Analysis Health Systems

As Reach of Catholic Hospitals Grows, So Does Risk to Patient Reproductive Health Care

Jessica Mason Pieklo

A recent case in California highlights the ongoing threat that widespread Catholic-affiliated hospitals potentially pose to reproductive health care.

By the close of 2011, one in nine hospital beds in this country existed in a Catholic or Catholic-sponsored health-care facility. If viewed together as one corporate entity, the ten largest Catholic-sponsored health systems of hospitals and clinics would constitute the largest in the country. And these hospitals are routinely denying medical care to women, citing Catholic doctrine as justification.

Case in point: It took months of appeals and the threat of a sex-discrimination lawsuit from the American Civil Liberties Union before one Catholic hospital in California reversed course this month and agreed to allow an area doctor to perform a postpartum tubal ligation on a patient. Mercy Medical Center, owned by Dignity Health of San Francisco—a not-for-profit benefits corporation that was founded by the Sisters of Mercy in 1986 and that operates Catholic hospitals and ancillary care facilities in 17 states—had previously refused to allow Rachel Miller to undergo the procedure when she delivers her third child later this month via a scheduled cesarean section.

Mercy Medical, like all other Catholic hospitals in the country, follows “Ethical and Religious Directives for Catholic Health Care Services” written by the United States Conference of Catholic Bishops. Those directives forbid doctors at Catholic facilities from participating in common reproductive health procedures like tubal ligation, contraception, sterilization, abortion even when the patient’s health is at risk, and in vitro fertilization, referring to many of them as “intrinsically evil.” The rules also direct health-care providers not to inform patients about alternatives inconsistent with the directives, even when those alternatives are the best option for the patient’s health.

In response to Mercy Medical’s original denial of the procedure, Miller’s insurance company had offered to cover her delivery at the UC Davis Medical Center in Sacramento, which would allow her to obtain the tubal ligation. But that hospital is more than 160 miles away. It would have required her to deliver with a different doctor and to force her family to travel that distance to be with her.

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After the American Civil Liberties Union and the ACLU of California sent a demand letter on Miller’s behalf charging that the hospital had unlawfully denied her reproductive health care, Mercy Medical eventually approved the procedure.

“This is a decision that I made with my family and my doctor and no one else should be involved in that process,” said Miller in a statement. “I hope my case will shine a light on this issue so that others aren’t turned away.”

Advocates point out, though, that Miller’s situation was just a small part of a systemic problem. “While we’re grateful Mercy Medical has agreed to provide medical care in this instance for Ms. Miller, the reality remains that there is a clear conflict between the best interests of patients and the directives of the Catholic hospital system,” Elizabeth Gill, senior attorney at the ACLU of Northern California, told Rewire in an interview.

As Gill explained, hospitals like Mercy Medical, which serve the general public, should not be permitted to withhold care based on doctrine. “Religious institutions that provide services to the general public should not be allowed to hold religion as an excuse to discriminate or deny important health care,” said Gill. “With Catholic hospitals increasingly prevalent, including as the only option for some women, Rachel is just one of many women who risk being denied care, because Catholic bishops are telling medical professionals how to operate.”

This presents a real challenge for making sure patients across the country have access to high-quality, comprehensive reproductive health care. Such a difficulty is exacerbated by the fact that across the country, there is no consistency in which Catholic or Catholic-sponsored hospitals strictly adhere to the directives and which do not—as seen with Mercy Medical’s eventual concession to Miller’s requests.

“There are a lot of variations in what Catholic hospitals will do,” Lois Uttley, the director of MergerWatch, a nonprofit group that tracks Catholic mergers in health care, told Rewire.

“It has to do with the stance of their local bishop, it has to do with what system they might be in and what ethical policies they follow,” said Uttley, who holds a master’s degree in public policy.

Overall, though, the reality is that Catholic interference with reproductive health care reaches well beyond Hobby Lobby and the contraception challenges to the Affordable Care Act, or even the web of state-level abortion restrictions. It reaches all the way into the labor and delivery ward.

A Web of Denials

For mostly economic reasons, such as the dominance of insurance companies in driving health-care costs prior to the implementation of the Affordable Care Act, hospitals—including Catholic-sponsored ones—went through a period of rapid mergers in the 1990s. These mergers allowed previously stand-alone facilities to better negotiate prices with insurance companies by consolidating local market share within one hospital system. Catholic facilities merged with other Catholic and non-Catholic ones, in a trend that continues today.

That trend means that the reach of Catholic health-care institutions has spread throughout the United States. According to a 2011 report released by the ACLU and MergerWatch, in many states, such as Washington, Iowa, Wisconsin, and Missouri, almost 30 percent of hospitals are Catholic or Catholic-affiliated. Meanwhile, in California, where Miller was almost denied care, Mercy Medical—itself the fifth largest system in the country—is the state’s largest hospital provider.

Such an overwhelming presence means that for some patients, it’s either a Catholic hospital or no hospital at all. And advocates say that for every Rachel Miller who pushes back against religious refusals of care, there are countless other patients unable to do the same. Hospitals don’t specifically have to disclose their affiliation or notify patients up front that the directives will dictate the range of medical care available, so some patients don’t even know they will be subject to potentially limited services by seeking help at certain facilities.

When it comes to birthing care in particular, the influence of religious doctrines is especially evident when patients request procedures like tubal ligation, which in many cases is the standard of care following labor and delivery. “It makes no sense to tell a woman who is pregnant and wants to have a tubal ligation upon delivery of the child that she has to wait and do that later at another time because the hospital won’t allow it,” said Uttley. “It makes great medical sense to do it at the same time because the woman is already in the hospital, you are paying for the delivery, and in many cases if it is a c-section it makes great sense to do a tubal ligation while the woman is already under anesthesia. It is not good quality to send her away and force her to go back either into the hospital or the doctor’s office and to have a tubal ligation.”

Still, “there are many ordinary women out there who are refused the service and don’t understand that they could argue,” Uttley said.

“The problem is the most acute in areas where patients have no choice and where physicians are limited in where they can practice,” Uttley added. “We hear from doctors, for example, who are practicing in rural areas of western states where there is only a Catholic hospital and these doctors have patients who desperately need a tubal ligation at the time of delivery.”

Uttley continued, “Many times there are also complicating factors for the patient. For example, the woman could be obese, she could have diabetes, she could have hypertension. She could have a lot of complications that make pregnancy quite dangerous for her and she and her doctor have decided that upon delivery of the last child she will have a tubal ligation. We hear from doctors who are distraught at not being able to provide what they see as essential, quality care for their patients.”

Because pregnant patients often work with one OB-GYN, not hospitals, even those who try to avoid the doctrines can end up having their care restricted, Uttley said. She shared one example of a patient with whom her organization was in touch while working on the 2011 report: “There was a woman in upstate New York who already had four children [and who] was having her fifth child, and was talking with her OB-GYN ahead of time about having a tubal ligation at the same time as delivery.”

“The physician had admitting privileges at both a Catholic and a non-Catholic hospital, so they had planned this would take place at the non-Catholic hospital,” she continued. “However, when the time came for her to deliver he was at the Catholic hospital, so she ended up not being able to get the tubal ligation that she wanted even though her doctor did have admitting privileges at a non-Catholic facility because he wasn’t there at the time she delivered.”

These rules can also make obtaining care dangerous for patients experiencing pregnancy complications. Dr. Ashlee Bergin, a practicing OB-GYN in Chicago, shared a story during an interview with Rewire of seeing a patient within the last month who came to Bergin’s non-Catholic-affiliated hospital experiencing a spontaneous miscarriage at about 18 weeks. According to Bergin, the patient was bleeding quite significantly and yet had been turned away from two different Catholic hospitals, because there was still a fetal heartbeat. By the time the patient got to Bergin’s hospital, she was anemic and in an emergency situation.

“In a lot of these situations, it definitely impacts our ability to provide the complete spectrum of care, especially reproductive health care, to women,” Bergin told Rewire. “Catholic doctrine interferes with our ability to provide medically timely care,” she continued. “Not only that, it’s the right thing to do for these women and we are being told we can’t do what’s right for these women because of these doctrines.”

“Ideally, we should be able to provide the full range of reproductive health care for women and Catholic directives don’t allow that happen,” she said.

A recent national survey found that 52 percent of OB-GYNs working in Catholic hospitals experience conflict with religiously based policies about care. Physicians interviewed reported reactions ranging from “mild concern” to “outright shock” about the way the directives impacted their ability to offer treatment to patients experiencing certain emergencies, such as miscarriage or pre-viable premature rupture of membranes (PPROM). In these cases, physicians felt ending the pregnancy via abortion was justified, especially when the failing pregnancy was deeply wanted. The “wantedness” of the pregnancy was referenced in the context of defending the need for treatment and arguing that it was solely for the sake of safety and comfort for the pregnant patient, not because she did not wish to have a child. Still, the directives prohibited the the procedure until there was no longer a fetal heartbeat.

Holding Catholic Hospitals Legally Accountable

Such restrictions on care have yet to be successfully challenged in the courts. In 2010, a then-18 weeks pregnant Tamesha Means showed up at Mercy Health Partners in Muskegon, Michigan, in the middle of having a miscarriage. Her water had broken and she was experiencing severe cramping. Mercy Health, a Catholic-sponsored facility, told Means there was nothing it could do for her, because treatment would have terminated the pregnancy, and sent her home. Means came back the next day, this time in more pain and bleeding, and was again told the course of action was to wait and see.

As detailed in court documents, Means, a mother of three, returned to Mercy Health a third time, this time suffering from a significant infection from her untreated miscarriage. In response, the hospital gave Means some aspirin to treat her fever and prepared to send her home. Before the hospital discharged Means for a third time, she started to deliver. It wasn’t until then that the hospital decided to admit Means and to treat her condition. Means eventually delivered a baby who died within hours of birth.

Means sued, claiming the directives followed by Mercy Health—and other Catholic hospitals—amount to the delivery of negligent care.

A district court dismissed Means’ case on procedural grounds, ruling in part that the doctrine of ecclesiastical abstention prevents courts from reviewing cases like Means’. That doctrine dates back to an 1871 Supreme Court decision, Watson v. Jones, which first established principles limiting the role of civil courts in deciding religious controversies. Watson and the cases that followed limit the power of courts to hear suits “whenever the questions of discipline, or of faith, or ecclesiastical rule, custom, or law have been decided by … church judicatories.”

The idea behind the ecclesiastical abstention doctrine is that courts should not settle what would amount to disputes about religious doctrine. In other words, it is not up to the judiciary to decide whether or not particular religious tenets are “correct.” If it involves a question of interpreting church doctrine, the courts are supposed to just stay out of it.

In Means’ case, the defendants, including Mercy Hospital and the United States Conference of Catholic Bishops, claimed the directives offer “a statement of the Roman Catholic Church’s moral and religious postures as it relates to health care issues” and are in place “to provide authoritative guidance on certain moral issues that face Catholic health care today.” Therefore, the defendants argued, a court must interpret the directives in order to assess whether they ensure patients receive reasonable care. In turn, they claim that interpreting the directives in this way means interpreting Catholic theology, which the ecclesiastical abstention doctrine prohibits.

Means’ attorneys responded that the ecclesiastical abstention doctrine was not at issue because they were not asking the court to determine the validity of the directives, but to determine whether the imposition of the directives on Mercy Health caused her harm. It wasn’t the validity of the directives that was at issue, Means’ attorneys argued, it was the delivery of substandard medical care they dictated. But the lower court disagreed, ruling Means’ claims “oversimplifies the text and theological underpinnings of the ERDs, as well as how the Directives are applied in hospital settings.” According to the court:

Plaintiff’s complaint about the unavailability of “direct abortions” under the ERDs would require a nuanced discussion about how a “direct abortion” is defined in Catholic doctrine. Directive 45 clearly prohibits direct abortions, defined as “the directly intended termination of a pregnancy before viability.” Do procedures that directly intend to treat a serious pathologic condition of the mother (such as acute chorioamnionitis and funisitis), and indirectly result in termination of the pregnancy, constitute a direct abortion? (See Directive 47.) When do medical procedures that augment—rather than induce—labor constitute a direct abortion? (See Directive 49.) Must the procedure satisfy the Catholic principle of double-effect to be permissible under the ERDs? (See Directive 45’s discussion of “sole immediate effect” and “material cooperation.”) Can the treating doctor exercise independent judgment or is she required to consult a Catholic ethicist before providing emergency care? (See Directive 37.) Does the ethicist have an obligation to consult the local bishop in his moral and theological analysis of the medical treatment options? (See General Introduction; Directive 37.)

The court continued:

These questions demonstrate how the application of the Directives are inextricably intertwined with the Catholic Church’s religious tenets. This Court is competent to address whether the medical care provided by Mercy physicians, and vicariously provided by Trinity Health, constitute negligence or medical malpractice. However, the Court cannot determine whether the establishment of the ERDs constitute negligence because it necessarily involves inquiry into the ERDs themselves, and thus into Church doctrine.

The court could look at individual applications of care, but could not explore the fact that the directives were the source of that care thanks to the ecclesiastical abstention doctrine. Attorneys representing Means filed an immediate appeal of the decision with the U.S. Court of Appeals for the Sixth Circuit.

That case is still pending. But should conservatives prevail in advancing their argument that the ecclesiastical abstention doctrine insulates Catholic hospitals from medical negligence liability, patients will be left with very few, if any, ways to hold those institutions accountable for delivering any substandard medical care.

A Market-Based Solution?

Although the courts may be doing very little to advance policies that promote good patient care, Uttley hopes the market can do more. While individuals may not think of market-based approaches to care when choosing an OB-GYN, health insurers and employers who offer benefits plans to their workers do when deciding which facilities to contract with.

“There is a big push right now in the country for what is called ‘value-based health care,’” explained Uttley. “It’s a big push of HHS; it’s also a huge drive of many state governments and of insurance companies and employers. They are all looking to purchase health care that meets the standards of quality and cost-effectiveness. It is [MergerWatch’s] position that refusing to give women reproductive health care when they need it doesn’t meet those standards.”

From a government perspective, investing in high-quality, cost-effective care is especially fiscally relevant because at this point, medical services at Catholic facilities are heavily subsidized by taxpayers. In 2011, Catholic-sponsored or -affiliated hospitals billed the federal government approximately $115 billion related to patient care and reported receiving $27.1 billion in net government revenues in 2011, principally from Medicaid.

“There is a big drive to establish quality metrics [for value-based health care] now, and in fact some Catholic hospitals are in the leadership of that movement and do deliver high quality care in other areas of their health-care delivery,” said Uttley.

But when it comes to reproductive care, she says, “this is a big gaping hole, and we see it potentially as quite a challenge for Catholic hospitals and health-care systems to meet their aspirations of delivering quality, cost-effective care when because of doctrine the care ends up being fragmented.”

Ultimately, as seen in the Miller case, the decision to deny a patient reproductive health care based on religious directive is completely, utterly arbitrary. But it has lasting, potentially devastating effects—both for the individuals involved and for those who may rely on the hospital in the future.

“It’s important that people in a community feel good about their hospital and feel like they will get the care they need at that hospital,” said Uttley. “When an incident like the Rachel Miller one occurs, it can rattle that confidence.”

Analysis Politics

Advocates: Bill to Address Gaps in Mental Health Care Would Do More Harm Than Good

Katie Klabusich

Advocates say that U.S. Rep. Tim Murphy's "Helping Families in Mental Health Crisis Act," purported to help address gaps in care, is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

The need for reform of the mental health-care system is well documented; those of us who have spent time trying to access often costly, out-of-reach treatment will attest to how time-consuming and expensive care can be—if you can get the necessary time off work to pursue that care. Advocates say, however, that U.S. Rep. Tim Murphy’s (R-PA) “Helping Families in Mental Health Crisis Act” (HR 2646), purported to help address gaps in care, is not the answer. Instead, they say, it is regressive and strips rights away from those diagnosed with mental illness. This leaves those in the LGBTQ community—who already often have an adversarial relationship with the mental health sector—at particular risk.

“We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” wrote the political action committee Leadership Conference on Civil and Human Rights in a March letter to House Committee on Energy and Commerce Chairman Rep. Fred Upton (R-MI) and ranking member Rep. Frank Pallone (D-NJ) on behalf of more than 100 social justice organizations. “The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness.”

Despite the pushback, Murphy continues to draw on the bill’s mental health industry support; groups like the American Psychiatric Association (APA) and the National Alliance on Mental Illness (NAMI) back the bill.

Murphy and Rep. Eddie Bernice Johnson (D-TX) reintroduced HR 2646 earlier this month, continuing to call it “groundbreaking” legislation that “breaks down federal barriers to care, clarifies privacy standards for families and caregivers; reforms outdated programs; expands parity accountability; and invests in services for the most difficult to treat cases while driving evidence-based care.”

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Some of the stated goals of HR 2646 are important: Yes, more inpatient care beds are needed; yes, smoother transitions from inpatient to outpatient care would help many; yes, prisons house too many people with mental illness. However, many of its objectives, such as “alternatives to institutionalization” potentially allow outpatient care to be mandated by judges with no medical training and pushed for by “concerned” family members. Even the “focus on suicide prevention” can lead to forced hospitalization and disempowerment of the person the system or family member is supposedly trying to help.

All in all, advocates say, HR 2646—which passed out of committee earlier this month—marks a danger to the autonomy of those with mental illness.

Victoria M. Rodríguez-Roldán, JD, director of the Trans/GNC Justice Project at the National LGBTQ Task Force, explained that the bill would usurp the Health Insurance Portability and Accountability Act (HIPAA), “making it easier for a mental health provider to give information about diagnosis and treatment … to any ‘caregiver’-family members, partners or spouses, children that may be caring for the person, and so forth.”

For the communities she serves, this is more than just a privacy violation: It could put clients at risk if family members use their diagnosis or treatment against them.

“When we consider the stigma around mental illness from an LGBT perspective, an intersectional perspective, 57 percent of trans people have experienced significant family rejection [and] 19 percent have experienced domestic violence as a result of their being trans,” said Rodríguez-Roldán, citing the National Transgender Discrimination Survey. “We can see here how the idea of ‘Let’s give access to the poor loved ones who want to help!’ is not that great an idea.”

“It’s really about taking away voice and choice and agency from people, which is a trend that’s very disturbing to me,” said Leah Harris, an organizer with the Campaign For Real Change in Mental Health Policy, also known as Real MH Change. “Mostly [H.R. 2646] is driven by families of these people, not the people themselves. It’s pitting families against people who are living this. There are a fair number of these family members that are well-meaning, but they’re pushing this very authoritarian [policy].”

Rodríguez-Roldán also pointed out that if a patient’s gender identity or sexual orientation is a contributing factor to their depression or suicide risk—because of discrimination, direct targeting, or fear of bigoted family, friends, or coworkers—then that identity or orientation would be pertinent to their diagnosis and possible need for treatment. Though Murphy’s office claims that psychotherapy notes are excluded from the increased access caregivers would be given under HR 2646, Rodríguez-Roldán isn’t buying it; she fears individuals could be inadvertently outed to their caregivers.

Rodríguez-Roldán echoed concern that while disability advocacy organizations largely oppose the bill, groups that represent either medical institutions or families of those with mental illnesses, or medical institutions—such as NAMI, Mental Health America, and the APA—seem to be driving this legislation.

“In disability rights, if the doc starts about talking about the plight and families of the people of the disabilities, it’s not going to go over well,” she said. “That’s basically what [HR 2646] does.”

Rodríguez-Roldán’s concerns extend beyond the potential harm of allowing families and caregivers easier access to individuals’ sensitive medical information; she also points out that the act itself is rooted in stigma. Rep. Murphy created the Helping Families in Mental Health Crisis Act in response to the Sandy Hook school shooting in 2012. Despite being a clinical psychologist for 30 years before joining Congress and being co-chair of the Mental Health Caucus, he continues to perpetuate the well-debunked myth that people with mental illness are violent. In fact, according to the Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

The act “is trying to prevent gun violence by ignoring gun control and going after the the rights of mentally ill people,” Rodríguez-Roldán noted.

In addition, advocates note, HR 2646 would make it easier to access assisted outpatient treatment, but would also give courts around the country the authority to mandate specific medications and treatments. In states where the courts already have that authority, Rodríguez-Roldán says, people of color are disproportionately mandated into treatment. When she has tried to point out these statistics to Murphy and his staff, she says, she has been shut down, being told that the disparity is due to a disproportionate number of people of color living in poverty.

Harris also expressed frustration at the hostility she and others have received attempting to take the lived experiences of those who would be affected by the bill to Murphy and his staff.

“I’ve talked to thousands of families … he’s actively opposed to talking to us,” she said. “Everyone has tried to engage with [Murphy and his staff]. I had one of the staffers in the room say, ‘You must have been misdiagnosed.’ I couldn’t have been that way,” meaning mentally ill. “It’s an ongoing struggle to maintain our mental and physical health, but they think we can’t get well.”

Multiple attempts to reach Murphy’s office by Rewire were unsuccessful.

LGBTQ people—transgender, nonbinary, and genderqueer people especially—are particularly susceptible to mistreatment in an institutional setting, where even the thoughts and experiences of patients with significant privilege are typically viewed with skepticism and disbelief. They’re also more likely to experience circumstances that already come with required hospitalization. This, as Rodríguez-Roldán explained, makes it even more vital that individuals not be made more susceptible to unnecessary treatment programs at the hands of judges or relatives with limited or no medical backgrounds.
Forty-one percent of all trans people have attempted suicide at some point in their lives,” said Rodríguez-Roldán. “Once you have attempted suicide—assuming you’re caught—standard procedure is you’ll end up in the hospital for five days [or] a week [on] average.”

In turn, that leaves people open to potential abuse. Rodríguez-Roldán said there isn’t much data yet on exactly how mistreated transgender people are specific to psychiatry, but considering the discrimination and mistreatment in health care in general, it’s safe to assume mental health care would be additionally hostile. A full 50 percent of transgender people report having to teach their physicians about transgender care and 19 percent were refused care—a statistic that spikes even higher for transgender people of color.

“What happens to the people who are already being mistreated, who are already being misgendered, harassed, retraumatized? After you’ve had a suicide attempt, let’s treat you like garbage even more than we treat most people,” said Rodríguez-Roldán, pointing out that with HR 2646, “there would be even less legal recourse” for those who wanted to shape their own treatment. “Those who face abusive families, who don’t have support and so on—more likely when you’re queer—are going to face a heightened risk of losing their privacy.”

Or, for example, individuals may face the conflation of transgender or gender-nonconforming status with mental illness. Rodríguez-Roldán has experienced the conflation herself.

“I had one psychiatrist in Arlington insist, ‘You’re not bipolar; it’s just that you have unresolved issues from your transition,'” she said.

While her abusive household and other life factors certainly added to her depression—the first symptom people with Bipolar II typically suffer from—Rodríguez-Roldán knew she was transgender at age 15 and began the process of transitioning at age 17. Bipolar disorder, meanwhile, is most often diagnosed in a person’s early 20s, making the conflation rather obvious. She acknowledges the privilege of having good insurance and not being low-income, which meant she could choose a different doctor.

“It was also in an outpatient setting, so I was able to nod along, pay the copay, get out of there and never come back,” she said. “It was not inside a hospital where they can use that as an excuse to keep me.”

The fear of having freedom and other rights stripped away came up repeatedly in a Twitter chat last month led by the Task Force to spread the word about HR 2646. More than 350 people participated, sharing their experiences and asking people to oppose Murphy’s bill.

In the meantime, Sen. Lamar Alexander (R-TN) has introduced the “Mental Health Reform Act of 2016” (SB 2680) which some supporters of HR 2646 are calling a companion bill. It has yet to be voted on.

Alexander’s bill has more real reform embedded in its language, shifting the focus from empowering families and medical personnel to funding prevention and community-based support services and programs. The U.S. Secretary of Health and Human Services would be tasked with evaluating existing programs for their effectiveness in handling co-current disorders (e.g., substance abuse and mental illness); reducing homelessness and incarceration of people with substance abuse and/or mental disorders; and providing recommendations on improving current community-based care.

Harris, with Real MH Change, considers Alexander’s bill an imperfect improvement over the Murphy legislation.

“Both of [the bills] have far too much emphasis on rolling back the clock, promoting institutionalization, and not enough of a preventive approach or a trauma-informed approach,” Harris said. “What they share in common is this trope of ‘comprehensive mental health reform.’ Of course the system is completely messed up. Comprehensive reform is needed, but for those of us who have lived through it, it’s not just ‘any change is good.'”

Harris and Rodríguez-Roldán both acknowledged that many of the HR 2646 co-sponsors and supporters in Congress have good intentions; those legislators are trusting Murphy’s professional background and are eager to make some kind of change. In doing so, the voices of those who are affected by the laws—those asking for more funding toward community-based and patient-centric care—are being sidelined.

“What is driving the change is going to influence what the change looks like. Right now, change is driven by fear and paternalism,” said Harris. “It’s not change at any cost.”

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.”