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Nov 18 2013

Separation of church and health care

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 [1] 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.

18 comments

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  1. 1
    raven

    Catholic health-care systems have gobbled up almost all the providers in Seattle. I live in Seattle. I object.

    People are starting to push back on that hard.

    IIRC, the community hospital in Ashland Oregon was up for sale. A Catholic group swooped in for the kill.

    It fell through when people pointed out that the health care for the majority of the population was about to get a whole lot worse.

  2. 2
    footface

    And this came to light because a patient complained? About being given information by her doctor?

  3. 3
    Giliell, professional cynic -Ilk-

    footface
    That’s today’s lesson in “women can be horrible misogynists, too”.
    That’s what you get from pro-forced birthers drumming fetus=baby into people’s heads.
    She probably looked at her baby and then went “Teh dogtor wanted to murrrderrr my bäbie.”

  4. 4
    cottonnero

    Why doesn’t this scenario happen?

    1. Pregnant patient has condition like Marfan’s making pregnancy dangerous.
    2. Doctor at Catholic hospital neglects to mention abortion as a treatment option.
    3. Patient dies due to complications from pregnancy.
    4. Patient’s relatives sue the doctor and hospital for malpractice.

    Do Catholic institutions have some sort of blanket exemption from malpractice under this situation?

  5. 5
    Pliny the in Between

    This is only going to get worse under the evolving ACO structure. Hospital systems have bought up medical practices and employed physicians to such an extent that there are very few independent practicioners left. All these systems are dictating how physicians practice. In the case of religiously based hospital systems, those biases are included. ACOs allow these biases to extend into ambulatory care as well.

  6. 6
    Morgan

    But, he added, patients and physicians “are free to use all information in the medical literature to make appropriate medical decisions.”

    Which apparently doesn’t mean that physicians are allowed to tell patients about information in the medical literature, in order to let them make appropriate medical decisions. The patient might prefer both not to seek information, and not to be given it.

    Or is that “appropriate” the problem? “Appropriate”, not “informed”. So long as the patient is making a decision that doesn’t include abortion, it’s “appropriate” and no further complicating information is needed?

  7. 7
    Pen

    Obviously they have to keep the doctors quiet about abortion because if they said ‘There’s this perfectly simple procedure we could do to save you but instead we’re going to watch you die. Which flowers would you like at your funeral?’ they’d look like total bastards.

  8. 8
    Claire Ramsey

    This business scares the shit out of me. I live in Seattle too. And I intentionally selected a doctor whose practice is completely independent. He worked at Big Business Corporate hospitals for long enough and bailed and set up his own practice w/no strings attached.

  9. 9
    smrnda

    Religions have no business running hospitals since eventually, dogma is going to interfere with patients getting the options they should be entitled to.

    On the patient complaining – I once overheard a guy who was a Christian complaining that his secular psychiatrist didn’t tell him not to have sex before he was married (he was doing it and seriously, it’s not a sign of mental illness so it’s not anything his psychiatrist should have been editorializing about.) Some Xtians (and probably quite a few others) take immense offense at health professionals who don’t seem insistent on also taking on the role of priest and confessor, and they can get horribly offended at just the mention of something they don’t agree with. “How dare a doctor suggest an abortion!” I mean, how dare the waiter suggest a wine to a teetotaling religious person.

  10. 10
    CaitieCat, in no way a robot nosireebot

    Sure is good you don’t have that socialised medicine and death panels, huh USans? :/

    YAY FREEDUMB!

  11. 11
    latsot

    So if a doctor suggests abortion, she’ll be disciplined, perhaps fired. If she doesn’t and the mother dies, won’t the doctor be the one sued for malpractice? Or at least, be implicated, likely with professional consequences?

    Wait, the Catholic church? Telling everyone what to do? And refusing to accept responsibility for the consequences, even when people die? And throwing people under the bus to protect their reputation? Nah, that’s a bit fanciful. right?

  12. 12
    Crip Dyke, Right Reverend Feminist FuckToy of Death & Her Handmaiden

    @cottonnero:

    of course, statistically, that’s bound to have happened every year in the US for many years now. But we know that the RCC has lawyers and money and a history of settling. When you might have to wait years for money your family needs *now* to feed existing children (given the loss of a breadwinner and/or someone providing services that otherwise require great sums of money, like childcare) and given that if you go the court route you’ll never hear anyone from the RCC say, “sorry,” which is emotionally important to many people, you have a lot of people willing to settle. But the RCC imposes conditions on settlements – conditions of non-disclosure. And the RCC will play much harder ball (does that make sense? I’m not as fluent in sport as others) if you have already gone public and don’t have the club of maybe-I-will-maybe-I-won’t still in your bag (because gold balls are about the hardest balls there are in sport, right? And clubs: they disappear after you use them? I think I’m getting the hang of this). Your silence is something of value to the RCC, and they’ll pay for it. Any good lawyer will let you know that up front. While you might gain, tactically, from enough media reporting on your case, it’s a severe gamble to take, not knowing which or how many editors might feel your case to be newsworthy.

    So, we get a whole lot of silence. I imagine that lawyers for the RCC might be more generous in a court case if it’s heading toward the end and looking bad for the RCC. But the RCC can always threaten to appeal and refuse to satisfy any judgement, necessitating longer delays and more costs. So even there, when someone is on the verge of winning judgement AND the right to speak together, the RCC’s lawyers are likely to be able to buy silence.

    Who knows exactly how often it’s happened, but settled lawsuits gaining no attention from media in part through gag orders when RCC employees have done reprehensible things? That’s not merely plausible speculation. That’s established fact.

  13. 13
    Mara

    Yup, when I was pregnant, I had a choice of two hospitals: Catholic or Adventist. I may not agree with the Adventists, but I was pretty sure they weren’t going to “accidentally” kill me if anything went wrong with my pregnancy. Also, I wanted to have a tubal ligation during the second c-section and the Adventist hospital had no problem with that.

    It’s sad, because the Catholic hospital is where I was born and it would have been sweet for my kids to be born there as well. However, my mother would have yelled at me, because the hospital has gone downhill in the intervening 40-some years.

  14. 14
    rq

    cottonnero

    Patient’s relatives sue the doctor and hospital for malpractice.

    Why sue? It was God’s will.
    Obviously.
    *barf*

  15. 15
    LykeX

    Why do these people still have a license to practice medicine? Surely, if you’re putting your personal convictions above the life of your patient, you’re not qualified to be a doctor.

    Isn’t there some law somewhere that says that you can’t run a hospital if you’re going to lie to your patients about life-threatening conditions and keep them in the dark about treatment options?

  16. 16
    freemage

    LykeX: Well, the people who have the licenses are the ones on the front lines. The commanders are the bishops–they don’t have a license at all, they just own the joint. That’s part of the problem here, of course–we have a group of men who are willfully ignorant of scientific medicine making the directives. What I wish is that any non-doctor who intervenes to this degree in the decision-making process would, in fact, get busted for practicing medicine without a license.

  17. 17
    Trebuchet

    @8, Claire:

    This business scares the shit out of me. I live in Seattle too. And I intentionally selected a doctor whose practice is completely independent. He worked at Big Business Corporate hospitals for long enough and bailed and set up his own practice w/no strings attached.

    And I live in Everett, where Providence is the dominant provider of care. Our doctor works for them. They own the only hospital in town and are still expanding. Pregnancy isn’t an issue at our ages but end-of-life care makes me a little nervous. I’ll admit, however, that they were good about not insisting on heroic measures when my mother-in-law was dying.

  18. 18
    dianne

    So if a doctor suggests abortion, she’ll be disciplined, perhaps fired. If she doesn’t and the mother dies, won’t the doctor be the one sued for malpractice?

    Yes. The moral is, if you value your license and professional reputation, do not work for a Catholic hospital.

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