The patient learned she had brain cancer in her first trimester of pregnancy. She needed chemotherapy and abortion care.
“I’ve got a woman whose life is threatened by brain cancer,” her doctor, an OB-GYN at a Catholic hospital, told authorities there. “I need to do a termination.”
Catholic hospitals follow religious directives that generally bar certain types of health care, including abortions, except when the patient is in imminent danger.
The hospital refused the treatment, telling the OB-GYN to refer his patient elsewhere.
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“They said, ‘Go take her to another hospital. Take her to another place. Those places are available to you. We don’t have to do it here…’,” the OB-GYN explained.
The case is among many contained in a new paper, “Referrals for Services Prohibited in Catholic Health Care Facilities,” which will be published in the September issue of Perspectives on Sexual and Reproductive Health. The study explores whether Catholic hospitals make timely referrals, provide complete and accurate health-care information, and supply emergency treatment when needed.
And it comes as Catholic facilities exert more and more control over U.S. health care, now accounting for one in six hospital beds nationwide, according to recent figures from the advocacy group MergerWatch.
“Until now, there hasn’t been a study asking about referral patterns in Catholic hospitals,” lead author, Dr. Debra B. Stulberg, assistant professor of family medicine at the University of Chicago, said in a phone interview with Rewire. “We set out to ask OB-GYNs how the institution where they worked affected the care they provide.”
In 2011 and 2012, Stulberg and her co-authors conducted in-depth interviews with 27 OB-GYNs who were working or had worked in Catholic hospitals.
The OB-GYNs came from a diversity of faiths and hailed from all parts of the country; 17 were female, ten were male. And while the qualitative nature of the survey means the responses cannot be generalized across Catholic hospitals nationwide, the survey reveals a referral process plagued by reports of inconsistencies and treatment delays.
Survey respondents described cases where they felt that referring a patient to an outside provider put the patient’s health at risk.
One OB-GYN found it “nearly impossible” to treat heavy vaginal bleeding because of the hospital’s ban on hormonal contraceptives.
“Say you have…a 45-year-old who comes in [at three in the morning] with heavy bleeding and irregular periods. The most common approach to stopping her bleeding is to give her high-dose birth control pills for a short period of time. So, that became very difficult…’cause they didn’t have them in stock. I won’t say it’s impossible to get them, because like the head pharmacist knows where there’s three secret packs, and if you happen to manage to find the head pharmacist at [that hour], you can. But it’s nearly impossible to get birth control pills to treat heavy bleeding.”
OB-GYNs described broad inconsistencies in how hospitals handled referrals, with some hospital administrators and ethicists encouraging or tolerating referrals, and others actively discouraging referrals. Sometimes doctors kept referrals hidden. Respondents reported that patients needing abortion care were given less assistance with a referral than those requesting other prohibited services.
In one instance, a secretary tried to block an abortion care referral.
“What doctors told us is sometimes for abortion … there was a sense of, ‘You’re on your own,'” Stulberg told Rewire. She said the disparities in referrals can delay medical treatment and reinforce abortion stigma.
By referring patients for abortions rather than allowing the doctors to administer the prohibited care, some respondents felt the hospital “dumped” or “punted” the patients.
“It tells women that this care is not standard. It’s something we do on the side, under the table,” Stulberg said. “Imagining myself in those patient’s shoes, I might feel really abandoned by my doctor.”
Respondents reported that they received mixed messages from hospital authorities when the facility’s moral teachings were pitted against its financial interests.
For example, Catholic doctrine prohibits handling eggs and sperm for in-vitro fertilization procedures, but a respondent said a Catholic hospital system skirted the ban by opening an off-site fertility clinic.
As the OB-GYN explained, “Now, they’re getting a little crafty with how they get around it, and they go off-campus [to provide such services]. So we actually do now have…an infertility specialist, who is starting up an in vitro fertilization clinic off-campus…. We had somewhere to send them anyway before—it was just out of the system—but now the system wants the business.”
The authors call on policymakers to require Catholic hospitals that refuse to offer care to refer patients to providers and to inform patients beforehand about the limits on treatment at religiously run facilities.
“Having consistent procedures and help to access abortion will reduce the chance that the patient will be given the run around and have her care delayed,” study co-author Lori R. Freedman, assistant professor in the departments of Obstetrics, Gynecology, and Reproductive Sciences at University of California-San Francisco, told Rewire in a phone interview.
The recommendations are in keeping with ethical guidelines from the American Congress of Obstetricians and Gynecologists, which advises health-care providers with religious objections to abortion care to notify patients beforehand and to refer them to abortion care providers.
The study builds on research published in Contraception by a team that included Freedman and Stulberg. They found that Catholic hospitals’ ban on tubal ligations caused unnecessary second surgeries and erected barriers to care for patients with low incomes.
“You really want women to find safe and compassionate providers as soon as possible,” Freedman told Rewire. “Delays…are not good for women.”