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Maryland

Refusal to Provide Medical Services

ABORTION REFUSAL CLAUSE

Maryland allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  No person may be required to participate in, or refer to any source for, medical procedures that result in an abortion.  No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in an abortion.  The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health-care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No, however, the law does not shield an individual from liability if their refusal to refer results in a life-threatening situation.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Has a court considered the constitutionality of this law?  A court has interpreted this law's use of "refer" to apply only to the refusal to refer patients and not to protect a hospital's refusal to send residents outside of the hospital to gain clinical experience in abortion services.  St. Agnes Hosp. of Baltimore, Inc. v. Riddick, 748 F. Supp. 319 (D. Md. 1990).

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1982; Last Amended 1991).

ARTIFICIAL INSEMINATION REFUSAL CLAUSE

Maryland allows certain individuals or entities to refuse to perform or participate in artificial insemination procedures.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  No person may be required to participate in, or refer to any source for, medical procedures that result in artificial insemination.  No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in artificial insemination.  The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although Maryland law requires health insurance plans that cover prescription medication to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply?  Religious employers for whom contraceptive coverage conflicts with their bona fide religious beliefs and practices.

What does the refusal clause allow?  A religious employer may require issuers of its health-insurance plans exclude coverage for contraception.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?  Yes.  By failing to define the term "religious employer," the law's refusal clause inappropriately includes a wide range of entities that perform non-religious functions in the public sphere.

Does the law require the refusing entity to notify the persons affected?  Yes.  An employer exercising a refusal clause must provide employees reasonable and timely notice of the exclusion.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  No.

Md. Code Ann., Ins. § 15-826 (Enacted 1998).

STERILIZATION REFUSAL CLAUSE

Maryland allows certain individuals or entities to refuse to perform or participate in sterilizing procedures.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  No person may be required to participate in, or refer to any source for, medical procedures that result in sterilization.  No hospital may be required to permit within the hospital the performance of, or to provide referrals for, medical procedures that result in sterilization.  The refusal to participate, permit, or refer may not be a basis for civil liability or other recriminatory action.

A health-care provider or hospital is not immune from civil liability or recriminatory action if the refusal to refer caused death or serious physical or long-lasting injury to the woman and was otherwise contrary to the standards of medical care.

Does the law require the refusing entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Md. Code Ann., Health-Gen. § 20-214 (Enacted 1973; Last Amended 1991).


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