By joining with a much bigger Catholic health system, a prominent Orange County hospital hopes to enhance patients' access to a host of services — except one.
Hoag Memorial Hospital Presbyterian, based in Newport Beach, started banning elective abortions this year after reaching an agreement to affiliate with St. Joseph Health, riling some doctors and women's advocates.
The controversy has fueled a feisty debate in local editorial pages and prompted a rally outside the hospital, making the Southern California suburbs the latest scene of a culture clash occurring across the country as Catholic and non-Catholic hospitals strike deals in a wave of health care industry mergers.
Women's health advocates say affiliations between non-Catholic and Catholic hospitals have squelched abortions in a number of locations, and full-blown mergers have also affected health services such as sterilization and contraception.
Hoag has a flagship 485-bed hospital with sweeping Pacific Ocean views and another hospital in nearby Irvine. It joined with Irvine-based St. Joseph Health, which has 14 acute care hospitals in California and Texas, after winning state approval to form a regional health care system called Covenant Health Network.
The economic downturn and health care overhaul have driven many nonprofit hospitals to form partnerships or merge entirely in recent years, and cultural conflicts related to religion, teaching style or other differences often need to be hashed out for the ventures to succeed, said Lisa Goldstein, associate managing director of the not-for-profit hospital ratings team at Moody's.
Dr. Richard Afable, Hoag's former president who now heads Covenant, said Hoag took a closer look at its abortion practices because it was joining with a Catholic health system where the procedure isn't allowed.
Afable said the hospital decided to cease performing elective abortions because it does so few of them anyway — only about 100 a year. He said Hoag will continue to perform abortions when medically indicated and that most elective abortions are done in a doctor's office or could be better performed at a center with a higher volume of the procedures.
"We looked very closely at all the things we do that are generally not supported at Catholic hospitals," he said. "We are not limiting any physician from conducting their medical practice in any way they would like. If a physician wants to do an elective abortion, there are places and locations where they can conduct that."
Obstetrician Dr. Richard Agnew said he worries Hoag may start to weed out other services over time. He also said he doesn't feel his patients who choose abortion should be shuffled off to a Planned Parenthood or different hospital, noting most are women who wanted to get pregnant but are carrying a fetus with genetic abnormalities and need a hospital level of care.
"It's not like they're doing anything illegal," Agnew said. "It's bad enough for them to have to make a decision."
Hospitals steeped in different faith traditions have had to contend with public concern over mergers and affiliations in states including Connecticut, Kentucky and Washington. The debate has most often surfaced in mergers involving Catholic hospitals due to the church's directives on issues ranging from abortion and birth control to end-of-life decisions.
In suburban Philadelphia, two hospitals, Abington and Holy Redeemer, called off a proposed partnership after community members were upset the plan would have ended abortions at Abington.
Catholic facilities account for more than one fifth of the country's hospital admissions, according to the Catholic Health Association.
Most commonly, affiliation agreements have led non-Catholic hospitals to stop providing abortions, while mergers and acquisitions have also led some institutions to stop performing other services, such as tubal ligation, said Sheila Reynertson, advocacy coordinator for New York-based Merger Watch, which tracks the effects of mergers between religious and secular hospitals on reproductive and other health services.
Lori Vandermeir, president of the National Organization for Women's Orange County chapter, said she worries the spate of hospital mergers will affect women's access to abortion even when no laws have changed.
"They have the ability to reset abortion-access behind the scenes, without the legislature being involved," she said.
In St. Joseph's statement of common values, the health system states that "direct abortion and physician assisted suicide are not part of St. Joseph Health services."
Afable said there have been no other changes to procedures offered at either hospital, noting Hoag will continue to perform sterilizations and provide contraception. He said no changes would be made to women's health services at Hoag for at least a decade under the agreement.
Pro-abortion rights groups staged a rally outside the hospital Thursday, while anti-abortion advocates who welcomed Hoag's decision held a counterdemonstration. The controversy has also sparked a spirited debate in the editorial pages of local newspapers.
Tom Johnson, a local businessman, wrote in the Orange County Register that while he supports abortion rights he doesn't see a problem with hospitals limiting their offerings. He recalled that he had to travel to Los Angeles for a kidney transplant eight years ago because Hoag did not perform the procedure.
"I'm 100 percent in favor of a woman's right to choose. Not 50 percent, not 75 percent - 100 percent," Johnson wrote in a guest column in the newspaper. "But I also, at the same time, respect the right of Hoag Hospital to choose what services it will provide and what services it will not."