California’s laws and policies dealing with reproductive health care are considered some of the most consumer-friendly in the country. They might have played a role in the ultimate solution to a disagreement between a patient and her hospital last month in Redding.
But the issues raised in the conflict between a Catholic-owned hospital and a pregnant woman seeking a tubal ligation will continue to generate controversy and present problems for women seeking reproductive choices, according to consumer advocates.
Rachel Miller, a Redding woman expecting her second child later this month, wanted this to be her last baby. She asked her physician to tie her fallopian tubes after she gave birth.
Mercy Medical Center, a Catholic hospital owned by Dignity Health, denied the physician’s request to perform the procedure.
Miller, an attorney, sought help from the American Civil Liberties Union, which threatened to sue the hospital. The hospital reversed its decision and agreed to allow the procedure later this month.
“Obviously, this is a great outcome for our client, but we don’t think of this as, ‘Problem solved. Now we can go home,'” said Elizabeth Gill, ACLU attorney who represented Miller.
“This is a national and growing problem, and we’re not the only ones dealing with it. There are a number of organizations keeping tabs on reproductive rights issues around the country,” Gill said.
“We already have some good laws in California. We think the laws we have now already do prohibit some of this kind of health care denial,” Gill said.
Dignity Health, based in San Francisco, would not comment on the Redding case specifically. In a written statement, Dignity said:
“In general, it is our practice not to provide sterilization services at Dignity Health’s Catholic facilities in accordance with the Ethical and Religious Directives for Catholic Health Care Services (ERDs) and the medical staff bylaws. As such, tubal ligations are not performed in Catholic hospitals except on a case-by-case basis where a formal review by a committee of physicians and others gives permission to perform the procedure.”
California Laws Considered Among Strongest
Reproductive-rights advocates in New York, Illinois and Washington state agree that California’s policies dealing with reproductive health care are among the country’s best for consumers.
“But that doesn’t mean there isn’t room for improvement — and it doesn’t mean you can take things for granted,” said Lois Uttley, director of MergerWatch Project, a women’s health advocacy organization in New York.
“What’s happening is that patients are losing choices when their hospital or their physician group is taken over by or mergers with a group that imposes restrictions,” Uttley said.
“Women needing reproductive care are increasingly having to act as their own advocates because their physicians sometimes can’t do it for them,” according to Christine Khaikin, advocacy coordinator for MergerWatch.
Lori Freedman, a professor at UC-San Francisco and author of the book “Willing and Unable: Doctors Constraints in Abortion Care,” said that while California leads the way in a number of areas, she sees the need for more changes.
“I personally would like to see policy changes that would protect women’s reproductive rights and improve transparency to patients,” Freedman said.
“I do research with [doctors] and patients and hear a lot from [doctors] about the difficulty in providing standard and timely care — especially with obstetric complications. And I hear a lot of comments from patients along the lines of, ‘I didn’t know there was any alternative,'” Freedman said.
MergerWatch has kept tabs on 120 mergers involving Catholic-run facilities in 38 states over the past 15 years. Problems arise, advocates said, when no other care is available in close proximity.
“When choices are reduced — when there’s not a choice of hospitals or [doctor] groups — that’s when conflicts arise,” Uttley said.
In Troy, N.Y., when a Catholic hospital system took over Samaritan Hospital — a formerly non-religious institution — the parties involved reached an unusual arrangement. The second floor of Samaritan became a separate and distinct entity that does not adhere to Catholic directives.
“There are ways sometimes to work out creative solutions,” Uttley said. “When St. Peters took over (St. Peters Health Partners acquired Samaritan) all the parties got together and worked out that the second floor of Samaritan would become a separate hospital within a hospital. It’s called the Burdett Care Center. The bishop approved it, and it’s working well,” Uttley said.
“There are ways to find solutions on a collegial basis. I’d like to see more cases like this,” Uttley said.
Is something like that possible in California?
In Redding, Miller, whose first child was born at Mercy Medical Center, said the closest hospital other than Mercy that would accept her insurance and deliver the baby followed by sterilization was the UC-Davis hospital 160 miles away.
Would Mercy or Dignity be open to the kind of arrangement worked out in Troy, New York?
Officials at Mercy Medical Center referred questions to Dignity corporate headquarters in San Francisco. Dignity officials would not comment.