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.
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.
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.
Hospital officials apparently were furious. The complaint contends that Demos was reprimanded and told 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 generally works by preventing implantation of a fertilized egg).
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 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.
Demos did not immediately return a call from ProPublica. But he was quoted by the Associated Press in a story this week.
"I think that ... physicians should be allowed to practice medicine unencumbered by religious beliefs," Demos told the AP.
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.