Wed 5/29: Update on the unsuccessful “side door” incursion of a Catholic hospital into our UC medical system. Thanks to all who called and emailed!

We won! This time.

(Original post from 5/15/19 here) Yesterday, we got news that the University of California Board of Regents put aside 3 years of planning and abandoned their proposal for UCSF Medical Center to “expand their relationship” with Catholic-based Dignity Health. If the proposed partnership had passed, the health needs of women, LGBTQ people and the dying would placed in the crosshairs of religious directives from the U.S. Catholic Conference of Bishops. Resistance in the form of protests from UCSF faculty and staffers, a record 147 speakers at the Regent’s board meeting, a lawsuit threat from the ACLU and calls and letters from people like us, convinced the board to stop the process.

Action – Call/email Governor Newsom to stop all taxpayer-funded religiously-based discrimination by hospitals. All hospitals. Full stop.

“We’ve heard a growing chorus of concern from multiple stakeholders over the last several weeks particularly in light of the passage of very severe anti-abortion legislation in many states and the stripping down of transgender anti-discrimination protections by the [Trump] administration.”- Vanessa Jacoby, an associate OB-GYN professor at UCSF, regarding the proposed “partnership”.

Minimal script: I’m calling from [zip code] and in light of the recent UCSF/Dignity Health issue, I want to know what Governor Newsom is going to do about Covered CA and other taxpayer-funder support to our 49 Catholic hospitals, one of which is a “sole community provider”. These hospitals systemically discriminate against the legal and common medical needs of women, the poor, minorities and our LGBTQ community.

Contact: Governor Gavin Newsom: (916) 445-2841, email.

Background

We want Californians to be able to walk into any hospital and get the treatment they need for best-practice reproductive services, gender-affirming services and end-of-life options, without being turned away, shamed, or forced to wait until near death for treatment. For women, this includes elective abortions, timely treatment of miscarriages and all forms of contraception, including tubal ligation. For LBGTQ folks – IVF and gender-affirming services. For those facing the end of their lives in pain – medical options. However, despite living in liberal CA, we have 49 Catholic hospitals where none of these basic services are possible. In fact, one of these facilities counts as a sole community provider.

We’ve already done something no other state has done. In 2018, Covered CA added a quality-focused stipulation – any hospital that doesn’t meet certain targets for safety and quality of maternal care could be excluded from the health plans sold through the marketplace. We want the same for religious discrimination. If a hospital openly stated that they wouldn’t treat certain patients because of their race (not inconceivable under this administration and at one time legal) we’d be picketing in front of their doors. So why do we let any of our taxes go to those that routinely discriminate against the legal and ordinary medical needs of women and LGBTQ people?

Here’s a list of the 49 Catholic hospitals in CA from the Alliance of Catholic Health Care, the umbrella organization for a system that includes 700 care center spanning 21 states, “accessible” to nearly one in 4 US residences. Sometimes a patient can tell from the name that they are entering a Catholic hospital, like “Dominican Hospital” or “Saint Francis Memorial Hospital”. Others have names that provide no warning of possible discrimination to entering patients:

Arroyo Grande Community Hospital
Bakersfield Memorial Hospital
Community Hospital of San Bernardino
French Hospital Medical Center, San Luis Obispo
Glendale Memorial Hospital and Health Center, Glendale
Mark Twain Medical Center, San Andreas
Northridge Hospital Medical Center
Woodland Healthcare
Petaluma Valley Hospital, Petaluma
Queen of the Valley Medical Center, Napa
Redwood Memorial Hospital, Fortuna
Santa Rosa Memorial Hospital, Santa Rosa
Sequoia Hospital” in Redwood City
Sierra Nevada Memorial Hospital in Grass Valley

CA already has one hospital – St. Elizabeth Community Hospital in Red Bluff, that is registered as a “sole community provider“, meaning it’s located between 25-35 miles or a 45 minutes drive away from other hospitals, or local conditions make accessing other hospitals difficult. In 2016, there were 46 Catholic-controlled “sole providers” in the U.S..

To apologists for these hospitals, we understand that not every service is provided at every hospital. But we’re not talking about specialties, like open-heart or major neurosurgeries, or new exotic therapies. We’re talking about bread-and-butter medical services that are standard in non-Catholic facilities, and if a secular hospital can’t provide a service, the patient is informed that the facility is lacking personnel or equipment, not that their needs are inherently sinful. That makes a big difference during the vulnerable condition of being a patient.

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.

As of 2016, 14.5 percent of all acute care hospitals in the United States are Catholic owned or affiliated.
Over the 15-year period 2001 to 2016, the number of acute care hospitals that are Catholic owned or affiliated grew by 22 percent, while the overall number of acute care hospitals dropped by 6 percent.
One in every six acute care hospital beds is in a facility that is Catholic owned or affiliated.
There are five states (Alaska, Iowa, Washington, Wisconsin and South Dakota)
where more than 40 percent of acute care beds are in hospitals operating under Catholic health restrictions. In another five states (Nebraska, Colorado, Missouri, Oregon and Kentucky), between 30 and 39 percent of the acute care beds are in facilities that are Catholic owned or affiliated.
There are 46 Catholic-restricted hospitals that are the sole community providers of short-term acute hospital care for people living in their geographic regions.
The largest Catholic health systems in the nation now control 384 hospitals, compared to 330 in 2011 and 259 in 2001.

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.

Background on the UCSF/Dignity Health debacle (from original posting)

Rot starts at the head: In the fight to ally Dignity Health with UCSF Medical Center, supporters stated that UCSF doctors shouldn’t worry about Catholic 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)
Catholic Hospitals Can Deny Patients Contraception. This Is My Story. (Rewire)
The rise of the “Zombie Religious” hospital (new republic)
Judge rules Catholic hospital can deny tubal ligation to Redding Woman (KQED)
Here’s what happen when a Catholic Hospital won’t try to save you (huffpost)
I almost died due to a Catholic hospital practicing “fetal personhood” (feministuppityandblack)
Black mom says Catholic hospital almost killed her (theroot)