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A Town Without Contraception

I used to live in Bartlesville, OK. It was just a short stop–six weeks–in the year of living in four towns. It’s a good thing we didn’t stay for a lot of reasons, but now I have one more.

Confidential sources told the Examiner-Enterprise this week that a meeting was held Wednesday to inform local doctors of gynecology and obstetrics that they can no longer prescribe contraceptives of any kind — if they are to be used as birth control.

How could this happen? Bartlesville is a town of only about 35,000 people. They have one hospital, Jane Phillips Medical Center. That hospital is part of Ascension Health, a large Catholic health care consortium, and nearly all of the OB-GYNs in town need to maintain privileges there in order to do their jobs.

When contacted Friday, one OB-GYN’s office confirmed that doctors had recently been told they could not prescribe birth control, but personnel appeared unsure if the policy was in effect immediately.

Only one local OB-GYN who is not affiliated with the hospital, Robert D. Oliver MD, an OB-GYN located at 226 SE DeBell Ave. in Bartlesville, remains unaffected by the measure.

Now, there are a few ways people can still get access to contraception. Dr. Oliver is likely to become as popular as he wants to be among those who don’t want to get pregnant, but those of his patients who need to be admitted to the hospital for some reason will have to have another OB-GYN while they’re there. Of course, he take everyone. Others might have family physicians who don’t need to be affiliated with the hospital. People could travel to Tulsa, 47 miles away.

People could also lie about why they wanted birth control, assuming their doctors were helpful enough, but people don’t want to have to lie to get basic health care. Additionally, only hormonal birth control is indicated for a wide range of conditions. IUDs, which are more carefree and more effective than birth control pills for the same cost, are not something you get from your doctor because you say you get migraines.

At this point, it’s hard to say how many Ascension Health facilities have put or are putting this policy in place. The local paper in Bartlesville is the only news outlet to have reported this so far, as far as I can tell. If this is a uniform policy, however, this will affect an awful lot of doctors–and far more patients.

According to online reports, Ascension Health owns more than 113,000 facilities and has 150,000 associations with more than 1,500 locations in 22 states and the District of Columbia. The company was established in November 1999 and is headquartered in St. Louis, Mo.

The company has published literature indicating it is decidedly against anything that would cause the death of a fetus.

Although their position is entirely anti-scientific, this last statement includes any form of birth control. Even if you’ve been raped, you’re probably not going to be allowed emergency contraception, because Ascension makes it clear that the situation is really iffy but hugely important (pdf). By the way, you’ve already agreed to this if you live in Bartlesville and are treated or work at the only hospital in town. No, really, the U.S. Conference of Bishops says so:

When the health care professional and the patient use institutional Catholic health care, they also accept its public commitment to the Church’s understanding of and witness to the dignity of the human person.

That comes from the Ethical And Religious Directives for Catholic Healthcare Services (pdf). You should probably read it if you live in one of those 1,500 locations in 22 states, wherever they are, or if your local hospital or clinic is Catholic-owned. There are 17 directives just in the section on “Issues in Care for the Beginning of Life”. I doubt they’ll hand you all 43 pages to read and sign off on in the emergency room.

From what I can tell, prior Ascension Health policy has been to prohibit abortion, sterilization, and the prescription of contraception only within the facilities it owns. Prohibiting affiliated doctors from providing this care in other spaces is new, assuming that this isn’t a gross miscommunication on Ascension Health’s part.

Whether this turns out to be true or not, this story exposes a gap in reproductive health protections. The Church Amendments (pdf) prohibit at the federal level discriminating against abortion or sterilization providers in granting privileges. No such protection appears (to my untrained eyes) to be granted to those who prescribe contraception, probably because no one imagined we would need that protection. Whether Ascension Health is currently moving this directions or not, it’s clear that some Catholic health group will.

We need to get regulation in place on this now.

H/T Dizzlski.

Comments

  1. Pteryxx says

    …what.

    (bolds mine)

    It is worth noting that a significant percentage of the health care delivered in the United States comes from the country’s 630 Catholic hospitals, which make up 12.6 percent of the nation’s total. People in certain areas may rely upon Catholic health care because there are few other options—nearly one-third (32 percent) of all Catholic hospitals are located in rural areas. The economically vulnerable individuals served by Medicaid are often treated at Catholic hospitals, which account for 13.7 percent of all Medicaid discharges in the United States (nearly one million patients, at 978,842).

    In addition, there are 56 Catholic health systems, which are enormous conglomerations made up of many separate Catholic-run hospitals. Catholic hospital systems are among the largest in the country—among the top five biggest nonprofit systems, four (80 percent) are Catholic, and all of the top three are Catholic. These three largest entities alone comprise 268 hospitals. Looking at the nation’s ten largest nonprofit health systems, six of the ten (60 percent) are Catholic. Of the group of the 25 largest nonprofit health-care systems, 11 (44 percent) are Catholic-run. When one considers the 868 hospitals affiliated with the top 25 largest hospital systems in the country, 493 of these are Catholic. All of those operate under the bishops’ directives.

    http://rhrealitycheck.org/article/2013/12/04/how-the-bishops-directives-derail-medical-decisions-at-catholic-hospitals/

  2. says

    How could this happen? Bartlesville is a town of only about 35,000 people. They have one hospital, Jane Phillips Medical Center. That hospital is part of Ascension Health, a large Catholic health care consortium

    This is really common in some parts of the US. And the monopoly “bubbles” for certain hospitals are pretty big, so if you want to get to a hospital or clinic not owned by the same hospital/company you sometimes have to travel pretty far.

    For example, a company called “Trinity Health” dominates healthcare provision in Minot; they’ve always had a horrible reputation (example: one of my former coworkers was given an unnecessary rubella vaccine while there for a prenatal checkup) so many people try to not use it unless necessary… except that sometimes that means traveling all the way to Bismarck.
    Given the name of the company and the name of their main hospital (St. Joseph’s), I’m assuming they’re a Catholic company as well; their website is highly uninformative regarding BC options (meaning: it’s not a thing discussed on their Ob/Gyn page, which is full of birthing/pediatrics stuff instead, and is only listed as “birth control options” on their Women’s Health Services page), so I don’t know how bullshitty they are on that topic, other than apparently preferring not to talk about it.

  3. says

    If we are not going to guillotine all the bishops, perhaps we could confiscate all the catholic owned hospitals to help pay off all the child rape victims of the catholic church & hand the hospitals to secular managers.

  4. says

    When the health care professional and the patient use institutional Catholic health care, they also accept its public commitment to the Church’s understanding of and witness to the dignity of the human person.

    No. No, they do not accept the Church’s understanding of anything. They accept health care professionals’ understanding of the best and most appropriate medical care for the human person who is the actual, you know, patient.

    My rage? There are no words.

  5. ema says

    IUDs, which are more carefree and more effective than birth control pills for the same cost, are not something you get from your doctor because you say you get migraines.

    I predict an “epidemic” of DUB complaints in Bartlesville.

    One puzzling thing is the lack of lawsuits. Voters/politicians/religious hospital officials abusing uterine containers is the norm. But lawyers not pursuing easy, big money malpractice cases just because they disdain potential clients, not so much.

  6. Randomfactor says

    America needs a Church of the Holy Hormone, which has as one of its sacraments the prescribing and use of contraceptives.

  7. says

    >>>When the health care professional and the patient use institutional Catholic health care, they also accept its public commitment to the Church’s understanding of and witness to the dignity of the human person.<<<

    WRONG!

    i accept my public commitment to MY understanding of and witness to the dignity of the human person.

    i have my personal beliefs, but my conscience dictates that the best interests of my patients overrides everything.

    THAT is my understanding and witness to the dignity of the human person.

    i have come to realize that not all health care providers are that fully committed to their patients and for that reason, i can no longer support individual conscience clauses.

    AND, giving such rights to any institution not only takes away the rights of my patients, it also denies me of my right to fully commit to them.

    now we all realize here that science teaches us that BC is not abortion. however, since their stance is based on their belief that it is, i think my argument is valid.

    i know i can't be the only nurse in the world that believes that my patients need to come first. i simply can't be. there have to be others, and if i feel this way, then surely there are others that do?

    i can't just expect it all to be a piece of cake and be seen as an angel of fucking mercy. shouldn't i expect my vocation to come with personal struggle?

    i just don't think that refusing to put my patients best interests ahead of myself is very admirable.

    that's not who i want to be.

    and according to this article, they are putting other health care professionals, i have no idea how many, into positions where not only can those who refuse to put their patients first ( in which case they shouldn't be in health care, imo) but they are actively denying health care providers the opportunity to commit fully to their patients.

  8. cuervocuero says

    @7. Wouldn’t matter if there was a church of the Holy Hormone. What this community and every community needs is either…

    …a breaking of the healthcare monopoly the Catholic church is abusing to run a theocratic “company town”, leaning on residents’ most basic survival needs
    …or some serious separation of church and state asskicking with complementary examination of their use of public monies.

    Both options sadly seem to need money, lots of money. And political will.

    It’s good to see the Catholic church shows what it will really do, especially for financially disadvantaged people, when it has them literally by the eggs and balls.

  9. Pteryxx says

    Singham just discussed the Means lawsuit vs the US Conference of Catholic Bishops:

    http://www.propublica.org/article/in-healthcare-suit-against-catholic-bishops-the-specter-of-an-early-defeat

    According to the suit, Means’ alleged mistreatment came to light in late 2012 or early 2013 when an unidentified researcher working on a federally funded project at Mercy uncovered what she said were not one, but five instances in which doctors there failed to terminate the pregnancies of women who were clearly miscarrying.

    When the researcher asked hospital officials to explain, they allegedly told her that they were following the Ethical and Religious Directives for Catholic Health Care, or ERDs — guidelines that govern medical treatment at every Catholic hospital and health system in the United States.

    also, look to your home states:

    Catholic hospitals now account for about 16 percent of hospital beds in the U.S. And in eight states — including Washington, Oregon, Iowa, and Missouri — they control more than 30 percent of beds. Ten of the 25 largest health-care networks in the country are Catholic-sponsored.

  10. Pteryxx says

    ema #6:

    One puzzling thing is the lack of lawsuits. Voters/politicians/religious hospital officials abusing uterine containers is the norm. But lawyers not pursuing easy, big money malpractice cases just because they disdain potential clients, not so much.

    First the patients would have to know when their doctors were lying to them about treatment, and be alert for religious shenanigans as a possibility. Then probably a lot of potential claims were settled with gag orders. Then there’s the statute of limitations, see the Means case above:

    The defense lawyers point out that Means had her miscarriage in December 2010, almost exactly three years before filing suit. The Michigan deadline for medical malpractice claims is two years.

  11. Pteryxx says

    Withholding information from the patients is standard in these cases, too:

    https://www.aclu.org/blog/reproductive-freedom-womens-rights-religion-belief/pregnant-woman-suffers-you-wont-believe-whos

    Because of the Directives, Tamesha was never told the truth about her situation—that her fetus had little chance of surviving, that by attempting to continue the pregnancy she risked her own health, and that completing the miscarriage and ending the pregnancy was the safest approach for a woman in her condition. All that information was withheld from her. Nor was she told that because of the Directives, the hospital would refuse to provide her the safest course of care—even to protect her health. Tamesha never had the chance to direct the course of her care or make a real decision.

    [...]

    Doctors are also barred from giving their patients full information about their treatment options. Recently, a cardiologist was reprimanded for telling a patient with signs of a potentially fatal condition that if it worsened, the American College of Cardiology and American Heart Association would recommend terminating the pregnancy in order to save her life.

    Patients are going to expect, quite reasonably, that their doctors are giving them the best care and telling them the truth.

  12. Pteryxx says

    …and this appeal to the Supreme Court about admitting-privileges restrictions could not have been worse timed. Heck, maybe that’s why this first report has just now come to light about a Catholic hospital using admitting privileges to order doctors not to prescribe contraception.

    http://rhrealitycheck.org/article/2014/03/27/wisconsin-asks-roberts-court-review-admitting-privileges-law/

    (bolds mine)

    Normally, the courts do not allow third parties to challenge laws based on the violations of the constitutional rights of others. But in a 1976 Supreme Court opinion, a plurality of justices ruled that prohibition on third-party standing did not apply to abortion providers challenging a regulation that prohibited Medicaid funds from being spent on abortions. The justices in that case reasoned that abortion providers should be able to assert claims based on the rights of their patients because of the close relationship between a physician and patient, and the fact that there would be little lost in effective advocacy due to the difficulties women face in bringing challenges themselves.

    Attorneys for the State of Wisconsin say that reasoning should not apply to cases like this one because abortion providers are challenging restrictions aimed at protecting maternal health. According to the state, when lawmakers regulate abortion based on “maternal health” concerns providers and patients no longer share a commonality of interest enough to allow doctors to challenge those restrictions on their behalf. “When maternal health regulations are challenged, abortion providers’ interests may not be aligned with their patients’ interests,” the petition reads.

  13. Emu Sam says

    I would like to see – I think it doesn’t exist anyway; maybe someone can correct me – a legal decision asserting the right to have consensual sex. It’s clearly in the penumbras of the precedences, but it’s never been explicitly stated that sex is not inherently immoral. It would need to be hedged about with wording specifying consensual interactions between adults.

    In my fantasy, this would end the abortion debate for all practical legal purposes, and anti-choicers would be stuck trying to influence our choice to not have an abortion. It would end opposition to homosexuality and a variety of other options; increase education; reduce unwanted and premature pregnancy; lead to better health and lives; reduce suicide; increase healthy outlets; reduce rape and assault; and I’d grind my teeth less.

  14. says

    From my understanding, what’s usually been asserted is an affirmative right to privacy, along with statements that X, Y, or Z doesn’t provide the state with enough of an interest to assert a competing right that overrides that right to privacy. So consensual sexual activity between adults is covered under that right to privacy. A lack of consent is recognized as something the state has a legitimate interest in. Sexual activity with children (for varying definitions of “children”) is another. The gender of the parties involved used to be considered to be a legitimate interest of the state. Tracking the transmission of certain diseases is still considered a legitimate interest, but not a strong one. The state can generally request but not demand information in that case.

    With Roe v. Wade, abortion was found to be similarly protected by privacy rights. The general trend since then has been to assert stronger privacy rights for health care, but to claim more and more interest for the state around this one particular procedure. Additionally, legislation has thrown up more hurdles to obtaining this procedure that do not directly go after privacy rights, and our Supreme Court has generally allowed that to happen.

    I’ve been told since I posted this that this issue is not unique to Oklahoma. It’s happened in other states, but generally without much publicity. It is also illegal under current law, but the federal government has not been enforcing that provision.

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