Frequently, doctors at Catholic institutions, many of whom are not Catholic, find workarounds to prevent patients from dying, Freedman said. An ethics committee headed by a priest or other religious figure at each hospital decides in the moment whether doctors can intervene. They may wait until the woman develops a fever (a sign of infection), until her bleeding increases or until the fetus dies, Freedman said.
The Ethical and Religious Directives at Catholic hospitals allow pregnancy termination for a “proportionately serious pathological condition of a pregnant woman,” but ethics committees at each hospital can have different interpretations of where to draw the line, Freedman said.
This approach, however, is often shocking to obstetricians in non-religious hospitals, Freedman said.
“When you talk to someone in a really high-quality obstetric service, their jaw drops because they’re like, ‘Well it’s not just die or not die,’” Freedman said. “What kind of level of suffering and risk are you going to require, before the intervention you know is going to happen is allowed to happen?”
The Catholic Health Association states in a policy brief that “Our deeply held religious and moral convictions are the source of both the work we do and the limits on what we will do.”
Those religious and moral convictions include a mandate to continue the “healing ministry of Christ,” to care for the poor, and to advocate for marginalized groups like immigrants, according to the Ethical and Religious Directives.
They also state that the “Catholic health care ministry is rooted in a commitment to promote and defend human dignity; this is the foundation of its concern to respect the sacredness of every human life from the moment of conception until death.”
Maryam Guiahi, an obstetrician in Santa Barbara who has previously worked in Catholic institutions in Chicago, said that’s where Catholic policies begin to conflict with modern secular medical ethics that place different emphasis on patient autonomy and avoiding harm.
In cases like Nusslock’s, in which the amniotic fluid sac breaks before the fetus is viable, terminating the pregnancy is typically the safest option and the standard of care, Guiahi said.
Guiahi said Catholic hospitals sometimes don’t allow doctors to tell patients that an abortion is an option.
“I’ve been in secular institutions and we can give that information. We can let people decide what they want, and some people will choose to continue and hope and see what happens, but other women don’t want to go through that,” Guiahi said.
Not telling patients all of the risks and options compromises their ability to consent and can lead to avoidable complications like infection and hemorrhaging, Guiahi said.
Guiahi said she never saw a patient die after being denied an emergency abortion at the Catholic hospital she worked at, but sometimes patients would come back septic and require care in the intensive care unit.
“To me, medicine is about ‘to do no harm.’ I don’t know many medical situations where we wait till people get sick in order to intervene,” Guiahi said.
Moving to have a baby
Nusslock is making plans to leave Eureka during her next pregnancy. She and her husband still desperately want to start a family, but she can’t drive past Providence St. Joseph Hospital without getting dizzy. She said she has been diagnosed with post-traumatic stress disorder.
“I still have that voice in the back of my head just screaming, ‘you’re bleeding to death,’” Nusslock said.
Most likely Nusslock said she’ll find a place in the Bay Area to live during her pregnancy.
Having few options to give birth reflects a larger loss of maternity services in California. The northern counties, including where Nusslock lives, have lost a third of their birthing hospitals since 2012, according to a CalMatters database on maternity care.
Statewide, 59 hospitals have stopped delivering babies in the same time period, creating broad swaths of maternity deserts particularly in rural and low-income communities.
Nearly 80% of those closures have been secular hospitals, increasing the influence of Catholic health care.
During the February court hearing, Providence lawyer Rochman said that a core mission of the Eureka hospital is to keep labor and delivery services available “when it may not be financially sensible to do so.”
In a statement, a Providence spokesperson said “providing high-quality labor and delivery services” is a “top priority” for the organization in Humboldt County and throughout the nation.
But having an operating maternity ward doesn’t mean all services are available. The Ethical and Religious Directives also prohibit the use of contraceptives to prevent pregnancy, including sterilization for both males and females, and in vitro fertilization.
Josie Urbina, an obstetrician with UC San Francisco Health who specializes in complex family planning, said this creates an unequal patchwork of services in the state.
“It’s unfortunate that in rural parts of California, which happen to be dominated by religious hospitals, that the standard of care is not being followed,” Urbina said. “It’s really just detrimental to patient care.”
For Nusslock, who moved to Eureka 10 years ago and quickly fell in love with the towering redwoods and small-town feel, the lawsuits are about ensuring her experience doesn’t happen to anyone else, she said in an interview with CalMatters.
“These are good people. These are people worth protecting,” Nusslock said. “If they’re going to give me an opportunity to speak for them and fight for them, I’m going to take every opportunity I can.”
CalMatters Data Reporter Erica Yee contributed to this story.
