Author Archives: catholicwatcher

Federal Judge: No Contraception for Employees of Catholic Institutions

According to the Boston Globe, a federal judge in Oklahoma City has granted nearly 200 Catholic employers an injunction to temporarily prevent the US government from “forcing” them to provide insurance coverage for contraceptives.

Here’s the complete post.

Noteworthy is the judge’s commentary that members of the Catholic Benefits Association, which filed the lawsuit in March, “believe in the Catholic teaching that any artificial interference with the creation and nurture of new life is wrong.”

The decision raises some questions regarding the recent statement by the chief spokesperson for Providence Health that they don’t discriminate on the basis of religion, which means that many of the people affected by this decision are nonCatholics.

Basically, the problem is this:

Even though Catholic institutions hire people of many different faiths and take public tax dollars, they believe it’s within their right to deny employees contraception coverage.  In fact, the Catholic Benefits Association believes that any non-profit or private for-profit company where the ownership is 51% Catholic should be allowed to deny contraception benefits to its employees and to limit insurance coverage for any health procedure that violates Catholic doctrine.

So now, we have a situation where the Catholic Church is very clear that it should be allowed to impose its views on employees in any situation where the majority of the ownership and/or control is Catholic, even when the employees are not.

The rights the Catholic Church is insisting upon of course will also end up being granted to people of other faiths who want to impose their views on others.  You can imagine the HR benefits conversation a year or two down the road:

“Genital mutilation?  Yes, that’s covered, but the porcine-based thyroid medicine you depend on to manage your metabolism and body temperature is completely out.  And the treatment for Parkinson’s that your husband needs?  Well, that’s out too, because the owner’s first wife who shares ownership had a bad experience with someone who has Parkinson’s and she has a sincerely held belief that “those people” don’t deserve medication.  And the owner’s second current wife (did I mention the owner isn’t from here?) doesn’t want your kid’s autism treatments covered because she has a sincerely held belief that your kid’s behaviors are caused by Satan.  The fourth wife is a Rastafarian so I would try to avoid any amputation scenarios because she doesn’t believe in amputations.  Oh, and I’m sorry, I meant to tell you about the fifth wife who sincerely believes that blood transfusions are completely and utterly wrong.  And the sixth, well she’s a fan of Tom Cruise, and after seeing that he doesn’t believe in mental health care, she’s decided that medical care for mental health issues violates her sincerely held beliefs.”

Judge Says Eastside Catholic Firing of Gay Vice Principal Case Should Proceed

Both the Issaquah Reporter and National Catholic Reporter have stories out today about the decision by Judge Catherine Shaffer, who denied a motion to dismiss the case filed against Eastside Catholic by former vice principal Mark Zmuda against the school and the Archdiocese of Seattle.  It’s going to be a very interesting suit, with implications for the tens of thousands of health care employees across Washington State who work for Catholic health care ministries.  Should they believe the promises against anti-discrimination touted on websites, or should they know that because they work for a Catholic ministry and the Catholic Church and its bishops teach that contraception, gay sex (or any unmarried or married non-procreative sex, for that matter) is immoral, they have reason to fear for their jobs and if they get fired, they should have known better?  Stay tuned.

According to the NCR story:

Among statements in Zmuda’s filing:

  • Because its handbook and website have stated that the school “would not discriminate on the basis of an employee or applicant’s race, religion, creed, color, sex, age, national origin, marital status, sexual orientation, or any other status or condition protected by local state or federal laws” … “ECS should have reasonably expected that its employees would rely on these promises of non-discrimination and exercise their legal rights to marry”;
  • During a meeting in November with Eastside administrators, Zmuda was told his marriage last summer to his longtime partner was “none of their (ECS’s) business” and that he “had ‘full support’ from the ECS administration”;
  • The school president told Zmuda about a week later that he would be “terminated unless he filed for a divorce,” but also that “if he were to divorce his husband, ECS would pay the costs of holding a ‘commitment ceremony’ in place of a wedding”;
  • On Dec. 16, the school president told Zmuda that she had met with Archbishop J. Peter Sartain “and others” to discuss the situation, that “Mr. Zmuda would be terminated because of his status as a married gay man,” and that the decision “came from the archbishop, and not the school.”
  • The school president called a faculty meeting Dec. 19 “to inform ECS employees of Mr. Zmuda’s termination” during which she “confirmed … the decision to terminate Mr. Zmuda was made by the archdiocese and that her ‘hands were tied’.”


Why Did the Board of Swedish Authorize an $810 Million Gift to the Catholic Church?

This post examines how former Swedish CEO and now Providence CEO Rod Hochman engineered, and the Swedish board authorized, a takeover by Providence Health that resulted in a $810 million gift to the Catholic Church. Although many board members have resigned since then, no one has investigated or held them to account for the deal that enriched an entity of the Catholic Church by more than $800 million and gutted the independence of what had been Seattle’s largest secular nonprofit medical system.

In 2012, Providence Health completed its takeover of Swedish Medical Center. Swedish is now a wholly-owned subsidiary of Providence.

A few years earlier, the prospects for such a deal looked remote. A glowing 2010 report in the Puget Sound Business Journal crowed about Swedish CEO Hochman, saying he was “at the top of his profession and known as one of the most powerful physician executives in health care. Hochman has been at Swedish three years, and in that short time has made dramatic strides in everything from broadening regional and national conversations on the delivery of health care, to fundraising.”

So when the deal between Providence and Swedish was first announced in October, 2011, many medical providers, business watchers, and patient advocates from throughout the Seattle community were taken aback. Rod Hochman portrayed it as all good news. The Seattle Times quoted him saying, “Health care must be made more cost-effective, and the only way you get there is by clinical transformation – change led by health care providers and not a bunch of bureaucrats.”

Patient advocates, who viewed the deal in terms of how Catholic restrictions would impact patient care, were skeptical, even after a 10-year deal with Planned Parenthood was announced.

In providing context for the deal, the Seattle Times reported that, “Citing a $19 million budget gap, (Swedish) recently announced it planned to reduce its workforce, evaluating some 300 positions.”

The affiliation would provide financial strength and operational efficiencies to Swedish. The Seattle Times referred to conversations with both the CEO of Providence and Hochman, then the CEO of Swedish (and now CEO of Providence): “It is not, the two emphasized, a merger or acquisition.”

Since its inception in 1907, Swedish had been known for scientific evidence-based care and prudent financial management. Then in the 21st century, as Seattle-area whispered narrative went, Swedish went on an aggressive expansion spree, eventually overextending itself to the point where it needed rescuing from a larger, more financially secure system.

Or did it?

According to the Providence Health Systems financial statements for 2013, the “affiliation resulted in an excess of assets acquired over liabilities assumed, reported as a contribution from Swedish to the (Providence) Health System of approximately $810,299,000. The unrestricted portion of the contribution of $744,252,000 is included in net nonoperating gains in the accompanying combined statement of operations.”

For the year ended December 31, 2013, Providence reported assets of $13.97 billion and total liabilities of $6.6 billion. Total operating revenues were $11.1 billion. In a section labeled “Organizational Changes,” Providence reported that:

“On February 1, 2012, Providence Health & Services (Providence) and Swedish Health Services (Swedish) (Providence and Swedish are collectively referred to as the Health System) effected an Affiliation Agreement, which financially, clinically, and operationally integrated the two health systems….Providence and Swedish have affiliated to create a fully integrated, nonprofit charitable health care system serving communities throughout Western Washington….This transaction was accounted for as an acquisition under Accounting Standards Codification (ASC) 958-805, Not-for-Profit Entities – Business Combinations. No consideration was paid by the Health System to acquire the net assets of Swedish. Swedish also operates the Swedish Medical Center Foundation to provide fundraising to further the charitable, educational, healthcare, and scientific activities of Swedish. The results of operations of these entitities have been included in the combined statements of operations of the Health System since the February 1, 2012 effective date of the Affiliation.”

The 2012 financial results of Swedish included in the “Health System’s 2012 combined statement of operations during the eleven-month period from the date of the affiliation through December 31, 2012 showed an “Excess of revenues over expenses of $330,209,000.” In other words, over an 11-month period after it supposedly needed to be rescued by Providence, and after its takeover was counted as an $810 million gift to the bottom line, Swedish contributed more than $330 million in additional profit to Providence.

A 19 million shortfall in one year, followed by an $810 million dollar asset contribution to Providence, and a $330 million 11-month post-acquisition contribution from Swedish to Providence’s bottom line.

Providence rewarded Rod Hochman by making him CEO over all of Providence. His total compensation in 2012 was $1.7 million dollars – an absolute bargain for a dealmaker who arguably brought in more than $1 billion to Providence in his first year.

WA Hospital Association chief argues for less transparency

In a recent community discussion up in Port Townsend on the Olympic Peninsula, Jeff Mero, the executive director of the Washington Hospital Association, made the case for less transparency.

Here’s what he said, as reported by the Port Townsend leader in this article:

“The more we push the bishops to be clearer about what the rules are, the more strongly we push for it to be black and white, the less likely we are to like the answer that comes out of that discussion.”

Let’s be totally clear.  The bishops are VERY clear about what the rules are and they are requiring hospitals and physicians across the state to follow their rules as a condition of employment, and in some cases, privileges.  These rules get implemented through internal policy statements and administrative oversight, including oversight from religiously driven ethics committees who operate under the scrutiny of the local bishop.

As UCSF professor and researcher Lori Freedman has documented, patient care in WA State is already being compromised because of the bishops’ rules.  Unfortunately, the patients often have no idea it’s happening to them because they’re not told what the bishops’ rules are and they have no way of knowing that their physicians are forbidden in many cases, especially those related to reproductive health care and end-of-life care, from providing the care that they believe is in the best interest of patients.

If you have any doubts, consider that in the most recent PeaceHealth policies posted online it says: “PeaceHealth does not promote or condone contraception….PeaceHealth requires that natural family planning information be available in the settings where PeaceHealth providers serve.”

Perhaps a key reason that physicians typically don’t recommend natural family planning to women who indicate that they don’t want to become pregnant is its high failure rate – according to the Guttmacher Institute, 24% of women who use “fertility awareness methods” under “typical use” conditions will get pregnant in a given year.  (By the way, that makes it less effective than the “withdrawal” method.)  Perhaps that’s why less than one percent of women aged 15-44 use “fertility awareness-based methods.”

With an implant (a reversible long acting contractive), “typical use” effectiveness is .05 percent, meaning 1 in 2000 women will get pregnant in a year.  (For comparison purposes, 1 in 200 women will get pregnant in a year after having had a tubal ligation.)

Similarly, PeaceHealth physicians will honor an advance directive UNLESS it “conflicts with hospital policy, law, or the Ethical and Religious Directives for Catholic Health Care.”  (And again, remember that these Directives require tube feeding in the case of a persistent, vegetative coma.)  Similarly, PeaceHealth caregivers “must not provide referral information to patients or families about organizations that actively participate in the arrangement of Physician Assisted Suicide.”  (Note that PeaceHealth refuses to even use the words “Death with Dignity” because that would acknowledge that a majority of Washington voters intended for people to be able to exercise their rights under the law.  I’m guessing that voters had no idea physicians would be operating under gag rules that prevent them from even telling patients how they can find a physician who will help them.)

The bishops’ rules distort the practice of medicine in ways that are damaging to patients and to the doctor-patient relationship.  The more we can do to shine a light on how these rules affect both physicians and patients, the greater the chance of finding solutions that truly respect the rights of patients, and the privacy of the doctor-patient relationship.


A WA Muslim Imam’s Advice about Women? Beat Them

In doing research for CatholicWatch, I wanted to help people understand what will happen as we allow religion to drive and control medical decisionmaking.  Jehovah’s Witness adherents don’t believe in blood transfusions, Rastafarians don’t believe in amputations, other religions refuse to allow the use of porcine-based (pig) medicines, etc.

A medical system governed by religion and religious leaders means beliefs that by any science-based stardard might seem horrific can and will be imposed on physicians and patients.  You can’t allow Catholic bishops to impose their beliefs without also allowing other religious leaders to impose their beliefs under similar circumstances.

And then, of course, there’s the issue of women, and specifically, how some religions systematically diminish women.  In Catholicism, women cannot be priests, bishops, or Cardinals, (or Pope) and they must answer to men.  Just this week, the Vatican’s chief doctrine enforcer told American nuns  that they cannot choose their own speakers or honorees without first getting clearance from Seattle’s Archbishop Sartain.  In any other situation, the idea that women can’t be trusted to even choose a speaker without the approval of a man would be called out as controlling, abusive behavior.

It was in this context that I came across this chilling video of a local Muslim Imam giving an educational session in Sammamish, Washington.  The person who gave this talk is an employee at Microsoft, where I used to work.  You should watch the video for yourself, but here’s a rough guide to what he teaches beginning about 8:10 into the video:

“When you learn a woman is going astray, you advise her, then you put her in a time out, and then you hit her.”

You can watch for yourself and then consider whether we want “holy men” to have rights that supercede those of physicians and patients.

CHI/Franciscan Takeover of Harrison – Overview and Q&A

On May 1, 2014, I’ll be appearing on a panel in Port Townsend alongside Harrison CEO Scott Bosch and representatives from LegalVoice and the American Civil Liberties Union to discuss issues related to religion and health care.  In preparation for that conversation, I wanted to provide background about Harrison Hospital, which was taken over by CHI/Franciscan in 2013.

Can you explain the organizational structure?

In August, 2013, Harrison Hospital in Bremerton, WA became part of the Franciscan Health System and thus part of Catholic Health Inititatives, an ultra-conservative Catholic health care ministry with $12.5 billion in revenue which reports directly to the Vatican, is technically an entity of the Catholic Church, and which requires all employees to follow the Ethical and Religious Directives for Catholic Health Care as a condition of employment.

According to documents filed with Washington State on October 7, 2013, Harrison is now part of the Franciscan Health System. In a letter on Catholic Health Initiatives letterhead, CHI makes clear that Harrison is officially part of Franciscan:  “SJMGroup, a non-profit tax-exempt corporation became the sole corporate member of Harrison and a corporate member of FHS (Franciscan Health System).”

In a footnote, CHI said in the same letter that “Franciscan anticipates changing the name of SJMGroup in the near future.  We anticipate the new name will be Franciscan Health Ventures.”

Franciscan is wholly owned by Catholic Health Initiatives.  On the Franciscan 990 for 2011, the organizational structure for Franciscan is explained as follows:

1) The sole member has the power to appoint, replace, or remove the members of the board of directors; and

2) The sole member of the organization is Catholic Health Initiatives, a Colorado non-profit organization.

Why does Scott Bosch, CEO of Harrison, insist that Harrison is “secular”?

I don’t know.  Harrison is part of Catholic Health Initiatives, which reports to the Vatican and is part of the Catholic Church.  The description of it as a secular entity mystifies me.

Bosch has said that Harrison does not have to follow all of the ERDs.  Does that make it secular?

When an entity is controlled and owned by an entity of the Catholic Church, it is Catholic.  A Catholic entity, by definition, is not secular.

But what about the fact that Harrison still allows doctors to provide birth control?

Over time, Harrison’s policies will mirror the policies of its parent organization, Catholic Health Initiatives.  In a recent article, CHI Senior Vice President John DiCola made clear that it gradually brings all partners into the fold.  “It doesn’t happen overnight, but we have a lot of programs and communications that help staff in our markets understand who we are–not just what we do, but how we do it.  We also bring organizations into CHI by setting some standards and by enforcing those standards.”

What can people in Bremerton do?

Your hospital is now owned and controlled by the Catholic Church.  As we’ve seen in other hospitals and medical facilities around the state and the country, the policies will change over time, likely under the radar of members of the community.

The time to have intervened was before Harrison was taken over.

In order to get any relief now, we need a systematic fix that is appropriate for the scale of the problem.  And in order for that to happen, people need to show their outrage and demand change from politicians, business leaders, and through the legal system.

But haven’t other Catholic-secular partnerships worked out?  What about Swedish?

Swedish is a wholly owned subsidiary of Providence Health Systems. it reports up through a management chain that is controlled by the Providence board.  Insiders at Swedish report that the culture and rules at Swedish are becoming Catholic.  Two concrete examples of how policies and culture are changing:

1) At the time the “affiliation” (which became a takeover) was announced, Swedish said the only change was that it would longer do “elective” abortions.  Since then, the goalpost has moved, and now Swedish says it will only do “emergency” abortions.  Women who are diagosed with a severe fetal abnormality or who learn that their fetus will never be viable cannot get an abortion at Swedish because that is not considered an “emergency.”

2) The legal, HR, and ethics teams have been combined, and Swedish senior leadership now undergoes Catholic Faith Formation leadership training, which was specifically designed to inculcate lay leaders into the values and traditions of the Catholic Church.

In a recent comment posted to an Open Letter to Swedish Donors, the former Chief of Medicine at Swedish said, “I am appalled by the heavily Catholic influence now being expressed (at Swedish). A leading general hospital in the the community should not be under the control of a religious organization. We did very well as an independently run, highly professional institution.”

What do you think is going to happen?

I don’t know and it all depends on Washington voters and citizens.  Right now, Washington voters and citizens are complacent and it’s because so much of this is happening under the radar.  It’s quite likely the catalyst for a groundswell will be a story or stories so horrifying that people can no longer ignore the problem of medieval rules dictating patient care.  This was the case in Ireland, when an utterly preventable death of a young mother served as a catalyst to cause a nation to change its anti-abortion laws.

We’ve already seen that Catholic hospitals are willing to turn a miscarrying woman away and we’ve had situations here in WA where women’s lives and health have been put at risk. Perhaps one of them will end up being a plaintiff here.

Of course, some of the most vulnerable people are the dying.  A volunteer from Compassion & Choices testified last Fall in Olympia about a patient who wanted to exercise his rights under Death with Dignity but instead ended up shooting himself. The volunteer believed it happened because the physicians in that area who work or need privileges at the increasingly powerful Catholic system no longer feel comfortable helping patients exercise their rights under the Death with Dignity law.

In addition to patient concerns, the workforce is at risk.  Here in Washington State, employees of religious instititutions are exempt from Washington anti-discrimination laws that were specifically designed to protect people on the basis of sexual orientation or marital status.   Now, if you’re gay or cohabitating and you work for a Catholic health care ministry, your job may be in jeopardy.

Some of the patient and employee stories have been made public by the American Civil Liberties Union and by reseachers and reporters who’ve been tracking these issues. Perhaps soon a patient or employee story will catch fire in social media and ignite the public to take action and demand that we no longer allow religious leaders to oversee and control the health care we all pay for.

But in the meantime, check out the ACLU’s website to learn more about what you can do and then do your part.  This problem isn’t going to be solved unless we work together to make it happen.

PeaceHealth Policies Revealed – The Bishops Rule

Last week, hospitals across WA State submitted their policies to the WA Department of Health and began posting them on their web site.   PeaceHealth, which operates tax-supported hospitals in several areas around the state, has now provided written proof which makes clear it follows the Ethical and Religious Directives for Catholic Health Care and is enforcing these directives on physicians and patients.

You can find a link to the complete set of policies here.

Meanwhile here are some excerpts and analysis of the PeaceHealth policies as they apply at PeaceIsland Medical Center in Friday Harbor, Washington, and at other hospitals around the state.  (The PeaceHealth facility in Friday Harbor is specifically cited because PeaceHealth negotiated a 50-year contract where it gets a direct tax subsidy from San Juan Island property tax owners even as it retains the right to deliver only those services which fit its mission and values.)

On Death with Dignity and Other End-of-Life Policies

Increasingly, PeaceHealth and other Catholic institutions are now forbidden from using the language “Death with Dignity.”  From conversations with physicians and others, they are being directed to use the description “euthanasia” or “physician-assisted suicide.”  In its policies, PeaceHealth specifically cites the Ethical and Religious Directives, 5th edition, before saying:

“Assisted suicide, even if legalized, violates both human dignity and the common good and does not respect the sacredness of life that is fundamental to Catholic Health Care ministry.”

Here’s what else PeaceHealth has to say on the topic:
“PeaceHealth recognizes death as a part of life and, as such, does not participate in or in any way support the hastening of the end of life through euthanasia.”

And later:

“PeaceHealth caregivers must not provide referral information to patients or famillies about organizations that actively participate in the arrangement of Physician-Assisted Suicide, however, PeaceHealth does not prevent patients from seeking information on Physician Assisted Suicide from available community resources.”

So PeaceHealth now makes clear that it will refuse to provide information or referrals to any physicians or entities that actively participate with Death with Dignity, but thankfully at least PeaceHealth employees won’t take a computer or cellphone away from a dying person to prevent him/her from accessing the information on his or her own.

PeaceHealth’s hard line against any participation with Death with Dignity should be troubling to the 75% of San Juan Islanders who voted in support of the Death with Dignity statute.  And it doesn’t stop there.  PeaceHealth also refuses to honor Advance Directives that “conflict with Catholic doctrine.”

Catholic doctrine requires that people in persistent, vegetative comas be kept on feeding tubes.  Alarmingly, among some Catholic ethicists, a new front is also developing against the use of “palliative sedation,” which is a way of inducing sleep when you have a horrible end-of-life illness and pain medication won’t help.  (This can happen with a terminal brain tumor known as a glioblastoma, for example.)  The reason that “palliative sedation” is now being targeted and discussed among Catholic ethicists (and physicians and caregivers who are required to listen to them), is that palliative sedation does not allow the patient to fully experience redemptive suffering in a way that can bring him/her closer to God.  Some Catholic ethicists also promote the idea that suffering benefits the caregiver.  In a paper presented at the University of St. Thomas in Minnesota entitled “Recognizing the Value of Suffering in Caring for Terminally Ill Patients,” Catholic philospher and bioethicist Jason Eberl states,  “Caregivers are inspired to perform acts of love and compassion toward a suffering patient, which yields the development of virtue in them.”

As someone who was at the bedside of my mother and sister in their final moments, it never occurred to me that development of my virtue should have any bearing on how much pain reliever my mother and sister received.

On Abortion and Contraception

First, on abortion, here’s the PeaceHealth policy:

“PeaceHealth does not allow direct abortions.  PeaceHealth allows the indirect termination of a pregnancy as a result of direct intervention against a maternal pathology to save the life of the mother.”

As discussed previously on CatholicWatch, when Catholic health care entities talk about removing or targeting a “maternal pathology,” they are generally talking about a situation where there is something discrete like a tumor that can be removed to save the life of the mother without directly targeting the embryo or pregnancy itself.  Following is discussion on the topic from the National Catholic Bioethics Center, making clear that the only morally acceptable treatment for an ectopic pregnancy is the removal of the Fallopian tube.  To quote the ethicist:  “There is always a difference between killing someone directly and allowing someone to die of indirect causes.  We may never take the life of an innocent human being, though we may sometimes tolerate the indirect and unintended loss that comes with trying to properly address a life-threatening medical situation.”  You can read the full discussion here:

It would also be morally acceptable for a fetus encased in a tumor to be removed to save a woman’s life, but it would not be OK to abort a fetus simply because it is causing so much stress on a woman’s body, she will not survive.  Tamesha Means, the woman who was turned away from a Catholic hospital in Illinois, even though her water broke prematurely and her pregnancy couldn’t survive, couldn’t get an abortion because it would have involved directly targeting the fetus.  Similarly, Savita Halappanavar, the young mother who died in Ireland in 2012, begged for an abortion because, as a medical professional, she understood that her dying fetus needed to be removed or she might die from infection.   Instead, she was made to wait until she became infected, and the infection ultimately killed her.  She wasn’t fortunate enough to have a tumor or something else that could have been cited as the direct target of an intervention; the pregnancy itself is what needed to be directly targeted to save her life.

Here in WA, we’ve now seen several instances where women in Catholic hospitals have been denied abortions in miscarriage-related situations that put the patient at unnecessary risk.  Lori Freedman, a researcher down at UCSF in California recently described a case from here in WA where a woman was denied a D&C at a Catholic hospital even after her physician told her she was miscarrying.  He instead ordered a transfusion to treat the symptoms of her heavy bleeding, and then a second one.  The transfusions introduced Kell antibodies which could have proved fatal to a subsequent pregnancy.  It’s only because the patient was a professional midwife that she understood what happened to her, and especially how crazy and unnecessary it all was:  You can read more about the case here:

On Contraception

Here’s an excerpt from the policy:

“PeaceHealth does not promote contraception, permanent or temporary.  It recognizes that medically indicated exceptions are necessary for the wellbeing of persons and to enable PeaceHealth to contribute to the health of the communities we serve.”

“PeaceHealth requires that natural planning information be available in the settings where PeaceHealth providers serve.  Moreover, it is the obligation of PeaceHealth to develop procedures which protect and foster the values of informed consent, freedom of conscience, and the privacy of the doctor-patient relationship.  Each facility evaluates contraceptive services the same as other services to insure that patients are receiving quality care.”

So now physicians within PeaceHealth can prescribe birth control for a “medically indicated” exception.  As I’ve described earlier, requiring physicians to come up with some reason other than “doesn’t want to get pregnant” encourages them to falsify patient records in ways that are dangerous and troubling. It’s also dangerous for physicians to prescribe birth control and NOT put it into the record, because subsequent medical professonals should have an accurate picture of someone’s health – and that includes knowing what medications a person is on and why.

The prohibition against birth control just to prevent pregnancy also means that patients will not have access to newer long-acting birth control services and/or technologies that have proven to provide the safest, most effective protection against unplanned pregnancy.

And the idea that hospitals should have to discuss “natural family planning” and make such information available is insulting.  My mother and other women of her generation endured the fallacy of “natural family planning.”  In my mother’s case, it resulted in her being pregnant ten times in 12 years.  She only quit getting pregnant after she had a hysterectomy, which may or may not have even been medically necessary – but was the common (and hugely invasive) way physicians tried to help women who simply couldn’t or shouldn’t have more children.

Other issues

Of course, PeaceHealth also has prohibitions against the use of fetal stem cells and will apply its moral framework to any new treatments that become available as a result of fetal stem cell research.  On the discrimination front, PeaceHealth makes clear that it does not tolerate “unlawful” discrimination. This is why it’s so important to understand that under WA State Law, PeaceHealth is exempted from the WA state antidiscrimination laws that protect people’s rights related to marital status and sexual orientation.

To sum up, the newly articulated policies from PeaceHealth are deeply troubling, as is their imposition on physicians and patients in tax-supported hospitals.

Washington Hospital Policies Decoded – Master List Updated as of April 1

WAhospitalpolicies is an Excel file that summarizes hospital policies submitted to the Washington Department of Health.  You can view this as an HTML table here. Wherever possible, I’ve also researched applicable policies on hospital web sites in order to determine what services are available.  You can also check for the latest updates directly at the DOH web site here.

In some cases, I’ve described the policies as “Vague. Follows ERDs.”  As an example, in the case of Providence, they’ve posted a Reproductive Health Policy that includes the phrase, “rooted in our Mission, tradition, ethics, and science.”  They used this phrase as the opening to a bullet point that begins “When it comes to complex pregnancies, clinicians at Providence exercise judgment and adhere to best practices and standards of care…”

What the uninformed patient needs to know is that the “Mission” of Providence requires that they follow the Ethical and Religious Directives for Catholic Health Care, which is a set of more than 70 Directives that are, in many cases, VERY specific.  It is these Directives that dictate what “best practices and standards of care” in Catholic hospitals are.

In the case of pregnancy crisis, for example, Providence clinicians need to figure out (with the help of their ethicists and the local bishop) how to follow ERDs that say, as an example “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.”

Very specifically, in the case of an extrauterine pregnancy (which is what an ectopic pregnancy is), clinicians need to figure out how to obey Directive 48, which says, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”

So when Providence says in its published policies that “In circumstances wherein a woman’s life is in danger such as an ectopic pregnancy, providers at Providence follow best practices of surgical and non-surgical options,” it’s unclear what they’re trying to communicate and how they balance that with a very specific ERD that they are required to follow which forbids a “direct” abortion.

At some point, I hope someone asks Archbishop J. Peter Sartain a very specific question as to why the bishops felt the need to include a specific Directive about extrauterine pregnancies forbidding “direct” abortion, when by definition, such pregnancies are not viable and put a woman’s life at risk.

It’s also worth noting that PeaceHealth has provided very explicit policies showing what they do and don’t provide.  At a high level, they follow the Ethical and Religious Directives for Catholic Health Care.  Patients who care about whether they can get appropriate reproductive health care or whether their advance directives will be honored should study the policies carefully.

For corrections, additions, please contact


Catholic Hospital Policies and a Fatally Flawed Report

A few days ago, hospitals around WA State were required to submit their reproductive, end-of-life, charity care, nondiscrimination, and access policies to the Department of Health.  You can find them here.

Today, Modern Health Care posted an article about the situation, saying that more than half the hospitals did not meet the regulatory deadline.  You can find that article here.

Also included in the article is a reference to a DRAFT report from the Office of Financial Management (OFM).  That draft relied on an outdated, very limited limited data set (focused on tubal ligations) and drew much broader conclusions about whether services were being curtailed.  Meanwhile Catholic systems continued their aggressive Embrace and Extinguish strategy of taking over secular systems and then cutting off services.

When Providence took over Swedish, it eliminated “elective” abortion services which included abortion services for high-risk pregnancies.  (The types of circumstances where a severe fetal anomaly might not be detectable earlier or where a fetus might run into severe trouble late in the pregnancy.)  Abortions where there’s a fetal heartbeat now have to be done off-site.  Swedish, a secular facility for more than a hundred years was THE place to go in Seattle for high risk pregnancies where termination might be medically appropriate/necessary.  Someone I know ran into these restriction and her story was recounted in an article for Seattle’s The Stranger in February of 2013.  Swedish is the largest hospital system in the Seattle area.

When Franciscan took over Highline (a network of hospitals/medical centers), it implemented the Ethical and Religious Directives for Catholic Health Care which forbid contraception, abortion, access to Death with Dignity, etc.

When Franciscan took over Harrison in Bremerton, it implemented the ERDs.

When PeaceHealth opened a new hospital/medical facility on San Juan Island (which was touted as an upgrade for an aging medical center), it eliminated access to abortion services, subsidized access to maternity services, and any physician participation in Death with Dignity.  The PeaceHealth facility on San Juan Island gets a direct tax subsidy.

PeaceHealth is now in the later stages of implementing partnership agreements with Cascade Valley and Skagit Valley Hospitals, two public hospitals.

In Bellingham, WA, the Catholic bishop asked PeaceHealth to cut off lab services to Planned Parenthood patients; only an outcry from the community kept this from happening.  PeaceHealth St. Joe’s in Bellingham gets a special tax break from the city BECAUSE it is a religious entity.

Many of the public hospitals that these Catholic systems are “affiliating with” are restricting services.  For example, PeaceHealth is set to take over running United General, a public hospital.  The policies they’ve just posted with the DOH (which includes allowing access to Death with Dignity) will soon change to bring them into line with Catholic doctrine.  

PeaceHealth also is in a partnership with UW Medicine that calls for expanded Family Medicine training.  As evidenced by a recent job posting on Linked In, family physicians at PeaceHealth in Vancouver are required to follow the ERDs.  This means UW medical students are learning family medicine in a “restricted” environment, where physicians are restricted from providing legal, medically appropriate services.  Those students are essentially learning that you can segregate services based on religious beliefs which have nothing to do with medical necessity or the best care patient standards.  UW physicians and medical students are alarmed.

These are a few examples of how and when services are curtailed.  But look for the Washington Hospital Association and the Catholic hospitals to continue pointing to a fatally flawed report that contradicts the ACTUAL policies that Catholic health care ministries now enforce on patients and physicians throughout the state.