Will Ties To A Catholic Hospital System Tie Doctors’ Hands?

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SAN FRANCISCO — As Catholic well being care programs throughout the nation broaden, the University of California’s flagship San Francisco hospital has turn out to be the newest area for an emotional debate: Should the famously progressive medical heart enhance its remedy area by becoming a member of forces with a Catholic-run system that restricts care in response to spiritual doctrine?

At challenge is a proposal that UCSF Medical Center affiliate with Dignity Health, an enormous Catholic well being care system that, like different Catholic chains, is sure by moral and spiritual directives from the United States Conference of Catholic Bishops. Among different prohibitions on providers, Dignity hospitals ban abortions until the mom’s life is in danger, in vitro fertilization and physician-assisted demise. Twenty-four of Dignity’s 39 hospitals prohibit contraception providers and gender-confirming take care of transgender folks, equivalent to hormone remedy and surgical procedures.

The affiliation wouldn’t maintain UCSF from performing such procedures at its personal medical heart and outpatient clinics, and each entities would stay impartial. UC medical doctors with practising privileges at Dignity could be free to debate all remedy choices and will refer sufferers to different services when obligatory.

But they must abide by Dignity’s care restrictions whereas practising at Dignity hospitals.

For opponents of the plan, the difficulty boils all the way down to a clear-cut precept: How can a public hospital that has been a pacesetter in ladies’s well being care and medical providers for the homosexual and transgender group companion with a non-public system that not solely denies such providers but in addition casts them as immoral?

“It feels really concerning to me that our university that has been a fierce advocate for women’s health and LGBTQ health would be affiliating with a corporation that doesn’t support those values and restricts care,” mentioned Dr. Jody Steinauer, who directs UCSF’s Bixby Center for Global Reproductive Health.

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The two programs have already got a relationship amongst a number of departments, together with neurology, cardiology and adolescent psychology. This new affiliation would formalize the collaboration at Dignity’s 4 Bay Area hospitals and will broaden providers to departments together with most cancers care and cardiology, which might be staffed by UCSF physicians.

The proposal has sharply cut up college and medical employees at UCSF, who’re airing their variations in impassioned letters and heated public boards. Participants on either side embody nationwide figures famend of their specialty fields.

Supporters of a better alliance with Dignity say it’s a simple manner so as to add capability to a public well being care system that’s strapped for mattress area and turning away greater than 800 sufferers a 12 months. They additionally be aware that Dignity is California’s largest non-public supplier for sufferers with Medi-Cal, the state-federal insurance coverage program for the poor.

“So much health care is being delivered in this country by faith-based organizations. For us to not participate with them seems like a missed opportunity,” Mark Laret, president and CEO of UCSF Health, advised a December assembly of the UC Board of Regents, which should resolve the difficulty.

The settlement might embody a brand new labor and supply unit based mostly at Dignity’s St. Francis Memorial Hospital, which might be staffed by non-UCSF obstetricians. That would let Dignity take up extra sufferers with low-risk pregnancies, leaving UCSF time and area to take care of extra complicated instances, mentioned Dr. Dana Gossett, a UCSF obstetrician-gynecologist who has been a part of the negotiations with Dignity.

“I feel a little like women’s health has been portrayed as a casualty of this negotiating,” mentioned Gossett. “But as someone who works in labor and delivery and is in the trenches every day, I see it differently. I see the damages our capacity problems have on women right now because we haven’t expanded our capacity enough to meet the need.”

Of specific concern to opponents of the affiliation are two latest lawsuits towards Dignity filed by the American Civil Liberties Union. In one case, a girl was denied a tubal ligation following a cesarean part supply at a Dignity facility in Redding, Calif. In one other, a transgender man was denied a hysterectomy after a Dignity facility in Sacramento realized the process was a part of his plan to align his gender id and physique.

In March, Steinauer, the pinnacle of the Bixby Center, joined greater than 1,500 UCSF college members, residents, college students and alumni in signing a letter opposing the affiliation. “Our affiliation with [Dignity] not only compromises the safety and quality of our patient care, but also threatens the integrity of our reputation as a provider of evidence-based care in an inclusive environment free of bias and discrimination,” they wrote.

UCSF is hardly the primary public hospital to wrestle with the query of Catholic well being care.

Catholic hospital programs now oversee 1 in 6 acute care hospital beds within the U.S., in response to MergerWatch, a nonprofit group that tracks hospital consolidation. And the variety of hospitals which might be Catholic-owned or -affiliated elevated by 22% from 2001 to 2016.

Earlier this 12 months, Dignity Health joined forces with one other system referred to as Catholic Health Initiatives in a merger accredited by each the California Department of Justice and the Vatican. The ensuing $29 billion system, CommonSpirit Health, has 119 acute care hospitals and is now the most important nonprofit hospital system within the nation, in response to MergerWatch.

(Courtesy of MergerWatch)

As well being programs throughout the nation scramble to merge and affiliate to achieve market share, Catholic well being programs have turn out to be an interesting companion for some secular hospitals, even when values diverge. In a extremely consolidated area like Northern California, partnership choices are restricted.

The University of Michigan is affiliated with two Catholic programs: Trinity Health and Ascension. The University of Washington affiliated with the Catholic nonprofit PeaceHealth in 2013.

Entanglements between secular and Catholic hospitals have introduced issues, mentioned Lois Uttley, who runs MergerWatch. During a trial affiliation between secular Sierra Vista Regional Health Center and the Catholic Carondelet Health Network, each in Arizona, obstetricians initially had been advised they may carry out tubal ligations, solely to be advised later they wanted to cease. The partnership was dissolved.

The UCSF administration mentioned a proper affiliation is critical to broaden providers and enhance income. Dignity is already an necessary a part of UCSF’s Canopy Health, a community of medical doctors and hospitals that may earn bonuses for delivering medical care extra effectively underneath a program created by the Affordable Care Act. Canopy Health goals to offer take care of upwards of 200,000 sufferers inside a number of years.

The particulars of the association are being labored out, however underneath dialogue is the likelihood that UCSF will get a monetary stake within the affiliated Dignity hospitals, in response to UCSF directors.

The association would offer “a revenue flow to support some of our money-losing programs,” UCSF’s Laret advised the UC Regents this month. “There really is not a good alternative from our standpoint,” he added. “If we have to disengage from our partnership with Dignity, forget UCSF, I think that it’s catastrophic for the health care delivery system in San Francisco.”

Dignity, in the meantime, would profit from the influx of sufferers at hospitals that always function underneath capability.

UCSF has promised workarounds to keep away from potential conflicts the place Dignity’s hospitals prohibit providers. Patients would be told upfront about which providers are usually not supplied at Dignity services, for instance, so they may select to go to their most popular hospital. No UCSF employees could be requested to offer obstetric or reproductive providers at Catholic services. And if sufferers at a Dignity hospital wanted a prohibited service, they could possibly be transferred to UCSF.

In an emailed assertion, Dr. Todd Strumwasser, a Dignity Health senior vice chairman, wrote that “physicians practicing at Dignity Health hospitals may discuss all treatment options with patients” and “facilitate access” to a different web site when a Dignity hospital doesn’t present a sure service. “In a situation in which a pregnant woman’s life is in danger, life-saving procedures that may result in termination of the pregnancy will be performed.”

Such insurance policies, nonetheless, are topic to adjustments by the bishops who set the foundations at Catholic hospitals, mentioned Lori Freedman, a UCSF professor who research reproductive well being care at Catholic hospitals.

“We don’t know what the future really looks like,” Freedman mentioned. “Sometimes workarounds don’t stick around.”

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