Wed 5/15: CA is not immune from forced-birther madness & LGBTQ discrimination. It’s just taking the “side door” into our UC medical campuses. Urgent call/email!

Action – Write an email/letter opposing any UC-system university affiliation with any religious, anti-choice, anti-LGBTQ hospital. 

The University of California regents are deciding if they should solve a bed-space issue at UC San Francisco Medical Center, one of the nation’s leading teaching hospitals, by “affiliating” with Dignity Health, a Catholic hospital chain that uses religious directives to openly discriminate against women and LGBTQ patients. If this goes through, it could be the beginning of other UC-Catholic hospital “affiliations,” spreading intolerance into our public hospitals with our own tax dollars as fuel. All the rights and values Californians are rightly proud of mean nothing if, in our most vulnerable moment as a patient, they are not respected.

The regents are meeting May 14-16. Our Governor, Lt. Governor and Assembly Speaker are voting members. This issue is NOT on the agenda but they will be voting on it soon. Call them, and write them an email or letter to tell them that this discussion of whether or not to allow this trojan horse into our health system should be an easy “NO”. Make it as personal as you can.

Minimal script: I’m calling from [zip code] and I want [__] to know that it would be unforgivable to tie UCSF Medical Center or any taxpayer-supported hospital with Dignity Health, or any other system that discriminates and harms women, the poor, minorities and our LGBTQ community.

More script if you want it: If religious hospitals refused to treat non-white people, we would shut them down. Why do we tolerate the verifiable harm these hospitals cause women and LGBTQ people?

• Gov Gavin Newsom: (916) 445-2841, email.
• Lt Gov Eleni Kounalakis: (916) 445-8994, email
• Assembly Speaker Anthony Rendon: (916) 319-2063, email
• The Regents Board: Email, Mail: Office of the Secretary and Chief of Staff to the Regents, 1111 Franklin St.,12th floor, Oakland, CA 94607

Background

Short story: UCSF has run out of room and Dignity Health has extra beds. The latter also has more “revenue flow” that could help UCSF offset losses from their low-income patients. The two entities already have clinical associations for specialties such as cardiology, pediatric burn services, neurosurgery and thoracic surgery. What’s profoundly different is that the UCSF Medical Center is a highly respected teaching hospital dedicated to science, best practices and public service, and Diginity Health is controlled by directives from a posse of celebate men who use non-medical issues to deny basic health care, and dignity, to women and the LGBTQ community and to override the wishes of the dying.

Short but alarming story on Catholic hospitals: 645 Catholic hospitals constitute the largest group of nonprofit healthcare providers in the country, caring for one in six patients. More than a third of women who rely on a Catholic hospital for reproductive services don’t realize it’s Catholic until they are refuse a normal treatment, like tubal ligation. One in five of these institutions don’t disclose their religious identity on their website. Even hospitals that list their ownership as public, or voluntary non-profit, can be actually be controlled by Catholic directives. From the latest MergerWatch report.

They are NOT Mother Teresa on steroids.:  Catholic provided charitable care is no greater than that provided by secular non-profit or for-profit hospitals (between 2-3%) and is only half of what public hospitals provide (5.6%). “Miscarriage of Medicine” concludes that today Catholic hospitals “…have organized into large systems that behave like businesses — aggressively expanding to capture greater market share — but rely on public funding and use religious doctrine to compromise women’s health care.” In 2011.  Catholic hospitals took in $115 billion in gross patient revenues from Medicare and Medicaid.  Michael Hiltzik of the Los Angeles Times observed, “(Catholic directives) were relatively unobjectionable when the typical Catholic hospital might have been a parochial facility concerned mostly with caring for local Catholics or as part of spiritual outreach. But their footprint is much greater now. Catholic healthcare systems receive billions of dollars in state and federal taxpayer funds and dominate some communities’ health landscapes.”

A tale of two hospitals, both bad for women & LGBTQ persons: Dignity Health describes itself as “the fifth largest health system in the nation and the largest hospital provider in California,” with 30 facilities in the state which they divide into “non-Catholic” and “Catholic”. Their “non-Catholic” versions still requires compliance with the church’s “statement of common values,” which bans “direct abortions,” physician-assisted suicide and fertility treatments such as in vitro fertilization (IVF) — the latter being the only way that gay and lesbian couples can conceive a biological child. So still Catholic, but what might be described as “Catholic-light”. Their “Catholic” hospitals operate under the Conference of Catholic Bishops-approved “Ethical and Religious Directives for Catholic Health Care Services” (ERDS) which bans as “instrinsically immoral” “direct abortions” at any stage, IVF, contraceptives, “direct sterilization” (such as tubal ligation),  assisted suicide and “gender affirming care” such as hormone treatments and surgeries for transgender patients, among other treatments. They have been used to limit crisis care for women suffering miscarriages or ectopic pregnancies, emergency contraception for sexual assault, and depending in part on the whim of the local bishop, can subject doctors and nurses to gag rules prohibiting counseling a patient or referring a patient to a place that would provide necessary services.

The proposed merger with UCSF would involve their doctors dealing with both versions – directives and ERDS.

Rot starts at the head: Supporters state that UCSF doctors shouldn’t worry about the prohibitions. For example, Dana Gossett, the chair of obstetrics and gynecology at UCSF, observed at a Regents meeting that there are “usually workarounds” for doctors to prescribe contraceptives. The ERDs ban them if they’re for birth control but allow their use for other medical problems like “menstrual disorders”. This clever, yet ultimately cynical methodology – falsification of patients’ record to circumvent a bagful of ancient religious edicts, has absolutely nothing to do with science or the highest goals for patient care. Not sure what workaround they use for LGBTQ patients’ needs… Doctors already tired of dealing with the demands of multiple insurers may decide that adding the capricious and illogical orders of Catholic priests is one problem too many and leave the system.

No one is fooling anyone: Like all employers, the men in red robes absolutely know what their employee doctors are up to. The bishops will allow them their subterfuge (doctors discuss it openly on YouTube, for goodness sakes!)…until the church’s control of our health system is large enough that they can simply shut off these escape routes. Need contraceptives for menstrual pain…too bad.

What can’t be escaped: No matter what Mark Laret, CEO of UCSF Health believes,  this proposed expansion would place more UCSF doctors and patients on a collision course with Dignity Health’s directives. Like other typical Catholic/secular hospital mergers, UCSF doctors will be made to “respect” (i.e. comply with) Catholic directives but Dignity Health will make no equivalent compromise to protect the health or dignity of all who enter their lobbies. LGBTQ patients would be exposed to the humiliation of refusal of services, and women suffering life-threatening miscarriages would be made to wait until heartbeats of non-viable fetuses ceased, a policy that killed a woman in Ireland, and has risked the lives of numerous American women. Those with the least choice – the poor, women needing immediate reproductive services, and minority communities will suffer needlessly. Here are some examples…

• Denial of proper miscarriage management

(clip below from ACLU )

• Tubal ligations: The safest time for a woman to have a tubal ligation, the second most common form of birth control, is at the time of her delivery. Half of the 700,000 done every year are done this way. However, because of Catholic directives, a patient will have to wait several weeks for her uterus to return to its normal size before undergoing another operation that involve multiple incisions under general anesthesia. Moreover, she will have to overcome the logistical hurdles of obtaining this significant surgery weeks or months after discharge while now caring for a newborn baby and often other children as well, manage the insurance issues for going out-of-plan and be able to get to another facility, which could be the next county over.  For some women, these obstacles will be insurmountable.
• Emergency contraception: An extensive survey of emergency rooms at U.S. Catholic hospitals in 2002 found that 55% of Catholic controlled heath care facilities did not provide emergency contraception (EC) even for rape victims, 23% provided EC only to rape victims, some required filing a police report first. This single area of intrusion of Christian dominance into the provision of medical services has a huge collective impact; it is estimated that the use of emergency contraception could prevent an estimated 1.7 million unintended pregnancies and 800,000 abortions in the U.S. each year.

Denial of care has costs: The ACLU letter states that “UCSF representatives acknowledged that patients would be denied care at Dignity Health hospitals. They asserted that the “transparency” of telling patients about these denials is of primary importance, suggesting that this would alleviate the problem of referring UCSF patients to Dignity Health hospitals.” No, it just makes gives shape and focus to the trauma of being discriminated against at one’s most vulnerable moment. There is limited data on what happens when women are denied reproductive care  but one 2011 study looked at the results of Catholic Loyola University Medical Center’s restriction of access to injectable contraception for patients who had just given birth. Pregnancy rates over the ensuing year increased, particularly for young women of color. Overall, women of color are more likely to give birth in Catholic institutions. A “turnaway” study of women denied abortion services found serious effects on a women’s wellbeing, including a higher likelihood of poverty, inability to leave abusive partnerships, serious health complications including death and eclampsia, anxiety, and derailment of life plans. For LGBTQ people, discrimination may make the delay or forego care, putting them at heightened risk of health issues, from depression and addiction to cancer and chronic conditions. A 2015 survey of almost 28,000 transgender people found that, in the year preceding the survey, 23 percent did not seek care they needed because of concern about mistreatment based on gender identity.

This could be just the beginning: The UCSF deal, if approved, could become a model for affiliations between other UC medical campuses and Catholic hospitals in their areas, spreading Dignity Health’s model of discrimination like a fungus. The ACLU of Northern California has questioned whether it’s even legal, (this is a great letter! Read and use in your comments!) given state and federal constitutional requirements for the separation of church and state, as well as state and federal anti-discrimination laws.

UCSF is a “teaching” hospital.: This includes learning to counsel LGBTQ patients on IVF issues, becoming familiar with gender-affirming care and completing training in obstetrics and gynecology, including prescribing contraception and performing safe abortions for the nearly one quarter of American women who will have one in their lifetimes. However, for the latter issue, an increasing number of medical schools, especially in states with legislative barriers to women’s access, or restrictive public funding, are refusing to teach these procedures. Hospital mergers with religious entities, like Dignity Health, that prohibit reproductive health service provision and training, not only limit woman’s ability to choose an elective abortion, but can also endanger her life if pregnancy complications arise. The last survey in  2014 found that only 24 of the 461 accredited family medicine residency programs offer integrated abortion training.

UCSF is a “public” hospital.: The ACLU’s letter reminds the UC system of the Establishment Clause, Equal Protection, California’s Constitutional No-Aid Clause and our Non-Discrimination Law. Though it seems obvious to us, the Regents may have felt that what seemed like a suspiciously easy and practical solution to their overcrowding problem could be done without much fuss. To buy into any form of discrimination is to encourage its growth. If this were a hospital that refused any non-white people, would this be an easy choice?  Think again, Regents!

Reading

• Letter to Mark Laret, President/CEO of UCSF Health and Chancellor Sam Hawgood, UCSF (ACLU)
• Report: Health care denied (ACLU)
• Health care denied at 550 hospitals (Forbes)
• As Catholic hospitals expand, so do limits on some procedures (NYT)
• UC’s deal with Catholic hospitals threatens the health of women and LGBTQ Patients (LA Times)
• Here’s anothe case of a Catholic hospital interfering with patient care. (LA Times)
• Catholic hospital systems: A growing threat to accesss to reproductive services (php.org)
• Catholic Health Care in the US (chausa.org)
• MergerWatch
• There’s almost no data about what happens when Catholic hospitals deny reproductive care (Rewire.News)
• Is your hospital Catholic? Many women don’t know (Rewire.News)
• Miscarriage of Medicine. The growth of Catholic hospitals and the threat to  reproductive health care (ACLU)
• The growth of Catholic hospitals, by the numbers (ProPublica)
• Directives – Statement of Values (DignityHealth.org)
• Ethical and Religious Directives for Catholic Health Care Services (USCCB.org)
• 2015 US Transegender Survey (Transsexuality.org)
• Will ties to a Catholic Hospital system tie doctors’ hands? (Kaiser Health News)