San Francisco successfully blocks discriminatory health care rule

Court blocks so-called ‘conscience rule’ that would have denied critical medical care to patients.

City Attorney Dennis Herrera

SAN FRANCISCO (Nov. 19, 2019) — City Attorney Dennis Herrera released the following statement today after a federal court issued a summary judgment invalidating a discriminatory federal health care rule sometimes referred to as the “conscience rule”:

“The decision today is a victory for health care equality and patients’ rights. Discriminatory regulations cannot be allowed to threaten patient health. No one should have to fear being denied critical medical service in their time of need. In particular, this rule targeted women, LGBTQ communities and other vulnerable patients, but it would have put anyone in an emergency situation at risk. We’re not about to let the Trump administration jeopardize public health and safety with this unconscionable rule.”

Case Background
San Francisco was the first in the country to take the administration to court over this health care refusal rule, filing a lawsuit within hours of Trump announcing it on May 2, 2019. The Trump administration misleadingly calls the refusal of care rule the “conscience rule.”

The new rule had been set to take effect July 22, 2019. San Francisco filed a preliminary injunction to halt the rule from taking effect, and the federal government agreed to delay the effective date of the rule until at least Nov. 22, 2019.

The rule would have allowed health care professionals to refuse to provide service to patients based on the staffer’s personal beliefs, threatening medical access for women; lesbian, gay, bisexual, and transgender people; and other medically or socially vulnerable populations.  Nurses across the country, including at San Francisco’s level one trauma center, would have been able to refuse to provide treatment to women experiencing life-threatening, pregnancy-related complications — even if no other personnel was available to step in. Call operators would have been 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 would have been emboldened to discriminate against LGBTQ patients or other vulnerable groups.

San Francisco’s lawsuit filed in the U.S. District Court for the Northern District of California asserts that the Department of Health and Human Services exceeded its statutory authority by creating the 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 City and County of San Francisco, the State of California, Santa Clara County, the Center for Reproductive Rights, Lambda Legal and Americans United for Separation of Church and State joined in arguing for the rule to be voided on Oct. 30, 2019.

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: