Pharmacist Violated Sex Discrimination Ban in Refusing to Fill Prescription for Emergency Contraceptive

 In Anderson v. Aitkin Pharmacy Services, LLC, (MN App., March 18, 2024), a Minnesota state appellate court held that a pharmacist violated the Minnesota Human Rights Act that prohibits intentionally refusing to do business with a person because of the person's sex. The pharmacist refused to dispense plaintiff's prescription for the emergency contraceptive ella because of his conscientious objection to dispensing any medication that prevents the implantation of a fertilized egg. The statute defines sex discrimination as including discrimination because of pregnancy. The court said in part:

Badeaux refused to dispense Anderson’s valid prescription because Badeaux believed she may have been pregnant.  Thus, pregnancy was a substantial causative factor in Badeaux’s refusal to dispense ella....

Badeaux did not assert a constitutional defense in district court and does not argue that the MHRA actually violates his constitutional rights.  Instead, he argues on appeal that the sex-discrimination language in the MHRA should be interpreted to avoid a constitutional conflict.... But we do not apply the constitutional-avoidance canon to a party’s proposed interpretation of a statute if the interpretation is contrary to the plain language of the statute.

The court however refused to reverse the jury's finding that the Pharmacy, as opposed to the individual pharmacist, did not violate the sex discrimination ban. The court said in part:

The evidence shows that Aitkin Pharmacy wanted to fill all valid prescriptions and had a pharmacist on staff who was willing to dispense emergency contraception.  The evidence also shows that, when Badeaux called Anderson on January 21, he communicated both that he was unwilling to dispense ella and that there was another pharmacist scheduled to work who was willing to dispense her prescription.... [T]here is a reasonable theory of the evidence to support the verdict that Aitkin Pharmacy did not intentionally refuse to do business with Anderson...

The court also concluded that, because of erroneous jury instructions, plaintiff should have been granted a new trial on her claim that the pharmacy violated the state's public accommodation law that bans denial of the full and equal enjoyment of goods and services in places of public accommodation because of sex. Courthouse News Service reports on the decision. [Thanks to Thomas Rutledge for the lead.]

European Court: Turkey Violated Rights of Conscientious Objector

In Kanatli v. Turkey, (ECHR, March 12, 2024) (full text of opinion in French), the European Court of Human Rights in a Chamber Judgment held that Turkey had violated Article 9 (freedom of thought, conscience and religion) of the European Convention on Human Rights when it convicted a military reservist who had subsequently become a conscientious objector for refusing to serve a one-day reserve duty call-up. The reservist, who had become an activist on the European Bureau for Conscientious Objection, was convicted of violating Turkey's Mobilization Act and fined the equivalent of 167 Euros. He refused to pay the fine and was therefore sentenced to ten days in prison. An English language press release from the Court summarizes its holding, saying in part:

The relevant national legislation – which provided for compulsory military service in the armed forces, including as a reservist – made no provision for potential conscientious objectors to perform an alternative form of service....

The Court had previously found that a system which provided for no alternative service or any effective and accessible procedure for the examination of a claim of conscientious objection could not be seen as having struck a fair balance between the general interest of society and that of conscientious objectors. No convincing arguments having been put forward by the Government, the Court saw no reason to depart from its case-law in the present case....

The Court held that Türkiye was to pay the applicant 9,000 euros (EUR) in respect of non-pecuniary damage and EUR 2,363 in respect of costs and expenses.

Nurse Sues Clinic for Refusing to Accommodate Her Objection to Prescribing Contraceptives

A religious discrimination lawsuit was filed last week in a Florida federal district court by a nurse-practitioner who was fired from her position at a Florida CVS MinuteClinic. The complaint (full text) in  Kristofersdottir v. CVS Health Corp., (SD FL, filed 1/18/2024), alleges that CVS revoked all religious accommodations that allowed employees to refuse to prescribe contraceptives, including the accommodation it had given to plaintiff for more than 7 years.  Plaintiff, a Roman Catholic, objected to prescribing hormonal contraceptives for patients. According to the complaint:

CVS corporate culture changed around 2021. Instead of protecting religious freedom, CVS began to treat religious practice as a source of "privilege."...

CVS never discussed possible accommodation options with Ms. Kristofersdottir even though CVS had numerous ways to provide a reasonable accommodation without undue hardship on the business.

When Florida subsequently passed a law protecting conscience-based objections by employees, CVS offered plaintiff her job back, but she declined the offer. The complaint alleges violations of Title VII and the Florida Civil Rights Act.

First Liberty issued a press release announcing the filing of the lawsuit.

HHS Adopts Rules Implementing Conscience Protections in Federal Law

The Department of Health and Human Services has made available a 100-page Release (full text) titled Safeguarding the Rights of Conscience as Protected by Federal Statutes that will be published in the Federal Register on January 11. The Release adopts the final version of amendments to rules initially adopted in 2011 and amended in 2019. though the 2019 version never took effect because of litigation. (See prior posting.) The new Rules seek to implement conscience protections in various statutes that bar recipients of federal funds from requiring health care personnel and organizations to participate in conduct that violates their religious or moral beliefs.  The new Rules provide in part:

OCR considers the posting of a notice consistent with this part as a best practice towards achieving compliance with and educating the public about the Federal health care conscience protection statutes, and encourages all entities subject to the Federal health care conscience protection statutes to post the model notice provided in Appendix A to this part. OCR will consider posting a notice as a factor in any investigation or compliance review under this rule.

(See prior related posting.) 

In a Release (full text) criticizing the new Rule, Alliance Defending Freedom said in part:

In its rule, HHS suggests it will continue its misguided use of the Emergency Medical Treatment and Labor Act to require doctors to perform abortions even though that federal law has no abortion requirement, and conscience laws provide no exception allowing forced performance of abortion.

In a Release (full text) commending the Biden Administration for the Rule change, the ACLU said in part:

The Biden administration announced it would partially repeal a dangerous and unnecessary Trump-era rule, which numerous courts had declared unlawful, that would have allowed health care institutions and providers to deny patients treatment and information based on personal religious or moral beliefs.

Conscience Clause in Health Insurance Mandate Does Not Violate Church's Free Exercise

In Cedar Park Assembly of God of Kirkland, Washington v. Kreidler, (WD WA, July 25, 2023), a Washington federal district court dismissed a free exercise challenge by a church to a Washington law requiring all health insurance plans that provide maternity coverage to also provide substantially equivalent abortion coverage. Under the law, employers with religious or moral objections to specific services do not have to purchase coverage for those services, but enrollees must still be able to access coverage for the services. The court said in part:

None of the State’s arguments seem to fully address the crux of Cedar Park’s facilitation complaint: that its employees would not have access to covered abortion services absent Cedar Park’s post-SB 6219 plan. This fact is undisputed and undoubtedly true. Because of SB 6219, Cedar Park’s employees gained coverage for abortion services under their employer-sponsored health insurance plan that they would not otherwise have. Even if the “facilitation” is somewhat minimal, SB 6219 requires Cedar Park to facilitate access to covered abortion services contrary to Cedar Park’s religious beliefs....

Because the Court concludes that SB 6219 is neutral and generally applicable, the law is valid if it is rationally related to a legitimate governmental purpose....

The Washington legislature identified multiple legitimate governmental purposes for enacting SB 6219, including promoting gender equity, promoting economic success of women, improving women’s health, and protecting privacy.

New Florida Law Protects Conscience Rights of Health Care Providers

 Yesterday Florida Governor Ron DeSantis signed Senate Bill 1580 (full text) which protects conscience rights of health care providers and insurers. The law provides in part:

It is the intent of the Legislature to provide the right of medical conscience for health care providers and payors to ensure they can care for patients in a manner consistent with their moral, ethical, and religious convictions. Further, it is the intent of the Legislature that licensed health care providers and payors be free from threat of discrimination for providing conscience-based health care....

 A health care provider or health care payor has the right to opt out of participation in or payment for any health care service on the basis of a conscience-based objection....

A board ... may not take disciplinary action against a health care practitioner’s license or deny a license to an individual solely because the individual has spoken or written publicly about a health care service or public policy, including, but not limited to, speech through the use of a social media platform ... provided that the individual is not using such speech or written communication to provide medical advice or treatment to a specific patient or patients....

Pensacola News Journal reports on the new law.

HHS Issues Notice of Proposed Rulemaking on Conscience Protections For Healthcare Providers

The U.S. Department of Health and Human Services released yesterday a Notice of Proposed Rulemaking (full text) titled Safeguarding the Rights of Conscience as Protected by Federal Statutes. In 2019, the Trump Administration HHS adopted final rules on protecting the conscience rights of health care providers. The rules were criticized as possibly imperiling care for persons seeking reproductive health care, weakening childhood vaccination efforts and potentially leading to discrimination against gay and transgender patients. (See prior posting.) Several courts enjoined enforcement of the 2019 rules. (See prior posting.) Yesterday's Notice of Proposed Rulemaking says in part:

The Department also proposes to retain, with some modifications, certain provisions of the 2019 Final Rule regarding federal conscience protections but eliminate others because they are redundant or confusing, because they undermine the balance Congress struck between safeguarding conscience rights and protecting access to health care access, or because significant questions have been raised as to their legal authorization. Further, the Department seeks to determine what additional regulations, if any, are necessary to implement certain conscience protection laws. The Department is seeking public comment on the proposal to retain certain provisions of the 2019 Final Rule, including on any alternative approaches for ensuring compliance with the conscience protection laws....

The ACLU issued a press release calling the HHS Notice "an important first step toward repealing the most harmful aspects of this dangerous rule."

Nurse Sues Clinic For Violating State Conscience Protections

Suit was filed yesterday in a Virginia state court by a Catholic nurse practitioner who was fired by a CVS Minute Clinic after she insisted that, for religious reasons, she would not provide or facilitate the use of hormonal contraceptives, Plan B and Ella which she considers abortifacients. For three years, the clinic had accommodated her religious beliefs, but it then changed its policy and refused to do so.  The complaint (full text) in Casey v. MinuteClinic Diagnostic of Virginia, LLC, (VA Cir. Ct., filed 8/31/2021) challenges her firing as a violation of Va. Code § 18.2-75 which provides that:

any person who shall state in writing an objection to any abortion or all abortions on personal, ethical, moral or religious grounds shall not be required to participate in procedures which will result in such abortion.

ADF issued a press release announcing the filing of the lawsuit.

South Carolina Adopts Law Protecting Conscience Rights Of Health Care Personnel and Institutions

As reported by WPDE News, on Friday South Carolina Governor Henry McMaster signed H4776, the Medical Ethics and Diversity Act (full text). The new law provides in part:

A medical practitioner, health care institutions, and health care payers have the right not to participate in or pay for any health care service which violates the practitioner's or entity's conscience....

... [A] religious medical practitioner, health care institutions, and health care payers that hold themselves out to the public as religious, state in their governing documents that they have a religious purpose or mission, and have internal operating policies or procedures that implement their religious beliefs, have the right to make employment, staffing, contracting, and admitting privilege decisions consistent with their religious beliefs....

No physician, nurse, technician, medical student, or other employee of a hospital, clinic or physician shall be required to recommend, perform or assist in the performance of an abortion if he advises the hospital, clinic or employing physician in writing that he objects to performing, assisting or otherwise participating in such procedures.

Suit Challenges Ohio's Health Care Conscience Law

Suit was filed last week in an Ohio state trial court challenging ORC §4743.10 which allows health care practitioners, hospitals and insurers to refuse to participate any health care service that violates teir conscience as informed by the moral, ethical, or religious beliefs or principles they hold. The suit was filed by a community health care system that provides services to the LGBTQ+ community.  The complaint (full text) in Equitas Health v. State of Ohio, (OH Com. Pl., filed 4/29/2022) contends that the law violates the Ohio constitution in that it is void for vagueness and violates the single-subject rule for legislation.  The provision was inserted into last year's 2400-page budget bill. News5Cleveland reports on the lawsuit.

Nurse's Religious Objections Should Have Been Accommodated Under Illinois Right of Conscience Act

 In Rojas v. Martell,(IL Cir. Ct., Oct. 25, 2021), an Illinois state trial court held that under Illinois Healthcare Right of Conscience Act, a county Health Department Clinic should have accommodated the objections of a nurse who on religious grounds would not participate in abortion referrals or provide contraceptives to patients. However, the court found that plaintiff was entitled only to the statutory minimum damages of $2500 because she should have mitigated damages by pursuing a position that was available at a nursing home. The court summarized its holding:

[W]hen one member of a team of employees makes an objection of conscience to performing a minority of her job duties, the employer should be required to accommodate the employee in her present position if doing so does not unreasonably compromise the employer's operations.

ADF issued a press release announcing the decision.

Religious Objections To Medical College's COVID Vaccination Requirement Upheld

In Magliulo v. Edward Via College of Osteopathic Medicine, ((WD LA, Aug. 17, 2021), a Louisiana federal district court issued a temporary restraining order barring a medical college from conditioning plaintiff students' enrollment on their receiving a COVID-19 vaccination. The students had requested an exemption from the college's requirements for religious reasons-- they believed the vaccine was derived from aborted fetal tissue. The college would grant the exemption only if the objecting students complied with extensive restrictions. The court held that Louisiana statutes allow students to assert religious or philosophical objections to the vaccine requirement. It also concluded that the refusal to exempt religious objectors violates the free exercise clause of the Louisiana constitution and the Louisiana Preservation of Religious Freedom Act.  The Louisiana Attorney General had backed the students' position in the case, and the AG's Office issued a press release discussing the decision.

Ohio Enacts Conscience Protections For Medical Personnel and Institutions

On July 1, Ohio Governor Mike DeWine signed Am. Sub. House Bill 110, Ohio's Budget bill. (Signing ceremony.) Included in the 2438-page bill is a provision providing conscience protections for health care practitioners, institutions and insurers (at pg. 1453- 1455, enacting ORC Sec. 4743.10). The new section reads in part:

Notwithstanding any conflicting provision of the Revised Code, a medical practitioner, health care institution, or health care payer has the freedom to decline to perform, participate in, or pay for any health care service which violates the practitioner's, institution's, or payer's conscience as informed by the moral, ethical, or religious beliefs or principles held by the practitioner, institution, or payer. Exercise of the right of conscience is limited to conscience-based objections to a particular health care service.

... When possible and when the medical practitioner is willing, the medical practitioner shall seek to transfer the patient to a colleague who will provide the requested health care service. If participation in a transfer of care for a particular health care service violates the medical practitioner's beliefs or convictions or no willing colleague is identified, the patient shall be notified and provided the opportunity to seek an alternate medical practitioner. Upon patient request, the patient's medical records shall be promptly released to the patient.

The law provides for treble damage actions and injunctive relief for medical personnel where the new conscience provisions have been violated.

Metro Weekly reports on the enactment of this provision. [Thanks to Scott Mange for the lead.]

Arkansas Enacts Conscience Protections For Medical Personnel

Last Friday, Arkansas Governor Asa Hutchinson signed SB289, the Medical Ethics and Diversity Act (full text). The law gives broad protection for medical practitioners, healthcare institutions, and healthcare payers who have religious, moral or ethical objections to participating in a particular healthcare service. Protections extend to a long list of providers, including doctors, nurses, pharmacists, researchers. counselors and student counselors. In his signing statement, the Governor said in part:

I support this right of conscience so long as emergency care is exempted and conscience objection cannot be used to deny general health service to any class of people. Most importantly, the federal laws that prohibit discrimination on the basis of race, sex, gender, and national origin continue to apply to the delivery of health care services.

ADF issued a press release regarding the signing. 

Korea's Supreme Court Accepts Secular Conscience Objection To Military Service

Korea JoongAng Daily reports that for the first time yesterday, Korea's Supreme Court held that a non-religious conscientious objector is entitled to an exemption from annual reservist training:

Reading the top court’s ruling, presiding Judge Lee Heung-goo said, “Although it is not based in religious belief, the defendant’s rejection of reservist training stems from a sincere conscientious objection grounded in his ethical, moral and philosophical convictions. We therefore see this as a justifiable application of the provision in the Reserve Forces Act for declining participation.”...

At his Supreme Court trial, the man testified, “Growing up under a violent father, I underwent a self-awakening about the use of force. Later, I saw a video of American soldiers shooting civilians from a helicopter, which led me to renounce the idea of possibly killing or murdering another human being.”

(See prior related posting.)

DOJ Sues Vermont Hospital For Violating Church Amendments

The Justice Department announced this week that it filed suit in a Vermont federal district court against the University of Vermont Medical Center for violating the Church Amendments that protect medical workers from being required to assist with abortions in violation of their religious or moral convictions. The complaint (full text) in United States v. University of Vermont Medical Center, (D VT, filed 12/16/2020) alleges in part:

Defendant has scheduled conscience objectors, including nurses, to assist with elective abortions despite specific and repeated requests from those personnel not to be assigned to elective abortions because of their religious beliefs or moral convictions. Moreover, Defendant has repeatedly assigned conscience objectors to participate in elective abortions without giving advance notice of the nature of the procedure.

New Jersey's Aid In Dying Act Is Upheld

In Petro v. Grewal, (NJ Super., April 1, 2020), a New Jersey state trial court dismissed a suit challenging the constitutionality of New Jersey's Medical Aid in Dying for the Terminally Ill Act.  Plaintiffs challenged the law on numerous grounds, including under the free exercise clause. First the court held that plaintiffs lack standing to challenge the law, saying in part:

Their deeply felt religious, ethical or professional objections to the Act do not suffice to establish standing, even under New Jersey's liberal standard.

The court however went on to also reject plaintiffs' claims on the merits. In part of its opinion, the court rejected plaintiffs' free exercise objections to the obligation of a doctor who refuses to provide aid in dying to transfer health care records to a patient's new doctor. The court said that the law is a neutral law of general applicability, and that the obligation to transfer records is "minimally burdensome."  North Jersey.com reports on the decision.

Court Interprets Defenses Under Illinois RFRA and Right of Conscience Act

In Rojas v. Martell, (IL App., March 6, 2020), an Illinois state appellate court answered four certified questions on the state's  Health Care Right of Conscience Act and its Religious Freedom Restoration Act. The court held that neither the analytic framework not the reasonable accommodation defense of Title VII should be read into these state statutes. It also concluded that transfer of an employee to a job that does not include the religiously objectionable duties may be permissible under the Right of Conscience Act. The issues arose in a case in which a county health department nurse claimed that the health department discriminated against her after she asserted that her Catholic religious beliefs prevented her from providing birth control, from providing Plan B emergency contraception, and from making abortion referrals.

Court Sets Aside New Health Care Conscience Rules

In City and County of San Francisco v. Azar, (ND CA, Nov. 19, 2019), a California federal district court set aside rules adopted earlier this year by the Department of Health and Human Services to give additional protection to conscience rights of health care providers. The court said in part:

With the minor exceptions noted below, the new rule is purely an interpretive rule, not a legislative rule. An agency, of course, must interpret a statute under its care. But an interpretation, even if cast in the form of a regulation, is nothing more than that — an interpretation. The statute itself is what has the force of law, not the interpretation. No interpretation can add or subtract from the actual scope of the statute itself. If the agency misconstrues a statute, then the statute controls, not the interpretation.....

... Congress tried to strike a balance between two competing considerations. One consideration was recognition that, due to religious or ethical beliefs, some doctors, nurses, and hospitals, among others, wanted no part in the performing of abortions and sterilizations, among other medical procedures, and Congress wanted to protect them from discrimination for their refusal to perform them. The countervailing consideration was recognition of the need to preserve the effective delivery of health care to Americans, including to those seeking, for example, abortions and sterilizations. Every doctor or nurse, for example, who bowed out of a procedure for religious or ethical reasons became one more doctor or nurse whose shifts had to be covered by someone else, a burden on the healthcare system. Congress struck a balance between these two opposing considerations.

In reading the rule in question, the Court sees a persistent and pronounced redefinition of statutory terms that significantly expands the scope of protected conscientious objections. As laudable as that sounds, however, it would come at a cost — a burden on the effective delivery of health care to Americans in derogation of the actual balance struck by Congress.

California's Attorney General issued a press release commenting on the decision.  KPIX5 reports on the decision.

Court Invalidates HHS Conscience Rules

In State of New York v. U.S. Department of Health and Human Services, (SD NY, Nov. 6, 2019), a New York federal district court vacated a 2019 rule promulgated by HHS which, as summarized by the court:

purports to interpret and provide for the implementation of more than 30 statutory provisions that recognize the right of an individual or entity to abstain from participation in medical procedures, programs, services, or research activities on account of a religious or moral objection. [See prior posting].

The court summarized the conclusions it reached in its 147-page opinion:

With respect to the Church, Coats-Snowe, and Weldon Amendments, HHS was never delegated and did not have substantive rule-making authority.....

 With respect to all Conscience Provisions, HSS was never delegated and did not have authority to promulgate a Rule authorizing, as a penalty available to the agency for a recipient’s non-compliance, the termination of all of the recipient’s HHS funds....

With respect to all Conscience Provisions, the Rule is contrary to law... insofar as (1) in its application to the employment context, it conflicts with Title VII of the Civil Rights Act of 1964 ... to prescribe a framework governing the circumstances under which an employer must accommodate an employee’s religion-based objections; and (2) in its application to emergencies, it conflicts with the 1986 Emergency Medical Treatment and Labor Act....

With respect to all Conscience Provisions, HHS acted arbitrarily and capriciously in promulgating the Rule,... because (1) HHS’s stated reasons for undertaking rulemaking are not substantiated by the record before the agency, (2) HHS did not adequately explain its change in policy, and (3) HHS failed to consider important aspects of the problem before it.

With respect to all Conscience Provisions, HHS did not observe proper rulemaking procedure in promulgating the Rule... insofar as portions of the Rule that define “discriminate or discrimination” were not a “logical outgrowth” of HHS’s notice of proposed rulemaking....

With respect to all Conscience Provisions, the Rule’s authorization ... as a penalty ... in the event of a recipient’s non-compliance of the termination of all of the recipient’s HHS funds, violated the Separation of Powers and the Spending Clause of the Constitution, U.S. Const. art. I, § 8, cl. 1.

Reuters reports on the decision.

UPDATE: A press release from the Washington state Attorney General's office reports that on Nov. 7 a federal district court in Washington also found the new conscience rules invalid.