Catholic hospitals are growing. What will that mean for reproductive health?

December 2, 2013

(Photo by Toni L. Sandys/The Washington Post)

Tamesha Means was 18 weeks pregnant when her water broke. Means, then 27 and the mother of two, knew something was wrong. So she called a friend to take her to the one hospital within a half-hour's drive, Mercy Health Partners.

During that trip to the hospital--and two return trips, one later that night and then again the next morning--Means says she was discharged with medication and instructions to wait for her pain to subside. According to her account, she was not offered the option to induce labor or terminate the pregnancy, options that could have ended her pain, nor was she told that the fetus was unlikely to survive.

“The pain was unbearable,” Means said in an interview from her home in Muskegon, Mich. “I told them, ‘I need you guys to help me.’ They told me there was nothing they could do.”

Three years later, Means’s treatment at Mercy, part of a Catholic health system, has become the centerpiece of an American Civil Liberties Union lawsuit against the United States Conference of Catholic Bishops.

The suit, filed in late November, argues that the Catholic Bishops' religious directives for hospitals--which generally bar discussion or performance of abortions--result in negligent care for patients such as Means.

Without being offered "the medically appropriate treatment option of terminating her pregnancy," the case argues, Means "suffered severe, unnecessary, and foreseeable physical and emotional pain."

The lawsuit comes in the midst of a wave of high-profile mergers between Catholic hospitals and secular systems. The partnerships have raised questions about how care will be delivered at institutions guided by religious directives, particularly in rural areas like Muskegon where patients have little choice of where to be seen.

“As the number of Catholic hospitals increases, we’re highlighting the way they can constrain care,” Louise Melling, ACLU deputy legal director, said. “The suit is significant in that it's calling attention to what is happening at these hospitals. In some instances, the directives are governing care rather than medical guidelines.”

Mercy Health Partners declined to comment on the case through a spokeswoman, as did the United States Conference of Catholic Bishops.

Much of the tension tends to center on reproductive health; 52 percent of obstetricians who work in Catholic hospitals say they have experienced a conflict over religious-based policies, according to a 2012 article in the American Journal of Obstetrics and Gynecology

One obstetrician, according to a recent report published this summer in the American Journal of Bioethics Primary Researchfaced off with his Catholic hospital's ethics committee when he wanted to terminate the pregnancy of a women newly-diagnosed with cancer, who needed to undergo chemotherapy.

Another doctor reported a conflict at her hospital that had been sold to a Catholic hospital chain three years prior. The ethics committee ruled that a doctor could not terminate a "molar pregnancy," where the embryo begins to develop but, due to a tumor, will not survive.

“Some of the doctors have read them all and practice exactly according to the directives,” study author Lori Freedman, a medical sociologist at the University of California - San Francisco, said. “Some don’t quite remember what they signed on for, but they learn from colleagues what you need to get approval for. I do hear about at least some level of awareness.”

There are 630 Catholic hospitals in the United States, according to the American Hospital Association, accounting for 15 percent of all hospital beds in the country. One-third of Catholic hospitals are in rural areas and, according to the Catholic Hospital Association, one in six American patients are treated in a Catholic facility.

The United States Conference of Catholic Bishops publishes ethical and religious directives for Catholic health care providers, meant to “to provide authoritative guidance on certain moral issues that face Catholic health care today.”

The directives guide the way that physicians practice, especially in situations involving sterilizations and obstetric complications, according to UCSF's Freedman.

"The most concerning conflicts I've heard about tend to revolve around restrictions on sterilization and obstetric complications," Freedman said. "They frequently bring up this exact scenario, where a woman is suffering pre-mature rupture of membranes in the second trimester. In a non-Catholic hospital you would talk about various options, if you want to miscarry naturally, induce labor or do you want us to do a surgical removal."

Some hospitals have changed their practices when they merge with Catholic institutions. In one of the more high profile cases, Swedish Health System, a secular hospital chain in Seattle, stopped offering elective abortions when it partnered with Providence Health, one of the larger Catholic hospital systems in the country.

The ACLU lawsuit, filed on Means' behalf, centers on Mercy Health in Muskegon, Mich., a city with 38,000 residents on the edge of Lake Michigan. The hospital became part of the nation’s second-largest Catholic health care system in May 2013 when its parent company, Trinity Health, merged with Catholic Health East, a hospital chain headquartered in Pennsylvania.

In both the lawsuit and a phone interview, Means said she made three trips to the hospital of the course of two days.

Means said she did not ask about the option of terminating her pregnancy and doctors did not offer that as a possible medical treatment. After her second discharge from the hospital, Means returned to the hospital again that evening. She said she gave birth while waiting for her third discharge from the hospital in two days.

Her child was pronounced dead two-and-a-half hours after delivery.

“I was in terrible pain,” Means said. “I was tired. I was frustrated. I still had no answers as to why they did nothing to help me, why they didn’t go ahead and induce my labor when they knew my baby wasn’t going to make it. They left me in pain for those days.”

The case is meant to push back against the Catholic health directives, ACLU’s Melling said. “It certainly alleges that the imposition of the directives in their current fashion violats the duty of care to patients,” she said.

“We are committed to defending Americans’ right to practice religion,” Melling continued. “We have a long history of doing that. But this isn’t about religious freedom. It’s about medical care.”

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