As required by a new state mandate, most hospitals in Washington have submitted their policies on patients’ access to a variety of health-care options, including reproductive health care, to the Washington State Department of Health. However, the policies that have been submitted vary significantly in format, information provided, and availability of access for people seeking reproductive health care at the state’s nearly 100 hospitals.
In addition to reproductive health-care policies, hospitals were also required to submit end-of-life care, non-discrimination, charity care, and admissions policies to the Department of Health. The disclosures were part of a policy initiative by Gov. Jay Inslee, in response to recent transactions in which hospitals were being acquired and purchased by other hospital associations, often Catholic associations. These mergers have lead to a lack of transparency surrounding changes to hospital policies.
Several hospitals missed the deadline to provide their policies to the health department. However, as of this writing, the majority of hospitals have provided their policies. The policies have been published in a clearing house on the Washington State Department of Health website. Hospitals are also required to publish these policies on their individual websites, but many hospitals have yet to comply with this requirement.
A review of published policies by RH Reality Check found that the lack of standardized format and required information resulted in documents submitted by hospitals that made their policies unclear. In some cases, the information provided would be of little or no relevance to patients. Reproductive health-care policies often included vague language about specific services provided, but it was evident that the full range of reproductive health care was only available at a handful of hospitals.
Among the 97 hospitals that are listed on the health department website, only nine provided policies that specifically indicate a full range of reproductive health care, including abortion services, as available at those facilities. About one-third of the policies included access to abortion care as part of their reproductive health care, which in many cases included providing abortion care only for reasons deemed medically necessary and referring patients to outside providers for elective abortion care.
Four hospital systems that manage multiple facilities in the state—PeaceHealth, Providence, Swedish, and the Franciscan Health System—provided identical reproductive health-care policies for each of the hospitals within their system. These policy statements are not comprehensive in nature, but they make clear each system’s policy on access to reproductive health care, including abortion and birth control.
Most often, policy disclosures included no specific information on available reproductive health care or access to abortion care. Legacy Salmon Creek Medical Center submitted not a policy document but a hospital pamphlet on “patient rights and responsibilities.” Both Mulitcare hospitals submitted only a document on procedures for care of sexual assault victims. Three Rivers Hospital submitted a document stating the relevant laws and regulations and that the hospital was compliant with them.
Sheila Reynertson, advocacy coordinator at the MergerWatch Project, which tracks hospital acquisitions, told RH Reality Check that she’s not surprised hospitals are not passing the new posting requirement with “flying colors.” Reynertson said there are a variety of reasons why hospitals may be struggling to meet the new requirements. “Some may be dragging their feet on this issue, but more likely they just don’t have built-in website design elements that make it easy for consumers to shop and compare, and others don’t seem clear about what they are supposed to post,” she said.
A coalition of organizations in the state came together to advocate for transparency and access to health care: NARAL Pro-Choice Washington, the American Civil Liberties Union of Washington, Legal Voice, Planned Parenthood Votes Northwest, People for Healthcare Freedom, and Compassion and Choices, all of which have different entry points into the work around hospital mergers.
Megan Burbank, a spokesperson at NARAL Pro-Choice Washington, told RH Reality Check that NARAL and other coalition members are currently reviewing the policies. She said the coalition has compiled a checklist of information about what services are offered that should be included in hospital policy disclosures. “Right now what we’re doing is using our checklist in comparison to the policies that have been released to see what measures up,” she said. “If our checklist had been used initially as an organizing principle to make sure that the policies addressed each point, we wouldn’t have this confusion.”