City Attorney Dennis Herrera today announced he has filed for a court order to halt enforcement of the Trump administration’s new rule that would allow health care staff to refuse to provide medical treatment to patients. If allowed to take effect, the U.S. Department of Health and Human Services’ new rule would threaten medical access for socially and medically vulnerable populations, including women and lesbian, gay, bisexual, and transgender people.
Herrera on June 3, 2019 filed a motion for a preliminary injunction to halt enforcement of the so-called “conscience” rule nationwide while his legal challenge to it is being decided in court. San Francisco was the first in the country to take the administration to court over this rule, filing a lawsuit within hours of Trump announcing it on May 2, 2019. The Trump administration misleading labels the rule as one of conscience, when in fact it is about denying people medical care.
The rule is slated to go into effect on July 22, 2019. If that happens, nurses across the country, including at San Francisco’s level one trauma center, would be able to refuse to provide treatment to women experiencing life-threatening, pregnancy-related complications — even if no other personnel is available to step in. Call operators would be able to refuse to direct patients and potential patients to the correct departments to access contraception, abortions or gender transition-related services. Staff at all levels could be emboldened to discriminate against LGBTQ patients or other vulnerable groups.
“If this rule takes effect, people could be denied vital medical care simply because of their health care provider’s beliefs,” Herrera said. “Health care workers could refuse to help pregnant women experiencing life-threatening complications or gay patients seeking HIV medications. It’s unconscionable. Hospitals are no place to put personal beliefs above patient care. Denying medical treatment should not leave anyone with a clear conscience.”
“The San Francisco Department of Public Health strongly opposes this rule, which will threaten the health of our patients and is likely to have a particularly negative impact on those who are low-income, women and LGBTQ,” said Dr. Grant Colfax, Director of Health for the City. “Our San Francisco Health Network serves more than 100,000 members of our community each year, whose access to care and right to be free from discrimination would be at risk if the rule is implemented. The rule contradicts and undermines San Francisco’s commitment to equity and the Health Department’s mission to protect and promote the health and well-being of all in San Francisco.”
If San Francisco refused to implement the rule, or if the federal Department of Health and Human Services decides San Francisco is not in full compliance with the rule, the City could lose nearly $1 billion in federal health care funding. Those funds make up approximately one-third of the San Francisco Department of Public Health’s total budget, nearly 40% of Zuckerberg San Francisco General’s budget, and over 60% of the budget for Laguna Honda Hospital. The money is used for everything from Medicaid and Medicare to HIV treatment to assistance for low-income families and foster children. The San Francisco Health Network, administered by the San Francisco Department of Public Health, would be critically affected. It has two hospitals and 14 clinics where patients can access health care services. This includes Zuckerberg San Francisco General Hospital, the only level one trauma center serving a region of more than 1.5 million people.
San Francisco sued the administration over this rule within hours of Trump announcing it on May 2, 2019. In that lawsuit filed in U.S. District Court for the Northern District of California, Herrera says that the Department of Health and Human Services exceeded its statutory authority by creating the denial of care rule and violated the Administrative Procedure Act, the spending clause, separation of powers principles, and other provisions of the U.S. Constitution. Advocacy groups and other state and local governments later filed similar lawsuits.
The new rule requires cities like San Francisco to prioritize a staff person’s religious or personal beliefs over the health and lives of patients. The rule is so broad it applies not just to doctors and nurses, but anyone even tangentially related to health care, like receptionists. For example, schedulers could refuse to make appointments for transgender patients seeking transition-related care or a woman seeking information about an abortion, with potentially devastating impacts on the patients’ lives. If San Francisco sought to transfer a staff person so their professional role did not conflict with their beliefs, that could be considered “discrimination” under the new federal rule.
“Once again, the Trump administration is unlawfully threatening to pull federal funding as a way to coerce local governments for the president’s political benefit,” Herrera said. “Losing this funding would be catastrophic. Primary care, pediatric care, HIV prevention and treatment, dental care, family planning, prenatal care and much more would be at risk. That is unacceptable.”
The case is: City and County of San Francisco v. Alex M. Azar II, U.S. District Court case number 3:19-cv-02405, filed May 2, 2019. More information can be found on the City Attorney’s website: www.sfcityattorney.org