Despite Doctors’ Concerns, UC Renews Ties With Religious Organizations

As the UC health system is renewing contracts with hundreds of third-party hospitals and clinics, many with religious affiliations, some of its physicians and faculty want doctors to be able to provide treatments they deem appropriate, including abortions for women or hysterectomy for women. transgender patients.

The University of California Public Health is in the middle of a two-year process to renew contracts with affiliated hospitals and clinics that are helping the university provide care in underserved parts of the state. Many agreements are with faith-based institutions, including well-known hospitals run by Dignity Health, Providence, or Adventist Health. Such arrangements generate over $20 million a year for the UC system and help the public university move closer to its goal of improving public health.

The current policy, adopted in 2021, states that UC physicians have the authority to advise, refer, prescribe, or provide emergency care, covering cases where a patient’s relocation “risks a significant deterioration in the patient’s condition.” But some doctors and faculty at the University of California fear that doctors will only be allowed to perform certain surgeries in emergencies.

They want to add a clause that doctors have the right to carry out procedures as they see fit or necessary without waiting for the patient’s condition to worsen.

Others have gone so far as to call on the university to stop partnering with hospitals that have ethical and religious directives against sterilization, abortion, some miscarriage treatments, and some gender-affirming therapies. The Academic Senate, the faculty body that helps the university set academic policy, and other faculty councils have urged the university president to avoid working with healthcare facilities because many of them have restrictions that “may have a discriminatory effect on patients.”

In response, university leaders publicly pledged to ensure that physicians and trainees could provide whatever care they deem necessary at affiliated institutions, but made no change to the wording of the policy.

“We’ve made it clear that it’s up to the treating physician to decide if there is an emergency and when to act,” said Dr. Carrie Byington, executive vice president of the University of California Public Health, at the fall meeting of the University of California Council. Regents, the governing council of the university system.

UC Health has given itself until the end of this year to bring contracts in line with its new policy. During the October board meeting, employees estimated that a third of the contracts had been evaluated. The administrators did not say if the current policy has thwarted any contracts.

Back in June 2021, the Regents approved a policy regulating the practice of doctors in third-party hospitals and clinics with religious or ethical restrictions. Regent John Perez has made significant changes to the staffing proposal. At the time, this was celebrated as a victory for those who advocated that the university override the religious directives of affiliates.

Pérez noted at the time that his amendments were intended to “clarify what the regents expect from politics, that nothing that is not based on science or [the] best medical practice should limit the ability of our practitioners to practice medicine in the interest of patients.”

But some doctors and educators have said that Perez’s proposal was then fabricated in words, as it was transformed from a vote of regents into official policy a few months later. Some have questioned whether the policy can be interpreted as limiting services unless there is an emergency and have said that it does not go far enough to define an emergency.

“Sounds good,” Dr. Tabeta Harken, director of Comprehensive Family Planning, Obstetrics and Gynecology at the University of California, Irvine, told the board. “It passes the common sense test, but it’s really just the federal minimum care requirement.”

Perez declined to comment to KHN.

At Regents meetings, interested physicians provided examples of maternity care and gender affirmation that they believe may be at risk in some hospitals.

One was a tubal ligation procedure, or sterilization procedures immediately after birth, to prevent future pregnancies that could put the woman at risk. It’s an easier procedure if done postpartum because the uterus is larger than usual and it eliminates the need for additional surgery, says Dr. Jennifer Kearns, UC San Francisco assistant professor and director of the school’s Comprehensive Family Planning Scholarship.

Dr. Maya Zapata of UCLA Health described the cases of two patients who may not have been able to receive the same care in a religiously restricted hospital: a trans man who seeks a hysterectomy based on a mental health referral for gender confirmation surgery, and a cisgender woman who seeks the same procedure for uterine fibroids.

In a restricted hospital, Zapata said, a cisgender patient would be able to get surgery but a trans patient would not, despite both being considered non-emergency cases.

But it’s unclear if doctors are facing problems. UC Health executives said there were no formal complaints from university doctors or interns practicing at affiliated medical centers that they were not allowed to provide care.

Critics say the lack of complaints may not reflect reality as doctors may find workarounds by transferring or referring patients elsewhere. One researcher, Lori Friedman, of the University of California, San Francisco, spoke to dozens of doctors working in religious hospitals around the country. Many did not file complaints about the care restrictions for fear that it could jeopardize their jobs, she said.

The debate involves a partnership with Dignity Health, a Catholic hospital system. In 2019, UCSF Medical Center leaders considered a controversial plan to create a formal affiliation with Dignity. Critics spoke out at heated public rallies and the plan drew condemnation from dozens of reproductive justice advocates as well as the gay and transgender communities. UCSF ultimately abandoned this plan.

When it became clear that UC Medical Centers across the state had similar affiliation agreements, faculty raised further concerns. Janet Napolitano, then president of the UC system, convened a task force to assess the impact of ending all agreements with religiously restricted organizations. Ultimately, the group stressed the importance of maintaining partnerships to help medically underserved populations.

“With one in seven patients in the U.S. being treated in a Catholic hospital,” the group writes in their report, “isolating the University of California from major players in the healthcare system will undermine our mission.”

Dignity Health, which merged with Catholic Health Initiatives to form CommonSpirit Health in 2019, has already entered into a new contract that adopts updated UC policies. Chad Burns, a spokesman for Dignity, said the hospital system appreciates working with UC Health for its expertise in areas such as childhood trauma, cancer, HIV and mental health. He added that the updated agreement reflects “the shared values ​​of UC and Dignity Health.”

Some doctors at the University of California note that they have not only state support, but also the legal right to perform various reproductive and contraceptive procedures. After California voters passed Proposition 1, the state constitution was formally amended in December to affirm that people have the right to have an abortion or use contraceptives. Unlike health care systems in other states, some educators say UC Health can advocate for reproductive rights.

“Being in California, we have a lot of leeway to be able to make those decisions and stand in our own power,” Kearns said. “I think it’s our responsibility.”

Other doctors say the university system should give priority to public service. Dr. Tamera Hatfield, a maternity and fetal health specialist at the University of California, Irvine, told a Regents meeting that she has never been asked to change patient care based on religious restrictions since her department joined Providence St. Joseph Hospital. Orange about ten years ago.

“Partnering with faith-based institutions dedicated to serving vulnerable populations empowers patients who are least able to navigate our complex health systems,” she said.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Foundation.

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