out of our hospitals and our politics. Sadly we appear to be going exactly the opposite direction. While pregnancy is no issue for me end of life will be at some point.

If the catholic church can’t abide by the law of the land then they need to divest themselves of their hospitals.

Of course, I realize that aside from money the driving force behind religion is to continue growing their congregation so they can continue on the gravy train.

Peter C. Sarna

Nov. 14, 2013, 6:02 p.m.

Imagine if the church spent as much time, energy and zeal in detecting and rooting out widespread sexual abuse by clergy members worldwide.  I suspect far more harm has been perpetrated upon innocent children than wrought by principled doctors making sound medical decisions, including the need for a life-saving abortion.

I agree with Peter above. I seems blatantly hypocritical for a Catholic hospital to deny a medically necessary abortion or one requested by a victim of violent rape. Exceptional circumstances are part of life and those affected deserve to be treated with love and compassion. To deny necessary abortions is to show a lack of care for the patient or victim.

Having tolerated the sexual abuse of children by consciously using administrative rotation to put accused predators in new congregation eradicates the moral superiority these institutions want to operate under. Licensing agencies and the federal government have a duty to require Catholic hospitals known as the sole qualified medical institution in the community have a moral obligation to their neighbors to employ medical personnel that will perform medically necessary abortions without hesitation.

I agree with Peter above. I seems blatantly hypocritical for a Catholic hospital to deny a medically necessary abortion or one requested by a victim of violent rape. Exceptional circumstances are part of life and those effected by trauma or sickness need to be treated with love and compassion.

Having tolerated the sexual abuse of children by consciously using administrative rotations to put accused predators in new congregations pretty much eradicates any moral superiority such institutions want to operate under. Licensing agencies and the federal government have a duty to require Catholic hospitals that are the sole qualified medical institution in the community to employ medical personnel who will perform medically necessary abortions without hesitation. This is an obligation they have to their community as good neighbors.

I totally agree with you, Jim.  We have 2 hospitals here in Colorado Springs and one is Catholic owned.  Would I want to be a vegtable if the right accident befell me?  Certainly not.  Do I trust the Catholic owned hospital to make the right choice for me if any accident or illness left me in that condition? Most certainly not!  Religion and health care should not mix, unless of course, it’s religious counseling the patient has asked for.  Past that, Catholics or any other religious groups should not have any decision making ability over my doctors or care.  It’s that simple, but ask Terry Schivo’s husband about that.  Religion, is was, always will be, the opiate of the people and plenty of people are being exploited by the likes of Cruz, Palin, and others for their political agenda’s.  Sad.

By the way, the fix for this mess, at least a healthy start for a fix, is to deny funding by the government to these hospitals if they insist on over-ruling doctors and patients in the care of patients.  In communities where a Catholic hospital is the sole hospital the government would have to get a bit more creative in this so as not to put the burden of the denied funding on patients but it can and must be done!  Next chapter in this battle of church and state over care of patients by hospitals owned by religious institutions is the religious institutions will cry loudly about the government banning their “religious freedom” in the care of patients.  I say to that: What about the patients?  Don’t they have the right for their care not to be influenced by some religious group?  Especially if the patient is adamantly against it?

Is this a “time warp?”  I thought this was 2013!!!!!  Not   “1713.”  Religion should be practiced personally (IF AT ALL),  and only if you live “on an isolated planet!  NOT   AMERICA!!!!  IT IS EXTREMELY DIFFICULT TO BELIEVE THAT A PERSON CAN BE SO BRILLANT TO BECOME A DOCTOR—BUT YET “SO IGNORANT”  SIMULTANEOUSLY.  You never know what to expect from any person (a catholic)  who lets their personal “beliefs”  rule their professional life AND DECISIONS!!  AND   OTHER’S LIVES!!!

If you are pregnant , don’t go to Mercy Hospital .

“Faith-based” health care?  What a load of codswallop.  Call it what it is - RELIGOUS healthcare.  What it should be is HEALTH-BASED healthcare, with all legally available treatment options available to all who want them.  If a patient has a religious objection to a treatment, the patient can DECLINE it and it will be noted in the chart.

If you are an active athiest, as many commenters here seem to be, you probably don’t want to go to a Catholic hospital.  That’s good, that’s how a free country works.
But, if it is problematic that a Catholic hospital does not agree with the law of the land, is it not also problematic that the law of the land is incompatable with Catholic doctrine?  We are not talking about the mystery of the Trinity, but of the question of murder.  And the discussion here, can an employer restrict an employee’s communications while on the job.  The law pretty consistantly says yes.  But….  Some of us seem to think that if that employer is a religious entity, and that communication is about recommending a murder, that that right is lost.  Without the idea that abortion is a God-given human right, how does this make sense.

In response to people who post that people who don’t like the religious immorality imposed by Catholic hospitals, I’d like to point out that in many rural communities people have only one hospital and it’s Catholic. That includes Northern New Mexico and rural Colorado. The only hospital in Northern New Mexico (literally) is a Christus operation, which infamously denied an abortion to a 12-yr-old who had been raped by her father. Since Christus purchased the local hospital it has been spending all it’s energy in dressing up the physical facade of the facility while breaking the local unions and ignoring quality of care.

WOW!  Just because a hospital is run/owned by a religious organization should NOT make the religious beliefs “manatory” for all personnel.
Any hospital staff (doctors, nurses, and yes, clergy) SHOULD be able to discuss ALL options with their patients and family!!  No option should be left out!!!  Let the patient & family make the decision that is best for them!!

What some religious organization seem to forget is that GOD gave us “free will” and the ability to make decisions that are “correct” for us, for our individual selves.

If my personal belief is that abortion is wrong than I would not consider it in my personal quest for a decision about my care, but I should still know ALL the options.

I could go on to make a comment about the “Catholic church” seems to regard all its members as “mindless idiots” that HAVE to have someone else tell them what to do or how to behave…...  but I won’t.

If we asked Pope Francis point-blank whether he approves of risking a pregnant woman’s life in order to comply with a Catholic-owned hospital’s “guidelines”—wonder what he would say?

abinico warez

Nov. 15, 2013, 5:19 p.m.

Freedom of religion means freedom of religion. The moment government intervenes for any reason, that freedom is lost. Does that mean wacky bad stuff could happen - yes it does; but that is the price of freedom.

” The moment government intervenes for any reason, that freedom is lost.”
You mean it’s a “loss of freedom” if the government prevents me from throwing my brother’s wife on his funeral pyre, or sacrificing 9 virgins on the stone alter to ensure good crops this year or, in this case, causing some women to die needlessly from a pregnancy complication? Why, I know some rednecks who think the government is acting tyrannically when it jails them just because they beat the sh*t out of their wives - like the bible tells them to.

We wuv our fweedums! So what if “wacky stuff happens”!

What a load of codswallop. Your “freedoms” stop when they begin impinging on public safety and health.

Dave F. I object to your murder reference.  But you do have the freedom to state your beliefs.  Wonder how you’d feel if your 12 year old daughter was FORCED to have the baby of her rapist.  What lunacy and cold heartdness towards the 12 year old.  As to freedom of religion meaning freedom of religion, that works 2 ways, Jaurez, and if I am forced to go to the only hospital for miles that happens to be Catholic I fully expect those doctors to tell me all options available and not have some religious zealot of a hospital CEO ban the doctor from telling me an option for my care because he , meaning the hospital CEO, objects to that option on religious grounds!  We give religious groups and Catholic hospitals tax exempt status, which I vehemntly object to and the least they can do in return is follow the law and tell me and ALL patients all options for care available.  That means the abortion option if it is deemed to be called for!!!

If you are pregnant, Do go to Mercy Hospital!  Human Life is respected there.  It is the mother and the baby involved- two human lives.  One is not worth more than the other. How can a mother live knowing she chose her life over her child’s?  The real war on women is abortion.  Wake up People.  We are killing ourselves!!!! Life after having an abortion is never better.  it can never be undone.

Unless I am mistaken, I believe the Catholic churcht’s one exception to no abortions is when the birth would possible cause a death to the mother.  If so, the doctor so in good conscience advise an abortion as a last resort.  Any priests out there who could clarify this?

Monica Harrington

Nov. 16, 2013, 2:11 a.m.

@john

According to the bishop’s directives, a procedure which directly targets the fetus, even when the pregnancy is not and never will be viable, is never allowed, even if it means a woman will die. 

It’s these type of rules that put the world on Death Watch recently in Ireland, where a woman with medical training who had small children and knew that she would die without an abortion begged the doctors to save her life.

Here in the U.S., the Catholic bishops unanimously agreed with the decision to excommunicate a nun who authorized an abortion in Arizona that saved a woman’s life.

Catholic health systems enjoy special tax privileges and even tax subsidies (my property taxes are now subsidizing a Catholic hospital in Washington State) even as they impose rules that violate patient rights and put women’s lives at risk.  That’s the bottom line.

Interesting that they had a whole discussion about abortion and didn’t have a clue what her diagnosis was.  An echo would normally have been done way early in the process.  Seems like someone was trying to make an issue instead of treating the patient…

Jeffersonranch

Nov. 16, 2013, 9:15 a.m.

Do not go to a Catholic hospital. It is that simple.

Reading comprehension, S Bork.

1. The woman was 8 weeks pregnant
2. She was referred to a specialist, the cardiologist, because of concerns she might have a genetic condition, Marfan’s syndrome, found in her family.
3. Pregnancy in a woman with Marfan’s can cause her aorta to enlarge to the point that it ruptures, at which point both she and the fetus die.
4. The cardiologist explained the concern to the woman: first they needed to know if she actually had the condition. If so, there would be frequent checks on the state of her aorta. If the aorta got enlarged to a certain point, then a termination could be done to save her life.
5. Tests were done, she didn’t have Marfan’s, hence no need to worry about the rest of it.

Would you suggest the doctor order up a bunch of tests and not tell her what he was looking for, why, and potential remedies? This wasn’t a boo-boo in need of a bandaid. He wasn’t on a fishing expedition. He was looking for a condition known to be in her family that could cause her to die within the next 32 weeks. It’s nice she can complain a year later with a healthy baby in her arms. It’s nice she never had to make the decision to abort or die. It’s legal that she has the right to make her own decision had things worked out differently. If her next child is a girl, she may get to revisit this question in another 20-40 years.

I briefly worked for a Catholic hospital system as a health policy intern. There is room in the Ethical and Religious Directives to treat conditions that threaten the mother’s health. For example, in an ectopic pregnancy, the mother could have the affected fallopian tube removed. Note my phrasing: abortion is not allowed under the ERD, but acts that save the mother’s life while indirectly ending the fetus’ life are acceptable.

While I don’t agree with the ERD (I am pro-choice), in the past it was usually interpreted flexibly in life or death situations. I do not know if the Bishops are tightening the interpretation. It could be that they are doing so. In any case, the cardiologist in question might not have been allowed to discuss abortion even under the more flexible interpretation of the ERD. I am not certain what course of treatment you would prescribe for Marfans plus pregnancy under the ERD.

That said, not all pregnant women with Marfan syndrome will have an aortic rupture.

I want to highlight what Lynn said and suggest that it’s only wrong by being too narrow.

This is what happens when a group is allowed to govern itself and others by philosophy rather than results.  Here, all life is precious, so we’ll sacrifice a mother for an unborn child.  In Washington, a day doesn’t go by without someone’s simple-minded philosophy fouling up all our lives.

In this particular case, though, let me be clear:  If your God is so obsessed with the letter of the law that you’re condemned for trying to save a life, you need to convert to another religion immediately.

That’s not to condone abortion.  Women in my life have gone through it, and it wasn’t pleasant.  Worse, nobody really walked them through the process.  However, that’s also not to say that the practice should be abandoned just because I’ve seen bad experiences.  The entire point is that it’s a case-by-case decision.

And GM, just to look at the situation from multiple perspectives, why would you let a child grow up with the guilt of killing his or her mother but not want the mother to deal with the child’s death?

“as well as emergency contraception after sexual assault (which generally works by preventing implantation of a fertilized egg).”

This is not actually true. EC works by giving a large bolus of hormone which is designed to stop the egg from being released from the follicle.  There is also a possibility that it may thicken the coat on the already released, but unfertilized, egg cell making it more difficult for the sperm to enter and fertilize the egg.

There is a good amount of published work pointing to the fact that one thing it does not do is prevent an already fertilized egg from implanting in the uterus.

The nun who had a Catholic hospital in Phoenix was excommunicated when she approved an abortion to save the mother’s life. That medical institution is no longer under Catholic aegis.

I postulated in comment submitted & rejected on 11/14 that NYC’s flagship Catholic hospital, St Vincent’s, may have been sacrificed when takeover negotiations with Mt Sinai Hospital, nominally Jewish, withdrew from negotiations (facilitated with bridge financing from then NYS Gov.
Paterson) were halted. It would have meant that for the 1st time in the institution’s history it would be offering women a procedure they could have never previously obtained. I noted, ironically, that St Vincent’s, located in what was the epicenter of NYC’s AIDS crisis, pioneered in that care, discretely caring for priests stricken by the disease. A public secret. The municipality that’s home to more Catholics than any other in the US no longer has a medical institution under that banner.

Chuck Slothower

Nov. 19, 2013, 2:23 p.m.

It would be nice if this article acknowledged and linked to the original story that my colleagues broke, in the remote, southwest corner of the state:

http://durangoherald.com/article/20131113/NEWS01/131119849/ACLU:-Mercy-anti-abortion-policy-illegal-