California Attorney General Rob Bonta has filed a lawsuit against Eureka's Providence St. Joseph Hospital, alleging it endangered a woman's life when it refused to abort a non-viable pregnancy in February.

"It is damning that here in California, where abortion care is a constitutional right, we have a hospital implementing a policy that's reminiscent of heartbeat laws in extremist red states," Bonta said in a press release about the suit filed Sept. 30 in Humboldt County Superior Court. "With today's lawsuit, I want to make this clear for all Californians: Abortion care is healthcare. You have the right to access timely and safe abortion services. At the California Department of Justice, we will use the full force of this office to hold accountable those who, like Providence, are breaking the law."

Specifically, the lawsuit alleges Providence St. Joseph violated state law that requires hospital emergency rooms to provide care to prevent not only maternal death, but "serious injury or illness," when it reportedly denied care to Anna Nusslock in February due to policies set in accordance with Ethical and Religious Directives for Catholic Health Care Services created by the United States Conference of Catholic Bishops. As a part of the suit, Bonta's office is seeking a preliminary injunction that would immediately stop the hospital from following its policy prohibiting providers from performing abortions unless a mother's life is at immediate risk.

Nusslock, a local chiropractor, was 15 weeks pregnant with twin girls when her water broke and she arrived at St. Joseph Hospital bleeding and in severe pain on Feb. 23, according to a sworn declaration. After an ultrasound, Nusslock said Sarah McGraw, the doctor on call that night at St. Joseph, diagnosed her with preterm premature rupture of membranes (also known as previable PROM), and told her that while both fetuses still had detectable heart tones, one had no chance of survival and the other had "essentially no chance," and that attempting to continue the pregnancy carried "significant maternal morbidity and mortality" risks.

A specialist Nusslock had been seeing at the University of California, San Francisco Medical Center recommended immediate abortion care — either through an induction or a dilation and evacuation procedure — and McGraw agreed, according to the declaration.

"I worked to process this information through overwhelming grief as I tried to start accepting that I was losing two daughters that day," Nusslock said in her declaration. "Understanding that there was no hope for either twin and that declining the abortion care that UCSF recommended would risk my health and potentially even my life, I gave consent to proceed. I was shaken by what happened next."

Nusslock said in the declaration that McGraw told her that she was not "permitted to provide" the needed care and that under St. Joseph policy "she could not do anything for me so long as my twins had 'heart tones.'" Conceding the situation was "horrible," McGraw recommended Nusslock be flown to UCSF to receive the necessary abortion, the declaration stated. Worried her insurance would not cover the $40,000 helicopter flight and her husband wouldn't be permitted to accompany her, Nusslock told McGraw it wouldn't work and asked if she could drive to UCSF instead, according to the declaration.

"Dr. McGraw responded: 'If you try to drive, you will hemorrhage and die before you get to a place that can help you,'" the declaration stated, adding that McGraw then left the room and returned a short time later to tell Nusslock that Mad River Community Hospital would take her.

Before Nusslock left St. Joseph Hospital to drive to Mad River, she said a nurse gave her a bucket and some towels, "in case something happens in the car." By the time Nusslock was admitted to the labor and delivery unit at Mad River, she said she'd "passed an apple-sized blood clot" and was bleeding heavily, according to the declaration. She was prepared for immediate surgery.

In a declaration filed with the lawsuit, Elizabeth Micks, the physician who treated Nusslock at Mad River, said Nusslock was "not clinically stable" and "appeared to be deteriorating" when she arrived at the hospital, and she "determined she needed to proceed to the operating room on an emergency basis," adding that Nusslock began actively hemorrhaging before arriving there.

"Though Ms. Nusslock was able to physically recover, I do not believe this was a foregone conclusion," Micks said in the declaration. "There is never a guarantee that doctors will be able to address and reverse the damage once a patient begins to deteriorate. Moreover, one complication can rapidly beget others: An infection can prevent a uterus from properly contracting, which can cause hemorrhage, and subsequent blood loss can both weaken the body's ability to fight the infection and create other complications. This is why the standard of care is to offer early intervention, and why care delayed may ultimately be care denied."

Micks' declaration stated there was no medical reason to delay Nusslock's care, as "there was no possibility of either fetus surviving to the point of viability."

Providence spokesperson Bryan Kawasaki emailed the Journal a statement in response for a request to comment on the lawsuit, saying the hospital is "deeply committed to the health and wellness of women and pregnant patients and provides services to all who walk through the doors in accordance with state and federal law."

"We are heartbroken over Dr. Nusslock's experience earlier this year," Kawasaki said in the email. "This morning was the first Providence had heard of the California attorney general's lawsuit, and we are currently reviewing the filings to understand what is being alleged. Because this case is in active litigation and due to patient confidentiality, we cannot comment on the matter."

Kawasaki added that St. Joseph reviews "every event that may not have met our patient needs or expectations to understand what happened and take appropriate steps to meet those needs and expectations for every patient we encounter."

A press release from Bonta's office asserts the lawsuit "is especially critical"because Mad River Community Hospital has announced it will close its labor and delivery unit this month, meaning patients in Nusslock's position in the future "will face an agonizing choice of risking a multi-hour drive to another hospital or waiting until they are close enough to death for Providence to intervene."

The Attorney General's Office said the lawsuit is necessary to enforce "the crucial right" to emergency abortion care under state law, noting that federal protections for such care have been cast in doubt by recent lawsuits in the wake of the U.S. Supreme Court overturning the legal precedent set in Roe v. Wade. The lawsuit argued the California Supreme Court has "upheld laws that require hospitals to provide medical care, even when doing so is at odds with religious beliefs."

For her part, Nusslock said in her declaration the experience "deeply traumatized" her and she continues to deal with "tremendous" anxiety, grief and depression.

"While still mired in grief from losing my daughters, I continue to relive the trauma of being forced to leave Providence Hospital in the midst of a medical emergency and the fear for my life I felt when I was told that I could not receive the emergency treatment I needed while at Providence Hospital," her declaration stated.

Thadeus Greenson (he/him) is the Journal's news editor. Reach him at (707) 442-1400, extension 321, or [email protected].