For the last several weeks, all eyes have been focused on the high-profile clash between Catholic bishops (if not their parishioners) and the Obama administration over mandated insurance coverage for contraception at their non-church institutions. But in cities and towns across the country, a second battlefront is jeopardizing access to essential reproductive care for millions of American women. As The New York Times and the New Republic each recently documented, the expansion of Catholic hospitals nationwide is putting women's reproductive care—and in some cases, their lives—at risk.
For over a hundred years, Catholic hospitals have been one of the cornerstones of the U.S. health system, providing care to tens of millions of Americans of all faiths, races, ethnicities and income levels. TNR's Jonathan Cohn explained just how big a role they play and the public support they enjoy in return:
Today, Catholic hospitals supply 15 percent of the nation's hospital beds, and Catholic hospital systems own 12 percent of the nation's community hospitals, which means, according to one popularly cited estimate, that about one in six Americans get treatment at a Catholic hospital at some point each year. We now depend upon Catholic hospitals to provide vital services--not just direct care of patients, but also the training of new doctors and assistance to the needy. In exchange, these institutions receive considerable public funding. In addition to the tax breaks to which all nonprofit institutions are entitled, Catholic hospitals also receive taxpayer dollars via public insurance programs like Medicare and Medicaid, as well as myriad federal programs that provide extra subsidies for such things as indigent care and medical research. (Older institutions also benefited from the 1946 Hill-Burton Act, which financed hospital construction for several decades.)
But increasingly, Cohn cautioned, "the dual mandates of these institutions—to heal the body and to nurture the spirit, to perform public functions but maintain private identities—are difficult to reconcile." For many communities, a Catholic facility is already the only choice. And with the accelerating trend of hospital mergers and partnerships, policies forbidding contraception, abortion and sterilization are becoming the norm at formerly public hospitals. In cities around America, the result is growing confusion for physicians and greater risk for their patients.
As The New York Times detailed, over just the last three years about 20 new partnerships combining stand-alone hospitals or smaller systems with larger, financially stronger Catholic institutions is adversely impacting the availability of common reproductive health care services. For example:
In Seattle, Swedish Health Services has offered elective abortions for decades. But the hospital agreed to stop when it joined forces this month with Providence Health & Services, one of the nation's largest Catholic systems.
And when Seton Healthcare Family in Texas, a unit of Ascension Health, began operating Austin's public Breckenridge hospital in 1995, it curbed reproductive health care services available to its patients:
In that case, Mr. [Charles] Barnett [of Ascension Health] says the system never agreed to provide services like elective abortions and sterilizations, and public officials and hospital administrators initially struggled to find a compromise. Although another system eventually offered sterilizations on a separate floor of the hospital, complete with a separate elevator, another hospital now provides those services.
Increasingly, the clashing requirements of the Catholic hospitals' public mission and religious tenets are putting patients, doctors and staff at risk. In 2007, physician Ramesh Raghavan wrote in the Journal of the American Medical Association of his wife's experience. As Cohn explained the horrifying episode:
[Raghavan's wife], a woman, also pregnant with twins, whose pregnancy was failing, threatening infection that could jeopardize her ability to have future children and perhaps her life. Distraught, she and her husband decided to terminate the pregnancy--only to learn the Catholic hospital would not perform the procedure.
A few years later, New Hampshire waitress Kathleen Prieskorn went to her doctor's office after a miscarriage—her second—began while she was three months pregnant. She quickly learned that her emergency was not one for which treatment would be available from her hospital's new operators:
Physicians at the hospital, which had recently merged with a Catholic health care system, told her they could not end the miscarriage with a uterine evacuation--the standard procedure--because the fetus still had a heartbeat. She had no insurance and no way to get to another hospital, so a doctor gave her $400 and put her in a cab to the closest available hospital, about 80 miles away. "During that trip, which seemed endless, I was not only devastated but terrified," Prieskorn recalled. "I knew that, if there were complications, I could lose my uterus--and maybe even my life."
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