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A pregnant mom was 'writhing in pain,' but a Catholic hospital refused to intervene

caption: Alison is portrayed on Friday, July 15, 2022, in Seattle.
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Alison is portrayed on Friday, July 15, 2022, in Seattle.
KUOW Photo/Megan Farmer

Alison was three months pregnant and on a camping trip with her family in 2013 when she started bleeding. She rushed home to Bellingham, where the only hospital is Catholic-owned PeaceHealth.

“They did an ultrasound,” Alison said. KUOW is not using her last name to protect her private health information. “They said that the baby was fine and told me to come back if I started bleeding more.”

Alison had to go back again, and then again. Each time, the hospital staff gave her an ultrasound, told her the fetus still had a heartbeat, and sent her home.

At that time, about 40 percent of hospital beds in Washington state were owned by Catholic health-care systems. Since then, CHI Franciscan has merged with Virginia Mason, and now nearly half the hospital beds statewide are under Catholic ownership. Three cities — Bellingham, Centralia, and Walla Walla — have only a Catholic hospital.

That limits what reproductive, gender-affirming, and end-of-life care they can offer. The providers at PeaceHealth would have been able to give Alison an operation to empty her uterus and prevent any further complications if they hadn’t detected fetal cardiac activity. But if there’s fetal cardiac activity, Catholic hospital policies don’t let providers act to terminate the pregnancy until they’ve determined that the pregnant person’s life is at risk. And when a patient crosses that line isn’t always clear.

On Alison’s third trip to the hospital, she arrived with abdominal pain, cramps, and vaginal bleeding. On her medical records she indicated her pain level was a 7 out of 10. She had a low-grade fever. A blood draw revealed an elevated white blood cell count, suggesting an infection.

“Once a patient comes back with a fever, that would have been really abnormal,” said Dr. Laura Sienas, a maternal-fetal physician at UW Medicine.

Sienas said the key is to pinpoint the source of the infection — and if no other cause can be found, in a case like Alison’s, it would likely be the uterus.

The only treatment for a uterine infection, and some other pregnancy complications Sienas sees regularly at her practice (like the patient’s water breaking early), is an abortion — or delivery, if the pregnancy is far enough along.

Sienas said the longer the provider waits, the greater the risk that the infection could spread and the patient could become septic and need ICU-level care. That’s why, at hospitals like the UW that allow abortions, providers let patients know when a pregnancy might not be viable and start the conversation about whether or not to terminate it. They try to intervene well before the patients’ lives are in danger. But at Catholic hospitals, policies don’t allow providers to act till the threat to the woman’s life is more immediate.

“It’s so ill-defined that, you know, what is life-threatening?” Sienas said. “And why is a provider trying to determine if your life is, you know, enough at risk to be able to offer this care?”

During Alison’s third trip to PeaceHealth, providers did not pinpoint a source of infection. Instead, she was discharged 4.5 hours after she arrived, still running a low-grade fever.

“RETURN TO ER IF PAIN WORSENS OR IS UNIMPROVED IN 12-24 HOURS,” the discharge instructions read in all capital letters.

That was late Saturday night. About 24 hours later, Alison’s fever spiked and she headed back to the Bellingham hospital for the fourth time.

She asked the ER doctor if there was any possibility that she had a uterine infection.

“I remember this so clearly,” Alison said. “His back was turned to me, and he just kind of froze. Just didn’t answer it, almost as if I hadn’t said it.”

caption: Alison is portrayed on Friday, July 15, 2022, in Seattle.
Enlarge Icon
Alison is portrayed on Friday, July 15, 2022, in Seattle.
KUOW Photo/Megan Farmer

Alison said the doctor then abruptly left the room. She’s not sure why but wonders if he didn’t want to consider the possibility of a uterine infection, because it would have meant she needed an abortion.

“By this point, I’m writhing in pain,” Alison said. “It felt like something from ‘The Exorcist’ — just gripping the side of the bed. And my mom was there with me and she nearly fainted just seeing me in that pain.”

By then, it was Monday morning, and Alison’s own obstetrician, who at the time was not affiliated with the Catholic hospital, arrived. He did a pelvic exam and told Alison she had a uterine infection, and the infection had spread. She was septic.

At that point, Alison was extremely sick. Her doctor wrote in her medical record that, in addition to severe pain, she had a fever; she had a sky-high white blood cell count, indicating a severe infection; and she was tachycardic — her heart rate was over 100.

“She is clinically worsening,” he wrote — getting sicker and sicker.

Alison said her doctor told her she needed a D&E — dilation and evacuation, a procedure to terminate the pregnancy and empty the uterus so providers could begin to address the infection and save her life.

“I hadn’t even thought about my life being in danger, and no one had brought that up,” Alison said. “As soon as the shock kind of wore off, I was able to switch gears to, ‘Please save my life. I have a daughter who needs me.’”

But it wasn’t that simple.

She said her doctor got very serious and said, “Okay, this is what needs to happen, and it all needs to happen very quickly. Because you’re in a Catholic hospital, that's not a procedure that they allow here. And what I need to do is go before the ethics board and just make a case and see if we can get this done here. And if that's not possible, you'll need to go to UW and have the procedure there.”

Alison’s doctor did not respond to KUOW’s attempts to reach him; since 2013, his practice has been absorbed by PeaceHealth.

Alison said she waited a couple of hours for her doctor to consult with the hospital about the ethics of her situation, but it felt like an eternity.

A spokesperson for PeaceHealth wrote in an email that, “if an ethics consult is requested by the physician, it takes place immediately, usually within one hour,” but, in a case like Alison’s, “the immediate clinical needs of the patient would trump an ethics consult.”

But Alison’s medical records show that an ethics consult did indeed occur, and in the end, the hospital did authorize a D&E.

“All questions were answered,” Alison’s doctor wrote. “The committee agrees to proceed.”

Later, a pathologist wrote in Alison’s medical record that the fetus showed signs of “intrauterine demise,” meaning that the fetus was not still alive when the pregnancy ended.

PeaceHealth declined multiple requests for an interview, but a spokesperson said in an email that the hospital “only allows the termination of a pregnancy when a mother’s life and/or long-term health are in danger.”

The spokesperson said that risk is determined by the physician, but ethics consults are available to help decide if terminating a specific pregnancy is allowable under Catholic medical ethics.

“Really what’s happening is people’s lives are being put at risk with delays,” said Hilary Schwandt, a professor at Western Washington University who studies reproductive health.

“Hospitals have all the power to decide what they do,” she said. “And providers have a lot of power too. And the people with the least power are those who need the services.”

Schwandt said she reviewed hospital policies around terminating pregnancies and found the policy of waiting till the pregnant woman’s life is in jeopardy is not limited to Catholic hospitals. She also said providers don’t necessarily tell patients that they need an abortion and should go elsewhere to get it — though, since Schwandt’s study, Washington state passed a law in 2020 protecting providers’ right to give their patients that information. It’s still not required that anyone do so.

As of last year, Washington state has a new law that states that hospitals cannot prevent willing providers from offering care, including pregnancy termination, to patients who are experiencing complications.

But PeaceHealth said it has not changed its policies in response to the law.

“I find that very concerning,” said Leah Rutman, the policy counsel for the American Civil Liberties Union of Washington. Rutman has been working on the issue of pregnancy care at Catholic hospitals for almost a decade. “It is incredibly important that, based on this law, health systems change their policies and ensure that providers recognize that they are allowed to treat patients in these situations.”

For enforcement, the law relies on providers or patients bringing lawsuits, so it still puts providers in the position of fighting with their employer.

Another bill that would give Washington state more oversight of hospital mergers died in the last legislative session, but advocates plan to try to get it introduced again in the next one.

Editor's note 8/23/22: KUOW changed this line in the story to make the meaning more clear: "Later, a pathologist wrote in Alison’s medical record that the fetus showed signs of 'intrauterine demise,' meaning that the fetus was not still alive when the pregnancy ended."

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