By Thalia Syracopoulos, Co-President of Seattle NOW and a PSARA member

In February 2012, Swedish Medical Center and Providence Health Systems of WA formed an “affiliation,” which potentially changed the availability of reproductive and end-of-life health care access. The only publicly announced change was that elective terminations of pregnancy would no longer be done at Swedish Hospital, or its affiliated campuses.

In response to an outcry from people concerned about the negative impact of this affiliation, Governor Inslee directed the state’s Department of Health to adopt new rules requiring that any hospital changing control through sale, affiliation or merger must seek a Certificate of Need [CON] review. The new CON was made public in December 2013 and will go into effect on January 23, 2014.

Surprisingly, the rules have nothing to do with whether or not the hospitals will provide or deny care. The new CON only requires that hospitals make information about what health care they do/do not deliver widely available to the public.

Governor Inslee also directed the WA Department of Health to provide a report on “Access to Care” in WA State in order to address the concerns of supporters of end-of-life services, reproductive rights, and the impact on our LGBT community. The preliminary report, documenting care through 2011, was issued in December 2013, and it is more reassuring than one might have anticipated.

While acknowledging that there were some data limitations, “our preliminary findings for those services assessed do not appear to suggest that communities predominately served by religious hospitals are experiencing barriers to care.”

It also specifically discussed the Swedish-Providence affiliation:

“…it is important to note that the affiliation Swedish has with Providence differs from other hospitals’ affiliations – and, in fact, Swedish considers itself a secular institution. While under the provisions of their affiliation they have agreed to not perform elective terminations, Swedish retains the right to perform an abortion if the mother’s life is at stake or if the fetus has a fatal anomaly; their physicians also retain the right to participate under the provisions of DWD when caring for terminally ill patients.”

This would be reassuring if it were true. However, in February 2013, The Stranger reported about a Seattle woman, 24 weeks pregnant, who came to Swedish Hospital because she was miscarrying and bleeding profusely. Swedish refused to perform an abortion and only acted to save the mother’s life after the fetal heartbeat had ceased. Fortunately, in this instance, the mother survived.

This lends credence to the information published in Catholic Watch-keeping watch on Catholic health care that the affiliation is now led by a 19-member board, with 5 members from Swedish and 14 from Providence. The board directs both Swedish and Providence.

“It’s been just over a year since Providence, …took over Swedish Medical, the largest nonprofit hospital system in the Seattle area. What’s the result? Swedish is now operated as a brand within Providence, and reports up through the Providence system, with oversight from the Catholic bishops. Prayers are held before management meetings. And abortions are no longer allowed, although Providence officials say they have been done when a woman’s life is in danger.”

The “oversight from the Catholic Bishops” refers to the “Ethical and Religious Directives for Catholic Health Care Services” [EDS].

Presently, in WA and OR, 30-37% of all hospital admissions are to Catholic hospitals. In King, Pierce and Spokane Counties, 50-99% of the hospitals are religiously affiliated. Whatcom, Skagit, Snohomish, Stevens, Cowlitz, Franklin, Kitsap and Walla Walla Counties have no non-religious-affiliated hospitals available to their residents.

Most of the affiliated or merged hospitals are public hospitals that receive considerable public funding. In addition to the tax breaks to which all nonprofit institutions are entitled, these hospitals also receive taxpayer dollars via public insurance programs like Medicare and Medicaid, as well as myriad federal programs that provide extra subsidies for such things as indigent care and medical research.

Attorney General Ferguson was asked to give an opinion regarding a San Juan County public hospital which had entered into an agreement with PeaceHealth, a Catholic health care corporation, to construct and operate a hospital. At issue was the providing of Termination of Pregnancy [TOP] and contraceptive care.

Attorney General Ferguson cited RCW 9.02.100 and .160 which were adopted as part of Initiative 120 (I-120) in 1991.

Accordingly (1) Every individual has the fundamental right to choose or refuse birth control, and (2) Every woman has the fundamental right to choose or refuse to have an abortion, except as specifically limited by RCW 9.02.

In August of 2013, Attorney General Ferguson rendered the following conclusion:

A public hospital district that provides, directly or by contract, maternity care benefits, services, or information to women, through any program administered or funded in whole or in part by the district, must also provide the substantially equivalent benefits, services, or information required by RCW 9.02.160 and .100.

Such opinions are not legally binding. For now, the major concern is whether persons whose only access is to a religiously affiliated hospital are able to receive regular or emergency care that is forbidden by the EDS.

WA’s Death With Dignity Act (2008) “permits terminally ill, competent adult WA residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician.” No physician who is bound by the directives of the EDS can honor that request if his private office is in a building owned by a religiously affiliated hospital.

Abortion is legal in WA State, but it is only one of the many services that may no longer be available at these institutions. The EDS states not just that contraception in any form cannot be provided, but education about any form of contraception is prohibited. The only exception to that rule is that married couples can be informed about “methods of natural family planning.” In vitro fertilization cannot be provided even to a heterosexual married couple. Artificial fertilization, even using a married man’s sperm to impregnate his wife, is also forbidden. Assistance for surrogacy in any form is not available.

Ectopic pregnancies may not be surgically terminated in advance of life-threatening complications even though lack of timely treatment may result in permanent sterilization or death for the mother. Pregnancy complications cannot be treated until there is no fetal heartbeat even if delaying treatment risks the death of the mother. It appears that this was the reason that the woman reported in The Stranger did not receive care in the early part of her miscarriage.

According to the EDS, a tubal ligation or vasectomy can never be done, although the “Access to Care” report by the Department of Health states that they are done.

For now, we can only be vigilant and hope that all legal and appropriate care is provided to all who seek it. But we should remember that while the Attorney General’s Opinion is not legally binding, it may well carry weight if a lawsuit for denial of care is brought.

If you, or anyone you know, has been denied care or provided care only after the EDS requirements have been met, contact the author of the “Access to Care” report, Joe Campo, at joe.campo@OFM. wa.gov. Send a copy of your report to Governor Inslee and Attorney General Ferguson.

Maybe we can get the care we are legally entitled to without a loss of life.