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Are Catholic hospitals bad for women's health? ACLU says yes.

A word of caution: If you are a woman of child-bearing age, Catholic hospitals may be hazardous to your health.

Why?

Because Catholic-affiliated hospitals, which now account for one of every nine acute-care hospital beds in the country, aren’t allowed to provide the medically accepted standard of care if it conflicts with Catholic teachings.

This can include denying a rape victim morning-after pills. Or refusing to give abortions for ectopic or molar pregnancies, which are not viable and may threaten the mother’s health or life. Or refusing to perform tubal ligations during cesarean sections, even when a future pregnancy could put a woman’s life at risk.

“My biggest concern is that the facilities have religious directives rather than medical standards governing care in some instances, and that patients don’t know that,” said ACLU Deputy Legal Director Louise Melling, co-author of a new study raising alarms about Catholic health systems. “The size and scope of the Catholic hospital system isn’t known to many people, and many don’t understand the restrictions that are in play once they step through those doors.”

“Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care,” a joint effort of the ACLU and the MergerWatch Project, echoes other reports about the expansion in the last decade of Catholic-affiliated hospital systems, which now account for 10 of the 25 largest health systems in the country, and impose religious standards after acquiring secular hospitals. In Washington state, the report notes, more than a quarter of hospitals are Catholic-affiliated, leaving “entire geographic regions” dependent on institutions that put religious imperatives first.

“As more hospitals are governed by Catholic doctrine,” says the report, “we expect to see more women denied appropriate care.”

Billions of dollars of public funds flow to Catholic hospitals from federal coffers in the form of Medicaid and Medicare payments, subjecting them to federal rules that govern patient treatment, including stipulations that patients must be informed of all options for their care. Yet the U.S. Conference of Catholic Bishops forbids its hospitals to offer care, referrals or even information in situations where a woman might opt for an abortion after rape, incest or to save her life.

The rules are contained in a document known as the “Ethical and Religious Directives for Catholic Health Care Services.”

The directives make a distinction between “direct” abortion, which is never permitted, and an “indirect” abortion, which is.

For instance, a pregnant woman with uterine cancer may have a hysterectomy to save her life even if she’s pregnant. The fetus’ death is a byproduct of treatment not related to the pregnancy and therefore the abortion is "indirect."

But if the pregnancy is, say, causing organ failure, doctors may not perform an abortion, because the fetus is the direct cause of the medical problem. “A good end cannot justify an evil means,” explained the bishops in a 2010 memo after the Catholic affiliation of a Phoenix hospital was revoked because doctors performed an abortion to save a mother’s life.

Even Catholic hospital doctors say this is bad medicine.

In a survey taken last year, more than half (52%) of OB/GYNs working in Catholic hospitals reported that their employer’s religious policies conflicted with sound medical practice.

“For some physicians, their hospital’s prohibition on abortion initially seemed congruent with their own principles,” wrote Lori Freedman and Debra Stulberg in the American Journal of Bioethics, “but when applied to cases in which patients were already losing a desired pregnancy and/or the patient’s health was at risk, some physicians found the institutional restrictions on care to be unacceptable.”

One recent example of allegedly botched Catholic obstetrical care garnered national attention after the ACLU took the unprecedented step of suing the U.S. Conference of Catholic Bishops for negligence.

The lawsuit was filed last month on behalf of Tamesha Means of Muskegon, Mich., who was 18 weeks pregnant when her water broke. She showed up at her local Catholic hospital and was sent home twice with only Tylenol.

According to the lawsuit, Means was not informed that her pregnancy was no longer viable, nor that she risked infection if an abortion were not performed. During her third trip the emergency room, in the grip of a serious infection, her body expelled the severely premature baby, who soon died.

Archbishop Joseph E. Kurtz, president of the bishops’ group, said the lawsuit was “misguided,” “baseless” and a “clear violation of the First Amendment.”

A spokeswoman for the bishops said she could not comment on the ACLU report until she had read it. However, a statement posted by the Catholic Health Assn. in response to a New York Times editorial about the Tamesha Means case, said: “There is nothing in the Ethical and Religious Directives that prevents the provision of quality clinical care for mothers and infants in obstetrical emergencies. Their experience in hundreds of Catholic hospitals over centuries is outstanding testimony to that.”

So should those of us who strongly believe that bishops do not have a woman’s best interest at heart in these cases forgive the church because it otherwise does so much good for the poor?

As the ACLU correctly notes, Catholic hospitals “often counter criticism of their reproductive health restrictions by emphasizing their mission of serving the poor and providing charity care.”

But the ACLU found that public hospitals provide twice as much charity care than Catholic hospitals. In 2011, that amounted to 5.6% of total patient revenue. Other kinds of hospitals, including religious and secular nonprofits, provide about the same amount of charity care as Catholic facilities, 2.9%. Only for-profit institutions, at 2%, provide less.

And it’s not just the indigent who get relatively less care at Catholic hospitals. Measuring Medicaid gross patient revenue, the ACLU also found that Catholic hospitals treat fewer low-income patients than any other type of hospital.

So what to do?

The ACLU recommends that the government step up its oversight of hospital mergers to make sure that women do not lose access to reproductive health services, that hospitals be required to make their reproductive healthcare policies public, and that they notify patients of any relevant restrictions.

The group suggests that federal law requiring hospitals to give patients full information about their range of treatment options be more energetically enforced, and that patients and doctors who believe they’ve experienced harm as a result of the bishops’ directives lodge complaints with the federal agency that oversees Medicaid.

Over the years, we’ve watched as state legislatures around the country have inceasingly chipped away at women’s reproductive rights, coming up with ever more creative ways to deny access to abortion: requiring ultrasounds, waiting periods and putting onerous restrictions on clinics and doctors.

But another kind of threat to women’s reproductive health has been happening right under the nose of the federal government, which should be watching out for women by enforcing its own regulations, instead of turning a blind eye.

Ladies, enter a Catholic hospital at your own risk.

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More from Robin Abcarian

Twitter: @robinabcarian

robin.abcarian@latimes.com

Copyright © 2014, The Baltimore Sun
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