On May 21, 2013, the ACLU of Washington and a group of concerned organizations called on Governor Jay Inslee to address the rapidly accelerating pace of religious hospital mergers in our state and their impact on patient access to lawful health care services, consistent with best medical practices and patients’ needs or interests and regardless of religious directives. In response, Governor Inslee today announced that he is issuing a directive to the Washington state Department of Health (DOH) to initiate rulemaking to modernize the Certificate of Need (CON) process, which he acknowledged “has not kept current with the changes in the health care delivery system.”
The Governor’s action is one important step—but far from the only one needed—toward ensuring that patients in Washington have access to lawful medical care, including reproductive health services, end-of-life services, and care for LBGTQ families, without restrictions based on religious doctrine.
The urgency of this issue in Washington is underscored by the fact that such mergers already are resulting in restrictions on patient access to care based on religious doctrine:
- When Swedish Medical Center (secular) in Seattle affiliated with Providence Health & Services (religious), it stopped performing elective abortions.
- When Highline Medical Center (secular) in south King County affiliated with Franciscan Health System (religious), it prohibited information about and referrals for aid-in-dying and restricted a wide range of reproductive health services, including contraception, tubal ligations, and elective abortions.
- After San Juan County Public Hospital District affiliated with PeaceHealth (religious) for the construction and operation of a new hospital in Friday Harbor, PeaceHealth imposed restrictions on an OBGYN who formerly could freely counsel and serve women, including schedule tubal ligations and abortions.
The Governor’s directive to modernize the CON process is an important step towards ensuring the regulatory process—long acknowledged to be outdated—works to protect patients. To that end, we urge that this reform include not just what transactions are covered by the CON process, but also its substance—ensuring patient access to care in their communities, regardless of religious doctrine. We look forward to engaging with the rulemaking process that DOH will initiate.
Similarly, we applaud the Governor’s recognition that the Community Health Needs Assessment already mandated in statute (but not performed due to budgetary reasons) will provide important information to ensure access to care, and his instruction to the Office of Financial Management (OFM) to begin to gather information on impact around the areas of concern we have raised. We urge our state’s leaders to continue to push for this critical, complete picture of the impact of religious mergers on patient access to care.
The Governor’s focus on transparency and openness in the merger process, as well as in ensuring hospitals make clear their policies on service provision, is also important—for too long, the merger process and its impact on services have been shrouded in misinformation. The Governor’s commitment to making hospital policies for health care services available to patients on the DOH website is a positive step. But given the gap that exists between hospitals’ stated policies and what patients are actually experiencing when they seek care, we urge the Governor and other state leaders to move beyond policies and towards ensuring that there actually is access based on the standard of best care for the patient in local communities.
Finally, we reiterate our concern over the proposed affiliation of three public, independent, secular hospitals (the “Interlocals”) in Skagit Valley. A religious affiliation in that case would result in a surge in the number of religiously affiliated hospital beds in our state and force Skagit Valley residents to travel for hours to access secular health care providers. Given that such an affiliation could move forward at any time, and could certainly occur before any CON reform takes place, we once again urge our state’s leaders to ensure that protections are in place to ensure that patients can continue to access the services currently provided in the event that the Interlocals affiliate with a religious hospital.
The Governor has recognized the seriousness of the problems that mergers between secular and religious health care organizations pose to patient access to best care, describing in his letter “… the potential of these relationships to lead to restrictions in constitutionally protected care for Washingtonians.” We look forward to working with our state’s leaders, including the Governor, to ensure both the success of this step and the implementation of additional measures to protect patient access to health care consistent with medical best practices and patient needs.
ACLU of Washington
Aurora Medical Services
Compassion & Choices, Washington
Mt. Baker Planned Parenthood
NARAL Pro-Choice Washington
People for Healthcare Freedom
Planned Parenthood Votes Northwest
PFLAG Washington State Council