Blocking women's health care: your hospital may have a policy you don't know about - Industry Overview

Progressive, The, Jan, 1998 by Melanie Conklin

In the parking lot of a hospital in central California, nurses are handing out plastic bags full of drugs to their patients. The nurses are not dispensing illegal substances. They are handing out the morning-after pill. But in the process, they are disobeying hospital policy.

Though emergency contraception is standard medical protocol in treating rape and incest, this hospital forbids prescribing the high dose of birth-control pills that can flush out a fertilized egg shortly after intercourse.

The hospital is Catholic, and the Roman Catholic Church says birth control is morally wrong.

Such instances where medical personnel are having to offer reproductive health care with a wink and a nod are on the rise as religious hospitals and clinics are merging at an accelerated pace with other health-care providers.

In this era of mergers and managed care, the Roman Catholic Church is having more of a say in all sorts of women's reproductive health-care services. Five of the ten largest hospital corporations are Catholic. (These are: Daughters of Charity National Health System, Catholic Health Initiatives, Catholic Healthcare West, Catholic Health Care Network, and Mercy Health Services.) There are more than 600 Catholic hospitals and 200 health-care centers serving some fifty million patients a year. And as the hospitals merge and affiliate with non-religious facilities, they often close off reproductive health care for women.

"We're seeing a huge increase in the number of hospitals and clinics being purchased by religious hospitals that refuse to offer the full range of reproductive care," says Susan Berke Fogel, legal director at the Women's Law Center in Los Angeles. Fogel tells the story of the nurses in the parking lot but declines to name the hospital or location, saying the nurses could lose their jobs for the stance they are taking.

"It's reprehensible at a time when medical trends are toward integrated health care that we are seeing this competing trend to isolate and marginalize women's health care," she says.

Catholic doctrine opposes abortion, contraception, tubal ligations, vasectomies, and fertility treatments. This doctrine applies not just to Catholics, but to any patient treated in a Catholic facility or even at a hospital or clinic affiliated with a Catholic institution that adheres to this doctrine.

And the number of these affiliated facilities is growing. Catholic Health Association estimates there were more than 100 mergers involving Catholic and secular hospitals in 1994 alone. Although other religious denominations, such as Baptists and Adventists, also run health-care facilities that may limit access to abortion, the biggest threat is from Catholic hospitals. A report by the Johns Hopkins School of Hygiene and Public Health found that 18 percent of all hospital affiliations in the past six years have involved a Catholic facility.

"We're seeing religious viewpoints being imposed in an extremely coercive way on people who don't share those views," says Catherine Weiss, director of the American Civil Liberties Union's Reproductive Freedom Project.

Often, the patients are the last to know that a hospital merger has restricted their reproductive health-care options.

Only 27 percent of women understood that being part of a Catholic hospital system could limit their reproductive care, according to a 1995 survey by Catholics for a Free Choice.

Catholics for a Free Choice cites the example of Jenni Zehr, who in 1988 went to Sacred Heart General Hospital, a Catholic hospital in Eugene, Oregon, to give birth. She requested to have a tubal ligation. Her doctors not only did not perform the procedure, they neglected to tell her. She found out when she became pregnant again.

Three years ago, according to the Oregon Register Guard, the Oregon Supreme Court ruled that Zehr could sue her doctor for the costs of raising that child.

A nineteen-year-old woman from Troy, New York, had one child and was struggling to put herself through community college. One day, she visited her clinic to get her regular birth-control shot. She didn't know that her clinic had merged with a religious facility.

"She was simply told, `We don't do that anymore,' end was not referred to any other provider," says Lois Uttley, director of MergerWatch, which is funded by Family Planning Advocates. "She did find a Planned Parenthood clinic, but many poor women in those circumstances might not have transportation or even a phone to help them find another clinic." For patients in smaller communities, there may be no other options.

Then there are the added problems that mergers cause.

Judy Stone is an infectious-disease doctor in Cumberland, Maryland. Two years ago, her employer, Memorial Hospital, affiliated with Sacred Heart, the Catholic hospital. This fall, Memorial decided to become a nursing home and planned to transfer all its hospital business over to Sacred Heart.

"I couldn't sleep at night keeping my mouth shut," says Dr. Stone. "The process was covert, and decisions that should have been being made by the community were hidden."