In the city of Merced, Calif., guess which hospitals have a monopoly on providing reproductive healthcare services, including sterilization and contraception?
The answer is Catholic Healthcare West, one of the country's largest Roman Catholic healthcare systems.
The California attorney general recently cleared the way for CHW's 101-bed Mercy Hospital and Health Services in Merced to buy the business operations of 158-bed Sutter Merced Medical Center, the city's only other hospital. But the state's approval came on the condition that Mercy would continue performing reproductive healthcare services at the former Sutter hospital, including tubal ligations, contraceptive services, family planning and emergency contraception.
Mercy must get attorney general approval to reduce those services in the future.
Other Catholic healthcare providers have been told to halt reproductive health services because they violate the Ethical and Religious Directives for Catholic Health Care Services, a sort of rule book for providers.
CHW's Mercy also performs tubal ligations and emergency contraception, said John Headding, the hospital's president.
"There's a great community need to provide those services," Headding said of reproductive services in the area. The city of Merced has a population of about 62,000.
CHW spokeswoman Lori Aldrete declined to comment.
"This is a sensitive issue, and we're not going to comment on it any further," she said.
Other Catholic providers have come under criticism for providing similar services. Two Catholic Health Initiatives hospitals in Arkansas and North Dakota stopped performing tubal ligations after church officials in the U.S. and Rome clamped down (Dec. 11, 2000, p. 24).
However, local diocesan officials have allowed CHW's 93-bed Saint Louise Regional Hospital in Gilroy, Calif., to perform tubal ligations (Nov. 20, 2000, p. 12).
Also, when secular hospitals join CHW, the system has given those hospitals a truncated version of the directives to follow which allow for tubal ligations, contraception and vasectomies (Sept. 28, 1998, p. 28).
Recently, the Catholic directives have come under scrutiny as the National Conference of Catholic Bishops is expected to discuss possible revisions to the rules when they meet in June in Atlanta.
California Deputy Attorney General Mark Urban said it was his impression that the agreement to continue the reproductive services at the former Sutter hospital is a combination of CHW's interpretation of the directives and discussions with the Diocese of Fresno, Calif.
"They are permitted to continue to provide all existing reproductive services," Urban said.
Urban wrote a March 30 letter clearing CHW's takeover of the former Sutter hospital. The attorney general has statutory authority to review all changes in control of not-for-profit healthcare facilities.
William Lucido, a spokesman for the Diocese of Fresno, said the diocese is studying the matter.
When the attorney general's office cleared the Merced deal, it acknowledged some uncertainty in implementing the Catholic directives.
In his letter, Urban wrote that while the Merced agreement is consistent with the directives as implemented, that doesn't mean there won't be future changes in the directives or their implementation.
If that happens, and it's likely to result in a reduction of reproductive services, Mercy must submit a plan for approval to the attorney general that explains how it intends to ensure the continued availability of services.
But the attorney general gives Mercy a safety net, saying that "Mercy shall not be required to take any action that conflicts with the principles inherent" in the directives, the letter says.
Watchdogs of women's reproductive services are satisfied with how the Merced deal has transpired.
"I think we've made a lot of progress in this deal," said Susan Fogel, legal director of the California Women's Law Center, which was active in the public scrutiny of the deal.
CHW paid $21 million to $23 million to buy the business operations from Sutter, said Michael Ford, the Merced County public health director. Sutter had leased the hospital for four years from Merced County, which owns the hospital facility.
CHW is now leasing the hospital building from the county. However, CHW plans to build a new hospital to replace its two Merced hospitals, which have since been renamed. Mercy is now known as the Domincan campus of Mercy Medical Center Merced, and the former Sutter hospital is the Community campus.