As the UCLA health system renews contracts with hundreds of hospitals and outpatient clinics — many with religious affiliations — some doctors and faculty want stronger language to ensure that doctors can perform treatments they see fit, including abortions for women or hysterectomies. transgender patients.
UCLA 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 disadvantaged parts of the state. Many have agreements with religious facilities, including notable hospitals operated by Dignity Health, Providence, or Adventist Health. Such arrangements generate more than $20 million annually for the University of California system and help the public university achieve its goal of improving public health.
The current policy, adopted in 2021, states that UCLA physicians are free to advise, refer, prescribe or provide emergency care, which covers cases where transfer of a patient would result in a “risk of physical deterioration in the patient’s condition.” But some UCLA doctors and faculty are concerned that doctors are only allowed to perform some surgeries in emergencies.
They want to add a clause stating that doctors have the right to perform procedures as they see fit or necessary without waiting for the patient’s condition to deteriorate.
Others have gone so far as to urge the university to reject partnerships with hospitals that have ethical and religious directives against sterilization, abortion, certain abortion management procedures, and certain gender confirmation treatments. The Academic Senate, the faculty that helps the university set academic policies, and other college boards urged the university’s president to avoid working with healthcare facilities because many of them have restrictions that “potentially have a discriminatory effect on patients.”
In response, university leaders have publicly pledged to ensure that physicians and interns can provide whatever care they deem necessary at affiliated facilities but have not made changes to policy language.
“We’ve made it clear that the treatment provider is the one who decides if there is an emergency and when to act,” Dr. Carrie Pennington, executive vice president of UCLA Health, said at the fall meeting of the UCLA Board. Referees, University System Board of Directors.
UC Health has given itself until the end of this year to bring contracts in line with its new policy. During a board meeting in October, employees estimated that a third of contracts had been evaluated. Officials did not say whether the current policy has frustrated any contracts.
In June 2021, the governors approved the policy governing how doctors can practice in hospitals and outpatient clinics with religious or ethical restrictions. Regent John Perez made significant amendments to the staff proposal. At the time, it was celebrated as a triumph by those advocating the university for undoing the religious directives of the associates.
Perez noted at the time that his amendments were meant to “make it clear that what rulers expect in politics is that there is nothing that is not based on science or [the] Medicine best practices should limit the ability of our practitioners to practice medicine for the benefit of patients.”
But some doctors and faculty said Perez’s suggestion was then worded as it was passed from a gubernatorial vote into official policy months later. Some questioned whether the policy could be interpreted as restricting services unless there is an emergency, and said it does not go far enough to define an emergency.
“It sounds very good,” Dr. Tabitha Harkin, director of the division of combined family planning and obstetrics and gynecology at the University of California, Irvine School of Medicine, testified to the board. “It passed the reasoning test, but in fact, that’s just the minimum requirement for federal sponsorship.”
Perez declined to comment on KHN.
At the governors’ meetings, concerned clinicians presented examples of pregnancy and sex confirmation care that they believe would be at risk in some hospitals.
One was tubal ligation or sterilization procedures immediately after childbirth to prevent future pregnancies that might put the woman at risk. It’s a simpler procedure if it’s done after birth because the uterus is larger than normal and eliminates the need for additional surgery, said Dr. Jennifer Kerns, an assistant professor at the University of California, San Francisco and director of the School’s Planned Parenthood Complex Fellowship.
Dr. Mia Zapata of UCLA described the case of two patients who may not be able to access the same care in a religiously restricted hospital: a trans man seeking a hysterectomy based on a mental health referral for a gender confirmation operation, and a cisgender female seeking the same The procedure for uterine fibroids.
In a hospital with the restrictions, Zapata said, a cisgender patient can perform the surgery but a trans patient cannot, even though they are considered non-emergency cases.
But it is not clear if doctors are having problems. UCLA health leaders said there have been no formal complaints from university doctors or interns working at affiliated medical centers about being denied care.
Critics said the lack of complaints may not reflect reality because doctors may find workarounds by transferring or referring patients elsewhere. The researcher, Laurie Friedman, who works at the University of California, San Francisco, spoke to dozens of doctors working in faith-based hospitals across the country. She said many did not file complaints about care restrictions for fear of jeopardizing their jobs.
The discussion stems from a partnership with Dignity Health, a Catholic affiliated hospital system. In 2019, UCSF Medical Center leaders considered a controversial plan to create a formal affiliation with the Dignity. Critics voiced their opposition in heated public meetings, and the plan drew condemnation from dozens of reproductive justice advocates and LGBTQ communities. UCSF eventually backed out of the plan.
When it became clear that UCLA medical centers across the state had similar affiliations, faculty members raised additional concerns. Janet Napolitano, then president of the University of California System, convened a working group to assess the consequences of terminating all agreements with organizations that had religious restrictions. Ultimately, the group stressed the importance of maintaining partnerships to provide care to medically disadvantaged populations.
“With 1 in 7 patients in the United States cared for in a Catholic hospital, isolating UCLA from key participants in the health care system would undermine our mission,” the group wrote in its report.
Dignity Health, which in 2019 merged with Catholic Health Initiatives to form CommonSpirit Health, has already reached a new contract that adopts the updated UC policy. Chad Burns, a spokesperson for Dignity, said the hospital system appreciates working with UC Health for its expertise in specialties, such as pediatric trauma, cancer, HIV, and mental health. He added that the updated agreement reflects “the shared values between UC and Dignity Health.”
Some UCSD doctors point out that they not only have public support, but also the legal standing to perform a variety of reproductive and contraceptive treatments. After California voters passed Proposition 1, the state constitution was officially changed in December to affirm that people have the right to choose to have an abortion or to use birth control. Unlike health systems in other states, some faculty say UCHC can assert reproductive rights.
“We have a lot of freedom, being in California, to be able to make these decisions and stand in our own power,” Kearns said. “I think it is our responsibility to do that.”
Other doctors say the university system should prioritize public service. Dr. Tamera Hatfield, a maternal-fetal medicine specialist at the University of California, Irvine, testified at a meeting of governors that she had never been asked to adjust care for patients based on religious restrictions since her department formed an affiliation with Providence St. Joseph-Orange about a decade ago.
“Partnerships with faith-based organizations dedicated to serving vulnerable populations provide opportunities for patients who are least able to cope with our complex health systems,” she said.
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
This article is reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization not affiliated with Kaiser Permanente.