Washington state passed the law requiring public disclosure of the wide range of hospital policies in the wake of Providence Health & Services' 2012 deal to acquire Swedish Health Services, a non-profit secular system. That merger renewed the debate around reproductive health that sometimes follows Catholic-secular mergers.
While the deal allowed Swedish to retain its secular identity, local critics sounded the alarm after Swedish said it would stop performing elective abortions and instead outsource those services through a partnership with Planned Parenthood.
As of Thursday, information was available on the health department website for most of the hospitals under the Providence umbrella, but not for Swedish Health Services. A spokeswoman for Providence said both Providence and Swedish submitted separate policy documents to the Department of Health on March 25, and also posted the information on the hospitals' respective websites.
The Department of Health implemented the new transparency rules on Jan. 23 and gave hospitals 60 days to comply. The policies are available on the department's website and also must be posted on hospitals' own websites.
Reproductive rights activists and their supporters fear proposed and completed mergers between Catholic and secular health systems will affect the availability of medical services. They point to the Ethical and Religious Directives for Healthcare Services issued by the U.S. Conference of Catholic Bishops, which is the doctrine that guides care at all Catholic hospitals, nursing homes, and other healthcare facilities. Enforcement of the doctrine is left up to local bishops.
A December report (PDF) from the state's Office of Financial Management did not find barriers to reproductive and end-of-life care options in communities served primarily by religious hospitals. It also didn't find any instances of discrimination toward same-sex patients or their families. However, it suggested continued monitoring to ensure that access continues.
“I think a lot of the tempest that is being created … is without merit,” said William Cox, president and CEO of the California-based Alliance for Catholic Health Care. “There hasn't been one study that has shown that there's any diminishment of services as a result of a merger with a Catholic health system. The facts always contradict what's stirred up in those reports.”
Washington state long has protected abortion rights, and voters approved the Death with Dignity Act in 2008. Individuals hospitals and providers were given the option of opting out of its requirements.
The new transparency rules were requested by Democratic Gov. Jay Inslee in the wake of the Providence-Swedish merger. He asked the Washington Department of Health to increase transparency for healthcare consumers.
A spokesman for the Department of Health said 46 policies have either been posted or are in the process of being posted, 27 are in review and 23 hospitals haven't responded. Hospitals that haven't submitted policies will receive a reminder notice, but the program staff is still determining what enforcement action to take if they don't comply, he said.
The Washington State Hospital Association opposed the new rules. “The issue that we raised is that it's not going to provide great information to the public,” said Mary Kay Clunies Ross, VP of communications and public affairs for the association. She added that individual providers can opt out of providing abortions and the Death with Dignity Act so the hospital policies alone don't provide a complete picture of available services.
The hospital association also filed a lawsuit last month challenging the expanded CON rules, which now cover any change of control. It argued that the health department doesn't have the authority to redefine the law, which previously has not applied to mergers and affiliations, but only a “sale, purchase or lease.” Expanding its scope will raise the costs for providers, many of whom could face closure if they don't find a partner, Clunies Ross said.
A day after the rules went into effect, policies were publicly available for about 40 hospitals, while more than 50 had incomplete information posted. Many hospitals, including Catholic facilities, had no information available about their policies regarding reproductive and end-of-life care, which are the two biggest areas of controversy. However, the health department is continuing to update the site.
Some hospitals, including Virginia Mason Medical Center and United General Hospital, directly addressed the issue of the state's Death with Dignity law, which allows doctors to prescribe a lethal medication for terminally ill patients who are competent and request it. They both said they allow their providers to assist such patients with the aid in dying option, though not in their facilities.
During the public comment period, opponents criticized the health department for overstepping its bounds and placing an undue burden on providers. Others said disclosure alone would do little to help patients in rural settings who have limited choice about where to be treated. But some observers say it's essential for patients and their families to be able to find out what a healthcare facility's policies are before going there.
Washington's Office of Financial Management, in its analysis of how religious-Catholic mergers are impacting access to reproductive services, calculated that 44% of the state's hospital beds are currently under the umbrella of either Catholic or Seventh Day Adventists Church systems, up from 26% in 2010. However, that number drops to 34% when Swedish Medical Center's hospitals are categorized as secular.
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