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Attorney General asked for opinion about restrictions on healthcare at PIMC

State Senator Kevin Ranker (D-Orcas Island) has asked Washington State Attorney General Bob Ferguson for a formal opinion related to a 50-year public subsidy on San Juan Island for a “Catholic health care ministry.”

(This is the term the Catholic Church and the bishops now use for Catholic hospitals.)

The American Civil Liberties Union estimates that 47% of acute care hospital beds in Washington State will be Catholic-controlled by the end of 2013.

The answer to Ranker’s question could have an important bearing on hospital district contracts throughout the state.

The specific question being asked is:

“Does a public hospital district violate RCW 9.02 if it solely contracts with a provider of health care services that refuses to provide services or information including contraceptive care, voluntary termination of pregnancy care, and other services that relate to a patient’s fundamental rights, as described in RCW 9.02.100, and the public hospital district does not provide “substantially equivalent benefits, services, or information” with respect to voluntary termination of pregnancy care, as required by RCW 9.02.160?”

9:02.100 is the initiative passed into law by Washington voters on November 5, 1991.

9.02.100 Reproductive privacy — Public policy.

The sovereign people hereby declare that every individual possesses a fundamental right of privacy with respect to personal reproductive decisions.

Accordingly, it is the public policy of the state of Washington that:

(1) Every individual has the fundamental right to choose or refuse birth control;

(2) Every woman has the fundamental right to choose or refuse to have an abortion, except as specifically limited by RCW 9.02.100 through 9.02.170 and 9.02.900 through 9.02.902;

(3) Except as specifically permitted by RCW 9.02.100 through 9.02.170 and 9.02.900 through 9.02.902, the state shall not deny or interfere with a woman’s fundamental right to choose or refuse to have an abortion; and

(4) The state shall not discriminate against the exercise of these rights in the regulation or provision of benefits, facilities, services, or information.

The Coalition for Transparency and Equity in Healthcare wrote a letter (posted below) to the San Juan County Hospital District Board in September 2012 asking it to seek an Attorney General's opinion. The board declined to do so, though in response to a question from San Juan Islander editor Sharon Kivisto at the board meeting, Board Chair Lenore Bayuk said it might be something they do in the future.

The elected board is responsible for the tax money collected for the hospital district and for emergency medical services on San Juan Island. The EMS tax revenue funds San Juan EMS which is a separate entity from Peace Island Medical Center.

Almost all of the tax revenue for medical care, which in the past was used to fund Inter-Island Medical Center, is now given to PeaceHealth to be mostly used for charity care at PIMC. The hospital district board's role regarding the tax revenue is to review the way it is spent by Peace Health.

A separate board, composed of Peace Health personnel and community members, was selected by PeaceHealth to serve as community oversight of PIMC. The board members are: Jim Barnhart, PIMC chief administrative officer

Kathleen Pruitt, CSJP

Charles Anderson, chair

Tom Cable, vice chair

Peg Gerlock

Julie Gralow, M.D.

Rebecca Pohlad

George Von Gehr

Michael Wingren, M.D.

The letter:

Dear Commissioners,

We, the undersigned, appreciate all of the hard work the commission has done in bringing a hospital to San Juan Island. The hospital will play an important role in the fabric of our community for generations to come.

As the new facility is getting ready to open, we have specific questions for the hospital commissioners about the subsidy agreement that was made with PeaceHealth and how that will affect health care for islanders in the near-term and over the 50-year lifespan of the agreement. We feel compelled to ask these questions because we believe it’s critical to ensure that health care needs of current and future islanders are addressed in a fair and equitable way.

We know there are many islanders who have expressed an interest in these issues, and the hospital board has said that it wants to operate with transparency, so we respectfully request the hospital board to respond in writing and publicly to the following questions/concerns:

In the agreement, PeaceHealth has the right to merge, acquire, or be acquired by another facility that shares its same mission. It has declared its intent to merge with a division of another, much larger Catholic health system, Catholic Health Initiatives (CHI), resulting, in the CHI CEO’s words “in a fully integrated new health system.” Catholic Health Initiatives says on its web site and in its employee handbook that it follows the Bishops’ Ethical and Religious Directives. The bishops’ directives prohibit many types of medical procedures and require others and according to one of the directives, all employees are required to follow all of the directives as a condition of employment. Among the forbidden services/activities/procedures:

Abortion under any circumstance, including in the case of extrauterine (ectopic) pregancies, rape, or incest

All contraception, including IUDs, The Pill, and emergency contraception (Plan B)

Sterilization, including tubal ligation and vasectomies

Participation by physicians and other health care providers in the Washington Death with Dignity Act (DWDA), which was approved by 75% of the voters in San Juan County, including providing information about the DWDA to patients, as well as referrals to organizations that provide counseling and support to patients who want the option to use the law

The directives also require employees to disregard patient health advance directives if they conflict with the bishops’ directives. This means, among other things, that patients similar to Terri Schiavo who are in persistent, vegetative states must be given artificial nutrition even if the patient has expressly directed otherwise through an Advance Directive.

Given all of the above, here are our questions:

What written and legally binding guarantees did the hospital board get from PeaceHealth that services and practices currently available through InterIsland Medical Center but which are in conflict with the bishops’ directives, especially those related to reproductive health (e.g., IUD placement, birth control services), will be available in theory and in practice at the new taxpayer-subsized medical facility over the life of the agreement?

What written and legally binding guarantees did the hospital board get from PeaceHealth that patient advance directives, especially with respect to artificial nutrition (feeding tubes) will be followed?

Given that between 95% and 97% of taxpayer health care dollars funded through the hospital taxing district and not subject to voter approval are committed to PeaceHealth through the next 50 years, what legally binding provision is there for funding health care treatments that are not or will not be available through PeaceHealth? (An example today might be reproductive health services; an example into the future might be treatments for Parkinson’s or other diseases made possible through the use of embryonic stem cells, which the bishops’ directives expressly forbid.)

After seven years, PeaceHealth has the ability to withdraw from the agreement with three years’ notice if reimbursement rates change substantially or if they determine that the hospital is not financially viable. What provisions exist for the District to withdraw from the agreement over the next 50 years if future hospital board commissioners believe that PeaceHealth is not meeting the health care needs of islanders?

We look forward to reading your responses and we thank you for your attention to these issues.


Coalition for Health Care Transparency and Equity (more than 300 names were on list attached)

Editor's note: This story used, with permission, part of a story from Catholichealthwatch.org.

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