When Hospitals and Doctors Play God

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.