New York reproductive care eroding amid Catholic-secular hospital mergers

For the last few years, New York leaders have worked to solidify abortion protections – and fast-tracked such measures this year after a draft decision was leaked that correctly predicted the U.S. Supreme Court would overturn Roe v. Wade. 

But there is an erosion in women's health care that is currently being overseen by the state Health Department – mergers between secular and Catholic-run health care facilities that result in reproductive services disappearing from communities.

Catholic hospitals are governed by ethical and religious directives published by the U.S. Conference of Catholic Bishops, which prohibit abortion, contraception, sterilization and most fertility treatments. Physicians at these facilities are also constrained in how they handle impending miscarriages, which causes delays in treatment that can put women at risk of sepsis or death, health advocates say.

When faith-based hospitals merge with or take over other facilities, health care deserts that cover swaths of the state widen. 

This is particularly evident in the Capital Region, where two health systems have swallowed up the majority of hospitals and clinics in the 11-county region. Albany Medical Center offers a full range of reproductive health services and the other, St. Peter's Health Partners, does not. 

And continuing merger negotiations between St. Peter’s and Ellis Medicine in Schenectady County, if finalized, could deprive an already medically underserved community of reproductive care options, critics say.

An effort to block the merger and demand more transparency from both parties has the backing of many Schenectady officials and the New York Civil Liberties Union (NYCLU). It has also drawn interest from Gov. Kathy Hochul and state Attorney General Letitia James' office, though neither office has directly intervened.

According to NYCLU Capital Region Director Melanie Trimble, the merger would force Ellis’ health practitioners to prioritize religious directives over medical science.

“St. Peter’s Health Partners is secretly merging with Ellis Medicine, which includes Bellevue Woman’s Center, the Capital Region’s only inpatient hospital providing dedicated care to women and infants, leaving Schenectady residents in the dark about the loss of health care services at their community hospital at a time when reproductive freedom is on the national chopping block," Trimble said.

The great consolidation

A consolidation of the U.S. health care industry has accelerated in the last two decades, sparking battles over access to reproductive health services.

As Catholic health systems grow, so does the faith-based hospital sector's influence, experts say. Catholic organizations now own a significant share of the hospitals and physician practices in the U.S. and are expanding into urgent care, retail health clinics and ambulatory surgery, according to a 2020 report from Community Catalyst, a Boston-based nonprofit that says it advocates for health systems to be accountable, particularly to those who are low income, people of color, the LBGTQ community and women. 

Michigan-based Trinity Health, which owns St. Peter's Health Partners, is now the sixth-largest health conglomerate in the U.S.

Some health organizations have sought creative solutions to preserve reproductive health services during an acquisition by a Catholic entity.

When the St. Peter's Health Partners-affiliated Samaritan Hospital in Troy absorbed Burdett Birth Center in 2011, promises were made to keep reproductive health care unimpeded on a "non-Catholic" floor of the center.

That approach proved financially unsustainable, and in 2020, the floor was absorbed back into the main hospital system, according to a St. Peter's press release. Burdett stopped offering sterilization procedures like tubal ligations and vasectomies, which conflict with the Catholic bishops' directives.

In 2013, the state attorney general’s office intervened in a hospital merger between a Catholic and secular hospital in Utica to preserve access to some reproductive health services in the area.

In Schenectady, community leaders say they hope the attorney general will again step in to negotiate the merger between Ellis and St. Peter's, which they say will curtail reproductive care in a community that is a 30-minute drive to Albany Med, burdening residents without easy access to transportation.

"I instantly think about how is this going to impact poorer communities and people who use Ellis Hospital's emergency room as their primary physician," said Arthur Butler, executive director of the Schenectady Human Rights Commission. "We want to make sure that underserved and marginalized communities continue to have the full range of reproductive services."

Public transportation involves two buses and would take well over an hour, a trip that is not feasible for many community members, according to Schenectady County Legislator Michelle Ostrelich, a founding member of the Schenectady Coalition for Healthcare Access.

"It becomes a real equity issue because there are folks in Schenectady who don't go to Albany — it's just not in their world. They are not going to travel for health care. They are going to stay close," Ostrelich said.

At the end of last year, the two health care organizations agreed to start consolidating management services with the blessing of the state Department of Health, but they have not fully merged. A joint release from Ellis and St. Peter's in December 2021 said the companies would work over a two-year time span to see if a merger will be feasible. "While the long-term vision continues to be a full affiliation in the years ahead, the MSA does not commit either Ellis or SPHP to a full affiliation in the future," the release said.

“As this is not a merger or change of governance between Saint Peter's Health Partners and Ellis Medicine, it does not require a Certificate of Need and does not change the delivery of services at these hospitals," the state Health Department said in a statement to the Times Union on Friday. (The agency's Certificate of Need program is a state-mandated review process governing the establishment, ownership, construction, renovation and change in service of specific types of health care facilities.)

Ellis Medicine executives have said the merger is necessary to keep its hospital financially afloat. The hospital did not answer the Times Union's questions this past week about its current arrangement with St. Peter's, referring inquiries to St. Peter's.

St. Peter's leaders say the objective of the merger is to expand access to quality health care services across the region – especially for underserved communities – and it is constantly engaging with stakeholders to hear their perspectives.

Hospital spokesman Robert Webster said St. Peter's is committed to providing "the highest level of compassionate care."

"Physicians decide what procedures are medically appropriate based on their independent medical judgment and are expected to inform patients of all health care options, prescribe all appropriate medications, and transfer care when needed," Webster said.

A 'moral injury'

However, some practitioners say the constraints around reproductive health care at faith-based hospitals can inflict trauma on patients, while also impacting physicians and clinical staff who go into the field wanting to provide the best possible medical care. 

The restrictions often come into play when patients seek implanted contraceptive devices, or IUDs, because other birth control methods aren't working for them, or when a fetus is determined not to be viable.

While a dilation and curettage, or dilation and evacuation after the first trimester of pregnancy, are surgeries used in elective abortion, they are also common procedures for women whose bodies do not expel some or all of the fetal tissue after a miscarriage. Removing such tissue "helps prevent infection or heavy bleeding," according to the American Pregnancy Association, a Texas nonprofit that lobbies to increase awareness of reproductive and pregnancy needs.

At faith-based hospitals, doctors are prohibited from inducing birth or removing tissue from the uterus until the fetal heartbeat has stopped or the mother develops an infection or begins hemorrhaging, doctors say.

Dr. Corinne McLeod, a gynecologist who works out of Albany Medical Center's Myrtle Avenue offices and has practiced within the St. Peter's system in the past, said the inability to remove the fetus until the situation is dire is "extremely frustrating and disheartening."

"Frankly, I like the term 'medical injury' that's being used a lot in the medical field these days," McLeod said. "The feeling of not being able to practice the best medicine for your patients to give them optimal care."

The constraints on doctors can become life-threatening when the patient has an ectopic pregnancy, which refers to a fertilized egg that implants and begins to grow outside the uterus, such as in the fallopian tubes, bowel, liver or another part of the body. A pregnancy outside the uterus is not viable.

"As (the embryo) grows they are trying to leach blood supply from other organs that aren't set up to provide that blood supply," McLeod said. "Eventually, (the organs) will grow and burst and that will cause massive hemorrhage inside the abdomen and can easily lead to death."

A 2019 study from the University of Chicago found that physicians and other medical and non-medical staff working at Catholic hospitals had strong discomfort over restrictions around reproductive care. 

Some doctors will produce a medical justification to perform a procedure, like excessive menstrual bleeding, as a reason to implant an IUD contraceptive device, doctors said. Or they might cite a patient's cervical cancer risk to perform a sterilization procedure during a cesarean section.

Some went as far as intentionally misdiagnosing a patient with a condition that would justify the provision of contraceptive care, according to the survey, which is based on interviews of 28 medical providers and non-clinical staff at faith-based and secular hospitals nationwide.

Webster said that St. Peter's does not allow elective abortions or sterilization, but hospitals will treat life-threatening complications in pregnancy and "will save the life of the mother even when it may result in the unintended death of the unborn child."

"Emergent and urgent care are always provided within the standard of care to patients with pregnancy complications, miscarriages and ectopic pregnancies and comprehensive care is always provided to victims of sexual assault, including the provision of emergency contraception," the hospital spokesman said. "These are difficult and painful medical decisions that our providers strive to handle with compassion for both mother and child," Webster said.

"Back-room" deals

Advocates say the lack of transparency from St. Peter's about its ethical and religious directives has made it difficult for pregnant women to make informed decisions about their care. The hospital system has also not been forthcoming with information about the status of the merger and how it will impact care in Schenectady, critics said. 

The St. Peter's Hospital website does not disclose its ethical constraints. It’s unclear to what extent physicians are expected to disclose the directives to pregnant patients, even in high risk situations.

Advocates are pushing for the passage of a hospital transparency bill that will require the state Department of Health to collect a list of policy-based exclusions from hospitals and publish that information in simple language online. Hospitals would also be required to publish disclosures regarding patients’ rights and responsibilities online.

The legislation would require the DOH to produce a report on restrictions at New York hospitals and how they impact residents' abilities to access affordable, comprehensive care close to home.

Last December, Gov. Kathy Hochul signed a law requiring a community health equity assessment before a merger, acquisition or elimination of services.

When hospitals make a merger request, the state Department of Health must evaluate its impact on the surrounding community and speak to the applicants about how eliminated services will be provided elsewhere, according to a law, which goes into effect next year.

Merger requests do already trigger a public comment process. But advocates contend that St. Peter's and Ellis tried to bypass public scrutiny with a management services agreement, which only requires authorization from the Department of Health.

"When Ellis and St. Peter's proposed their merger, there was a large community outcry," said Lois Uttley, who works with the national reproductive health advocacy group Community Catalyst. "So what they did was sidestep that merger for the time being and instead develop this management services agreement. A management of services agreement does not require public review like a (merger) filing does."

The agreement is extensive, stipulating that Ellis will pay St. Peter's to run its operations, including by hiring some of the Schenectady hospital's executive staff. Everything from nursing, to patient management, food services and purchasing will be overseen by St. Peter's. 

The contract, obtained by the Times Union, shields St. Peter's staff from participating in procedures prohibited by the religious directives but does not include any language protecting the rights of Ellis patients who require these services.

A separate management agreement with Ellis primary care providers has already placed restrictions on reproductive care, the hospitals confirmed. 

At a March 2021 meeting, hospital executives told the Schenectady coalition opposing the merger that official plans would not materialize for at least a year.

The announcement of a service-sharing agreement less than six months later undermined those promises, according to Ostrelich, the Schenectady County legislator.

"Not one of the concerns raised at the forum have been addressed — formally or informally," Ostrelich said at a rally in Schenectady's Veteran's Park last year. "None of this speaks to the transparency we were initially assured. Backroom deals are not transparency.”

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