The story of Tamesha Means and her miscarriage three years ago,if it happened the way her lawyers claim it did, is truly awful:Means was 18 weeks pregnant when her water broke and she was rushedto a hospital in Muskegon, Mich. The fetus wasn't viable, and thepregnancy—Means' third—was doomed.

But doctors at the hospital, part of the Catholic healthcarenetwork known as Mercy Health Partners, didn't tell her that,Means' lawyers say. Instead of the normal course oftreatment—inducing labor and terminating the pregnancy to stave offpotentially risky complications—Means was allegedly kept in thedark about her condition, given painkillers, and sent home.

Bleeding and wracked with pain, she returned to Mercy twice overthe next day or so and received more or less the same response, herlawyers claim. Just as she was about to be sent home a third time,by now feverish from a severe infection, she began to deliver. Thebaby died.

The case has received an enormous amount of attention because ofwho Means' attorneys at the American Civil Liberties Union chose tosue last November: not her doctors or the hospital but the U.S. Conference of Catholic Bishops(USCCB).

Means' lawyers claim that she was subjected to dangerouslysubstandard treatment, that her own health was placed in peril, andthat she was deprived of information about her condition because ofrules issued by the bishops conference that govern all Catholichealth care in the U.S. The rules—which Mercy and its staff arerequired to follow—prohibit abortion, and as a result, according toMeans' lawyers, doctors would not give up on the pregnancy.

The move to sue the bishops was unprecedented, and everyone fromthe New York Times to the National Catholic Register heralded the case as a new front inthe culture war over religious liberty, gender equality andreproductive care—a version of the same raging conflict that willplay out before the Supreme Court next week when it hears argumentsin the Hobby Lobby/Conestoga Industries contraceptioncases. Those cases challenge the Affordable Care Act's rulesrequiring employers to provide birth-control benefits to theirworkers, even if the employers have religious objections.

When the Means suit was filed, the bishops called theallegations “baseless” and “misguided” and defended Catholic healthcare's “stellar history of caring for mothers and infants.”Otherwise, though, they were silent.

Now, the bishops and their attorneys have followed up with amotion to dismiss the case, and ProPublica has taken the firstsustained look at their arguments.

The bishops, for the most part, have chosen to avoid sweepinglanguage about constitutional rights and freedoms, instead focusingon the nitty-gritty procedural issues that are basic to high-stakescivil litigation. They argue, essentially, that the ACLU has chosenthe wrong venue—federal court in Detroit—to sue (the USCCB is basedin Washington D.C.) and is mistaken in blaming the USCCB fordecisions made by individual bishops in their own dioceses.

The arguments echo what some legal scholars have been saying forsome time: that the lawsuit is at best a long-shot. A hearing isscheduled for May on the motion to dismiss.

First some background: The ACLU and women's groups have beenvoicing concern since the 1990s about the growing role of Catholichealth care operations around the country and what they see as theresulting threats posed to women's reproductive rights. Thosecomplaints have grown louder in recent years as Catholic facilities have moved aggressively to merge with secularhospitals and reports have surfaced about the challenges – some saycontortions—that doctors and nurses have sometimes had to face tocomply with church teachings on abortion, birth control, andend-of-life care while fulfilling their duty to patients.

Catholic hospitals now account for about 16 percent ofhospital beds in the U.S. And in eight states—includingWashington, Oregon, Iowa, and Missouri—they control more than 30 percent of beds. Ten of the 25 largest health-carenetworks in the country are Catholic-sponsored.

The Means case touched a nerve because it seemed to bringtogether many of the issues that have worried women's advocates themost. Indeed, if the allegations are true, what happened at MercyHealth Partners was even worse than has been reported at the timeof the initial filing of the lawsuit.

According to the suit, Means' alleged mistreatment came to lightin late 2012 or early 2013 when an unidentified researcher workingon a federally funded project at Mercy uncovered what she said werenot one, but five instances in which doctors there failedto terminate the pregnancies of women who were clearlymiscarrying.

When the researcher asked hospital officials to explain, theyallegedly told her that they were following the Ethical and Religious Directives for Catholic Health Care, orERDs—guidelines that govern medical treatment at every Catholichospital and health system in the United States.

The ERDS—which are issued and regularly updated by the bishopscouncil—ban abortion and limit many other medical options,including sterilization and birth control, and apply to patientsand medical staff no matter what their religion.

Their impact, the advocates say, is greatest in places likeMuskegon, where the only hospitals in the county are Catholic.Doctors who fail to comply with the ERDs risk losing theiradmitting privileges; other employees who similarly fail to abideby the ERDs face losing their jobs. (In Colorado recently, a cardiologist at a Catholic facility was reprimanded formerely mentioning abortion as a treatment option for a woman forwhom pregnancy could have been deadly.)

“The bishops aren't doctors, and yet they issue rules that tiedoctors' hands, preventing them from giving their patients fullinformation about their health care options and, in some cases,preventing them from providing medically appropriate care,” theACLU's deputy legal director, Louise Melling, blogged on the organization's website in December. “That's notright.”

But in motions filed over the past two months, the bishops andtheir co-defendants—three officials at an entity called Catholic HealthMinistries created to “oversee the healing ministry andCatholic identity” of Mercy and other hospitals in its network—haveargued that the ACLU lawsuit has a series of potentially fatalflaws.

Perhaps the most basic involves the statute of limitations. Thedefense lawyers point out that Means had her miscarriage inDecember 2010, almost exactly three years before filing suit.The Michigan deadlinefor medical malpractice claims is two years.

The statute of limitations for negligence, on the other hand, isthree years. Negligence is the cause of action that forms the basisof the ACLU's complaint—something the attorneys for the bishopshave signaled they plan to challenge. They describe the lawsuit as“a poorly disguised medical malpractice action” and “a frivolousand totally fabricated cause of action.”

The lawyers also question the ACLU's choice of venue. Instead ofbringing the case in federal court in Western Michigan, where Meanslives and Mercy Health Partners is located, the organization filedsuit in the Eastern District, where Mercy's owner, Trinity Health,is based. But Trinity isn't a defendant. (Though the court filingsdon't say so, the judges in the Western District are mainly Republicans, while the Eastern District—based in Detroit—is dominated by Clinton andObama appointees.)

In their filings, the bishops conferencedoesn't address whether Means' allegations are true. Instead, theyargue that the ACLU has fundamentally misread the ERDs. Despite theban on abortion, the directives do not “preclude anyone from beinggiven appropriate medical care,” Linda Hunt, a USCCB executive,said in an affidavit. She noted that the ERDs “specifically require'free and informed consent…. for medical treatments andprocedures'” including “risks, side-effects, consequences andcosts; and any reasonable and morally legitimate alternatives.”

Hunt reiterated, “There is no directive that requires or allowsa pregnant woman to be harmed in any way.”

The bishops and their lawyers, to date, have not speciallyaddressed the care Means received.

Means, in an interview in January, described her version of events.

“They sent me home with no answers. I was begging, 'You guyshave to help me. I am in a lot of pain. I can't keep going homelike this. Please help me.'

“After we were sent home the second time, I knew the baby wasn'tgoing to make it. I felt alone. I can't even put into words. I feltconfused, in pain and devastated.”

The arguments made so far by the bishops track what some legalscholars have been saying about the case since it was filed.

“I don't doubt that if [Means] sued the hospital or the doctor,this would be plain, vanilla medical malpractice,” Robin FretwellWilson, a law professor at the University of Illinois, toldthe American Prospect in December. “But they're not suing thedoctor, the hospital, the local bishops, the board oftrustees—you're many layers removed from the person who reallyshould owe this woman a remedy if everything in the complaint istaken as accurate.”

Richmond School of Law professor Kevin Walshfirst noted the statute of limitations problem in a post on the Catholic legal blog Mirror of Justice. “If oneassumes for purposes of analysis that medical malpractice wascommitted, then why not sue for medical malpractice? Why repackagea potentially winning claim of medical malpractice into a seeminglylosing claim of theological malpractice?”

Another explanation, Walsh wrote, “may be that the ACLU's goalin the case is not to obtain personal redress for their client butinstead to place a dark cloud over Catholic healthcare moregenerally. That is not only plausible but probable.”

But in an interview last December, the ACLU's Melling disputedthat.

“First and foremost we care about Tamesha Means,” she said. “Weare filing this suit on behalf of a woman who was wronged. Shewasn't provided adequate care and as a result, she sufferedunnecessarily.”

Melling, though, also was clear that her organization was tryingto make a larger point.

“We know Tamesha Means wasn't the only person in the country whowas denied prompt and appropriate care. The bishops set thestandards for health care in Catholic hospitals, and thosestandards can't be putting patients at risk.”

Nina Martin covers gender and sexuality for ProPublica.Martin has been a reporter and editor specializing in women's,legal and health issues for more than 30 years.

This story was originallypublished by ProPublica, and has beenreproduced with permission.