Catholic Hospital Denies It Violated CA Law, Attorney General Makes Case For Abortion Protection

Dr. Anna Nusslock, seen here at the rally before Senator McGuire addressed the crowd. [Photo by Ryan Hutson]

The California Attorney General is asking for a preliminary injunction requiring the Eureka hospital, owned by a Catholic nonprofit Providence Health, to comply with California’s state emergency care law. St. Joseph Hospital (SJH) disputes the need for such legal orders. They argue that they already follow the law and that Nusslock’s condition did not constitute a medical emergency.

Violating a court-ordered injunction (or the currently standing Stipulated Agreement) could result in charges of contempt of court, with penalties including substantial fines and, in cases of willful defiance, potential criminal charges could be sought by the Attorney General. 

The Attorney General’s office focused on emergency medical care rather than religious protections, arguing that the hospital’s unwritten policy of withholding intervention ‘until death was certain’ means ‘waiting until a patient is in septic shock, cardiac arrest or otherwise in peril of dying.’ The State’s attorney asserted, ‘Many such patients would die. Those who survive would likely be left with lifelong, serious ailments.

Flanked by two additional deputy AGs, Deputy Attorney General David Hauska asked Humboldt Superior Court Judge Timothy Canning to issue a preliminary injunction forcing St. Joseph Hospital — owned by Catholic nonprofit Providence Health — to comply with California’s Emergency Services Law (ESL) when pregnant patients need emergency abortion care. The State’s case is based on two key witnesses: Dr. Anna Nusslock, and Jane Roe, the anonymous second witness for The People in the case. 

Harvey L. Rochman, Attorney for the Defendant in the case, St. Joseph Health Northern California (SJH) presented the hospital’s defense, also with two other lawyers present on behalf of SJH. 

Wednesday, when Nusslock testified about her February 2024 arrival at St. Joseph Hospital, she said she was bleeding and in active labor – but despite her doctors’ recommendations that an emergency abortion was the only treatment option and that there was no time to get to San Francisco for the recommended procedure – staff handed her a bucket and towels “in case something happens in the car,” on the drive to Mad River Community Hospital, Nusslock explained.

“My doctor told me,” she recounted, “that they couldn’t help me because of Providence’s religious hospital policy,” she said. “They told me, if I tried to drive to San Francisco, I would hemorrhage and die.”

Attorney for St. Joseph Hospital Harvey L. Rochman addresses the court, as Hon. Judge Canning looks on. [Photo by Ryan Hutson]

Bell explained, “[T]he hospital in this case, which is part of a large chain, is claiming it doesn’t have to comply with state emergency care laws because it is a religious hospital. Failing to hold Providence accountable would embolden other hospitals to disregard the law and refuse to provide care in emergencies, when minutes count.” 

Bell replied, “This is a major concern given that 1 in 6 hospital beds in the US are in Catholic hospitals,” when asked about implications for affiliated hospitals. 

Nusslock’s description of that experience was called “a false narrative” by Attorney Rochman, as Nusslock – the State’s key witness – looked on from the gallery shaking her head in a gesture of disapproval. Although he noted that Nusslock and Roe’s experiences were “very unfortunate” and offered that the “hospital absolutely sympathizes” with the women, Rochman reiterated that the SJH’s opinion is that the Attorney General has exaggerated and “misrepresented the facts” to the court and to the public. Rochman told the court that Nusslock’s condition at the time of her departure from SJH did “not seem to be dangerous at all.” 

Regarding the defense’s characterization of Nusslock’s pregnancy condition and the resulting traumatic loss of twins weeks before “viability” outside the womb, Bell stated, “After losing their argument that this case should be dismissed because of the hospital’s religious status, their attorneys are now adding insult to Dr. Anna Nusslock’s injuries, claiming this was not an emergency at all. The tragic reality is that by the time she was able to see another doctor, she was “sitting in a pool of blood,” and continues to suffer two years later because of the fear for her life that night.”   

As part of the defense’s argument, Attorney Rochman asserted that the hospital already complies with California’s ESL, while disputing that there was any emergency to respond to – both in Nusslock’s case, and in the case of Jane Roe. 

St. Joseph’s lead counsel argues that the Attorney General’s office was attempting to compel the hospital to provide abortions unnecessarily, outside of the law. In what the AG says is a policy contradiction, SJH has framed the case in part as a Constitutional Freedom of Religion issue, asserting that any requirement to perform abortion care apart from Vasa’s stated guidance would be a violation of their  Catholic “Ethical and Religious Directives” (ERD’s), and would therefore be illegal. Yet, the hospital also claims that it does abide by California’s ESL in cases where an abortion is necessary. Explaining to the court that the hospital’s doctors “do not speak for the hospital” instead relying on outside professionals and depositions of administrative level staff. Rochman quoted SJH Director of Nursing Kristen Hanson who stated, “if an abortion is needed in an emergency situation, then it is provided,” but asserted that this was not needed for Nusslock or Roe. 

Is Previable PPROM an Emergency?

At the center of the legal dispute is a medical condition called PPROM—preterm premature rupture of membranes—which occurs when the amniotic sac breaks before 37 weeks of pregnancy. The condition causes approximately one-third of all preterm births in the United States and carries serious risks: infection leading to sepsis, hemorrhage, and fetal death. Medical research shows that maternal sepsis can progress to death in as little as 18 hours from onset. Both Anna Nusslock and Jane Roe were diagnosed with previable PPROM. Nusslock miscarried twins at 15 weeks, while Roe experienced the condition three times between 2021 and 2022. In both cases, their doctors advised that an emergency abortion was the medically necessary remedy.

When PPROM occurs before viability—the point at which a fetus could survive outside the womb—standard medical care often involves terminating the pregnancy to protect the mother’s health.

But St. Joseph Hospital’s attorneys told Judge Canning that neither woman was experiencing a medical emergency at the time they sought care. Attorney Harvey Rochman argued that PPROM “is not an emergency condition unless it has complications,” and that both patients were “appropriately assessed” with “vital signs within the normal limit” when discharged from St. Joseph’s.

The hospital’s position, Rochman explained, is that California’s Emergency Services Law requires hospitals to “stabilize the patient” but does not require treatment of diagnosed conditions unless the patient is actively unstable.  Rochman asserted to the court that California’s emergency services law was not applicable, because he argued, neither case was an emergency.

Deputy Attorney General David Hauska rejected that interpretation. The determination of a medical emergency, he argued, hinges on risk to the patient’s health, not on waiting for a catastrophic outcome. “Emergent medical decisions are defined by risk, not certainty,” Hauska told Judge Canning.

Interview with Dr. Anna Nusslock before The State Attorney General’s rebuttal at the Preliminary Injunction hearing. [Video by Ryan Hutson]

By the time each woman received treatment at other facilities, Hauska said, “both were suffering from serious hemorrhages and lost a combined three and a half liters of blood”—a potentially fatal amount.

California law permits abortion before viability, which the state defines as when “a doctor determines that the fetus could live outside the uterus without extreme medical measures,” according to the California Department of Public Health. In both Nusslock’s and Roe’s cases, their pregnancies were not viable—the fetuses could not survive—but the question before Judge Canning is whether the hospital was legally required to act before the mothers’ conditions became immediately life-threatening.

The “Certain Death” Standard

The gap between California law and St. Joseph’s practice comes down to timing, according to the Attorney General. Deputy AG Hauska pointed to a letter from Catholic Bishop Robert F. Vasa, who oversees the region, stating that a hospital may only terminate a previable pregnancy when “the only alternative is certain death of both mother and child.”

One is a law which requires action when patients are at serious risk. The other is a policy, the AG asserts, that strategically waits until death is imminent in order to not run afoul of Catholic Ethical and Religious Directives (ERD) which serve as official guidance and policy for hospitals under the umbrella of Providence St. Joseph Health, which are overseen by Robert F. Vasa, Bishop of Santa Rosa. 

Waiting until patients approach death puts them at imminent risk of septic shock and multiple organ failure. “At that point,” Hauska contended that the hospital’s preference for Vasa’s direction to wait until “certain death” was extreme, illegal, and untenable for mothers and families across the state but particularly for women in Humboldt. According to the State’s witnesses and research, “even an aggressive and active intervention will not be enough. The mortality rate of patients who progress to septic shock is estimated at 50 to 60 percent.”

Deputy AG Hauska argued that while the hospital claims to have a written policy aligned with California’s ESL, the actual working policy regarding emergency abortion care at St. Joseph is commonly understood among medical staff but had not been written down until Bishop Vasa’s letter arrived from Santa Rosa. According to the United States Conference of Catholic Bishops, Bishop Vasa serves on the Task Force on Health Care and oversees the Diocese of Santa Rosa (which includes Humboldt County) , where roughly 18 percent of residents are Catholic.

Despite there being no definitive publicly available written policy on abortion care at St. Joseph Hospital, AG Hauska asserted that witnesses, including doctors, had consistently confirmed the existence of the standard. “Despite not being written documentation, multiple witnesses use almost exactly the same language to describe said policy,” Hauska told the judge. “Three individual sources converging on the same point” –doctors could only intervene when the mother’s life was in immediate danger.

Dr. Simon Stampe, who treated Jane Roe, testified that at St. Joseph Hospital, an emergency abortion is only permitted when the patient is “actively dying,” Hauska told the court while refuting the hospital’s assertion that they do comply with California’s ESL.  

Deputy AG David Hauska seen here making the State’s rebuttal before Hon. Judge Timothy Canning. [Photo by Ryan Hutson]

Patient Transfer or Patient Dumping? 

The Attorney General characterized what happened to Nusslock as patient dumping—sending a miscarrying, actively hemorrhaging patient to a smaller hospital with limited obstetric capacity.

In Nusslock’s written declaration to the court, she recounted the moment she was told to go to Mad River as an alternative: “‘Mad River will take you,’ Nusslock testified  the doctor said. She added, “I knew that Mad River was a small community hospital in Arcata, California. With no other feasible option for obtaining the emergency treatment I needed and in fear for my life, I submitted to leave Providence Hospital and go to Mad River.”

“No one at Providence Hospital told me about the risks involved with leaving the hospital and driving in my own car to Mad River,” Nusslock explained under penalty of perjury. She added, “They also did not tell me that leaving Providence Hospital or declining an ambulance would be against medical advice or require that I sign any paperwork to that effect.” 

When she arrived at Mad River, she said the situation deteriorated further. “The medical staff at the Mad River [Emergency Department] were not expecting me and were not aware that I was coming from Providence Hospital,” Nusslock stated in her declaration. “They did not seem to have any of my medical records. When I arrived, therefore, I was unable to go directly to [Labor & Delivery]. Instead, I had to wait in the Mad River ED while my bleeding and pain continued. I also had to explain, by myself, to the ED staff the details of all I had been through that night.”

By the time treatment began, the emergency had become critical. “Within hours, both were suffering from serious hemorrhages and lost a combined three and a half liters of blood,” Hauska said of Nusslock and Roe. The medical record “does show she was bleeding upon arrival at Mad River,” he said, adding that Nusslock testified “she had passed an apple-sized blood clot” by the time she was admitted to Mad River.

Attorney Rochman disputed this characterization of understaffing and poor communication regarding her referral to Mad River entirely. He pointed to medical records showing she didn’t receive a dilation and curettage until after 10:30 a.m.—nearly four hours after arriving—noting the records mentioned use of mifepristone to induce contractions and the wait time involved. “So it turns out that this whole series of events actually is a vindication for St. Joseph Hospital,” Rochman said.

Anna Nusslock observed the hearing from the front row, Wednesday December 10. [Photo by Ryan Hutson]

Hauska seized on this point, arguing that St. Joseph had been negligent in sending patients experiencing urgent pregnancy complications to a facility with unreliable obstetric coverage. For a service to be truly “available,” he argued, it needs to be accessible around the clock. “Emergencies happen 24 hours a day, seven days a week,” Hauska said.

The Broader Stakes

“Your Honor, we’re asking for an injunction that requires them to follow the law,” Hauska concluded, landing the State’s case with a grim prediction, saying to Judge Canning that without an injunction, “[T]here will be another woman on the gurney”.

Judge Canning took the matter under submission and has 90 days to issue a ruling. The stipulated agreement requiring St. Joseph to follow emergency care law – the same agreement Bishop Vasa objected to – remains in effect while Canning weighs the urgency of the matter, in deciding if an Injunction is warranted. 

Clarifying the technical enforcement of the currently standing Stipulated Agreement between the State and SJH, Attorney Bell explained that the “injunction / stipulation that is currently in place… binds only the hospital in Eureka,” until the Judge issues a further ruling. 

As far as consequences, Bell replied, “Someone who violates an injunction can be held “in contempt” by the court and forced to pay fines or even, in extreme circumstances, held criminally liable.” Nusslock’s Attorney added, “It is important for community members to know that Providence hospital in Eureka is currently operating under a court order to comply with the law and provide emergency abortion care if the patient’s provider determines it is necessary. If a pregnant patient does not get the care they need, they should contact the Attorney General’s office at [email protected].” 

Outside of the courthouse, Senator Mike McGuire made an appearance at the courthouse rally, lauding Nusslock for her steadfastness in the matter, saying, “Ms. Nusslock, your strength, your courage, your conviction- you’re standing up, and you’re standing strong to ensure that no other woman in this state faces the horrific conditions that you did.” Asked for his thoughts on the big picture for other California families and the case that the State had presented, McGuire told Redheaded Blackbelt, “…[T]his lawsuit is about Anna, but it’s also about sending a message to every health care institution in California, every health care institution across the land that no one is above the law.”

Judge Canning’s ruling on the request for a Preliminary Injunction could reshape how religiously affiliated hospitals statewide balance institutional directives with legal obligations, particularly in rural areas with limited options in medical emergencies. Looking at the big picture for California, Bell wrote, “While these injunctions will not bind other hospitals, the Emergency Services Law does, and I’m sure other hospitals will be watching to see if this Court enforces the law.” 

Additionally, as the Hon. Judge Canning considers the State’s case against SJH, Dr. Anna Nusslok’s personal civil lawsuit, Bell noted, “unlike the AG’s case,” Nusslock “is also seeking to hold all of Providence accountable for their roles in setting the hospital’s discriminatory policy.” In that case, the next hearing “on the parent companies’ latest attempt to get out of the case” Attorney Bell says, “will be held Dec. 22,” also in Humboldt County Superior Court.  

EARLIER:

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Providence St. Joseph Hospital Agrees to Terms Amid Ongoing Lawsuit About Hum Co Woman Denied Abortion Care