One year after Washington State’s Attorney General issued a formal opinion related to hospital taxing districts and their obligation to provide appropriate care to pregnant women, pregnant women around the state are finding some Public Hospital Districts refusing to support maternity care services.
Here’s how that happened on San Juan Island.
San Juan Island lies in the NW corner of Washington State and is accessible only by ferry, boat or air. The island has one hospital, PeaceIsland Medical Center, a critical access hospital which also provides primary care. PeaceIsland is owned and operated by PeaceHealth, a Catholic health care ministry that says it follows the Ethical and Religious Directives for Catholic Health Care, a 43-page set of doctrinal rules promulgated and enforced by the U.S. Conference of Catholic Bishops.
PeaceIsland Medical Center receives a public tax subsidy, paid for by island residents, of approximately $1.5 million a year. The contract between PeaceHealth and the public hospital district ensures that 95-97% of all funds available through the hospital taxing district’s levy authority over the next 50 years will go to PeaceHealth.
Islander concerns about whether the public hospital taxing district on San Juan Island was violating the Reproductive Privacy Act led to a request for a Formal Opinion by the Attorney General. His formal opinion, issued in August 2013, essentially said that any public hospital taxing district which supports maternity care must also provide substantially equivalent support for abortion and contraception services.
PeaceHealth responded to the AG’s opinion by clarifying that it “provides NO maternity care” on San Juan Island, which in its view, meant that the public hospital taxing district was under no obligation to provide support for contraception or abortion either.
In policies submitted to Washington’s Department of Health in March, 2014, PeaceHealth further said that “PeaceHealth does not allow direct abortions. PeaceHealth does allow the indirect termination of a pregnancy as a result of a direct intervention against a maternal pathology to save the life of the mother.”
PeaceHealth’s position on abortions is consistent with the ERDs: In Catholic hospitals, physicians can never terminate a pregnancy “directly,” but under certain circumstances, such as when a fetus is encased in a tumor, they can treat a “pathology” that threatens the life of a mother, thereby causing an “indirect” termination of a pregnancy. Where no pathology exists and the danger to a woman is the pregnancy itself, no pregnancy termination is allowed. Women who want or need a pregnancy termination, no matter the cause, are expected go elsewhere.
When PeaceIsland Medical Center is incapable of meeting the emergency needs of a patient, those patients are typically flown off-island for advanced care via a publicly-subsidized air transport service. On the San Juan Island Emergency Services website, patients are advised that “Due to changing and severe weather patterns, however, sometimes helicopters and planes cannot fly or can be significantly delayed because they are on another call.”
Recently, in testimony before the San Juan County Board of Health, Dr. Michael Edwards, who chairs the San Juan Public Hospital District Board, said that in 2013, there were 32 weather-related “turndowns” because of “known icing conditions.”
Dr. Edwards did not specify whether any of those “turndowns” involved a pregnant woman.
In that same May 21st meeting, Dr. Edwards and Jim Barnhart, the administrator for PeaceIsland Medical Center, affirmed that PeaceHealth provides no prenatal care on San Juan Island, even though it is a Critical Access Hospital which also provides primary care, cancer care, surgeries, and colonoscopies.
According to Barnhart, PeaceHealth employs no physicians with the background and/or training to appropriately treat pregnant women and there are currently no plans to hire a primary care physician who can provide prenatal care. In an announcement made after the May 21st meeting, PeaceHealth said that the five most recently-hired physicians include three emergency room physicians, an internist, and a surgeon.
When asked about the Ethical and Religious Directives and how they impact patient care, Jim Barnhart said, “I can’t comment on how a document may impact an individual physician….I’m not an expert on the ERDs.”
Although PeaceHealth does not provide prenatal care, PeaceHealth does lease space to an ob-gyn and a midwife from off-island, who can see patients on an appointment basis. (Anyone leasing space in the PeaceHealth facility is also required to abide by PeaceHealth rules.)
According to Barnhart’s testimony, PeaceHealth is also not prepared to handle a D&C procedure, which the Mayo Clinic defines as a procedure to remove tissue from inside a woman’s uterus. According to the Mayo Clinic, “Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.”
When asked what happens when a woman faces a pregnancy-related crisis during a time when air transport is not available, Barnhart said that “Phone calls are made to obstetricians and other specialists on the mainland” to guide the available staff.
At this point, Dr. Michael Edwards, perhaps wanting to build support for more air transport services and funding said, “I just want to raise the issue of continuing dependence on air transport and….all you need are two bad things happening simultaneously, and you’ve got a disaster.”
So now, we have a situation on San Juan Island where: 1) none of the doctors on staff at the only hospital provide care regularly to pregnant women, 2) the physicians at the only hospital are expressly forbidden from ever “directly” terminating a pregnancy and are unprepared to do a procedure commonly done in conjunction with a miscarriage; and 3) air evacuation is frequently unavailable because of other calls or, as happened more than 30 times in the last year, because of “known icing conditions.”
The situation on San Juan Island is dangerous in the extreme. All it will take for a woman to pay the ultimate price is a pregnancy-related crisis in bad weather where on-island physicians are ill-prepared and/or afraid to act for fear of violating the ERDs and the policies PeaceHealth submitted to WA’s Department of Health.
Which raises a question: When a vendor and a government agency (in this case PeaceHealth and the public hospital taxing district) deny services to pregnant women in order to avoid compliance with WA’s Reproductive Privacy Act, and in the process create foreseeable and extreme danger to pregnant women, who should be held accountable?
(A video of the May 21 testimony given before the San Juan County Board of Health by the chair of San Juan Island’s public hospital district and the chief administrator of PeaceHealth is available here.)