Divine intervention

Bartlesville hospital issue sparks debate over religion in health care

When Brooke Cox and her friends heard reports that doctors affiliated with the Jane Phillips Medical Center in Bartlesville were allegedly going to stop prescribing contraceptives strictly for birth control, they knew they didn’t like it.

The question became what they were going to do about it.

The answer they came up with cast a spotlight on Oklahoma and intensified the national debate about what can happen when organizations with religious affiliations get involved in the administration of health care facilities.

On its website, Ascension Health describes itself as the “nation’s largest Catholic and nonprofit health system” with its “mission focused health ministries” employing more than 150,000 associates serving in more than 1,500 locations in 23 states and the District of Columbia.

St. John Health System joined Ascension Health in April 2013, a transaction which also brought Jane Phillips Medical Center under Ascension control.

The development illustrated a growing trend throughout the United States. According to a report released last December by the American Civil Liberties Union and the Merger Watch Project, the number of Catholic sponsored or affiliated acute care hospitals increased by 16 percent from 2001 until 2011. The report says that the number of other types of non-profit hospitals declined during that decade, as did the number of publicly owned hospitals. The report also states that 10 of the 25 largest health systems in the United States are Catholic-sponsored.

Sheila Reynertson is the advocacy coordinator for the Merger Watch Project, which was created in 1996 when the merger between religious and secular hospitals in Troy, N.Y., caused the loss of contraceptive services at an outpatient clinic.

Merger Watch works directly with communities to find ways of protecting patients’ rights and access to care when “non-religious hospitals are proposing mergers with religious health systems,” according to its website.

Reynertson told The Tulsa Voice recently that problems arise in situations in which a health care system attempts to take steps in which its stated religious beliefs threaten to infringe on patients’ rights.

According to its website, Merger Watch is dedicated to the idea that health care should be guided by accurate medical information and the patient’s own religious or ethical beliefs. Merger Watch believes  “in medical decision-making, the patient’s rights must come first, ” the site says.

Reynertson said issues connected to patient care become particularly pressing in smaller communities in which a particular medical facility is essentially “the only game in town” when it comes to health care.

That’s where the controversy that sprung up in Bartlesville in late March enters the picture. Rightly or wrongly, word began to spread through the city that—on or about March 26­—doctors affiliated with Jane Phillips Medical Center had been instructed that they would no longer be permitted to prescribe contraceptives strictly for birth control, although such prescriptions would purportedly still be allowed for other medical purposes.

St. John officials have not confirmed whether such a meeting ever took place. Instead, a media statement was issued that said, “Consistent with Catholic health care organizations, St. John Health System operates in accordance with the Ethical and Religious Directives for Catholic Health Care Services and therefore, does not approve or support contraceptive practices.”

“However, only physicians (not institutions) are licensed to practice medicine and make medical judgments. While our physicians agree to abide by the directives, they also have the ability to prescribe medications, including hormonal medications, in accordance with their independent professional medical judgment. This includes informing patients when they are operating under their own professional judgment and not on behalf of St. John Health System.”

Even if the supposed March 26 meeting with doctors affiliated with Jane Phillips Medical Center never took place-or if what was said there was misunderstood-there is no denying the public outcry that occurred in the days that followed.

Cox said she heard about the situation from friends and that “the more we talked, the more we realized a lot of people didn’t like it.”

Their outrage manifested itself in an on-line effort during the following weekend that resulted in the founding of the “Bartlesville United for Healthcare” Facebook page, which stated “we believe that everyone has a right to healthcare that is free from religious agendas.”

Cox said she had no idea that the site—which quickly collected more than 1,000 likes-- would catch on “like wildfire.”

By March 31, St. John issued a written statement that appeared to defuse the controversy, which by that point had drawn national media attention.

Reynertson subsequently said she was “not totally convinced” that the Bartlesville birth control controversy was forever resolved. She said the statement released by St. John appeared “intentionally vague” and that she has seen examples of “double speak” and “promises kept and promised broken” in similar situations elsewhere in the country.

Still, she said people in Bartlesville did a “fantastic job” of banding together over the issue by creating a grass roots effort that prompted an almost immediate reaction.

These sorts of controversies may be just beginning in the state.  The Oklahoma State University Medical Authority announced recently that it has selected Mercy Health System to manage the OSU Medical Center in Tulsa.

Mercy is the sixth largest Catholic health care system in the U.S. with 33 acute care hospitals and nearly 700 clinic and outpatient facilities, according to its website.

Such business arrangements in the world of health care have been increasingly occurring since the mid-1990s as community hospitals sought to ease financial stress, according to Merger Watch.

All of this is playing out against a larger health care issue. There have been dozens of lawsuits filed by various corporations challenging the birth control coverage benefits contained in the Affordable Care Act.

The U.S. Supreme Court  is expected to issue a ruling by late June which could clarify whether businesses have a religious liberty right or whether such constitutional protections apply only to individuals.

Cox said “everybody has a right to believe what they want to believe” but that those beliefs should not be pushed on others.

She said that although the Bartlesville birth control controversy has seemingly passed, the “Bartlesville United for Healthcare” effort will not be going away. She said organizers are still researching their options to accomplish their long-term goal of health care that is free from religious agendas.

The joint Merger Watch and ACLU report issued last December, recommended that “going  forward, we need broad policy reform such that women’s health and rights are respected.”

Specifically, the report recommended steps that include enforcing federal law to ensure that patients are given full information about their treatment options and establishing higher standards for facilities designated as  “sole community hospitals” in order to meet the health needs of patients in their areas.

Cox said that Bartlesville residents don’t have the array of health care options that people in a city like Tulsa have. While the two cities are only roughly an hour apart, Cox pointed out that the distance is not easily traveled for some.

The joint report also recommended the exposition of harms to patients that allegedly could result from enforcement of the Ethical and Religious Directives for Catholic Health Care Services.

Among other things,  the report also advocated transparency of public funding for religiously affiliated hospitals and requiring hospitals to make public their policies on the provision of reproductive health care.

Reynertson said it “becomes a problem” when organizations that are in the field of health care try to assert that their religious freedom trumps patients’ rights to have access to health care.

Whatever happened in Bartlesville at the end of March, it certainly focused a lot of attention on what can happen when the worlds of religion and health care attempt to co-exist. These issues will only continue to grow in the area, especially if a long-term agreement is reached for Mercy Health System to manage the OSU Medical Center. The Merger Watch website says “medical care that is restricted by institutional religious doctrine or the provider’s moral beliefs can pose a significant threat to patients’ rights and access to care.”