Photo Credits: KIYOMI WATSON / AGGIE
Some argue that partnering with Dignity restrict care to LGBTQ+ people, women, others argue more are harmed by not partnering
Unable to agree on a single set of recommendations, a UC task force presented two options on how best to affiliate with health care systems outside of the system to UC President Janet Napolitano in the Working Group on Comprehensive Access (WGCA) Chair’s Report of Findings and Recommendations.
The WGCA was formed in August of 2019 after public outcry in the spring when UCSF was revealed to be expanding affiliations with faith-based hospital system Dignity Health. The WGCA was composed of 15 UC officials: a regent, chancellors, deans, faculty, Academic Senate representatives and UC health leadership.
Ten of the 15 WGCA members had already expressed support for the UCSF and Dignity Health partnership before the formation of the WGCA. All three Academic Senate Representatives in the WGCA, as well as UC San Diego Professor Gabriel Haddad, were explicitly not in favor of a UCSF and Dignity Health partnership before the formation of the WGCA.
The group was tasked with creating a list of policy recommendations to ensure the values of the UC are upheld in all affiliations with other health care systems and that UC personnel would be unrestricted in providing medical care.
Unable to agree to one set of recommendations, the WGCA created two options which could be adopted individually or in combination with one another, according to UC Irvine Chancellor and Chair of the WGCA Howard Gillman.
Option 1, supported primarily by UC Health officials “allow affiliations with organizations that have non-evidence-based policy restrictions on care if governed by appropriate policies and guidelines,” Gillman said in the report. Option 2, supported by those who could not endorse the report was “designed to impose a prohibition on such affiliations.”
In short, Option 1 encouraged continued affiliation with health care systems that may restrict health care based on religious doctrine if clear guidelines are created to protect UC personnel. Option 2 discouraged continued affiliation with health care systems that have restrictions based on religion.
The two groups formed because the WGCA could not unite in answering two fundamental questions: “Whether UC should affiliate at all with organizations whose institutional policies (a) prohibit the use of contraception, abortion, assisted reproductive technology, gender-affirming care for transgender people, and the full range of end-of-life options and (b) permit non-clinicians to make clinical decisions affecting the health and safety of individual patients irrespective of the professional judgment of health care providers and/or the informed decisions of patients.”
Though the WGCA was tasked with making policy recommendations that protect the freedoms of UC personnel, enable the appropriate care of patients regardless of which facility they are first examined and encompass respect for a diversity of opinions, the issue comes down to the fact that some Catholic Church-sponsored hospitals restrict care based on religious convictions. These convictions, called Ethical and Religious Directives (ERDs), are determined by the U.S. Conference of Catholic Bishops (USCCB), not doctors.
The ERDs do not allow the prescription of any FDA-approved methods for preventing pregnancy including sterilization, elective abortion; assistive reproductive technology such as in-vetro fertalization (IVF) or the use of a surrogate for pregnancy; gender affirming care such as hormone replacement therapy or surgery or physician-assisted aid in dying.
Women and transgender individuals are those most affected by these policies, and gay couples who need IVF or a surrogate for biological pregnancy are also highly impacted.
Dignity Health, which has agreements with five of six UC medical centers, operates under the ERDs at 17 out of 31 California hospitals. At the other 14, they operate under the Statement of Common Values where they do not perform elective abortions, IVF or physician-assisted death.
“It’s pretty clear why [these policies are] discriminatory against transgender people,” said WGCA member and UCSF Ob/Gyn Vanessa Jacoby. The discrimination against women is trickier to pick out, though, Jacoby argued.
“Policies that prohibit women from getting standard of care services are discriminatory against women because the vast majority of our contraception is for women,” Jacoby said. “Women who are prohibited from getting contraception are the ones that bear the consequences of undesired pregnancy.”
Because Jacoby views these policies as so discriminatory towards women and members of LGBTQ community, Jacoby is fundamentally against these partnerships as they conflict with the values of UC.
“When I’m considering a healthcare decision, if one of the harms is discrimination against any group, but in this case discrimination against women and against LGBT people and against transgender patients […] that, to me, overwhelms any potential benefit,” Jacoby said. “I don’t believe UC should violate our anti-discrimination policies, no matter what the potential benefits are.”
UC Davis’ ASUCD shares this belief and unanimously passed Senate Resolution #18 which calls for the UC to end all plans to expand affiliations with Dignity Health.
Others such as David Lubarsky, vice chancellor of Human Health Sciences and CEO for UC Davis Health, follows a different line of reasoning. Since many of Dignity’s facilities are in rural areas, the only healthcare facilities for miles, UC would not have access to these patients if not for partnerships with Dignity Health. Lubarsky said he believes that more harm would be done to these rural communities by not partnering with systems like Dignity Health than could potentially be done by partnering with them.
“We agree 100% that we have to do everything we can promote for Reproductive Rights and full access to health care for the LGBTQ community in every way,” Lubarsky said in an interview earlier this year with The California Aggie’s Editorial Board. “But that principle cannot trump the real harm that would be done to a large population of individuals who [would no longer be able to] get advanced care at a UC hospital.”
Lubarsky put bluntly what a complete disengagement with Dignity Health would do: “It prevents the poor people [which] Dignity primarily serves from having access to any UC hospital.”
Lubarsky said he believes the WGCA did not get to the root of the problem: How can we balance the need of the underserved communities that need access to UC doctors through Dignity with our own values surrounding women’s reproductive health care and LGBTQ+ healthcare?
“It became an argument over a single issue, which was actually a mistake,” Lubarsky said, saying he believes “a broader discussion about ‘How do we best serve the human beings we’re responsible for?’” would have been more productive.
Dan Loeterman, the director of External Communications for Dignity Health, said he agrees.
“It’s very clear to us that tens of thousands of Californians depend on [UC and Dignity] programs for their health each year,” Loeterman said. “We believe that there’s a lot more where [UC and Dignity] agree than where we disagree.”
Everyone does seem to agree on the fact that the partnership between UC and Dignity Health is highly political, especially because each is a powerhouse of medical care, since half of California doctors are trained at UC, and Dignity Health is the largest hospital chain in California.
“UC Health will try to say this isn’t about politics — this is about one of the most important issues facing this country,” said UC Davis Professor and Member of the WGCA Robert May. “If Roe v. Wade is overturned, and there’s a very good likelihood that that will happen, that will engender a major health crisis in this country. Our getting involved with this is just aiding that.”
Lubarsky said he thinks otherwise. By participating in these affiliations, the UC is able to at least have some sway in the conversation regarding the treatment of patients at hospitals that operate under the ERDs.
“By disengagement, we lose our voice in that argument,” Lubarsky said. “We think principled engagement plus support of organizations like Planned Parenthood will be a better tactic than disengagement.”
Jacoby, however, did not adhere to this idea.
“I really believe that the University of California can find solutions to address our clinical needs, our research needs, our educational needs, that do not compromise our core values and our anti-discrimination policies,” Jacoby said. “I would love [for leadership in the UC] to propose solutions that don’t have this controversy around it and don’t discriminate against women or LGBT people.”
Written by: Jessica Baggott — firstname.lastname@example.org