Questions That Need Answers

 

Hospital Affiliation Questions and Concerns 

According to news reports, as a condition of affiliating with St. Peter’s and Seton Health Systems, NE Health has agreed to adhere to the Ethical and Religious Directives for Catholic Health Care Services (ERDs). The ERDs are a set of 72 religiously-based rules that Catholic hospitals adhere to in the provision of health care services. These religious doctrines ban the provision of a number of reproductive health services, including abortion, sterilization (tubal ligation and vasectomy) and birth control, as they are considered morally illegitimate. The ERDs also ban health care providers from counseling patients about health care options that are considered morally illegitimate and, therefore, can act to limit providers from counseling patients about services such as birth control options and safer sex practices to prevent the spread of HIV and other Sexually Transmitted Infections (STIs). This proposed affiliation raises significant questions about the continuity of care and the impact on access to comprehensive services, especially for women of reproductive age. 

Continuity of Care and Access to Services 

NE Health’s agreement to adhere to the ERDs could lead to significant and detrimental changes in how health care is delivered. NE Health operates two hospitals as well as a primary health center. Questions that need to be answered include the following: 

Q. What services that are currently offered in Samaritan and Albany Memorial would be banned?  

Q. How will the hospitals handle the discussion of services that will be banned from the hospital?

Concern: Will health care providers be prohibited from discussing services that have been banned? Will providers be allowed to offer referrals for services that are banned? How will this affect the care of patients who are hospitalized for illnesses such as cancer or heart disease and for whom pregnancy would pose health risks? Will patients with HIV/AIDS receive safer sex counseling, including discussions on the use of condoms? 

Q. Can contraceptives be prescribed when the purpose is for reasons other than birth control?

Concern: For example, instances in which contraceptives are used to treat a medical condition.  

Q. Will there be changes to current Northeast Healthcare’s protocols on treating patients experiencing miscarriage?  

Q. Will genetic testing, such as amniocentesis, be provided if the patient would consider abortion if she learns a fetus has a serious anomaly? 

Questions about the separate facility and how it affects continuity of care

 

Q. What services will be offered at the separate reproductive health care facility? 

Q. What services will be banned from the separate reproductive health care facility? 

Q. Will the new reproductive health care facility be able to contract with the new health system for staff, or will the new health system be prohibited from entering into agreements for staffing and supplies with the reproductive health facility?  

Q. If the new facility will be located at Samaritan, has there been an agreement that maternity services will remain at Samaritan?

Concern: If consolidation of services between the hospitals occurs in the future, will the administration agree to leave maternity services (and other services that could be affected by religious rules) at the nonsectarian hospital? How will the division of services affect patient accessibility? 

Q. What rules will govern the provision of sterilization?

Concern: Will women who are giving birth be able to obtain a sterilization while in the hospital? Will sterilizations be performed in conjunction with c-sections? If there are preconditions, under what circumstances will they be allowed? What is the process for approval?

Q: How would a separate facility impact the care received by patients who want to have a tubal ligation? Would a patient have to check out of one facility and into another? 
Concern: Unless the separate facility included a birthing center, it would create a real hardship for women who have decided they do not want any more children and wish to have a post partum tubal ligation. This is the most convenient time, when the woman is in the hospital. For women who have c-sections, this policy would be particularly problematic as they would be unnecessarily exposed to the dangers of undergoing a second surgical procedure with all the attendant risks of surgery and anesthesia, as well as incur additional expenses.  In addition to the interruption of care this would cause, would the patient have to pay a co-pay to each facility, increasing health care and patient costs?

Q: Has there been consideration of reproductive health care needs that can’t be met in a separate facility?  
Concern: Reproductive health care isn’t something that is separate from women’s overall health care needs. The need for services that would be banned, such as counseling on birth control, can arise during the course of treating an array of medical conditions, including diabetes, heart disease, liver and kidney disease, cancer and psychiatric illnesses. 

Contraceptive counseling is part of the standard of care all women should receive prior to leaving the hospital after giving birth to a baby. Many women choose to receive a contraceptive shot (Depo) before being discharged—especially young mothers who have already experienced an unplanned pregnancy. Will the patient have to leave the current treatment center to go to another facility to receive birth control by injection or elsewhere for a prescription? 

How will the affiliation affect NE Health’s primary care system? 

Q. Will primary care offices (eg, Family Medical Group) be required to adhere to the ERDs?

Concern: Will providers be banned from counseling patients about birth control, prescribing birth control, or providing any contraceptive services, such as insertion of IUDs or offering of injectable birth control methods? Will there be limits on referring patients for services that are banned? 

Q. How will the hospitals handle admitting privileges?

Concern: In order to retain admitting privileges or hospital staff positions, will doctors be required to sign an agreement upholding the religious health care doctrine? Will other hospital employees, such as nurses, be required to sign agreements to adhere to religiously-based rules as conditions of employment? 

Other questions 

Q. Will employees lose health insurance benefits?

Concern: Will the new entity continue to provide coverage for birth control and other reproductive health care services currently offered?

Q. Will the parties involved commit to releasing the full terms and conditions of the proposed merger prior to finalization of any merger, so that patients who depend on these health care facilities can learn what the future of their health care will be and have the opportunity to comment?

Additional Questions For Northeast Health


Doesn’t NE Health have options other than an agreement that requires it to operate under the religious rules of its partner and ban reproductive health services? 


Q. Has NE Health considered an affiliation with a non-sectarian hospital or system? Wouldn’t a merger with Albany Medical Center be more compatible with Northeast’s historically non-sectarian mission? 


Q. Has NE explored options that would allow it and St Peter’s to see efficiencies and cost-savings in the delivery of health care without the requirement that NE agree to operate under the 72 religious rules that St. Peter’s operates under?


How will this agreement—which calls for a separate corporate entity to provide health care services banned by the religious rules--impact the continuity of care and patient ability to obtain a comprehensive range of health care services?

Q: Has there been consideration of reproductive health care needs that can’t be met in a separate facility? 

Concern: Reproductive health care isn’t something that is separate from women’s overall health care needs. The need for services that could be banned, such as counseling on birth control, can arise during the course of treating an array of medical conditions, including diabetes, heart disease, liver and kidney disease, cancer and psychiatric illnesses.

Q. Will the reproductive facility be prohibited from providing medically necessary abortions, including ones that cannot be safely provided in an office setting? 


Northeast Health operates a network of primary care facilities. Will there be services these providers currently offer that will no longer be allowed because of the agreement to follow the Directives? Directives  #27 and #52 ban the provision of and counseling about birth control—will it be clear in any final agreement that primary care providers can continue to counsel patients about birth control options? Will providers be able to offer patients IUDs and implantable or injected contraceptive methods in their offices?
 


Family Planning Advocates of New York State


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