Federal court rejects challenge of abortion-refusal law

A federal judge tossed out California's constitutional challenge to a federal measure boosting protections for physicians who object to providing abortion-related services based on their personal beliefs.

Organizations on both sides of the abortion debate found some good in the ruling. But the decision may leave the door open for a future legal battle.

The Weldon Amendment allows the government to withhold federal funding from any federal, state or local entities that discriminate against doctors, hospitals or health plans that choose not to offer or cover abortion services. This federal conscience protection passed in 2005 and has been extended each year since.

In addition to the federal measure, 46 states, including California, have their own "conscience clause" laws giving doctors the right to decline to provide abortions for moral, ethical or religious reasons, according to the Guttmacher Institute, a nonprofit organization that supports abortion rights.

But California worried that it stood to lose as much as $50 billion in health care and other federal dollars if it enforced a different state law requiring health care entities to provide or refer emergency abortions when the life or health of the pregnant woman is at risk. State officials argued that the Weldon Amendment was unconstitutional because it lacked an explicit exception for such scenarios and interfered with California's right to carry out its statute.

U.S. District Judge Jeffrey S. White in the U.S. District Court for the Northern District of California rejected those claims, saying the state did not show that anyone -- patients or the state -- has been harmed by the seeming conflict. White also suggested that the Weldon Amendment could be interpreted in conjunction with the federal Emergency Medical Treatment and Active Labor Act, which requires emergency departments to treat, stabilize or, if needed, transfer patients for appropriate care. "In light of this standard, it is far from clear whether the Weldon Amendment would prohibit California from enforcing its own version of the EMTALA in medical emergencies," the March 18 opinion states.

California Deputy Attorney General Antonette Cordero said the ruling appears to relieve state fears that a potential conflict threatened to harm women's access to abortion and the state's right to apply its own health care laws.

"Women have the right to receive emergency medical care, regardless of what that care is," she said. "Our concern was we didn't know whether we could enforce our law or not without running afoul of the Weldon Amendment, and potentially losing funding could be catastrophic."

Cordero said the federal government has yet to enforce the amendment in California or elsewhere and hopes that will continue. Meanwhile, the state still is weighing its appeal options, she said.

Some physicians worried that the possible friction between the state and federal laws would put doctors in the difficult position of choosing between compromising federal funding and providing necessary emergency medical treatment, stated a friend-of-the-court brief by the California Medical Assn. and Planned Parenthood Affiliates of California Inc. Neither organization was available for comment. Doctors and other health care entities that fail to comply with California's emergency statute also risk civil penalties or disciplinary action, the brief states.

The CMA and Planned Parenthood in their brief said they support conscience protections like those in California's law "to the extent that those beliefs do not imperil the health or life of patients."

Anti-abortion doctors applaud ruling

Physicians defending the Weldon Amendment also praised the court for upholding what they say is a fundamental part of medical practice.

"The Weldon Amendment is a very essential protection for all physicians, and this [case] has a potential impact greater than the abortion issue because it goes to the very heart of professionals' right of conscience," said David Stevens, MD, CEO of the Christian Medical and Dental Assns. That group opposes abortion and joined the lawsuit as a defendant.

Doctors don't object to providing emergency abortions, which Dr. Stevens defined as those performed because the woman's life was threatened. But if California imposed its law to pressure doctors or hospitals to perform the procedure in other circumstances -- or censure them if they don't -- the issue may find its way back to court, he said.

The district court also suggested that California was not powerless to take future legal action. If the state finds that a woman is denied emergency abortion-related services and enforces its law, and the federal government denies or threatens to take away funding, "the case then would be ripe for a court to consider this matter," White wrote.

The California case is not the first legal test of the Weldon Amendment. In 2006 the U.S. Court of Appeals for the District of Columbia Circuit dismissed a similar constitutional challenge brought by the National Family Planning & Reproductive Health Assn.