Submitted by Elaine Magliaro, Guest Blogger

There has been a lot of discussion in the media recently about the HHS contraception coverage mandate. Much of the talk has focused on women’s sex lives and the types of birth control that doctors prescribe for women in order to prevent pregnancy—as well as on the separation of church and state and the mandate’s infringement on religious freedom and the Catholic Church’s First Amendment rights. There has been much less talk about women’s health, women’s rights, and the use of birth control pills to treat certain female medical conditions, including polycystic ovary syndrome and endometriosis. Both of these conditions can cause severe pain and lead to other health problems. According to Bruce Nolan of The Times-Picayune, the Institute of Medicine—which is a non-profit advisory panel—recommended the contraception coverage because “those services are basic to individual health.”

Many Americans—especially women—think that contraceptive coverage and other “female-related” medical services ARE basic to women’s health.  Catholic bishops, however, believe that contraceptive coverage and some hospital services are in conflict with the church’s “moral conscience.” The bishops contend that the church has the right to deny certain types of health insurance coverage for women who work for Catholic institutions. It doesn’t matter to the bishops whether the female employees are members of other religions…are atheists or agnostics. The church’s position is that all female employees of Catholic institutions should be denied access to all forms of contraceptives and not be provided medical insurance that would cover the cost of certain medical procedures. The bishops also believe that certain types of treatment and procedures—including tubal ligations—should not be provided to women at Catholic hospitals.

When I was doing research on an earlier post, The National Women’s Law Center Takes a Position on Contraceptive Coverage & “Extreme” Legislation, I came across some information about Catholic hospitals that caused me great concern. The information left me with the belief that Catholic bishops and the Catholic Church do not seem to value the lives of women as much as they value the lives of men and the unborn. In this post, I will look at the “usurpation of female patients’ rights” at Catholic hospitals. I think after reading my post you will understand why I drew the conclusion that I did.

In January of 2011, the National Women’s Law Center issued a report about women’s health and lives being at risk at some hospitals because of religious restrictions. The NWLC report includes a legal analysis of the implications of its study—which focused on Catholic-affiliated hospitals’ treatment of women with pregnancy complications.

From the National Women’s Law Center:

The Center’s report, Below the Radar: Ibis Study Shows that Health Care Providers’ Religious Refusals Can Endanger Pregnant Women’s Lives and Health, demonstrates that certain hospitals, because of their religious beliefs, deny emergency care, the standard of care and adequate information to make treatment decisions to patients experiencing miscarriages and ectopic pregnancies. The study and report focused on cases where no medical intervention was possible that would allow the patient to continue her pregnancy and where delaying treatment would endanger the woman’s health or even life. These hospital treatment practices violate federal laws and regulations that are intended to protect patients and ensure the delivery of quality health care services at hospitals receiving Medicare funds…

“Most women assume that when they go to a hospital they will be offered the best medical treatment options for their diagnosis,” said NWLC Co-President Marcia D. Greenberger. “But this report paints a chilling picture of women with ectopic pregnancies or suffering miscarriages who are not offered the full spectrum of medically appropriate treatment options because they have gone to a hospital whose religious affiliation conflicts with the provision of those options. To make matters worse, women denied certain medical options may never even be told that these options could, for example, improve their chances of having a healthy pregnancy in the future. Women who fail to receive appropriate treatment or to be informed that preferable options would be provided in another hospital can suffer serious harm with long-term adverse consequences to their lives and health.”

The reports highlight stark cases where doctors noted a discrepancy between the medically-accepted standard of care for miscarriage and ectopic pregnancy and the treatment provided by hospitals due to their religious affiliation. For example, while the standard of care for certain ectopic pregnancies requires patients to receive the medication methotrexate, doctors in the study reported that their hospitals forbade the use of the drug. Instead, patients were either transferred to another hospital or required to undergo unnecessary and invasive surgery to resolve their condition, thereby being denied the standard of care.

One doctor in the study reported several instances of potentially fatal tubal ruptures in patients with ectopic pregnancies at her Catholic-affiliated hospital. She said that her hospital subjected patients with ectopic pregnancies to unnecessary delays in treatment, despite patients’ exhibiting serious symptoms indicating that a tubal rupture was possible. These patients, therefore, were denied emergency care to which they were legally entitled.

In some of the miscarriage cases described in the Ibis Study, the standard of care also required immediate treatment. Yet doctors practicing at Catholic-affiliated hospitals were forced to delay treatment while performing medically unnecessary tests. Even though these miscarriages were inevitable, and no medical treatment was available to save the fetus, some patients were transferred because doctors were required to wait until there was no longer a fetal heartbeat to provide the needed medical care. This delay subjected these patients to further risks of hemorrhage and infection and could have violated their right to receive emergency medical treatment under federal law.

Early last year, the NWLC filed a complaint with the Centers for Medicare and Medicaid Services in which it identified violations of health care provider obligations “under the Medicare Conditions of Participation (CoPs) resulting from these practices.” The complaint urged “HHS to issue a notification reminding hospitals that they are bound by all CoPs; to require hospitals to institute policies and procedures to protect patients’ legally enforceable rights; to investigate the failure of hospitals to provide standard of care and informed consent, and to take corrective action to prevent further violations.”

Jill Morrison, Senior Counsel for NWLC, said that religious dictates should not “trump bedrock legal protections that entitle patients to the standard of care and informed consent in the American medical system.” She claimed that hospitals had been allowed to disregard their obligation “to prioritize women’s health and lives” for too long. Morrison added, “It’s time to shine a light on these serious violations and make hospitals accountable to protect the lives and health of the patients they serve.”

I think it is of great import for women to read the study. According to the National Catholic Reporter, “Catholic health care facilities form the largest not-for-profit health service sector in the United States, caring for nearly one-sixth of all U.S. hospital patients each year.”

In his article in the March/April 2011 issue of The Humanist, Rob Boston wrote about Catholic Hospitals’ usurpation of patients’ rights:

Healthcare has been in the news a lot lately, but much of the discussion has centered on the bill backed by President Barack Obama that Republicans in Congress are trying to repeal. Americans obviously have different opinions about that legislation. We can hope, however, that most Americans don’t support medical decisions being made subservient to religious dogma.

Yet about a fifth of all U.S. hospitals abide by a series of directives promulgated by the U.S. Conference of Catholic Bishops. The directives ban abortions for any reason, forbid distribution of birth control (often including “morning after” pills for rape victims), deny sterilization operations such as vasectomies and tubal ligations, and nullify advanced directives and “living wills” that conflict with Catholic doctrine.

Catholic hospitals impose these narrow doctrinal views—which are so strict that even most American Catholics don’t support them—while receiving a windfall of public support through direct government subsidies and participation in Medicare and Medicaid programs.

Americans are increasingly finding that medical services they took for granted have evaporated as a spate of hospital mergers across the country has subjected many people to the bishops’ directives. Why is this? Because when Catholic hospitals merge with non-Catholic institutions, the latter are required to accept the directives as part of the deal.

Women’s rights groups and advocates of reproductive freedom have been speaking out, but too often their complaints fall on deaf ears. In Montgomery County, Maryland—an affluent suburb of Washington, DC, with a well educated population that leans toward progressive politics—state regulators recently ruled that a Catholic hospital group could build the county’s first new hospital in thirty years. In making this decision, the board bypassed a rival proposal from a group run by the Seventh-day Adventists. Although both groups are religious, the Adventists had promised to provide the full range of reproductive services.

Asked about the lack of reproductive healthcare at the new facility, one hospital regulator blithely said that people who needed those services could go elsewhere.

An Example of Catholic Courage

It is good to hear stories about people of conscience who work as administrators and doctors at some Catholic hospitals. These are individuals who choose to provide life-saving medical services frowned upon by bishops to pregnant female patients in emergency situations.

Sister Margaret McBride, a nun who worked as the administrator of St. Joseph’s Hospital and Medical Center in Phoenix, Arizona, chose to sign off on an abortion “for a woman who was eleven weeks pregnant and suffering from life-threatening pulmonary hypertension.” The woman was twenty-seven-years-old and the mother of four children. Doctors at the hospital had determined that terminating the woman’s pregnancy was the only way to save her life because her heart and lungs were in jeopardy. The nun’s action did not sit well with Phoenix Bishop Thomas J. Olmsted. The bishop was “furious” and demoted Sister McBride. He also announced the she had automatically excommunicated herself from the Catholic Church by her actions. Olmsted also stripped the hospital of its affiliation with the Roman Catholic diocese.

In his New York Times column Tussling over Jesus, Nicholas Kristof said that Sister McBride appears to be the individual in this story who “emulated the life of Jesus” and not the bishop. Kristof wrote that Bishop Olmsted had spent much of his life “as a Vatican bureaucrat climbing the career ladder.” He added that what happened at St. Joseph’s Hospital “is a bellwether of a profound disagreement that is playing out at many Catholic hospitals around the country.” Kristof believes that we are likely to see more clashes like the one between the bishop and the hospital in Arizona in the future “as the church hierarchy grows more conservative, and as hospitals and laity grow more impatient with bishops who seem increasingly out of touch.”

Click here to watch a PBS video on the subject of Catholic-Secular Hospital Mergers. The video is just under ten minutes long.

SOURCES

Women’s Health and Lives at Risk Due to Religious Restrictions at Hospitals, New Center Study Shows: National Women’s Law Center Files Complaint with Department of Health and Human Services (National Women’s Law Center)

Below the Radar Fact Sheet: Religious Refusals to Treat Pregnancy Complications Put Women in Danger (National Women’s Law Center)

Assessing Hospital Policies & Practices Regarding Ectopic Pregnancies & Miscarriage Management (National Women’s Law Center)

Commentary: Dust-up over contraceptive rule ignores rights of employees (The Kansas City Star)

Catholic hospitals serve one in six patients in the United States (National Catholic Reporter)

U.S. Catholic Bishops Major Force Behind War on Women: Statement of NOW President Terry O’Neill (NOW)

The Men Behind The War On Women (Huffington Post)

Prescription For Disaster: Hospital Mergers And Heavy-Handed Tactics Are Giving The Catholic Hierarchy An Increasingly Problematic Role In American Health Care (Americans United for Separation of Church and State)

House Passes H.R. 358, the “Let Women Die” Act of 2011 (RH Reality Check)

Catholic Death Panels Coming to a Hospital Near You (Ms. Magazine)

Employees Need Birth Control Coverage Mandate (The Nation)

Hospital merger limits medical options: Catholic rules will bar tubal ligations at University hospital (Courier-Journal)

Catholic-Secular Hospital Mergers (PBS)

Medical Emergency: Catholic Hospitals Usurp Patients’ Rights (The Humanist)

Merger Watch

Tussling Over Jesus (New York Times)

Americans almost evenly split over conscience exemption in birth control coverage (The Times-Picayune)

Contraception and Separation (Turley Blawg)