UC San Francisco has walked away from an expanded affiliation with Dignity Health following concerns of limits to women's reproductive services, LGBTQ care, end-of-life options and other treatment restricted by religious directives.
UCSF aimed to build on its 20-year affiliation with Dignity's Bay Area hospitals to boost access to meet a growing demand. But that effort was met with stern opposition regarding abortions, gender reassignment surgery and physician-assisted suicide.
"Many of you have expressed strong concerns about a significantly expanded UCSF relationship with a healthcare system that has certain limits on women's reproductive services, LGBTQ care and end-of-life options," UCSF Chancellor Sam Hawgood and UCSF Health President and CEO Mark Laret wrote in a March 28 letter to staff. "Given the concerns, we will not continue to pursue the affiliation as it had been envisioned."
The organizations were not considering a merger or any arrangement in which Dignity Health would have had a role at UCSF's facilities, UCSF wrote in a related FAQ. The goal was to expand cancer services, build new primary-care clinics, support Dignity's St. Francis Memorial Hospital in developing a new obstetrics unit, grow adult and adolescent mental health services, give UCSF surgeons access to Dignity Health hospitals to reduce wait times, and offer more outpatient women's health services near Dignity hospitals. The four Dignity Bay Area hospitals involved were St. Francis Memorial and St. Mary's Medical Center in San Francisco, Sequoia Hospital in Redwood City and Dominican Hospital in Santa Cruz.
While the academic health system will not pursue a formal relationship, it will continue to work with Dignity to provide services related to mental health, neurology, neurosurgery and pediatric burn care, among others.
UCSF said that it turned away 855 patient transfers to its hospitals last year. Each month, it receives more than 1,000 new primary-care requests that UCSF cannot accommodate. The UCSF-Dignity collaboration has helped UCSF avert capping or closing neurology and surgery programs through their working together to recruit physicians at Dignity, UCSF said.
In support of the affiliation, UCSF professor of pediatrics Dr. David Teitel cited Dignity's service to the underserved, writing in a letter to Hawgood that Dignity is the largest private provider of Medicaid patients in the country, and outperforms Stanford Health, Sutter Health, and Kaiser Permanente in treating MediCal patients.
"It is true that UCSF strongly disagrees with Dignity Health concerning the reproductive rights of women and the treatment associated with those rights," Teitel wrote. "Their approach to end-of-life issues may also be not congruent with ours. However, when looking at the totality of our principles, our values and our care of patients, UCSF aligns far more closely with Dignity Health than with any other healthcare system in Northern California."
In a letter of opposition, more than 1,500 faculty members, residents, students and alumni wrote that Dignity's recent merger with Catholic Health Initiatives to form CommonSpirit Health stoked their concern.
"Dignity Health owns some non-Catholic hospitals (e.g. St. Francis in San Francisco), but these facilities must follow the Dignity Health Statement of Common Values which does not permit use of in vitro fertilization, or the termination of pregnancy," the letter reads. "In addition, Catholic healthcare facilities interpret the Ethical and Religious Directives to explicitly prohibit the provision of gender affirming services (such as hormone treatment, hysterectomy and mastectomy) for transgender people. We believe the religious policies that govern care at Dignity and CHI hospitals are in direct conflict with key principles of UCSF and UCSF Health."