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Commentary | PERSPECTIVE ON HEALTH

When Hospitals and Doctors Play God

Public health systems must not let religious providers dictate what reproductive services are and are not available.

April 08, 1998|SUSAN BERKE FOGEL | Susan Berke Fogel is the legal director of the California Women's Law Center, a statewide nonprofit policy and advocacy center that protects the civil rights of women and girls

Access to reproductive health care is secretly being negotiated away by hospital and HMO executives every day in California and across the country. Overnight, consumers are finding that reproductive health services have disappeared from their community hospitals and health systems. This dismantling of services eliminates access to birth control devices, voluntary sterilization for men and women, the distribution of condoms to combat the spread of AIDS and sexually transmitted diseases, emergency contraception for rape victims, most fertility treatments and abortion.

In the absence of national health reform, the health care industry is transforming itself. Religiously sponsored health systems are taking over community hospitals and affiliating with nonsectarian health providers at an unprecedented rate. These religious health care giants--eight out of the 13 largest health systems in the country are Catholic--impose the Catholic prohibitions of most reproductive health services on their staff and patients. Advance medical directives and other end-of-life decisions may also be taken out of the hands of patients and their families.

This stealth elimination of services is felt in every aspect of health care delivery. In hospitals, women who want tubal ligations after giving birth are forced to undergo a second procedure at another time and place. Rape victims may be denied emergency contraception; at one hospital, victim advocates who believe a woman should not be compelled to bear a rapist's child are forced to assist women out in the parking lot.

With little warning, employees must go without insurance coverage for these services when the insurer contracts exclusively with a Catholic hospital. Lease restrictions dictate what doctors can and cannot do in their private medical offices. Some doctors are told they should not provide abortions anywhere, even on their own time. Women in managed care plans, including Medi-Cal, may find that these services are geographically unavailable.

Most disturbing, the elimination of these services usually takes communities by surprise. The public is generally aware that Catholic hospitals do not provide abortions, but many people are taken aback by the scope of prohibited services.

These hospital mergers also raise important concerns about the separation of church and state, since billions of government dollars go to institutions that deny women and men a critical aspect of their health care.

With significant state and national implications for reproductive health care, this scenario is currently playing out across the Southland. Catholic Healthcare West has recently taken over hospitals in San Bernardino and Bakersfield and is in negotiations to merge with UniHealth, which owns eight hospitals in the greater Los Angeles area, including Northridge Hospital Medical Center. Last week, the Beach Cities Health District voted to lease a portion of South Bay Medical Center to Little Company of Mary Hospital.

South Bay Medical Center is a public community hospital owned by the Beach Cities Heath District and, as such, provides all reproductive health services. Little Company of Mary is a Catholic hospital and strictly abides by the religious prohibitions on reproductive health services. Not only is Little Company of Mary refusing to provide any of these reproductive health services, but it is insisting that no one else be allowed to provide them in the rest of the building.

In the aftermath of the approval of Little Company of Mary lease, the Beach Cities Health District is looking for collaborations that will replace and expand the reproductive health services that have been eliminated, as well it should.

It is unconscionable for a public health system to allow a religious provider to dictate what health care services are available to its community. It is time to hold all health care systems, both for-profit and nonprofit, accountable to ensure that these affiliations do not continue to harm the men and women of our communities.

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