Case Name: Mary DOE et al., Appellants, v. GENERAL HOSPITAL OF the DISTRICT OF COLUMBIA et al., Appellees
Court: United States Court of Appeals for the District of Columbia Circuit
Jurisdiction: United States
Decision Date: 1970-03-20
Citations: 434 F.2d 423
Docket Number: No. 24011
Parties: Mary DOE et al., Appellants, v. GENERAL HOSPITAL OF the DISTRICT OF COLUMBIA et al., Appellees.
Judges: Before BAZELON, Chief Judge, and McGOWAN and MaeKINNON, Circuit Judges, in chambers.
Reporter: Federal Reporter 2d Series
Volume: 434
Pages: 423–427

Head Matter:
Mary DOE et al., Appellants, v. GENERAL HOSPITAL OF the DISTRICT OF COLUMBIA et al., Appellees.
No. 24011.
United States Court of Appeals, District of Columbia Circuit.
March 20, 1970.
For supplemental opinion see 434 F.2d 427.
Mr. Michael Nussbaum, Washington, D. C., was on the motion for appellants. Mr. Gilbert C. Miller, and Miss Caroline Nickerson, Washington, D. C., also entered appearances for appellants.
Messrs. Charles T. Duncan, Corporation Counsel, Hubert B. Pair, Principal Asst. Corporation Counsel, and Richard W. Barton and David P. Sutton, Asst. Corporation Counsel, were on the opposition to the motion for appellees.
Before BAZELON, Chief Judge, and McGOWAN and MaeKINNON, Circuit Judges, in chambers.

Opinion:
PER CURIAM:
This case is before us once again on a question pertaining to preliminary injunctive relief. Appellants Mary Doe and Jane Roe, for themselves and others similarly situated, seek to compel D.C. General Hospital to grant abortions to all women who desire them and who otherwise meet the standards for admission to the hospital. For themselves, the individual appellants sought orders compelling the hospital to provide them with therapeutic abortions.
On March 11, 1970, after a hearing, the District Court made findings of fact and issued a preliminary injunction to restrain appellees from refusing to perform therapeutic abortions under the Hospital's own rules and regulations,
313 F.Supp. 1170 as these were found by the Court. Appellants sought broader relief and moved here for summary reversal. We denied that motion so that the case could be fully briefed and argued. However, because of the critical importance of the matter to women in the class represented by appellants, we sought to clarify certain portions of the District Court's order that had apparently been misunderstood by the parties. In addition, as each individual appellant was nearing the end of the first trimester of her pregnancy, we ordered the Hospital to process their applications for abortions without delay.
Almost immediately after the entry of our order, Mary Doe presented herself at the hospital. She brought with her a letter from an area mental health clinic psychiatrist recommending that she receive an abortion in order to safeguard her mental health. Contrary to the spirit, if not the letter of our order, Dr. Lowe, Chief of the Hospital's Department of Obstetrics and Gynecology, refused to permit an abortion to be performed. Acting upon instructions from his superiors, he insisted that Miss Doe first submit to an examination by a private consultant to the Department of Health, and that the consultant conclude that an abortion was required. He further advised Miss Doe that he could set no specific time for an abortion in any event, because he viewed thereapeutic abortion as an "elective procedure" and only emergency measures would be taken on afternoons, weekends and holidays. Since further delay in performing the abortion could have serious consequences, Miss Doe arranged to procure an abortion outside of D.C. General Hospital. Believing that the hospital's action was in contempt of the orders of this and the District Court, appellants have moved to find the appellees in civil contempt.
Our order of March 12, 1970, concluded that, pending final resolution of the issues, persons in the class represented by appellants should be permitted to "receive an abortion upon a recommendation by a psychiatrist that the termination of the unwanted pregnancy may be necessary for the preservation of the patient's mental health." Neither this language nor the regulations as construed by the District Court support appellees' action in calling upon a private psychiatric consultant to scrutinize the diagnosis of an area mental health psychiatrist, particularly in view of the fact that appellees had expressly argued in court that consultation with area mental health psychiatrists, rather than with private psychiatrists, should be required. Nor does it appear that the services of a private consultant had ever been required by Hospital policy in the past.
Furthermore, Dr. Lowe's reluctance to eommit Hospital facilities on the ground that therapeutic abortion is an "elective" procedure flies in the face of this court's finding that an emergency existed. The order requiring applications by Mary Doe and Jane Roe to be processed immediately was perfectly clear in this respect, and we find the claim of ambiguity tenuous at best. Nevertheless, we cannot completely rule out the possibility that the District Court's order be read to require strict adherence to the regulation that "two specific specialists" must concur in writing before an abor tion could be performed, in spite of the prior practice to the contrary.
Because of this possible confusion, and because Miss Doe has already obtained the relief she sought, we deny the motion to find appellees in contempt of court. However, it is apparent that further action on our part is necessary to prevent similar confusion in the future. We had hoped that the Hospital could devise interim procedures that would be adequate to deal with such emergency situations as might arise during the pendency of this litigation. But in view of the repeated conflicts between the parties and the continuing inaction on the part of the hospital, we reluctantly find it necessary to set forth in an Appendix to this opinion the conditions under which the District of Columbia General Hospital must perform therapeutic abortions on mental health grounds until this case is ultimately resolved on the merits. In so doing, we express no opinion whatsoever regarding the final resolution of this matter; our action is prompted by our conclusion that, if the contentions advanced by the plaintiffs in the District Court ultimately prevail, Jane Roe and the class she represents will have been seriously and irreparably harmed if interim relief is not available; whereas any injury done to the hospital by requiring it to perform the operations is of far lesser magnitude.
The motion to find appellees in contempt of court is denied. Appellees are directed, pending final resolution of this case by the District Court or further order of this Court, to process applications for abortions on mental health grounds according to the guidelines set forth in the Appendix to this opinion. This order is without prejudice to the Hospital's right to seek a modification of the prescribed procedures, if additional or alternative steps are deemed by it to be medically necessary, or appellants' right to seek modification if the procedure does not adequately protect the class they represent.
So ordered.
APPENDIX
1. Any woman requesting a therapeutic abortion on mental health grounds should be received and her application processed with due regard for the urgency of the matter, particularly the extent to which her pregnancy has progressed in light of the fact that the abortion should be performed during the first trimester of the pregnancy.
2. The Hospital may inquire into residence and indigence, and previous medical history; and it may of course complete the other necessary admission procedures.
3. The patient should then be directed to a gynecologist who is willing to perform therapeutic abortions. The doctor may perform any preliminary medical examination and incidental medical tests necessary to verify pregnancy, to ascertain the stage of development, and to identify any possible medical contraindications to abortion.
4. The patient may establish psychiatric grounds for the abortion by presenting letters of recommendation from two area mental health clinic psychiatrists at the time of the initial examination. If the patient has not at that time seen a psychiatrist, the gynecologist should refer her to an area mental health clinic or, if he chooses, permit her to consult with a private psychiatrist willing to perform the service for the patient. The individual gynecologist will determine whether one or two psychiatric evaluations will be required. That is, he may require one or two recommendations from area mental health psychiatrists, or in lieu thereof he may accept recommendations from one or two private psychiatrists who are willing to perform the service for the patient.
5. If the patient satisfies the criteria above, the abortion should be scheduled and performed without delay. No further criteria may be added.
6. Appellees should take every step necessary to give immediate effect to the above procedures pending final resolution of this case.
. There was some controversy below with regard to what the hospital's regulations actually were. This controversy was resolved by specific findings of fact by the District Court.
. Danger of an abortion to the pregnant woman increases substantially after the end of the first trimester.
. Dr. Lowe did not suggest what the alternatives to this "elective procedure" might be. Presumably, they are birth of the child and the consequent injury or death to the mother that forms the basis for performing the abortion under the Hospital's regulations.