Nina Martin at ProPublica has a story on another example of a Catholic hospital attempting to prevent doctors from discussing abortion with patients even when a pregnancy threatens a woman’s life.
A dispute between a Colorado cardiologist and the hospital he works for has highlighted a growing area of concern among patient advocates and civil libertarians: gag rules imposed on doctors and nurses by Catholic health-care providers.
In a complaint filed Wednesday, ACLU of Colorado  accused Mercy Regional Medical Center in Durango, in the remote southwest corner of the state, of illegally telling doctors and other employees that they cannot discuss abortion with patients, even if a pregnancy threatens a woman’s life. The complaint was filed with the Colorado Department of Public Health and Environment, which oversees the state’s hospitals.
Even if a pregnancy threatens a woman’s life. Study that. Fix it in your memory. Think about it. Most people don’t realize this can happen at Catholic hospitals and healthcare systems, and they don’t believe you when you tell them. It can and it does.
A pregnant patient showed signs of Marfan syndrome, a heart condition which can turn fatal with pregnancy.
According to the complaint, Demos met with the patient, who was eight weeks pregnant and displayed signs of having the disorder, in early 2012. As he tells it, he recommended follow-up testing and discussed the treatment options — including abortion — should the results indicate that her life was in danger. Fortunately, an echocardiogram showed that the patient’s blood vessels were normal, Marfan syndrome was ruled out, and she went on to have a healthy baby. “I never saw her again,” Demos said.
But then more than a year later the patient complained to the hospital that Demos had discussed abortion, and the hospital told Demos not to do that any more.
A Brooklyn native who has lived in Durango since 2008, he said he became a Mercy employee in July 2011, when his private practice group was bought out by another group that eventually became part of Mercy. He can’t recall whether he knew what Mercy’s policies were on abortion: “Perhaps I should have known, but I didn’t.” And he had more than the usual reason to be cautious about a patient who might have Marfan: Many years ago, he said, he treated another pregnant woman with the condition who died. Not to have discussed the option of abortion with someone who might suffer from the disorder “would have been malpractice,” he said.
But hospital officials apparently saw it differently. Demos was reprimanded and told (in the words of the complaint) that he was “not permitted to recommend an abortion, nor is he permitted to even discuss the possibility of terminating a pregnancy with a Mercy Regional patient, regardless of the circumstances.”
Later, Mercy Regional’s chief medical officer, John Boyd, assured the patient in writing that the hospital would “provide education to all our employed providers, reminding them that they should not recommend abortion — even to patients who may have serious illnesses,” the ACLU’s complaint says, quoting his letters. Boyd also reaffirmed that under The Ethical and Religious Directives for Catholic Health Care Services, Mercy Regional’s staff was “precluded … from providing or recommending abortion.”
Precluded. Note that. The staff is “precluded” by a bit of Catholic bullshit from providing a medical procedure even to save a patient’s life. Precluded! As if Catholic dogma calls the shots in hospitals!
The ERDs, a set of 72 guidelines issued by the U.S. Conference of Catholic Bishops, restrict a range of reproductive health options that conflict with church teachings — abortion, birth control, sterilization, fertility treatments — as well as certain end-of-life care possibilities and stem cell research. The directives also have been interpreted by many hospitals to prohibit emergency abortions for miscarriages and ectopic pregnancies as well as emergency contraception after sexual assault (which generally works by preventing implantation of a fertilized egg).
The directives have long been controversial with women’s health advocates and civil libertarians, and the Colorado episode, they say, underscores why. The guidelines don’t just restrict what doctors and nurses at Catholic providers may do; they can even limit what health professionals are allowed to say.
Mercy’s policy “prevents physicians from fulfilling their ethical obligations” to patients and “interferes with patients’ rights to make informed decisions regarding their medical care,” the complaint said. The policy also violates patient safeguards under Medicare and Medicaid as well as a Colorado law protecting physicians’ autonomy, the ACLU said.
Mark Silverstein, ACLU of Colorado’s legal director, said that by barring doctors from informing patients about all possible treatment options, Mercy Regional poses “a potential threat to the health, safety and even the lives of its patients.”
Catholic bishops are setting medical policy. This should not be allowed.
The potential risk to patients is especially grave in communities like Durango, where a Catholic hospital is the only one for miles around, added Sheila Reynertson of MergerWatch, a New York–based nonprofit that tracks Catholic hospital consolidations and their impact. She noted that so-called “sole provider” hospitals — there are 30 of them in mostly isolated parts of the country — receive additional federal funds to serve the needs of their communities, as well as Medicare, Medicaid and other tax breaks.
Reynertson said that gag policies like Mercy’s are “absolutely” common — and are becoming more so as Catholic health-care systems gobble up other providers in a merger boom touched off by health-care reform. “What’s unusual about this case is that you have it in writing,” Reynertson said. “Usually, the policies are not so clear cut.”
Catholic health-care systems have gobbled up almost all the providers in Seattle. I live in Seattle. I object.
But vague gag rules may be just as problematic, Reynertson added, especially at secular hospitals and practices, like Demos’s, that find themselves under Catholic control. “People tend to overreact to keep their jobs. This is what we’ve heard many times — the nurse in the emergency room who is suddenly very nervous about that pregnancy emergency because there’s a heart beat. Doctors become nervous, hospital administrators become nervous. It’s a chilling effect.”
Does that sound familiar? University Hospital Galway?
Also unusual is that Demos is a heart specialist, suggesting that the gag rules can have a broader reach than many people realize. “Usually you would expect to see this kind of thing happening to an OB/GYN” — the doctors who have historically been most likely to come into conflict with the ERDs, Silverstein said.
In his statement, spokesman David Bruzzese acknowledged that, as a faith-based hospital, Mercy is committed to carrying out its mission and ministry “in a manner that is consistent with our religious and ethical directives.”
But, he added, patients and physicians “are free to use all information in the medical literature to make appropriate medical decisions.”
The ACLU, meanwhile, urged state health department officials to intervene to stop Mercy Regional from enforcing its gag policy and from “inappropriately interfering with its physicians’ practice of medicine.” It has requested a response from the state by the end of the month.
But we know that the state (which includes the federal one) is very queasy about messing with bishops.
Thanks to Michael DeDora for sending me this.