Catholic Nurse Cites Her Conscience in Refusing to Help Gravely Ill Woman

There! Much better! My title carries a whole different set of connotations than the anti-abortion media’s headlines: “Catholic nurse forced to participate in abortion, lawsuit filed” (Catholic News Agency) and “Nurse ‘Forced’ to Help Abort (the New York Post). Despite vigorous googling, I’m not finding much other reporting on this story at all, except from Jill at Feministe. You know your sources are thin when the Washington Times appears to give the most dispassionate and complete account:

Catherina Lorena Cenzon-DeCarlo, 35, a Filipina nurse who is a permanent U.S. resident and married to an American, says that Mount Sinai Hospital in Manhattan “blatantly” violated a 35-year-old federal law that protects health care workers with religious objections from having to assist in performing abortions.

The hospital performed a late-term abortion on a woman whose health was not at risk, she says. The nurse is asking for a jury trial that could strip the hospital of hundreds of millions of dollars in federal funding until it complies with the law….

According to the 26-page complaint filed in U.S. District Court for New York’s Eastern District, the lawsuit says when Mrs. DeCarlo was hired in August 2004, she told hospital officials outright that she would not participate in abortions. She is Catholic and her uncle is Bishop Carlito J. Cenzon, who leads the Roman Catholic diocese of Baguio in the northern Philippines.

The hospital did not object to this and gave her a form to complete that indicated her refusal to take part in the procedure. During the nearly five years from her hiring date until this May, the lawsuit said, the hospital had avoided asking her to assist on abortions, as it has a cadre of other nurses who have indicated their unwillingness to do so. …

But it was on May 24, a Sunday morning shift over Memorial Day weekend, when matters came to a head. The nurse said she was told she was assigned to help with a “D&C,” signifying “dilation and curettage,” a procedure to remove the remains of a miscarriage from a woman’s womb. But when she began preparing the operating room, she learned she had been assigned to help with aborting a 22-week pregnancy.

Dr. Noel Strong, the resident on duty, said the mother had preeclampsia, a medical complication involving hypertension and protein in the urine that is treatable with magnesium sulfate. Mrs. DeCarlo thought the preeclampsia not to be life-threatening and thus not an immediate cause for an emergency abortion. A flurry of calls then erupted between her and supervisors Fran Carpo and Ella Shapiro after Mrs. DeCarlo refused to take part in the procedure, the lawsuit says.

Ms. Carpo – on instructions from Ms. Shapiro – then forbade the nurse to try to find a substitute, adding that the doctor performing the abortion had called her, furious about the delay, the lawsuit charges. While Ms. Carpo said the patient was in mortal danger, Mrs. DeCarlo pointed out the patient was not even on magnesium therapy, the first step of treatment for the condition.

Ms. Carpo, the lawsuit said, was the manager on duty and could have easily stepped in as a replacement but instead threatened to charge Mrs. DeCarlo with “insubordination and patient abandonment,” charges that could have ended Mrs. DeCarlo’s career.

Mrs. DeCarlo broke down at this point and offered to get her priest on the phone to explain her point of view, says the lawsuit, but hospital officials were adamant that she participate. When she pointed out the abortion could be delayed until another nurse could be found to take part, she received more threats, the lawsuit says, until she finally capitulated, saying she would take part “under protest.”

When asked why she didn’t simply walk out of the building, one of her attorneys, Matt Bowman of the Alliance Defense Fund, said the plaintiff “strenuously protested to the point of tears. Employees should not be forced to choose between their jobs and their beliefs.”

The nurse said she was “forced to watch the doctor remove the bloody arms and legs of the child from its mother’s body with forceps” and carry those body parts in a cup to another area of the operating room.

Bear in mind that the only source of info for this story is the lawsuit filed. Everyone else is refusing comment. Of course the patient’s identity and history are being kept confidential, as well they should.

Jill and her commenters have done a fine job discussing the legal and moral obligations of hospitals and medical practitioners. I don’t want to rehash that here. I’ll just say that no nurse or doctor should be hired to work in the ER, as DeCarlo was, if they would withhold lifesaving treatment.

Instead, I want to look more closely at the medical issues. Preeclampsia is a fairly common complication of pregnancy, occurring in 5 to 10% of all pregnancies. It’s signaled by a rise in their blood pressure, protein in their urine, and (sometimes) edema, or swelling, especially of the extremities. Many women experience no overt symptoms and might not even know that they have it. Most women survive it just fine.

But in a small number of women – between 5 and 7 per 10,000 deliveries – preeclampsia progresses to full-blown eclampsia, which includes seizures sometimes followed by coma and death. It accounts for 17.6% of maternal deaths in the U.S and 15% of premature deliveries.

Just because preeclampsia is a fairly common condition doesn’t make it harmless. I know someone who died of it, a college classmate of mine. A former colleague of my husband’s lost his partner to it.

We don’t have many more tools to predict or control eclampsia than we did 100 years ago, although one major reason health officials tout prenatal care is that it can catch and monitor preeclampsia while it’s still mild. We also don’t understand its causative mechanisms, despite countless research studies. Magnesium sulfate can be given by IV to prevent seizures, and while it saves lives, it’s no miracle drug. The only definitive treatment is delivery of the fetus – and even then, the new mother remains at risk for a few days thereafter. Of the three major killers of expectant mothers 100 years ago – hemorrhage, infection, and eclampsia – we’ve only made great inroads against the first two, thanks to transfusions and antibiotics. Mortality from eclampsia remains significant.

So what was going on with the pregnant woman in DeCarlo’s case? Well, according to the Catholic News Agency, she wasn’t really in jeopardy at all:

Hospital officials told Cenzon-DeCarlo that the situation was an “emergency,” although evidence suggests that this was not the case.  The hospital itself labeled the case as a “Category II,” meaning that the operation needed to take place within six hours.  This would have allowed enough time to find another nurse without moral objections to assisting in the abortion, her lawyers said.

Matt Bowman, legal counsel for the ADF, explained that the hospital could not legally have required the nurse to participate in the abortion even if the case had been a “Category I,” meaning that the patient required “immediate surgical intervention for life or limb threatening conditions.”  Federal statutes prohibit recipients of federal health funds from requiring employees to perform abortions, Bowman told CNA.

However, the evidence in the case suggested that the patient was not even at the “Category II” level, as the hospital had claimed.  When the woman was brought into the room, Cenzon-DeCarlo observed no indications that the case was a medical emergency.  The woman’s blood pressure was not at a crisis level, and standard procedures for patients in crisis [administration of magnesium sulfate] had not been taken.  Yet the nurse was still required to aid in the abortion.

Since we don’t have any hard information, I’d like to put on my historian-of-childbirth hat and offer some informed speculation. Severe preeclampsia at 22 weeks’ pregnancy is not very common. However, it can occur, and there’s one variant that would demand immediate action: HELLP syndrome. Here’s how Reese at Feminist Mormon Housewives describes her experience with HELLP:

Earlier this year I had my first child. He was born at 28 weeks because my life was in danger. It turned out that I had HELLP syndrome, which is basically preeclampsia turned up to 11. My blood pressure was 186/110, my organs were failing, my red blood cells were disintegrating, and my platelet count was dropping making it so that my blood wouldn’t clot. If I could manage to function with my organs failing, and if I could have avoided having a stroke or heart attack, I would have bled to death in childbirth.

If the patient at Mt. Sinai was suffering from HELLP syndrome, the attending physician could have very reasonably determined that there was no way she could hold out for several more weeks, hoping for a viable but very premature fetus. Indeed, he judged her case serious enough to require intervention within the next several hours. This suggests either HELLP or another serious complication, such as a severe headache (indicating a high risk of seizure) or chest pain (possible embolism). If you’re going to go straight to delivery (in this case, abortion, because the fetus was still a couple weeks short of the very outer limit of viability), then you might start administering magnesium sulfate as seizure prophylaxis as part of pre-op procedures, but the main priority would be to get the operation underway. Ordinarily a nurse would start an IV. In this case, the assigned nurse was arguing with her supervisor instead of tending to the patient. Could that possibly have anything to do with why the patient wasn’t on magnesium sulfate?

The patient’s relatively normal blood pressure is a red herring, because as emedicine notes, HELLP can present differently than regular preeclampsia:

HELLP syndrome (hemolysis, elevated liver enzyme, low platelets) is a form of severe preeclampsia that has been associated with particularly high maternal and perinatal morbidity and mortality and may be present without hypertension or, in some occasions, without proteinuria. [my emphasis]

So we don’t know all the details, but certainly my speculations are a whole lot more believable than a scenario where mild preeclampsia was used as a pretext for elective abortion at 22 weeks. This was presumably a wanted fetus. On the off chance that it wasn’t, the woman could have sought elective abortion, which can still be carried out legally at 22 weeks. While it can be tough to find a provider for late-term terminations, last I knew New York City was one of the meccas for women needing such abortions. So there’d be absolutely reason to show up in the ER, hoping on spec that you could get an elective abortion. There’s also no reason why an ER doctor would prioritize a procedure if it weren’t urgent. Folks in the ER have a few other problems on their plate.

Just imagine you’re a woman hoping to bring a child into the world. Imagine you get sick with a condition in mid-pregnancy that you’d never even heard of. Imagine hearing the ER doctor – whom you’ve never met in you life – tell you that you need to abort in order to save your own life; otherwise, HELLP syndrome is liable to put you into liver failure, possibly complicated by kidney failure and blood that refuses to clot. And then imagine that your story of loss is plastered throughout the court system and the yellow press, trumpeted by pro-lifers as evil incarnate, and held out as an example of women’s and doctors’ supreme depravity.

No, we don’t know exactly what happened. But my speculative reading of the paltry facts is a whole lot more coherent and compelling than the tale DeCarlo tells in her court filings. Given that DeCarlo is the niece of a Catholic bishop, this whole thing stinks of a set-up. If it’s not, why she didn’t she just quit on the spot when her boss ordered her to aid in an act she considered murder? I’d like to think that I’d have that much moral courage. Instead, DeCarlo cooperated just enough to add drama to her lawsuit – after she’d gambled with a woman’s life.