Text by Janet Wells
Illustration by Lee Ballard
When Teresa Rodriguez* found out in her fifth month of pregnancy that her fetus had no kidneys and would die within hours of birth, she decided to have an abortion. It was not a choice Teresa wanted to make. She was devastated at the news about her baby. But the idea of carrying for four more months a child who could not survive outside of her womb was just too much to endure, so she chose to terminate the pregnancy.
Still, there was a catch.
Even at 20 weeks, abortion is a perfectly legal procedure. Starting with the Roe vs. Wade case more than 25 years ago, the U.S. Supreme Court has made several rulings affirming the right to make choices about birth control and abortion.
But Teresa, along with a growing number of women nationwide, has discovered that freedom of choice is a minefield when it comes to abortion. Too far along in her term to go to the only clinic in Petaluma to offer the procedure and in need of hospitalization, Teresa could not go a few blocks away to Petaluma Valley Hospital. The hospital used to perform abortions, but now the facility is in partnership with the Catholic Church-owned Sisters of St. Joseph of Orange, and the church prohibits abortion even in cases of rape or when the mother’s health may be compromised.
A low-income Sonoma County resident, Teresa was forced to travel back and forth to San Francisco twice over two days to have seaweed extract inserted to soften her cervix. After 48 hours, she went back yet a third time to have her pregnancy terminated.
If Teresa’s situation seems extreme or far from home, think again. The Catholic Church, which sees abortion and birth control as virtual crimes against church doctrine, took over management of publicly-owned Petaluma Valley Hospital in 1997; purchased Santa Rosa-based Primary Care Associates, one of the county’s busiest medical groups, in 1998; leases office space to several independent doctors and small medical groups throughout the county; and owns Santa Rosa Memorial Hospital.
Whether the Catholic Church owns the hospital or is merely the landlord to a consortium of independent doctors, the contract is the same: All doctors must agree not to perform abortions on church property. And doctors who work for a Catholic-owned facility–regardless of their own faith or social beliefs–are prohibited from performing abortions even on their own time at other sites.
“What we’re seeing right now is opponents of abortion trying to limit women’s access by different means. The Catholic Church is doing it by stealth, buying hospitals left and right and taking away rights of non-Catholics,” says Linda McCabe, spokeswoman for Sonoma County National Organization for Women.
“Individual Catholic physicians and patients can follow their religious beliefs, but they should not push that off on other people,” McCabe adds. “No one would accept it if Jehovah’s Witnesses started buying up hospitals and started denying people blood transfusions because that’s their belief.”
CATHOLIC HOSPITALS are the largest non-profit health-care provider in the country. The Catholic Church owns eight of the 14 largest health-care systems in America, controlling 600 hospitals with 140,000 beds. Compare that to Kaiser Permanente, the nation’s fourth largest non-profit provider, with just 28 hospitals and slightly more than 6,000 beds.
In the era of managed care, with more and more hospitals merging to cut costs, the numbers in the Catholic column will only increase. According to a study by Catholics for Free Choice, in the past eight years nearly 100 mergers have occurred nationwide with a non-Catholic hospital teaming up with a Catholic facility. In half of those deals, reproductive services have been either cut back or dropped completely.
Abortion services are unavailable in 84 percent of the counties in the United States, according to the American Civil Liberties Union. One third of all American women live in these counties. There are 76 communities across 26 states in which the sole hospital is Catholic. “Emergency contraception for rape victims, distribution of condoms for HIV, abortion, tubal ligation, fertility services–all these are in danger of getting wiped out,” says Lourdes Rivera, staff attorney with the National Health Law Program. “These are services that are important to women and need to be an integral part of health care.”
Doctors are increasingly hesitant to counter the Catholic strictures by performing a procedure that has swirled in controversy and violence for decades in America. If they criticize their boss or landlord–in this case, the Catholic Church–they could lose their job and livelihood. If the doctor is a vocal supporter of abortion rights, he or she could be killed, like Dr. Barnett Slepian, an upstate New York physician murdered by a sniper in October.
In Sonoma County, with a population of nearly a half million people, there are fewer than two dozen doctors who perform abortions. Planned Parenthood in Rohnert Park does the procedure only twice a month, because one of its two doctors quit and the clinic has been unable to find a replacement. The other four clinics in the county that offer abortion services are swamped, sometimes doing as many as 30 procedures in one night.
“People don’t know what’s going on in their own backyard,” says Dr. Susan Lewis, a family-practice doctor in Petaluma.
A fiercely pro-choice physician who performs abortions as a small part of her practice, Lewis is frustrated and appalled by the “horror stories” she hears from her patients.
One evening last fall at a Santa Rosa clinic, Lewis did an abortion for a Sonoma resident in her mid-20s. The woman, about nine weeks pregnant, had first asked her regular doctor to do the procedure.
“First the doctor said, ‘Let’s pray for your unborn baby.’ Then the doctor told her she had to have an ultrasound, and wrote on the ultrasound slip, ‘Show the heartbeat,’ ” Lewis says, shaking her head. “You don’t do that if someone wants an abortion. It’s not just weird, it’s mean. They showed the woman the heartbeat, and she cried.”
The woman then called the clinic to set up the procedure, Lewis says.
Lewis, like all physicians interviewed for this story, is wary of being labeled an “abortion doctor” in the community or being targeted by anti-abortion activists. She continues to do abortions, she says, “because it’s the right thing to do. It’s not my choice to make for people. I don’t know what’s happening in these women’s lives.
“When I was living in England in the 1980s, I thought I was pregnant,” she says. “I saw a billboard that said, “Unwanted pregnancy? Call this number.” I called and a woman answered, asked how I was, knew I was American. She was nice. Then she said my baby was alive, it had a heartbeat. I remember standing in this phone booth in the freezing rain, pumping money in the coin slot, crying. I was all alone, no family, 100 percent broke. It took me a long time to hang up on her.
“Women,” Lewis says simply, “should have the choice.”
If, however, your doctor is affiliated with the Catholic Church, that choice may not be so easy to make.
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THE RULE BOOK for Catholic hospitals also should serve as a heads-up to any non-religious institution flirting with a merger deal or even leasing space. Part of any partnership agreement is adherence to the “Ethical and Religious Directives for Catholic Care Services,” 70 commandments drafted by the National Conference of Catholic Bishops, prohibiting abortion, most forms of birth control, tubal ligation, removal of ectopic pregnancies, even the morning-after pill for rape victims.
Catholic hospitals can even refuse to refer patients to facilities that do offer such services.
Legislative tolerance of such restrictions is growing, according to a January article in The Nation. The 1997 Balanced Budget Act applies the “conscience clause”–which originally meant that individuals would be able to opt out of doing procedures like abortion on moral grounds–to managed-care institutions. As a result, health plans for federal employees may use religious or ethical grounds to curtail reproductive care.
According to The Nation, pharmacists in South Dakota are legally allowed to deny a woman a prescription if they have reason to believe it will be used to terminate a pregnancy.
Catholic health-care providers aren’t cagey about the church’s philosophy. Larry Maniscalco, director of Mission Services for Memorial Hospital in Santa Rosa, offers to provide articles and pamphlets, even underlining sections of the directives that apply to reproductive care. Maniscalco readily concedes that an affiliation between Catholic and non-Catholic institutions “usually does result in the loss of reproductive services.”
As for whether a truncated menu of services equals full health care for women, he says, “You have to look at whether it is available elsewhere in the community, and I think it is available in the community.”
One Santa Rosa primary-care physician says that the Catholic Church isn’t the enemy as much as doctors eager to cash in on the partnership gold mine. “The most destructive thing happening in women’s reproductive-health care is that doctors are caving in,” says Dr. Renee Walker. “Catholic hospitals are doing what they’ve done for 2,000 years. The medical world is caving in for financial expediency.
“They sold women down the river because it made financial sense.”
Walker is particularly critical of Primary Care Associates, which merged with Memorial Hospital last year. With more than 50 physicians, the group cares for about 100,000 patients in Sonoma County.
Before the merger, nine of the PCA doctors would perform abortions, Walker says. The merger contract now prohibits the group’s doctors from offering abortions at their offices–as well as on their own time somewhere else.
“Patients had no idea,” Walker says. “And the doctors signed this agreement.”
Along with the new title of president and chief executive officer of the St. Joseph Health Foundation of Northern California, PCA head Gary Greensweig also netted a tidy profit from the deal, Walker says.
Greensweig demurs when asked if the merger deal was personally lucrative, but concedes that he profited from the deal. “There was an acquisition of certain assets,” he says.
Why were PCA doctors willing to give up their right to provide reproductive services? “The medical group believes that the type of care for the underserved and community partnership programs that have historically been present with Memorial are very compatible with the medical group’s own identities and values,” Greensweig says. “Basically, the bottom line is from our standpoint; our patients get the reproductive services they need. But in most cases they don’t get them from us.”
PCA doctors have “a variety of referral services,” Greensweig says, an attitude that infuriates Walker, who, as a doctor with a private group in Sonoma County, bears the brunt of PCA’s agreement to not provide abortions.
“They don’t counsel these women, they just give out a number,” Walker says. “These women would come over to our office frantic. Often we didn’t get paid a dime because it wasn’t a formal referral.”
In October, Walker says her group refused to take any more PCA patients. “They never fixed it. They didn’t care.”
THE NUMBER OF WOMEN going to clinics like Commonwoman’s Health Project and Women’s Health Specialists in Santa Rosa has mushroomed in the last several years, clinic workers say, and the profile of a woman seeking an abortion has changed dramatically as well.
“When I first started working in 1992, the majority of patients were the underserved, with no insurance, Spanish-speaking,” Walker says. “Now they have private insurance, are employed, even have college degrees. They have their own doctor and there they are, a huge group of insured that don’t have anywhere to get an abortion.”
When Walker and her colleagues wanted to lease space from the Sisters of St. Joseph of Orange, an order that runs Memorial Hospital as well as owning numerous buildings in the area, they were asked to sign the usual agreement: no abortions anywhere anytime, no talking about birth control to unmarried couples, no invasive fertility treatments or sterilization.
But there is some wiggle room with the church directives. The church wanted Walker’s busy practice as a tenant enough to make some concessions. Walker and her colleagues can violate just about all of the reproductive directives, except abortion–and that they can do elsewhere.
When publicly owned Petaluma Valley Hospital proposed a merger with Memorial Hospital in 1995, community members went ballistic at the notion that reproductive services would no longer be available. Because of a financially creative compromise that gave the hospital the resources of the Catholic Church while keeping it separate through a lease agreement, tubal ligations still are performed at the hospital.
But abortions are one of the bottom-line no-nos for Catholics. Instead of finding a pro-choice partner for the hospital, women’s health services–including abortion–were shunted off to a separate clinic, the Petaluma Health Center.
While the “separate, but equal” solution does give women access to abortions, patients and doctors feel segregated and isolated from the main hospital. (If there were complications with an abortion requiring transfer of a patient to the hospital, clinic doctors say they don’t know whether Petaluma Valley Hospital would refuse the patient, resulting in a potentially life-threatening 15-mile drive to Sutter Medical Center in Santa Rosa.)
Such concessions aren’t perfect, and they are far from consistently applied when it comes to mergers. Concessions that affect reproductive care are made case by case, based on, it seems, how hard people fight. Greensweig and his PCA doctors decided to swallow the directives whole.
“We did not want to be in a position to negotiate away those core beliefs that our partner health system had,” he says.
And because PCA, unlike Petaluma Valley Hospital, is a private doctors’ group, patients don’t find out what they have lost until after the ink is dry on the merger deal.
“These decisions are made behind closed doors and boardrooms,” says attorney Rivera. “There is no requirement that there be any kind of notice.”
Sonoma Valley Hospital administrators announced recently that they are searching for a partner to bail the hospital out of financial straits, but there is no law requiring that the public must be in on the details of a merger.
PRO-CHOICE physicians are not happy about the merger trend and resulting loss of reproductive services. “But to stand up to the system can cost them their careers,” says Sepi Djavaheri, community organizer for the California Women’s Law Center. “There are few doctors who are willing to do that.”
And patients are ambivalent. “There’s so much shame with an abortion, and patients have internalized it. They aren’t going to go back to their doctor and say, ‘How dare you?’ They’d rather forget about the issue,” Dr. Walker says. “We want [abortion] to be available, we want it to be safe, but we don’t want to do it. It’s like garbage collectors. You want to put it out there and have it gone.”
*Names of patients and doctors changed at their request for privacy and security.
This is the first of a two-part series on abortion issues. Next week, how the religious right fills the post-abortion void.
From the February 25-March 3, 1999 issue of the Sonoma County Independent.
© Metro Publishing Inc.