UVM Medical Center

UVM Medical Center Rebukes Baseless Federal Enforcement Actions Threatening Access to Patient Reproductive Rights

Hospital reaffirms the compliance of its employee medical procedure opt-out policies in letter to US Department of Health and Human Services


Burlington, VT – The University of Vermont Medical Center sent a letter today to the United States Department of Health and Human Services (HHS) Office for Civil Rights (OCR) reaffirming its compliance with federal laws that provide hospital employees the ability to reasonably opt-out of participating in medical procedures they oppose on religious or personal beliefs, which include reproductive care, sterilizations, blood transfusions, and others. The letter is in response to December 11 and December 14 correspondence from HHS threatening the hospital with federal enforcement stemming from an August 2019 “Notice of Violation” OCR issued to UVM Medical Center and the press, despite lacking any legal authority to do so. The administration’s new threat of litigation is an abrupt turnaround by HHS’s and OCR’s leaders, who agreed late last year to not recommend any further enforcement of OCR’s 2019 allegations, following multiple decisions by federal courts rejecting OCR’s interpretation of the law. 

In the letter, UVM Medical Center informed HHS that it declined to further alter its opt-out policies and practices in a manner that would create barriers to the delivery of safe, legal, and effective reproductive health care and is also not required by law. In fact, since receiving OCR’s “Notice of Violation” last summer, the hospital has only strengthened its already-compliant provider opt-out policies and practices. For instance, the hospital has improved the way it schedules both patients and staff for pregnancy termination procedures, utilizing regular, designated operating room times for those procedures whenever possible and staffing them with providers who have opted into participating. Through this and other recent changes, UVM Medical Center’s goal is to eliminate those instances – already exceedingly rare – in which employees’ religious or moral beliefs come into conflict with the hospital’s patient care obligations, while enhancing the care provided to patients.

“As the primary tertiary care center for our region, we have an obligation to provide access to safe and legal reproductive health care to our patients who rely on us,” said Stephen Leffler, MD, President and Chief Operating Officer of UVM Medical Center. “At the same time, since we were first contacted by OCR last year, we have taken a thorough look at all of our policies and practices and have modified and strengthened them to respect the many beliefs of the thousands of care givers that work here. OCR’s latest threats are not just baseless from a legal standpoint, they’re an attack on reproductive care and we will do everything we can to protect our patients’ access to the services they need.”

The response by UVM Medical Center points out that the latest threat by HHS defies recent decisions issued by federal courts across the country, which have rejected the legal theory on which the current presidential administration is relying in its attempt to prevent the hospital from providing pregnancy termination services. 


On August 28, 2019, HHS OCR sent UVM Medical Center a “Notice of Violation,” alleging that it had violated the “Church Amendments,” which provide health care workers a qualified right to opt-out of participating in certain medical procedures, such as sterilizations or abortions, due to religious or moral objections. It was OCR’s position that employers must allow employees to opt out of procedures at any time, regardless of the impact on patient safety or the availability of legal health care services.

At the same time OCR issued the notice to UVM Medical Center, a number of States (including Vermont) and interest groups sued HHS, challenging the administration’s novel interpretation of the Church Amendments and similar provisions of federal law. In the fall of 2019, two separate federal district courts explicitly rejected HHS’ position that the Church Amendments provided an unqualified opt-out right to health care workers. HHS has appealed those trial court decisions, and HHS has been enjoined from enforcing its new regulations while its appeals are pending.

In the wake of those decisions and in response to UVM Medical Center’s strengthened policies and practices, in November 2019, senior HHS and OCR representatives stated they would recommend that HHS not continue to pursue enforcement action against UVM Medical Center, at least until the appeals are resolved. UVM Medical Center heard nothing further from HHS on this matter until this week—more than a year later. The threats issued by HHS this week are directly at odds both with its prior representations to UVM Medical Center and last year’s federal court decisions.