News Health Systems

Washington Policy Disclosures Provide Little Clarity on Reproductive Health-Care Access at Hospitals

Teddy Wilson

As required by a new state mandate, most hospitals in Washington have submitted their policies on patients’ access to a variety of health-care options. However, the policies vary significantly in format, information provided, and availability of access for people seeking reproductive health care.

As required by a new state mandate, most hospitals in Washington have submitted their policies on patients’ access to a variety of health-care options, including reproductive health care, to the Washington State Department of Health. However, the policies that have been submitted vary significantly in format, information provided, and availability of access for people seeking reproductive health care at the state’s nearly 100 hospitals.

In addition to reproductive health-care policies, hospitals were also required to submit end-of-life care, non-discrimination, charity care, and admissions policies to the Department of Health. The disclosures were part of a policy initiative by Gov. Jay Inslee, in response to recent transactions in which hospitals were being acquired and purchased by other hospital associations, often Catholic associations. These mergers have lead to a lack of transparency surrounding changes to hospital policies.

Several hospitals missed the deadline to provide their policies to the health department. However, as of this writing, the majority of hospitals have provided their policies. The policies have been published in a clearing house on the Washington State Department of Health website. Hospitals are also required to publish these policies on their individual websites, but many hospitals have yet to comply with this requirement.

A review of published policies by Rewire found that the lack of standardized format and required information resulted in documents submitted by hospitals that made their policies unclear. In some cases, the information provided would be of little or no relevance to patients. Reproductive health-care policies often included vague language about specific services provided, but it was evident that the full range of reproductive health care was only available at a handful of hospitals.

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Among the 97 hospitals that are listed on the health department website, only nine provided policies that specifically indicate a full range of reproductive health care, including abortion services, as available at those facilities. About one-third of the policies included access to abortion care as part of their reproductive health care, which in many cases included providing abortion care only for reasons deemed medically necessary and referring patients to outside providers for elective abortion care.

Four hospital systems that manage multiple facilities in the state—PeaceHealth, Providence, Swedish, and the Franciscan Health System—provided identical reproductive health-care policies for each of the hospitals within their system. These policy statements are not comprehensive in nature, but they make clear each system’s policy on access to reproductive health care, including abortion and birth control.

Most often, policy disclosures included no specific information on available reproductive health care or access to abortion care. Legacy Salmon Creek Medical Center submitted not a policy document but a hospital pamphlet on “patient rights and responsibilities.” Both Mulitcare hospitals submitted only a document on procedures for care of sexual assault victims. Three Rivers Hospital submitted a document stating the relevant laws and regulations and that the hospital was compliant with them.

Sheila Reynertson, advocacy coordinator at the MergerWatch Project, which tracks hospital acquisitions, told Rewire that she’s not surprised hospitals are not passing the new posting requirement with “flying colors.” Reynertson said there are a variety of reasons why hospitals may be struggling to meet the new requirements. “Some may be dragging their feet on this issue, but more likely they just don’t have built-in website design elements that make it easy for consumers to shop and compare, and others don’t seem clear about what they are supposed to post,” she said.

A coalition of organizations in the state came together to advocate for transparency and access to health care: NARAL Pro-Choice Washington, the American Civil Liberties Union of Washington, Legal Voice, Planned Parenthood Votes Northwest, People for Healthcare Freedom, and Compassion and Choices, all of which have different entry points into the work around hospital mergers.

Megan Burbank, a spokesperson at NARAL Pro-Choice Washington, told Rewire that NARAL and other coalition members are currently reviewing the policies. She said the coalition has compiled a checklist of information about what services are offered that should be included in hospital policy disclosures. “Right now what we’re doing is using our checklist in comparison to the policies that have been released to see what measures up,” she said. “If our checklist had been used initially as an organizing principle to make sure that the policies addressed each point, we wouldn’t have this confusion.”

News Abortion

Washington Judge: Public Hospitals Must Offer Abortion Care

Nicole Knight Shine

Passed by voter initiative in 1991, the Reproductive Privacy Act says, "The state shall not deny or interfere with a woman's fundamental right to choose or refuse to have an abortion," and that a public hospital may not discriminate against that right.

Public hospitals in Washington state must offer abortion care if they also provide maternity services, a state superior court judge ruled Tuesday.

Judge Raquel Montoya-Lewis found that the Skagit Valley Hospital violated the state Reproductive Privacy Act (RPA) by failing to employ staff to perform abortions, and instead referred patients to a Planned Parenthood clinic roughly 29 miles away.

Passed by voter initiative in 1991, the RPA says, “The state shall not deny or interfere with a woman’s fundamental right to choose or refuse to have an abortion,” and that a public hospital may not discriminate against that right. The law does not apply to private medical facilities and individuals.

Skagit Valley Hospital, located in northwest Washington and part of the third-largest public district hospital in the state, is licensed for 137 beds, and offers maternity, emergency, cancer, and cardiac care, among other services. In a lawsuit filed in Skagit County Superior Court last year, Kevan Coffey, a licensed nurse practitioner who lives in Skagit County, charged the public hospital with breaking the law by referring patients who seek abortion care to Planned Parenthood.

In the complaint, Coffey said she was “unable to carry a pregnancy to term without facing severe, life-birth defects,” noting, “I personally want to have all options, including abortion, available to me.”

The hospital, however, contended in court documents that it couldn’t find staff to perform abortions.

The judge didn’t buy it, writing in her decision, “In effect, the Hospital District shrugs its shoulders and informs patients that they will have to find that aspect of their healthcare elsewhere.”

Judge Montoya-Lewis continued, “Compliance with the RPA is not aspirational; it is mandatory.”

Tom Ahearne, an attorney for Skagit Valley Hospital, said the hospital board would be meeting Thursday and has not yet decided whether to appeal, as the Stranger reported.

Chris Charbonneau, CEO of Planned Parenthood of the Great Northwest and the Hawaiian Islands, told Rewire that the hospital’s practice of referring patients to a Planned Parenthood clinic in Bellingham, Washington, imposed a hardship on patients. She said that about one-third of those seeking abortion care in the state have to drive through two or more counties.

“Hospitals that accept public funding ought to live by the laws of the state that they’re in,” Charbonneau said in a phone interview Wednesday. “When the people of Washington voted for this, they were serious. You don’t just get to ignore the law.”

Washington state and California are among the few states with a Reproductive Privacy Act to guarantee an individual’s right to end a pregnancy.

In a statement issued after the decision, representatives from the American Civil Liberties Union (ACLU) of Washington, which brought the lawsuit on Coffey’s behalf, called the decision “a huge victory.”

“We hope this ruling makes the promise of the state’s Reproductive Privacy Act a reality for all women across Washington state,” Kathleen Taylor, executive director of the ACLU of Washington, said.

Coffey said in a statement that she was “pleased that the court has affirmed the right of women to have access to the full range of reproductive health care services.”

Ahearne, who represents the hospital, told the Stranger that hospital leaders “feel stuck between a rock and a hard place,” concerned about breaking the law by requiring doctors to perform abortions.

The hospital had argued that it “cannot affirmatively seek to hire [abortion] providers … nor can it require them to do so.”

But the judge countered that the provision in the RPA that carves out exceptions for those who don’t wish to offer abortion care applies to individuals and private medical facilities, not public hospitals.

News Health Systems

Illinois Bill: Catholic Hospitals Must Inform Patients Where They Can Obtain Denied Care

Nicole Knight Shine

The legislation amends the state Health Care Right of Conscience Act to require religiously affiliated facilities to inform patients in writing about health-care providers "who they reasonably believe" offer procedures that the institutions will not perform.

Religiously affiliated hospitals in Illinois must advise patients where they can find treatments that the institutions won’t offer on religious grounds, under new legislation sitting on the governor’s desk.

The patient information measure, SB 1564, comes at a time when almost about 30 percent of hospital beds in the state—and one in six in the nation—are in Catholic institutions that bar certain reproductive health and end-of-life treatments, according to recent figures from the advocacy group MergerWatch.

The legislation amends the state Health Care Right of Conscience Act to require religiously affiliated facilities to inform patients in writing about health-care providers “who they reasonably believe” offer procedures that the institutions will not perform, or to refer or transfer patients to those alternate providers. Hospitals must do this in response to patient requests for such procedures. The legislation cleared the state house on a 61-54 vote and the senate on a 34-19 vote. Democrats control both chambers.

The office of Illinois Gov. Bruce Rauner (R) did not respond to request for comment on whether he would sign the bill.

Catholic facilities often follow U.S. Conference of Catholic Bishops religious directives  that generally bar treatments such as sterilization, in vitro fertilization, and abortion care. The federal Church Amendment and some state laws protect these faith-based objections.

Even so, growing concerns over facilities that deny treatment that patients want—and that doctors advise—has recently prompted lawmakers in Illinois, Michigan, and Washington state to advance patient information measures.

A Michigan lawsuit now on appeal alleges a Catholic facility caused unnecessary trauma by denying a patient treatment. In 2010, then-18-weeks pregnant Tamesha Means arrived at a Catholic hospital, Mercy Health Partners in Muskegon, Michigan, bleeding and miscarrying. On two occasions, the hospital turned away Means, as Rewire reported. It wasn’t until Means started delivering on her third hospital visit that she received treatment.

The Illinois legislation represents a compromise among the Illinois Catholic Health Association, the Illinois State Medical Society, and the Illinois affiliate of the American Civil Liberties Union (ACLU), representatives from the groups told Rewire.

Lorie Chaiten, director of the ACLU of Illinois’ Reproductive Rights Project, said in an online statement that the legislation “protects patients when health care providers exercise religious refusals.”

Research indicates that patients aren’t always aware that religiously affiliated facilities don’t provide a full spectrum of reproductive health services, according to a 2014 paper published in Contraception.

Patrick Cacchione, executive director of the Illinois Catholic Health Association, said the organization, which represents the state’s 43 Catholic hospitals, opposed an early version of the bill requiring religious health-care facilities to give patients a written list of known medical providers that perform the treatments that the religious institutions oppose.

Cacchione said such a direct referral would have made Catholic hospitals “complicit.”

“We will provide all the information you need, but we will not make a direct referral,” he told Rewire in a phone interview Monday. The new version of the legislation does not require hospitals to confirm that providers perform the treatments; the facilities must only have a “reasonable belief” that they do.

He said Illinois hospitals are already doing what the legislation now requires.

Approximately one in five doctors surveyed at religiously affiliated institutions “had experienced conflict with the institution over religiously based patient care policies,” according to the 2010 paper, “Religious Hospitals and Primary Care Physicians: Conflicts Over Policies for Patient Care,” published in the Journal of General Internal Medicine.

In an emailed statement, Dr. Thomas M. Anderson, a Chicago radiologist and president of the Illinois State Medical Society, told Rewire, “The Society strongly believes physicians should be able to exercise their right of conscience and changes made to SB 1564 protect that right.”