The Let Women Die Bill of 2011: H.R. 358 Forces Women to Play Russian Roulette in Their Hospital Emergency Room

Last week’s vote on H.R. 538, the Let Women Die Act of 2011, was a deeply disappointing new low for the House of Representatives, even if  the outcome was unsurprising given the chamber’s recent record of extremist, anti-woman bills.  The heated debate occasioned dueling Dear Colleague letters by Rep.’s Jan Schakowsky (D-IL) and the author of the bill, Rep. Joseph Pitts (R-PA), that made competing claims about the critical issue of whether the bill newly imperils the lives of women by allowing institutions and doctors to refuse to provide care even in life-threatening emergencies.

The dispute concerns the present scope of patient protections offered by an anti-patient-dumping law, the Emergency Medical Treatment and Active Labor Act, or EMTALA. Schakowsky’s letter highlighted the issue by noting that the “bill would, in effect, strip EMTALA of its power to ensure that women in emergency situations receive abortion care at hospitals by making their right to health care secondary to the hospital’s ability to refuse to provide abortion care.” Pitts, on the other hand, claimed in his Dear Colleague that because EMTALA already includes a reference to the “unborn child,” then “EMTALA currently recognizes both lives.”

Who’s right? A basic review of the law says that Schakowsky is, by a mile.  EMTALA uses the words “unborn child” in three places; all three make clear that the protection is intended to assure that a hospital seeking to transfer a woman in “active labor” (as in the title of the Act) must assess any health risks associated with the transfer for both the woman in labor and the child she is about to deliver.  The law does not, as Pitts claims, confer a freestanding interest in the health of an “unborn child” that would allow hospitals to deny care to a woman experiencing a miscarriage.  If it did so, this aspect of the Pitts bill would be superfluous.

In fact, in this American Journal of Public Health article by Lori Freedman, a religiously-affiliated hospital that actively refused to complete a miscarriage and risked a woman’s health in doing so, was reported for an EMTALA violation when it sought to transfer the patient.

She notes:

“Dr B, an obstetrician-gynecologist working in an academic medical center, described how a Catholic-owned hospital in her western urban area asked her to accept a patient who was already septic [suffering from infection].

When she received the request, she recommended that the physician from the Catholic-owned hospital perform a uterine aspiration there and not further risk the health of the woman by delaying her care with the transport.

[From the doctor:] “Because the fetus was still alive, they wouldn’t intervene. And she was hemorrhaging, and they called me and wanted to transport her, and I said, ‘‘It sounds like she’s unstable, and it sounds like you need to take care of her there.’’

And I was on a recorded line, I reported them as an EMTALA violation. And the physician  [said], ‘‘This isn’t something that we can take care of.’’ And I [said], ‘‘Well, if I don’t accept her, what are you going to do with her?’’

[He answered], ‘‘We’ll put her on a floor [i.e., admit her to a bed in the hospital instead of keeping her in the emergency room]; we’ll transfuse her as much as we can, and we’ll just wait till the fetus dies.’’

This risky delay in care is caused by hospitals’ adherence to the Religious Directives put forward by the Catholic bishops – including in cases in which the Directives clearly conflict with commonly accepted medical standards.  The Directives specify that hospitals must wait until the fetal heart tone ceases before acting to complete a miscarriage, even if the pregnancy is clearly no longer viable.  Yet in the meantime, as in the case described by this doctor, women are at risk of becoming septic, a serious and life-threatening form of infection, and death.

One loophole that is rarely mentioned but is highlighted by the above story is that the protections of EMTALA cease to apply if a patient is admitted from the emergency room into the hospital, which may be one mechanism by which religiously affiliated hospitals currently escape the conflict while continuing to deny care.  In addition, if no one is seeking to transfer a patient, EMTALA is silent on the quality of care given to the patient, as courts have been clear that EMTALA does not, by itself, set out a standard by which to judge medical negligence. Ironically, then, if no physician seeks out a transfer to a facility willing to provide more appropriate care, thus risking a violation of EMTALA, patients may fall through the cracks, as  Freedman’s article describes.

The Pitts bill would also allow institutions to insist on policies that deny care to patients, even trumping the professional judgment and medical training of physicians. Freedman’s report tells one such story: a doctor appalled at the denial of care to a woman in the midst of miscarriage – a woman so ill that her eyes filled up with blood from the infection caused by the delay – subsequently quit his job in disgust. While his decision to resign assuaged his conscience, the next woman to find herself in a similar situation at that hospital may be even worse off, because the hospital has lost at least one doctor who prefers science-based medical care.

Nationally, one-sixth of hospital visits are to religiously-affiliated hospitals, that serve millions of people. The notion that care would differ so drastically from one emergency room to the next is out-of-step both with public health needs and with the beliefs of even religious adherents, who, polls indicate, agree with the broader public that access to medical care should not be restricted by religion. Women should not have to engage in a game of Russian roulette at their local hospital emergency room.

Only physicians, not institutions, have a conscience. Granting institutions a right of refusal merely guarantees that the very real consciences of doctors who choose to provide care consistent with their own beliefs and medical training will not be able to do so. Chillingly, the Pitts bill would ensure that hospitals’ institutional dictates, including those at odds with medical science, could override the consciences of the doctors who work for them, even when those dictates unreasonably risk women’s lives.

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  • catfitz

    Dr. B shouldn’t make diagnoses over the phone, and you’re tendentiously not telling us the outcome of this story and whether any independent review was performed. Hospitals and doctors should not be forced to go against their conscience and forced to permit abortions. Even the Catholic ban on abortion doesn’t include such a notion that if a mother’s life was in danger and killing the fetus would somehow remedy this (an extremely rare occurrence) that it would be somehow disallowed. The idea that there are this many edge cases and women desperate for care that somehow is only available in Catholic hospitals is a chimera, and it’s about merely undermining the case for conscience. If you don’t want the government coming in and telling you what to do with your body, you have to concede by the same token that the government cannot come in and tell you to go against your conscience.


    I’d give some credence to all the screeching from the pro-choice, leftwing/alternative press about this if…I didn’t go read the bill myself.


    And there, I see that it contains a clause saying that exceptions to the ban on abortion funding of medical care would include…if the mother’s life was in peril (and surely you can admit this is a rare medical condition).

    Here’s the text — and I don’t know how in good conscience any of you here can keep calling this the “Let Women Die” bill with this text in mind:



    (c) Limitation on Abortion Funding-

        `(1) IN GENERAL- No funds authorized or appropriated by this Act (or an amendment made by this Act), including credits applied toward qualified health plans under section 36B of the Internal Revenue Code of 1986 or cost-sharing reductions under section 1402 of this Act, may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except–
          `(A) if the pregnancy is the result of an act of rape or incest; or
          `(B) in the case where a pregnant female suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the female in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself.
  • prochoiceferret

    Since you basically copied-and-pasted this comment from a different thread, I’m going to copy-and-paste Jodi’s reply:

    That statement above is reiteration of Hyde policy with respect to Medicaid funding of abortion… it repeats current law.

    You fail to read the rest of the bill which does exactly all the things I have described in my article.

    and since I have now seen this exact misleading comment in several places on other sites under different names I am quite sure you are a troll.

    So, begone, troll!

  • forced-birth-rape

    ~”Church excommunicates mother of 9-year-old rape victim – but not accused rapist.”~

    ~ “A senior Vatican cleric has defended the Catholic Church’s decision to excommunicate the mother and doctors of a nine-year-old rape victim who had a life-saving abortion in Brazil.” ~

    ~ “Police believe the girl was sexually assaulted for years by her stepfather, possibly since she was six. That she was four months pregnant with twins emerged only after she was taken to hospital complaining of severe stomach pains.” Not that the pro-life child raping catholic church gives a tiny damn. ~




    Catholic Church Protected Priest Who Raped 200 Deaf Children

  • littleblue


    The parts you are neglecting to read are:


    ‘(2) OPTION TO PURCHASE SEPARATE COVERAGE OR PLAN- Nothing in this subsection shall be construed as prohibiting any non-Federal entity (including an individual or a State or local government) from purchasing separate coverage for abortions for which funding is prohibited under this subsection, or a qualified health plan that includes such abortions, so long as–


    ‘(A) such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and


    ‘(B) such coverage or plan is not purchased using–


    ‘(i) individual premium payments required for a qualified health plan offered through an Exchange towards which a credit is applied under section 36B of the Internal Revenue Code of 1986; or


    ‘(ii) other non-Federal funds required to receive a Federal payment, including a State’s or locality’s contribution of Medicaid matching funds.


    ‘(3) OPTION TO OFFER COVERAGE OR PLAN- Nothing in this subsection or section 1311(d)(2)(B)(i) shall restrict any non-Federal health insurance issuer offering a qualified health plan from offering separate coverage for abortions for which funding is prohibited under this subsection, or a qualified health plan that includes such abortions, so long as–


    ‘(A) premiums for such separate coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;


    ‘(B) administrative costs and all services offered through such coverage or plan are paid for using only premiums collected for such coverage or plan; and


    ‘(C) any such non-Federal health insurance issuer that offers a qualified health plan through an Exchange that includes coverage for abortions for which funding is prohibited under this subsection also offers a qualified health plan through the Exchange that is identical in every respect except that it does not cover abortions for which funding is prohibited under this subsection.’;





    ‘(g) Nondiscrimination on Abortion-


    ‘(1) NONDISCRIMINATION- A Federal agency or program, and any State or local government that receives Federal financial assistance under this Act (or an amendment made by this Act), may not subject any institutional or individual health care entity to discrimination, or require any health plan created or regulated under this Act (or an amendment made by this Act) to subject any institutional or individual health care entity to discrimination, on the basis that the health care entity refuses to–


    ‘(A) undergo training in the performance of induced abortions;


    ‘(B) require or provide such training;


    ‘(C) perform, participate in, provide coverage of, or pay for induced abortions; or


    ‘(D) provide referrals for such training or such abortions.

  • jodi-jacobson

    The last part you cite does exactly as I have described, which is to allow insitiutions and individuals to suffer no consequences whatsoever if they allow a woman in need of an emergency abortion to die.  Perhaps you don’t understand legislative language?

    may NOT subject to discrimination or require… any institutional or individual health care entity to discrimination, on the basis that the health care entity refuses to–…..


    And the first part is also as I describe it because any single exchange under health reform that takes a single dollar of federal funding for any person out of thousands or millions in the system then becomes federallyfunded for the purposes of this act.  therefore even if i pay my premium out of my pocket entirely, that exchange can not offer me abortion coverage because they took a dollar to subsidize SOMEONE ELSE’s PREMIUM.

  • colleen

    Even the Catholic ban on abortion doesn’t include such a notion that if a mother’s life was in danger and killing the fetus would somehow remedy this (an extremely rare occurrence) that it would be somehow disallowed.

    This is, quite simply, not true. The Church’s position is quite clear, If a woman’s body is unable to sustain a pregnancy it is better that she die than outlive her ‘child’. (or, in normal terms,  10 week embryo in some documented cases). This bill allows the Church to set this as a matter of hospital policy and to kill any woman unfortunate enough to go to a Catholic hospital when her pregnancy is killing her.This bill allows the sons of bitches to kill women as a matter of hospital policy and to do so legally and without fear of expensive lawsuits or loss of medicare funds.

    And may I say how craven and stupid it is go on about how “extremely rare” it is to need an abortion for medical reasons. How many easily preventable deaths are acceptable to you folks? The US is 42nd in maternal mortality (which is to say that 41 other countries do a better job of keeping pregnant women alive when their lives are endangered by a pregnancy).Clearly the USCCB, the Blue Dogs and the Republican party wish to do everything they can to increase that number. 

    The fact that the ‘pro-life’  astroturf is limited to really pathetic lies from people who berate and demean us for “not reading the bill” (when it’s abundantly clear that they have not read or understood the bill themselves) tells me that whoever ordered the astroturf knows this bill is morally and legally indefensible.

  • littleblue

    I was responding to Catfitz who, as it seems, neglected to read the entire bill.

  • claire-keyes

    Between the news articles and the blogs, the status of women in this country could not be more clear.  The Catholic Church, much like Wall St, has managed to deflect their own outrageous criminal behavior. Legislatures, often in the pocket of the church/es, is now creating medical policy, ignoring the views of the medical profession, public health experts, and sociologists who have stated unequivocally that instituting costly roadblocks to abortion will have dire effects on women, families and communities.  The majority of the public has clearly stated for decades that they want abortion to be legal, safe and available.  The legislators, with their own anti-woman agenda, is ignoring the wishes of the public despite the dire predictions of the consequences of children being born to mothers who are not at this time able to care for them.  

    The only solution is for voters to begin to organize NOW to be sure that we send a message to these legislators that we want our voices to be heard, that we want women to have the true choice that the Supreme Court gave us, that we must be able to determine if and when we are able to care for a new life for 21 years.  If legislators do not hear us, we will vote for those who DO hear us!

  • robynmarigny

    14th amendment applies here.  You cannot force a citizen into bondage.


    A women’s egg is no more a citizen than a corporation is.

  • carolrhill814

    Let us say it plain and simple women are second class citizens and we always will be because men are scared to death of us and they know we can and will take over and they stand that thought and that is a fact.

  • equalist

    And don’t forget that for some women, the only hospital within reach in an emergency IS a catholic hospital.  Not to mention, if a woman is unconscious or delierious due to her medical condition, she’s not exactly in any condition to direct the ambulance driver to take her to another hospital if the one she’s being taken to is a catholic hospital. 

  • equalist

    There are those (though a few) in the medical profession defending bills like this because the procedure is against their personal concience.  The thing I’ve never understood about this is what are they doing in the medical profession anyway?  Or at least in any part of it where they might have to perform or assist in an abortion?  Your “sensibilities” and “concience” don’t matter one whit to the woman dying on the examination table who may not have time for other staff to be called in when you’re right the hell there.  If you can’t take the heat, get the f*** out of the kitchen, and leave the saving of lives to people willing to do their jobs.

  • crowepps

    Maybe women’s groups could do a little fundraising by selling Medic Alert bracelets to women that tell the paramedics “Allergic to Catholic Healthcare”.

  • ahunt

    Medic Alert Bracelet.


    My ______ (Mom- Dad- Brother- Sister- Husband) is a wildly successful malpractice attorney who loves me very much.

  • colleen

    Not just to women of childbearing age. Catholic hospitals also refuse to honor end of life directives and Do not Resuscitate orders. As long as the dying person has the money/insurance to pay the bills. Of course,  once the insurance and available assets run out it’s  death panel time.


  • iupapaw



  • elburto

    If someone would rather save souls (than lives) they should get the fuck out of healthcare, and join the clergy instead.

    Every time I read another new piece of disgusting anti-woman legislation out of the US I want to cry for everyone stuck there. I’m so glad my society is secular, and that religion is largely dead here.