A bill threatens to ban University of California health systems from partnering with institutions that follow Catholic ethics, prompting concern ideological motives on abortion and LGBT issues will damage longtime partnerships and limit medical care access.


An organization of Catholic hospitals has defended its efforts to adhere to Catholic ethics, but also defend the partnership on the ground that they or their network hospitals provide some procedures related to gender transitioning and have won recognition from major LGBT groups.


“Currently there are many, many, many, contracts with the University of California and Catholic healthcare,” Edward Dolejsi, interim executive director of the California Catholic Conference, told CNA. “Primarily because we provide services in a variety of underserved communities, and the University of California wants access to those communities and wants to train their physicians in those communities.”


Dolejsi said Catholic institutions are “proud” to partner with the university system.


“But as always if you’re working at one of our facilities, we follow the (Catholic bishops’) ethical and religious directives,” he said. “We do not allow abortions, elective sterilizations, transgender surgeries etc. in those healthcare facilities.”

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The U.S. Conference of Catholic Bishops’ Ethical and Religious Directives, last revised in 2018, aim to ensure ethical treatment at Catholic hospitals.


However, prospective state legislation called the Equitable and Inclusive University of California Healthcare Act would require the University of California health system to renegotiate agreements with Catholic hospitals. The hospitals would be forced to allow its staff to provide all care they deem medically necessary or to end its links to the state university medical system. The proposal, numbered Senate Bill 379, is under consideration in the California Senate.


A spokesman for bill sponsor Sen. Scott Weiner, D-San Francisco, told an LGBT California publication that partnering with institutions like Catholic ones violates California standards.


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“It is unacceptable to subject patients to discriminatory and harmful restrictions on the types of care they can receive, including reproductive and LGBTQ-inclusive care,” the spokesman said. “California law recognizes reproductive healthcare, including abortion, as basic healthcare. California state law restricts public health entities from preferring one pregnancy outcome over another, and prohibits discrimination against transgender patients seeking gender-affirming care. Despite existing law, people in California are still being denied these very critical healthcare services.”


Co-sponsors of the legislation include the ACLU of California, NARAL Pro-Choice California, and Equality California.


Dolejsi said the controversy is “primary ideological.” Passage of the bill would end up limiting medical access for many Californians, particularly the poor and struggling. It would also limit physicians’ abilities to practice or train.


“That’s always the challenge here: do you want to provide services and resources in a quality way for all the people of California or do you want to expand an ideology?” Dolejsi asked. He suggested that Catholic health care  systems are “probably one of the larger providers of medical services in California.”


“It’s going to be interesting to see how it moves forward,” he said, adding that legislators are “trying to require us to allow physicians to do whatever they wish to do within our facilities.”


In February Weiner’s office said the university system’s agreements “explicitly prevent (University of California) doctors and students from providing reproductive and LGBTQ inclusive care, including: contraception, sterilization, abortion, gender-affirming care, and urgent care, such as treatment for miscarriage and ectopic pregnancy.”


In a May 3 letter to Sen. Anthony Portantino, chair of the Senate Appropriations Committee, the Alliance of Catholic Health Care made its case against the bill. Critics of Catholic healthcare have made allegations with “numerous inaccuracies,” the alliance letter said. It stressed that Catholic hospitals’ services are “provided to all, without discrimination.” Resident physicians trained at Catholic hospitals are not arbitrarily assigned, but choose their training.


“Catholic hospitals agree to uphold Catholic values, and therefore we do not provide elective abortion or procedures for the primary purpose of sterilization such as tubal ligations, hysterectomies (when no pathology is present), vasectomies and in-vitro fertilization (the latter two services are not typically performed in hospitals regardless of religious affiliation). Catholic hospitals do not limit availability of emergency or medically-necessary pregnancy care,” the letter said.


The alliance said Catholic hospitals “provide the standard of care for women with pregnancy complications, miscarriages and ectopic pregnancies.” They always provide “urgent and emergent care”  to the mother, “even if it results in the foreseen, but unintended, death of the fetus.”


“Our health facilities provide compassionate and comprehensive care to victims of sexual assault, including the provision of emergency contraception,” the alliance said, adding, “More than 10 Catholic-affiliated facilities are designated as the comprehensive rape treatment center or are the sexual assault response team.


Catholic ethics forbid direct abortion and direct sterilization. The U.S. bishops’ ethical and religious directives allow medication to sex assault victims to prevent conception if there is no evidence conception has already taken place. The directives add: “it is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.”


The Catholic alliance letter described intra-uterine devices, which prevent implantation, as a “multi-purpose device.” If the appropriate care for a patient is “elective sterilizations,’ the letter said, “we expect the physician to ensure that care is provided in a facility that provides that service.”


The alliance’s health systems include 51 acute care hospitals, nearly 15% of all hospitals and 16% of hospital beds in California. Affiliations with the University of California health system are “essential to ensuring and expanding access to quality health care services across our State – especially so for underserved communities,” the alliance’s letter said. University of California Health has estimated the bill would cost millions of dollars in lost revenue currently generated through partnership agreements.


In some parts of California, University of California health care is reliant on its Catholic partners.


The alliance said its health systems played an important role in the response to the COVID-19 pandemic, providing “scarce front-line medical, bed-capacity, PPE, testing and vaccine resources.”


The alliance letter added that its hospitals offer primary, specialty, and urgent care for LGBTQ persons. It added: “specifically for transgender patients, we provide hormone therapy, breast augmentation or reduction, and facial feminization or masculinization”


CNA asked the Alliance of Catholic Health Care why its hospitals provided transgender-specific drugs and procedures. Lori Capello Dangberg, vice president at the alliance, told CNA May 10 that “numerous states in which Catholic hospitals operate have statutes that prohibit discrimination against patients on the basis of sex and gender identity, among other things.”


“Should the hospitals decline to provide a service to one protected class of people that they can morally provide to another class of people, they will be in violation of these statutes. Such a practice cannot be defended on the basis of religious freedom, as the courts will hold that it’s first and foremost a matter of discrimination against a protected class of people.”


Dangberg did not address the question of legislation, but there are concerns that proposals like the federal Equality Act and other decisions advocated by the Biden Administration could further mandate the provision of drugs and procedures which violate Catholic ethics while also stripping religious freedom protections. While Catholic institutions have some protections under existing federal rules and laws such as the Religious Freedom Restoration Act, California has fewer religious protections at the state level.


The letter to the Senate appropriations committee chairman also mentions non-Catholic hospitals under the Alliance for Catholic Health Care umbrella that provide specialty transgender care.


“We are proud to offer the only specialty transgender care center in San Francisco, the Gender Institute at Saint Francis Memorial Hospital,” the letter said. The institute has been established “to deliver compassionate, high-quality, affordable health services to transgender patients and their families.”


The letter noted that St. Mary’s Medical Center in Long Beach is the first in the Dignity Health System to be recognized with health equity leader status by the Human Rights Campaign, an influential LGBT advocacy group.


The Human Rights Campaign has been effective at recruiting major companies to advocate for compliance to LGBT policies and political demands, including for a federal Equality Act stripped of religious freedom protections. It has asked the Biden administration to create accreditation regulations of religious schools that would enforce the recognition of same-sex unions as marriages and other LGBT causes.


In 2014, the campaign launched a lobbying effort linked with the Catholic Church’s Synod on the Family, targeting leading Catholic bishops it said have been “most outspoken in their rejection of LGBT Catholics, their civil rights, and their rightful place in the Church.”


Another proposed California bill, S.B. 642, purports to defend medical staff’s clinical judgement from hospital administration’s “non-clinical” standards, including ethical standards, that hinder a doctor from providing a particular medical treatment. Such treatment could include legal abortion and legal assisted suicide. The legislation would significantly impact the ability for Catholic hospitals to require staff to follow Catholic ethical directives.


“Catholic healthcare is fighting on two fronts here in California,” Dolejsi told CNA.

Joe Bukuras contributed to this report.