We say “NO” (AGAIN!) to discrimination in UC health care, and “YES” to the high-quality, evidence-based care that all patients expect and deserve.
A mechanical voice but a good, short overview.
A little more than a year ago, we asked people to email the University of California Board of Regents, as they were planning to partner up the UC San Francisco Medical Center, one of the nation’s leading teaching hospitals, with Dignity Health, a Catholic hospital chain that uses religious directives to openly discriminate against women, disproportionately affecting women of color, LGBTQ patients, and those seeking end-of-life care, in order to help resolve a bedspace problem. We, the people who demand the separation of church and state in our health care, said “NO!,” and the Board backed off, then. But since then, the ACLU has discovered that every single UC Health center has contracts that impose harmful non-medical restrictions on care.
On Wednesday, the regents are going to vote on a policy which would allow UC Health, the university division that oversees six health centers 20 health professional schools, and the medical education more than fifty percent of our state’s doctors, to normalize the process of affiliating with Catholic or other entities with discriminatory religious restrictions, despite the fact that contracting with such organizations is in clear violation of CA’s constitution and state laws.
The Regent’s draft policy being voted on has guidelines that would prevent these affiliate hospitals from actually gagging UC professionals’ from counseling their patients and prescribing treatments they feel are in the patients’ best interest, at least for now… However, they are absolutely unable to ensure that those professionals can actually perform those treatments at these facilities, as hard experience shows that the Conference of Catholic Bishops will place their Ethical and Reigious Directives (ERDs) over doctor/patient decisions, even at the cost of human life.
Reading between the lines of Point #3 of the draft policy, the authors anticipate the bewilderment, humiliation and possible endangerment that people will face upon being denied legal health care on the grounds that what they need is considered “intrinsically evil.” This includes women seeking abortions, miscarriage treatment, contraception or sterilization, LGBTQ+ patients seeking gender-affirming surgeries and the terminally ill seeking euthanasia (legal since 2016).
Each University location contracting with healthcare organizations that have adopted policy-based restrictions on care must develop and implement a process to inform UC patients, faculty, staff, and trainees: (i) about such restrictions at sites to which they may be referred or assigned; (ii) that such referrals or assignments are voluntary; and (iii) and that information about alternative sites for care, practice, and training will be provided upon request.
The paragraph ends on how to relocate people who need such “restricted services,” resulting in a “stigma inconsistent with the history and dynamics of civil rights laws that ensure equal access to goods, services, and public accommodations.”
Each location must also develop a process to transfer patients who need restricted services to a UC or other location where the services can be provided.
It’s also a dry reminder of how dangerous their religious strictures are, as these facilities have to “relocate” women suffering from miscarriage emergencies, because the best practices to save their lives would be construed as an abortion by their ERD rules. The is modern “separate, but definitely not equal accommodation,” and we don’t accept it.
Action #1 – EMAIL the UC Board of Regents to oppose any UC-system health care affiliation with any religious, anti-choice, anti-LGBTQ hospital.
Write them an email to tell them that this discussion of whether or not to allow this trojan horse of discrimination into our health system should be an easy “NO”. Use whatever of the attached sample script makes sense to you. Make it as personal as you can, by adding any stories how this type of discrimination could have or did affect you, family member or an acquaintance.
Sample email script:
(Put in “Subject” line): DRAFT Regents Policy on Affiliations with Healthcare Organizations that Have Adopted Policy-Based Restrictions on Care
I’m writing to demand that the Board of Regents vote “NO” on the draft policy that would affiliate UC Health with any entities whose “policy-based restrictions” discriminate against certain treatments for women, the LGBTQ community and terminally ill patients. As a public entity, such alliances are completely contrary to California’s values of equality, and inclusivity, not to mention our constitution and state laws. If this policy is approved, not only will it harm the most vulnerable patients, it will expose CA taxpayers to completely justifiable lawsuits. It will also hurt UC health care’s credibility and standing, while allowing entities who practice such discriminatory and non-scientific policy-based medical practices to trade on the reputation of our medical professionals while rewarding themselves with more of our tax dollars. The points made by the ACLU against a 2019 vote as to whether or not to connect Dignity Health to UC San Francisco Medical Center are still relevant. (https://s3.documentcloud.org/documents/5828506/ACLU-UCSF-Dignity-Letter-2019-03-12.pdf)
- Both the U.S. and California Constitutions prohibit “sponsorship, financial support, and active involvement of the [state] in religious activity.” Even where the purpose of the government action is secular, the Establishment Clauses may still be violated where the principal or primary effect of the action advances religion or where the action fosters an excessive entanglement with religion.
- Equal protection: Denying transgender people gender-affirming care constitutes sex discrimination in violation of constitutional equal protection.
- The California Constitution requires that governmental entities must treat all pregnancy options neutrally. Thus, patients seeking care from any part of our health care sytem cannot only be offered obstetric and gynecologic care—they also must be offered abortion care. Making some hit the road to get care is not equal.
- California’s Constitutional No-Aid Clause: Article XVI, Section 5 of the California Constitution provides that no California state entity “shall ever make an appropriation, or pay from any public fund whatever, or grant anything to or in aid of any religious sect, church, creed, or sectarian purpose, or help support or sustain any school, college, university, hospital or other institution controlled by any religious creed, church or sectarian denomination…”
- California Non-Discrimination Law: Per Cal. Gov’t Code § 11135, entities in California may not discriminate on the basis of sex, including gender identity, gender expression, and sexual orientation. Nor may government entities contract with entities that discriminate on these bases. Cal. Gov’t Code § 12990.
- California’s Unruh Civil Rights Act promises that all those within the jurisdiction of the state are “free and equal” and “entitled to the full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind whatsoever.” Cal. Civ. Code § 51(b), which prohibits discrimination on the basis of sex, including gender identity, gender expression, and sexual orientation in all business establishments. Id. § 51(e)(5).
- California law (Cal. Gov’t Code § 11139.8(b)) protects UC employees from the type of discrimination that their patients will suffer. The preamble to the law that protects UC employees from discrimination states: “[t]he exercise of religious freedom should not be a justification for discrimination.” Id. at § 11139.8(a)(4).
- The proposal “defies the university’s commitment to provide treatment based on the best scientific information available,” the UC Academic Senate observed in a May 11 letter to UC President Michael Drake, “it goes against the university’s obligation … not to discriminate against any individuals.’
Expediancy is no excuse. If these religious hospitals had “policy-based restrictictions” that refused treatment based on race, we would not be having this discussion. However, it’s disturbing that their strictures against care needed disproportionaly by women of color, the LGTBQ+ community and the sickest of patients, aren’t enough for this body to automatically jettison this proposal, without even mentioning the many ways this policy violates CA law.
Instead of caving repeatedly to these entities’ rules, or pretending that stigmatizing workarounds like “relocation” are reasonable accommodations, I demand that NO entity that places discriminatory, nonmedical restrictions on UC medical providers and students and refuses treatment to any patients seeking reproductive and gender-affirming care be eligible to affiliate with UC Health and that any existing contracts that “impose religious restrictions on care” be terminated as well. Now. Immediately. I stand with Equality California, NARAL Pro-Choice California, and ACLU of California, the California Democratic Party, leading California policymakers in Congress and the California Legislature in saying “NO” to discrimination in UC health care, and “YES” to the high-quality, evidence-based care that all patients expect and deserve.
Do better, UC Board of Regents!
Copies to: Gov. Newsom, Lt Gov Eleni Kounalakis, CA State Attorney General Rob Bonta, (your state and federal legislators.)
(Written comments received addressing items on the agenda can be sent to the Office of the Secretary and Chief of Staff (firstname.lastname@example.org) no less than forty-eight (48) hours in advance of the scheduled start time of the first session of a Board meeting, regardless of whether the first session is a session of the Board or of a committee. Such materials will be distributed to the members of the Board and/or Committee.
If you miss this deadline, send your comment in anyway. They will know that there has been a flood of comments.)
Action #2 – Send out copies of your comments.
- Gov Gavin Newsom: email.
- Lt Gov Eleni Kounalakis: email
- CA State Attorney General Rob Bonta email
- Assembly Speaker Anthony Rendon: 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
- Rep. Julia Brownley: email
- or Rep. Salud Carbajal: email.
- Senator Feinstein: email,
- and Senator Padilla: email, SF (415) 981-9369, SD (619) 239-3884
- Who is my representative/senator?: https://whoismyrepresentative.com
Action #3 – Call into their meeting.
The following guidelines pertain to all speakers who will be addressing the Regents during the Public Comment Sessions. Please note that public comment is live-streamed on the internet during the Regents meeting, and the video is retained on the Regents website. The identity of speakers and their comments are recorded in the official minutes of the University, which are retained online and are publicly available in perpetuity.
- Speakers are requested to address items on the Regents’ agenda or topics relevant to the University of California.
- Individuals who wish to address the Regents may either: (1) call the Regents Office at 510-987-9220 and provide the day on which they wish to speak and the subject which they wish to address; or (2) email email@example.com and provide the day on which they wish to speak and the subject which they wish to address. Public comment sign ups will be accepted once the Notice of meeting is published on the Regents website, usually 10 days prior to the meeting. All public comments will be selected randomly; however those who sign up by 5:00 p.m. the day before the meeting will have priority.
- Efforts will be made to accommodate each individual who has signed up to speak. However, given time constraints, there is no guarantee that all who have signed up will be able to address the Regents.
- Speakers are not necessarily called in the order in which they signed up.
- Per policy, individual speakers will be invited to speak for up to three minutes, depending on the number of individuals who have signed up to speak. Often speakers have less time (one minute) due to demand.
Action #4 – Thank your federal legislators who wrote a protest letter.
Thank the federal legislators who signed onto this letter.
Reps. Barbara Lee, Julia Brownley, Mark Takano, Katie Porter, Judy Chu, Susan A Davis, Anna G. Eshoo, Alan Lowenthal, Jackie Spejar, Grace F. Napolitano, Jared Huffman, Gilbert R. Cisneros, Jr., Ted W. Lieu, Mike Levin, Zoe Lofgren, Adam B. Schiff, Eric Swalwell, Maxine Waters, Jimmy Gomez, Mike Thompson, Linda T. Sánchez, Pete Aguilar, Salud O. Carbajal, Mark DeSaulnier, Harley Rouda, Ami Bera, M.D., Ro Khanna, Karen Bass, Nanette Diaz Barragán, Lucille Roybal-Allard, Jerry McNerney, Tony Cárdenas, John Garamendi, Raul Ruiz M.D., Scott H. Peters, Norma J. Torres, Brad Sherman, Juan Vargas, Jimmy Panetta.
Background – What happened in 2019?
Short story: In 2019, 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.
- 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.
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 )
(Bearing Faith – The limits of Catholic Health Care for Women of Color) “Out of the thirty-three states and one territory from which we collected data, Wisconsin displays the highest percentage of births at Catholic hospitals compared to non-Catholic hospitals for all racial groups, but especially for women of color. One in three births to white women is at a Catholic hospital (33%) while just over one in two (52%) births to black women is in a Catholic hospital. In fact, Wisconsin is the only state we studied where black women are more likely to give birth at a Catholic than a non-Catholic facility. Hispanic women are also more likely than their white counterparts to give birth at a Catholic hospital, with 45% of births to Hispanic women occurring at a hospital abiding by the ERDs. Notably, 1 in 4 birth hospitals in Wisconsin is a Catholic institution.
Medical providers who have worked in two Catholic hospitals in Milwaukee, Wisconsin—Wheaton Franciscan-St. Joseph, which is located in a majority black neighborhood, and Columbia St. Mary’s—recently revealed in a news article the numerous ways in which the ERDs impacted the care they could provide to patients.50 In one instance, Dr. Jessika Ralph described being forced to wait more than twenty-four hours for her patient to deliver an eighteen-week fetus with no chance of survival rather than perform an abortion or induction.51 Dr. Ralph noted that she was bound by St. Joseph’s rule requiring her to wait until a patient “hemorrhaged or showed at least two signs of infection” before taking action.52 Wisconsin law allows hospitals to refuse to perform or admit patients for sterilizations or abortions without being held “liable for any civil damages resulting…if such refusal is based on religious or moral precepts.”53
- 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!
- (LATimes) Column: UC regents appear poised to surrender to Catholic healthcare restrictions
- (UC Regents) DRAFT Regents Policy on Affiliations with Healthcare Organizations that Have Adopted Policy-Based Restrictions on Care
- (lawrightsreligion.law) Devalued, Turned Away, and Refused Health Care: What Happens to Women of Color When Religion Dictates Patient Care
- (lawrightsreligion.law.columbia.edu) BEARING FAITH – THE LIMITS OF CATHOLIC HEALTH CARE FOR WOMEN OF COLOR
- (UCSF) Lawsuits Target Catholic Hospitals For Refusing To Provide Emergency Miscarriage Management
- (Letter to Michael Drake, President, University of CA) Letter from UC Academic Senate
- (ACLU) Letter to Mark Laret, President/CEO of UCSF Health and Chancellor Sam Hawgood, UCSF
- (ACLU) Report: Health care denied
- (Forbes) Health care denied at 550 hospitals
- (NYT) As Catholic hospitals expand, so do limits on some procedures (NYT)
- (LA Times) UC’s deal with Catholic hospitals threatens the health of women and LGBTQ Patients (LA Times)
- (LA Times) Here’s anothe case of a Catholic hospital interfering with patient care.
- (php.org) Catholic hospital systems: A growing threat to accesss to reproductive services
- (chausa.org)Catholic Health Care in the US (
- (Rewire.News) There’s almost no data about what happens when Catholic hospitals deny reproductive care
- (ACLU) Is your hospital Catholic? Many women don’t know
- (ProPublica) Miscarriage of Medicine. The growth of Catholic hospitals and the threat to reproductive health care
- The growth of Catholic hospitals, by the numbers
- (DignityHealth.org) Directives – Statement of Values
- (USCCB.org) Ethical and Religious Directives for Catholic Health Care Services
- (Transsexuality.org) 2015 US Transegender Survey
- (Kaiser Health News) Will ties to a Catholic Hospital system tie doctors’ hands?