by Anne Chalfant
Illustration by Malcolm Garris/PhotoDisc
November 6, 1998

When Catholic hospitals merge, or acquire, non-Catholic hospitals, reproductive health services become a chip on the bargaining table. Some, though not all, of these unions go beyond eliminating abortion, and cut off a wider range of previously offered reproductive services-including tubal ligations, "morning-after" pills, and in vitro fertilization.

Services eliminated

In Northern California's rural Susanville, the 1986 purchase of Lassen Community Hospital by Mercy General Hospital of Sacramento eliminated sterilizations and abortions in the community's only hospital, said Charlotte Newhart, chief administrative officer of the American College of Obstetricians and Gynecologists. And in Southern California's Beach Cities Health District, serving Redondo Beach, Hermosa Beach, and Manhattan Beach, Little Company of Mary Hospital in Torrance is now leasing the publicly owned South Bay Medical Center in Redondo Beach. Tubal ligations, emergency contraception, and abortion, all once available, are no longer offered. A directive on health care issued by the U.S. Catholic bishops outlined a list of procedures prohibited in Catholic hospitals, including tubal ligation, in vitro fertilization, contraceptive devices and "morning after" pills-even for cases of rape or incest. However, not every merger with a Catholic hospital or system results in elimination of these services.

Merger model

The "community sponsorship model"--developed by Catholic Healthcare West (CHW)--is venturing a new route. The largest owner of California nonprofit hospitals, CHW points to a model that allows continuance of "all of the services that they're currently providing with respect to sterilization and birth control," said Debbie Cantu, director of communications for CHW. "One thing that we ask them not to do is abortions," she said. The CHW model is in place at Bakersfield Memorial Hospital and at Community Hospital of San Bernardino, though physician-led litigation challenging the affiliations is under way in both communities, said Susan Fogel, attorney with the Women's Health Law Center in Los Angeles.

Sierra Nevada Memorial Hospital in Grass Valley, a small town in the Sierra foothills, is also a CHW partner under the community sponsorship model. Sierra Nevada's 1995 move toward a merger with Mercy General Hospital of Sacramento, owned by CHW, prompted community activism in Grass Valley. "It was a pretty hot topic in the community," said Joseph Lloyd, MD, an anesthesiologist and board member at Sierra Nevada Memorial Hospital.

From the start, Lloyd said, the hospital sought a partner compatible with the community health orientation of this rural hospital, and Mercy General Hospital of Sacramento matched Sierra's commitments on service to the poor and local control. But the Catholic religious directives on reproductive services were not a match in Grass Valley, Lloyd said.

The committee's concerns culminated in a meeting in the high school gymnasium, with more than 100 attending. In the end, "It became obvious that 'ethical directives' [of the U.S. Catholic bishops] weren't going to work for us as a community-recognizing that we did not want to be a Catholic hospital," Lloyd said. "We did spell it out in terms of [wanting to continue] tubal ligations, sterilization, dispensing birth control, and offering rape victims the morning-after pill." In response, CHW developed its hybrid community sponsorship model. Of the resulting 1995 affiliation, Lloyd said, "We've been real fortunate. Certainly the bishop in Sacramento allowed Mercy to go with a different approach."

Areas of concern

The American College of Obstetricians and Gynecologists is mindful of the loss of reproductive services in several California rural regions, said Newhart. But Newhart anticipates a "much bigger problem in the future." She sees the possibility of difficulties where managed care contracts link patient and physician to one specific hospital-potentially a Catholic facility that limits reproductive services.

Even in urban areas, Newhart said, patients may find themselves unable to procure tubal ligations, contraception following rape, and the range of reproductive services-unless they can pay out of pocket for services offered in an alternate hospital other than the one linked to their insurance. Fogel is critical of hospital boards willing to give up reproductive health services in mergers, pointing to Beach Cities Health District's decision to lease publicly owned South Bay Medical Center to Little Company of Mary Hospital.

However, Beach Cities Health District board member Vanessa Poster defended the lease of the hospital, citing the low numbers of reproductive health services that had been previously provided by the hospital. She said they can also be sought elsewhere in the community. Fogel said people wake up belatedly to lost services. "When you tell them that a woman with lupus can't get a tubal ligation even if her doctor believes a pregnancy could be life-threatening, or that a couple couldn't get fertility treatments, the general public is often shocked," Fogel said. "They certainly would never think you couldn't get condoms to prevent the spread of AIDS."

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