Roman Catholic hospitals in California narrowly escaped legislation that, if passed, would have penalized them for not making the full range of reproductive services available to patients.
Earlier this month, the California Assembly voted 31-29 in favor of the reproductive rights bill, but a 41-vote majority in the 80-member Assembly was needed to pass the measure.
The measure did not come up for a vote in the state Senate.
Catholic Healthcare West's acquisition last December of the eight Los Angeles-area hospitals owned by UniHealth, a secular not-for-profit system based in Burbank, Calif., helped spur the introduction of the bill, which was authored by Assemblywoman Sheila Kuehl, a Los Angeles Democrat.
At the former UniHealth hospitals CHW still permits tubal ligations, vasectomies and abortions if the mother's life is in danger but no longer allows elective abortions or fertility treatments.
Kuehl said concern about CHW's size spurred the legislation. With 46 hospitals statewide, including the UniHealth properties, San Francisco-based CHW is the largest hospital operator in California.
"It became more apparent that their (ownership of so many hospitals) was truncating access to reproductive services all over the state," she said.
Backers of the bill included Catholics for a Free Choice, the California chapter of Planned Parenthood and the California chapter of the National Organization for Women.
The bill that failed in the Assembly would have compelled CHW and any Catholic provider to offer patients the full gamut of reproductive services, including elective abortions, or refer them to such providers. The state would bar Catholic providers from obtaining low-interest tax-exempt government bonds if they did not comply.
Aside from the financial provisions, the legislation would have allowed California's attorney general to assess the impact of any hospital merger or purchase on reproductive services before approving such deals.
The bill would have hit CHW's pocketbook particularly hard because it is California's largest borrower of state-backed healthcare bonds, with total indebtedness of about $1 billion, according to state officials.
CHW spokeswoman Debbie Cantu said privately financing debt would have cost another $650 million in interest payments during the next decade.
Kuehl noted that CHW and other religious providers did not have to offer reproductive services at its hospitals-only provide referrals. But Cantu said CHW draws the line at referring patients for elective abortions or fertility services, which it bars at all its facilities.
CHW does allow on-site vasectomies and tubal ligations or makes referrals for the procedures at nine Southern California hospitals it acquired in the past year from UniHealth and another operator.
But its elimination of in-vitro fertilization and donor sperm and egg insemination at its new facilities raised the ire of some woman's groups, which fear other services may be eliminated.
"This is often a first step (toward eliminating such services)," said Frances Kissling, president at Catholics for a Free Choice, a Washington-based advocacy group that wants to preserve reproductive services at Catholic hospitals.
Elimination of reproductive services in the wake of a Catholic organization's takeover is not uncommon.
A 1998 study by Kissling's organization of 64 mergers involving Catholic hospital organizations between 1990 and 1997 showed that 48% of the transactions resulted in the elimination of all or some reproductive services offered at the hospitals prior to the merger. The partial curtailment of services by CHW would fall into this category.
In a rebuttal, the St. Louis-based Catholic Health Association asserted that Catholics for a Free Choice distorted and misrepresented the figures cited in its study (June 10, p. 14).
CHW's relatively liberal reproduction policy is being held up as a prototype of compromise by the Alliance of Catholic Healthcare Systems, a national lobby for Catholic providers. But alliance President Bill Cox said Kuehl has ignored CHW's approach in writing her legislation, which she said she intends to reintroduce when the Legislature begins its next session in January.
Replied Kuehl: "If (Catholic providers) can take that step (on vasectomies and tubal ligations), they shouldn't have problems with the other procedures."