The federal government’s rule designed to support health workers who opt out of providing care that violates their moral or religious beliefs will not go into effect in July as scheduled. The effective date has been delayed by four months, according to court orders.

The “Protecting Statutory Conscience Rights in Health Care” rule was originally issued in May by the Department of Health and Human Services’ Office for Civil Rights. It aligns with that office’s religious freedom priorities and would put new emphasis on existing laws that give health care workers the ability to file a complaint with that office if they are forced to participate in medical care that violates their conscience — such as abortion, gender confirmation surgery, and assisted suicide.

As NPR has reported, the rule also expands the type of workers who are able to file this kind of complaint to billing staff and receptionists and anyone else who in any way “assist[s] in the performance” of a procedure.

Complaints of “conscience rights” violations are relatively rare — for a decade, the office would receive an average of one complaint like this each year. Last year, that number jumped to 343. That number is dwarfed by the number of complaints the Office for Civil Rights receives over issues like health privacy or race, sex and age discrimination, which typically number in the thousands.

Several groups sued the federal government over the rule immediately after it was issued. New York state led a coalition of 23 cities and states in one suit, and three jurisdictions in California also sued, including California state and San Francisco. Yet another plaintiff, Santa Clara County in California’s Bay Area, made the case that the rule put patient safety at risk, since it gave health workers the right to opt out of providing care without prior notice — potentially even in an emergency.

“If the rule goes through as it’s written, patients will die,” Santa Clara’s county executive, Dr. Jeff Smith, told NPR last month. “We will have a guaranteed situation where a woman has had a complication of an abortion, where she’s bleeding out and needs to have the services of some employee who has moral objections. That patient will die because the employee is not providing the services that are needed.”

Santa Clara and several other plaintiffs had filed for a preliminary injunction to prevent the rule from going into effect while the legal process played out.

“The federal government actually reached out to all the plaintiffs in all of the different cases and basically said that they didn’t want to have to deal with a preliminary injunction,” says James Williams, county counsel for Santa Clara. He says the government is seeking “summary judgment,” which means the judge could rule in its favor based on the arguments and documents it files with the court. According to Williams the government told the plaintiffs that it “would be willing to stipulate to a delay in the effective date to allow that to happen.”

That new effective date is Nov. 22 — the federal judge in the California cases made that official over the weekend, and in the New York case, the federal judge certified the change on Monday.

HHS made clear in its court filing that by agreeing to this delay, it is not suggesting that the plaintiffs are likely to succeed in ultimately blocking the rule. Instead, the agency says, it’s a logistical move.

“In light of significant litigation over the rule, HHS agreed to a stipulated request to delay the effective date of the rule until November 22, 2019,” an HHS spokesperson wrote in a statement to NPR, adding that the delay will “allow the parties more time to respond to the litigation and to grant entities affected by the rule more time to prepare for compliance.”

For plaintiffs, like Santa Clara County, the delay gives some “breathing room” while the lawsuits continue, according to county counsel James Williams.

“The delay is certainly good news because it means that this rule isn’t going to take effect and that the harms are not going to happen now,” Williams says. “But it’s just an interim step, and we’re going to be pressing forward very vigorously with getting a decision and summary judgment to vacate the rule.”

All parties are hopeful that the judges will make their decisions in these cases before the new effective date in November.

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Government officials are bickering over hundreds of millions of dollars in settlements paid by Big Pharma, stemming from the nation’s deadly opioid epidemic.

The pharmaceutical industry paid out more than half a billion dollars over the last year alone. All sides expect the scale of settlements to grow fast as more cases go to trial.

Drug companies are accused of kick-starting the addiction crisis by aggressively marketing opioid pain medications over the past two decades. During the epidemic, roughly 218,000 Americans have died from overdoses tied to prescription pain pills, according to the Centers for Disease Control and Prevention.

Federal, state and local officials have filed hundreds of lawsuits against drug companies, using different teams of lawyers, while often making substantially different claims and legal arguments.

A growing number of sources have told NPR they’re concerned that the effort to hold the pharmaceutical industry accountable could unravel into a legal fight between governments.

There’s no agreement in place for how payouts will be distributed. In recent days, feuding between local, state and federal agencies has begun to spill into the open.

In an Ohio courtroom this week, a federal judge suspended work on a plan to compensate 24,000 local governments for their opioid-related costs, after state attorneys general weighed in strongly against the proposal.

“If we get money, how are going to use it?” asked Joe Rice, an architect of the proposal, who leads a team of attorneys representing more than 1,200 local governments suing Big Pharma.

Their cases have been consolidated into a single trial set to begin in federal court in Ohio in October. “Let’s get a plan in place. Because it also has to fit together,” Rice added.

The federal judge overseeing the consolidated trial, Dan Polster, has repeatedly urged officials to come up with just such a roadmap for compensation that will hasten a “global” settlement with the drug industry.

But after Rice’s group came up with a concept that would involve every local government in the U.S. — creating a kind of super-sized class action lawsuit – state attorneys general cried foul.

“To certify a negotiation class so quickly and so early in the process, before everyone’s had a chance to determine what their best interest is, constitutes a new and novel procedure that could result in a grave miscarriage of justice,” cautioned Texas Attorney General Ken Paxton, in a June 24 letter to Judge Polster.

The letter was co-signed by 26 other state attorneys general. Judge Polster delayed action on the plan until August.

Meanwhile, the federal government has entered the money fray, seeking to garnish “a portion” of Oklahoma’s recent $270 million settlement with Purdue Pharmaceuticals.

The demand came in a June 12 letter from the Centers for Medicare and Medicaid Services, which argued that part of Purdue’s payout was meant to cover alleged Medicaid fraud, which harmed federal as well as state taxpayers.

“We are aware of the letter and are reviewing it,” wrote Alex Gerszewski, a spokesman for Oklahoma Attorney General Mike Hunter, in an email to NPR. “This will not affect state revenue,” he added.

Even within individual states there are growing tensions over how opioid money will be allocated. When Hunter won Oklahoma’s settlement with Purdue in March, he agreed unilaterally to a plan for how the money would be spent.

The lion’s share won’t go to fund programs designed to aid people who are opioid-dependent, or to help local governments struggling with the crisis. Instead, Hunter agreed to divert roughly $200 million to pay for a new addiction research center at the Oklahoma State University in Tulsa.

State lawmakers in Oklahoma were furious. “Rose petals were not strewn in my path,” Hunter acknowledged in a speech before the Bipartisan Policy Council in Washington DC last month. “There was a great consternation with me going around the appropriations process.”

Now that the federal government is asking for its slice of the money, his plan has become even more controversial.

Oklahoma’s legislature has since passed a state law requiring that future opioid settlements go into the state’s general fund. Last week, the state’s politicians narrowly averted a legal clash over an $85 million payout from another drug firm called Teva Pharmaceuticals.

This money fight is playing out against the troubled history that followed the tobacco settlements of the 1990s. Cigarette makers agreed to pay more than $240 billion to end their liability for cancer deaths caused by their products.

But much of that cash has since been diverted by government officials away from health programs and campaigns aimed to reduce smoking rates.

Critics worry that drug industry settlements could also be used to fill budget gaps or to pay for local, state and federal programs unrelated to the opioid epidemic.

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