The University of California health system renews contracts with hundreds of outside hospitals and clinics, many of which are religiously related. Some doctors and faculty are calling for stronger language to ensure that doctors see appropriate treatments, such as female abortions and female hysterectomies. transgender patient.
The University of California Health is in the middle of a two-year process to renew contracts with affiliated hospitals and clinics that help the university provide care in underserved areas of the state. Many of the contracts are with faith-based institutions, including prominent hospitals operated by Dignity Health, Providence, or Adventist Health. Such an arrangement would $20 million annually For the UC system, it helps public universities move closer to their goals of improving public health.
Under the current policy, adopted in 2021, University of California physicians are not permitted to advise, refer, prescribe, or provide emergency treatment for cases where patient movement “risks a significant deterioration in the patient’s condition.” However, some UC doctors and faculty are concerned that doctors will only be allowed to perform certain surgeries in cases of emergency. .
They want to add a clause stating that doctors have the right to treat patients as they deem desirable or necessary without waiting for their condition to worsen.
Some have called on the university to refuse partnerships with hospitals that have ethical and religious mandates for sterilization, abortion, some miscarriage management procedures, and some gender-positive treatments. Academic Senate, a faculty body that helps the university set academic policy, and other faculty councils urged the president of the university Avoid collaborating with medical facilities, as many have restrictions that “may have a discriminatory effect on patients.”
In response, university leaders publicly committed to ensuring that affiliated facilities provided all the care doctors and trainees considered necessary, but changed the wording of the policy. Is not.
“We have made it clear that it is the care provider who decides if an emergency exists and when to act,” said Carrie Byington, Ph.D., executive vice president of the University of California Health. said at the conference’s autumn meeting. Regent, Steering Committee of the University System.
UC Health has committed to keeping contracts compliant with the new policy through the end of the year. At an October board meeting, staff estimated that his one-third of the contract had been valued. Management has not clarified whether the current policy interfered with the contract.
In June 2021, the Regent approved policies governing how doctors practice outside hospitals and clinics with religious or ethical restrictions. Regent John Perez made significant modifications to the staff proposal.was celebrated at the time as a victory By those who insist that universities push back against religious directives from affiliates.
Perez said at the time that his amendment “was intended to make clear that it was the regent’s expectation in policy that there was no science or nothing that was not based on science.” [the] Medical best practice should limit the ability of our practitioners to practice medicine for the benefit of their patients.”
However, some doctors and faculty say: Perez’s proposal That’s from the regent’s vote formal policy months later. Some questioned whether the policy could be construed as restricting service unless an emergency occurs, and some said it was not sufficient to define an emergency.
Dr. Tavetha Harken, director of complex family planning, obstetrics and gynecology at the University of California, Irvine School of Medicine, testified at the board meeting. “It passes the common sense test, but in reality, this is the federal minimum care requirement.”
Perez declined to comment to KHN.
At the Regency meeting, the doctors involved provided examples of pregnancy and gender confirmation care that some hospitals believe are at risk.
One was to perform tubal ligation or sterilization immediately after birth to prevent future pregnancies that could endanger the woman. , is a simpler procedure if performed postpartum.
Dr. Mya Zapata of UCLA Health described the case of two patients who may not have received the same care in a religiously restricted hospital. A cisgender woman looking for the same procedure for fibroids.
Zapata said restricted hospitals allow cisgender patients to undergo surgery, but not transgender patients.
However, it is unclear whether doctors face problems. UC Health leaders say there have been no formal complaints from the university’s physicians or trainees practicing at affiliated medical centers that they are being prevented from providing care.
Critics said the lack of complaints may not reflect reality, as doctors may find workarounds by transferring or referring patients elsewhere. One working researcher, Lori Freedman, spoke with dozens of doctors who work in religious hospitals across the country. Many people do not complain about restrictions on care for fear that their jobs will be jeopardized.
The controversy stems from its partnership with Dignity Health, a Catholic hospital system. In 2019, UCSF Medical Center leaders considered creating a controversial plan. Formal affiliation with dignityCritics voiced their opposition at heated public rallies, and the plan drew condemnation from reproductive justice advocates and the gay and transgender communities. UCSF eventually withdrew the plan.
Faculty members expressed further concern when it was revealed that UC medical centers statewide had similar partnership agreements. Janet Napolitano, then-president of UC Systems, convened her group working to assess the consequences of ending all agreements with organizations with religious restrictions. Ultimately, the group emphasized the importance of maintaining partnerships to provide care for the medically underserved.
“One in seven patients in the United States is being treated in a Catholic hospital,” the group wrote. in that report“Isolating UC from key participants in the health care system undermines our mission.”
Dignity Health, which merged with Catholic Health Initiatives to form CommonSpirit Health in 2019, has already reached new agreements to adopt updated UC policies. Dignity spokesperson Chad Burns said the hospital system values his work with UC Health in specialties such as pediatric trauma, cancer, HIV and mental health. He added that the renewed contract reflects “the shared values of UC and Dignity Health.”
Some UC doctors point out that they have legal status for performing various reproductive and contraceptive treatments, as well as public support. CALIFORNIA VOTERS PASS PROPOSITION 1the state constitution was officially changed in December to confirm that people have the right to choose whether to have an abortion or use contraceptives. says UC Health can claim reproductive rights.
“Because we are in California, we have a lot of freedom to make these decisions and stand in our power,” Kearns said. increase.”
Other doctors say the university system should prioritize public service. Tamera Hatfield, Ph.D., an expert in maternal-fetal medicine at the University of California, Irvine, has been trying to modify patient care based on religious restrictions since her department partnered with Providence St. Joseph’s Hospital. I testified before the Regency that I was never asked for it. Orange about 10 years ago.
“Partnering with faith-based institutions dedicated to serving vulnerable people gives opportunities to patients who have the most difficulty navigating a complex healthcare system,” she said. I got
This story was produced by KHNto issue california health linean editorially independent service of California Health Care Foundation.
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This article was reprinted from khn.org With permission from the Henry J. Kaiser Family Foundation. An editorially independent news service, Kaiser Health News is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization independent of Kaiser Permanente.
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