Caption: WASHINGTON , D.C., MARCH 4, 2011. Nurses of the Washington Hospital Center brace for a strike early Friday morning at the region's largest hospital. The nurses' contract expired last spring, but negotiations over wages, benefits, staffing and patient safety have not reached an agreement. (Photo by ASTRID RIECKEN For The Washington Post)
(Astrid Riecken for The Washington Post)

Of all the medical services carried out at the nation’s hospitals, one procedure is unlikely to end up in many glossy brochures: abortion.

About 4 percent of the nation’s pregnancy terminations take place in hospitals, according to the Guttmacher Institute, a reproductive rights think tank, and hospitals comprise more than a third of the nation’s abortion providers. Most do this work quietly, compared to the more visible standalone clinics such as Planned Parenthood.

But a legal complaint filed this week on behalf of Diane J. Horvath-Cosper, an obstetrician-gynecologist at MedStar Washington Hospital Center in the District and an outspoken abortion rights supporter, has shined a bright and, in the case of MedStar, unwelcome light on this little-known function of hospitals.

In a filing with the Office for Civil Rights at the Department of Health and Human Services, Horvath-Cosper alleges that she was asked by her superiors to tone down her advocacy for abortion rights and decline interview requests on the subject. The request came in December, she says, after a gunman killed three people outside a Planned Parenthood clinic in Colorado Springs.

Horvath-Cosper, 37, who last year wrote a Washington Post op-ed about threats abortion providers face, said she understands intimately the dangers faced by doctors and others who perform this controversial work.

But she alleges that rather than stepping up security at the MedStar family planning clinic, the hospital dealt with the risk by restricting her right to speak publicly on the issue.

“I personally think I can’t do this job without talking about it and without bringing abortion back into mainstream medicine where it belongs,” Horvath-Cosper said in an interview. “I don’t think we’re going to move forward as a community and a country on the issue of abortion unless we talk about it openly.”

The National Women’s Law Center and another law firm filed the complaint on Horvath-Cosper’s behalf. They say the hospital’s actions amount to discrimination under the Church Act, a law that protects medical personnel at facilities that receive federal funding from being forced to violate their beliefs on abortion, whether they support or oppose the procedure.

In the complaint, Horvath-Cosper alleges that the chief medical officer at one point told her he did “not want to put a K-Mart blue light special on the fact that we provide abortions at MedStar.” She said that the department eventually threatened to fire her and that it “isolated” her.

In a statement, Donna Arbogast, a spokeswoman for MedStar Washington Hospital Center, said only that the hospital “is committed to providing family planning services for our community, and we do so in a respectful, private and safe environment. We look forward to cooperating fully with the Office for Civil Rights.”

The hospital has always kept a “very, very, very, very low profile with our abortion providers,” said one doctor who is familiar with the ob-gyn practice at the region’s largest private hospital. The main reason, the doctor said, is to protect the physicians who perform the procedure.

“You cannot underestimate their fear of personal targeting,” said the doctor, who was not authorized to speak for the hospital and did not want to be identified because of the sensitivity of the subject.

The doctor was unaware of any “gag order” or any written policy about what abortion providers at the hospital could say publicly. But “there clearly was a protocol that this was not something we were going to advertise at health fairs at the Convention Center,” the physician said.

Even the procedures themselves are not performed at the hospital but at a professional office building on the grounds of the sprawling campus in Northwest Washington. “That way, we could honestly say that the hospital does not do them,” the doctor said.

“In general, large institutions tend to be — and rightfully so — very conscious of their reputation and image,” said Nancy Stanwood, a professor at the Yale School of Medicine and board chairwoman for Physicians for Reproductive Health, which supports abortion rights.

“They’re not necessarily going out there and waving a flag saying, ‘We’re doing abortion care,’ but they recognize that abortion care is a part of medical care that they need to be able to provide for their patients and a complete and essential part of women’s health education for medical students,” Stanwood said.

For decades, MedStar Washington Hospital Center has performed abortions for unwanted pregnancies and for women who had health complications. In recent years, the hospital became the center for treating women whose fetuses had a serious birth defect known as anencephaly, in which a baby is born without parts of the brain and skull. This year, its specialists have treated pregnant women infected with the Zika virus, which has been directly linked to a series of birth defects.

In addition to treating high-risk patients and special cases referred by the hospital, the clinic provides a range of family-planning services to local women who heard about the clinic through word of mouth, Horvath-Cosper said. In that way, she said, it functions similarly to a Planned Parenthood health center.

Horvath-Cosper takes issue with the idea that speaking openly in favor of abortion rights is necessarily dangerous to providers. For example, she said, shortly after she wrote about an antiabortion website posting a photo of her young daughter, the photo disappeared from the site.

I don’t know if it was related, but I can only imagine it didn’t look good for them to have a child’s picture on an antiabortion terrorism site,” she said.

She said she is still employed as a fellow with the hospital. Her fellowship is slated to end in June, and then she will start another fellowship — this time with Physicians for Reproductive Health.

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