Article taken from the July/August 2016 issue of the Women's Health Activist Newsletter.
Since 2001, there has been a nearly 18 percent increase in the reach of Catholic hospitals and health systems. But, what does it mean for women around the United States when acute care is dominated by the Catholic Church?
For the woman who met Dr. Robert Holder in the emergency room at Sierra Vista Regional Health Center, it meant medically unnecessary risks and emotional devastation. In the far corner of southeastern Arizona, “Patient x” was 15 weeks pregnant with twins — and in the middle of a life-threatening miscarriage. She had miscarried the first fetus at home. The second fetus had no chance of survival, the doctor told her and, because the placenta and umbilical cord from the first remained in her uterus, she was at serious risk of infection. They had to end the pregnancy now or risk dangerous complications.
But six months earlier, the only hospital in remote Sierra Vista had begun operating under the Ethical and Religious Directives for Catholic Health Care Services as part of a trial partnership with a Catholic health system, Carondelet Health Network. These directives prohibit medical staff from providing medically-appropriate care that violates Catholic doctrine. The woman’s only choices were to wait for the fetus’ heartbeat to stop on its own, or travel to Tucson, 80 miles away. Dr. Holder would later testify: “I was forbidden from providing Patient x with the standard of care in accordance with my medical training and the best available medical evidence. The Hospital interfered with the patient-physician relationship in violation of basic quality-of-care principles.”2
The experience provides an insight into just how much is at stake when the only hospital in a community must follow the directives of the Catholic Church, not medical standards:
[The Hospital's Vice President of Medical Services] asked if the remaining fetus had a heartbeat. When I answered yes, she replied that I had to send the patient out for treatment....She did not ask any questions regarding the possible risks or complications of delaying treatment to send Patient x elsewhere, or whether Patient x could possibly continue the pregnancy. She did not ask where Patient x would be transferred to or how long it would take for her to receive treatment.
I returned to Patient x and her husband, informed them of the Hospital's religious affiliation, and the Hospital's refusal to allow the treatment to which we had agreed. They were very upset that they could not receive the treatment they had decided upon.
They indicated that they had heard about the affiliation, but did not know what it meant with regard to services.
This month, the Women’s Health Activist spoke to Lois Uttley, Director of MergerWatch, which is a key ally to those fighting to stop the spread of Catholic health care restrictions that endanger women’s lives.
“When the hospital in Sierra Vista started its trial affiliation with Carondelet — part of Ascension Health, the largest Catholic health system in the nation — they told the doctors, ‘Don’t worry, nothing will happen to your practice.’ But OBGYNs quickly found out that they could no longer do tubal ligations at the hospital,” she told us. For women seeking permanent birth control after a C-section, the prohibition meant a second, medically-unnecessary abdominal surgery, with the associated risk of infection and anesthesia complications, and the challenge of having to recover from two surgeries instead of one.
This prompted members of the community to reach out to MergerWatch for help. But it wasn’t until the experience of “Patient x” that people began to realize just how dangerous the affiliation with Carondelet might be.
“When a hospital administrator stepped in and said, ‘oh no you can’t do that here,’ they were forced to send this woman up to Tucson, far away from her family and support system. The doctors were horrified; they felt they had been forced to abandon their patient. The community outrage helped what was a preexisting protest against the affiliation, and the affiliation was ended several weeks after that incident.
“The moral of the story is that when community people find out what it really means to have your only hospital following Catholic health restrictions, they are surprised and upset,” said Uttley.
Earlier this year, The Guardian reported that a single Catholic hospital — Mercy Health Partners hospital in Muskegon, Michigan — had denied emergency abortion care to five different miscarrying women in just 17 months. In all five cases, the women were at risk of serious complications, but Mercy staff refused to treat them — and refused to inform them that they could get immediate treatment at another hospital. (In fact, the women didn’t learn that they had been given medically inappropriate care until years later.) As a result, the women experienced life-threatening infection, unnecessary surgery, and emotional trauma. None of the fetuses survived. We know about the Muskegon cases today only because a courageous Muskegon County health official, Faith Groesbeck, began digging — and subsequently lost her job.
In an update this May to the 2013 report, Miscarriage of Medicine, MergerWatch details just how far-reaching the Catholic rules have become — even into for-profit hospitals — and how hard it is for patients to find out what restrictions the hospital may place on needed care.3
In Boston, for example, six out of the eleven hospitals run by for-profit Steward Health Care follow the Catholic directives — but you wouldn’t know it from visiting Steward’s website where, as the report notes, “Steward Health Care’s own website makes no mention of Catholic restrictions at any hospitals in its network.”
Uttley recounted to us how difficult it can be to ensure transparency. After Mid-Island Hospital joined with the Catholic Health Services of Long Island, the formerly secular hospital in Bethpage, New York adopted the Catholic directives, but changed its name to New Island Hospital. “So, not something Catholic,” noted Uttley, “and they refused to notify local people that the hospital was now under religious restrictions. We were able to get a condition attached [to the acquisition] that the sign in front of hospital had to say that it was part of Catholic Health Services of Long Island. I drove down there with a local advocate after the acquisition was final and we looked at the sign: it said ‘New Island Hospital’ in really big letters and then in tiny, tiny, tiny letters you could barely see, it said ‘Catholic Health Services of Long Island.’”
And, even when a hospital’s Catholic affiliation is clear, the Sierra Vista and Muskegon cases are a reminder that the public often doesn’t connect this affiliation with the restriction on services — until it is too late.
Two cases with opposite outcomes highlight the dangers for women when providers know that saving the life of a pregnant woman can mean their own dismissal and excommunication. In 2012, Savita Halappanavar died from preventable blood poisoning following a prolonged miscarriage at a hospital in Galway, Ireland. Despite her desperate pleas for help, medical staff refused to induce her as long as the fetus had a heartbeat. Ireland, they told her husband, “is a Catholic country” and abortion was prohibited. Apologists were quick to dismiss the case as an outlier and argue that the directives allow for such exceptions. But, just two years earlier, Church leaders in Phoenix, Arizona had automatically excommunicated Sister Margaret McBride, a hospital administrator at St. Joseph’s, after she allowed doctors to terminate the pregnancy of a woman whose chances of dying without the procedure were “close to 100 percent.”
And, the restrictions can go far beyond reproductive health.
“There are also concerns about end-of-life options,” Uttley noted, “particularly in states with ‘death with dignity’ protections. What we’ve seen in states like Oregon and Washington is that Catholic hospitals will forbid their staff from even providing information about their options, and certainly from providing any referrals to groups that might help a patient take advantage of them.
“And there also have been issues about LGBTQ [lesbian, gay, bisexual, transgender, and questioning] individuals’ health care, including a recent case in California in which a transgender patient wanted to have gender reassignment surgery and the physician was told it could not be performed at the Catholic hospital.”
But hope is not lost. Sometimes a proposed merger can be stopped. And, even when a merger itself can’t be stopped, MergerWatch has been successful in forcing hospitals to carve out key services and protect patients from the Catholic directives. In Troy, New York, for example, MergerWatch was able to work with the secular hospital during its merger to find a partial solution: “The hospital carved out part of the second floor and created a ‘hospital within a hospital,’ the Burdett Care Center, that combined the maternity services of the Catholic St. Mary’s and secular Samaritan [hospital]. Doctors and staff are employed by the Burdett Care Center under separate contracts that are distinct from their contracts with [the now-Catholic] Samaritan Hospital and that insulate them from the Catholic directives.”
Uttley continued, “One of MergerWatch’s big successes over the last 15 years or so is that the non-religious hospital officials now recognize that they need to have a plan for what’s going to happen to women’s health services if they’re going to propose a merger with a Catholic hospital. We don’t always like the proposal, and sometimes we fight to defeat them, but it is a sign of the difference the community can make.”
What can you do if a merger is proposed in your community?
Reach out to MergerWatch for help (www.mergerwatch.org). The organization “provides free technical assistance and coaching to local advocates,” says Uttley. “We help them assess the potential impact of the merger on the availability of affected health services — so, for example, helping them look at what are the other potential providers of these services, how far would women have to travel to get to these alternative providers, and so on. We help educate and mobilize the community, prepare local advocates to meet with hospital board members, and then, when there is a state hospital oversight process in place, we help them make use of that to influence state review of the merger. And we help community members prepare testimony for delivery, and coach them on how to deliver it. We strongly believe that the local people whose health care is at risk must be in the lead.”
Sarah Christopherson, MA, is the Legislative Director for the social justice campaign, Americans for Tax Fairness, and the NWHN’s former Policy Advocacy Director. Her 10 years working for Congress and her deep knowledge of health policy and consumer protection make her the NWHN’s issue area expert on federal health reform implementation and defense, drug and device safety and efficacy, and sexual and reproductive health.
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1. Data from Uttley, Khaikin, "Growth of Catholic Hospitals and Health Systems: 2016 Update of the Miscarriage of Medicine Report, MergerWatch, May 2016, available at www.mergerwatch.org
2. Affidavit of Dr. Robert Holder at 6 (Dec. 10, 2010), available at http://www.washingtonpost.com/wp-srv/health/documents/abortion/holder-affidavit.pdf
3. Data from Uttley, Khaikin, "Growth of Catholic Hospitals and Health Systems: 2016 Update of the Miscarriage of Medicine Report, MergerWatch, May 2016, available at www.mergerwatch.org