Holy Owned

By NADYA LABI

Zina Campos, 34, didn't intend to heed the biblical injunction to be fruitful and multiply. It just kind of happened. She was raised a Roman Catholic, but gave little thought to the Good Book when she had her first child at 17. Before long, though, she joined a gang and had fallen into the habit of having babies. She has eight kids and another due any day. "I didn't know a lot about birth control," Campos says. She has since studied her options and decided on a tubal ligation: a common procedure, usually performed after delivery, that permanently prevents pregnancy. "It has taken me since I was 17 to get off welfare and get a good job," says Campos, who has just left her public health counseling job in Gilroy, Calif., to prepare for the birth. "I love my children, but nine is way more than enough."

The hospital that serves her town of 40,000 apparently disagrees. Since October, not a single tubal ligation has been performed at the hospital--and Campos has been warned not to expect one. That is a dramatic change from last year, when more than 400 tubal ligations were performed at South Valley Hospital. In fact, nearly a fifth of all deliveries were immediately followed by the operation, which takes 15 min. and can often piggyback on the same epidural painkiller used during labor. So what changed? Well, South Valley became St. Louise Regional Health Center, and the hospital's new owner--Catholic Healthcare West--required the newly configured hospital to abide by the Ethical and Religious Directives for Catholic Health Care Services, a set of 70 regulations issued by Roman Catholic bishops in 1994.

In keeping with Vatican policy, the directives proscribe abortion and a host of reproductive services, including birth control, morning-after pills and sterilization. "We can't say we're opposed to abortion as a profound human evil and then go out and build an abortion clinic," says Father Michael Place, president of the Catholic Health Association, which represents more than 2,000 Catholic facilities in the U.S. "We can't be other than who we are."

So just who are these caregivers? Catholic health services have historically reached out to underserved communities, aggressively promoting immunization programs and sometimes even building low-income housing, considered fundamental to good health. Ten percent of the nation's 4,800 hospitals (not including long-term and specialty-care centers) are Catholic, according to the American Hospital Association. They enjoy a nonprofit tax status, a financial advantage that some critics feel is unfair in the highly competitive health-care market.

Eight of the nation's 13 largest health-care systems are Catholic, according to Catholics for a Free Choice, an advocacy group critical of the church's stance on reproductive issues. There were some 120 mergers between Catholic and non-Catholic institutions from 1994 to 1998, and CFFC estimates that reproductive health care was reduced or eliminated in half those cases.

Such unions are awkward, certainly, but most survive through the messy art of compromise. The first line of negotiation is the local bishop, who has the power to interpret the directives. For example, bishops disagree about whether Ovral, an emergency contraceptive drug for rape victims, induces abortion. At St. Louise, staff members will not give Ovral directly to rape victims, but they will allow a separate emergency-response unit to administer the drug on the premises. A similar kind of wiggle room is offered under mergers done according to the "community model." In that case, a Catholic hospital will join another institution and essentially tolerate forbidden practices in an area kept physically and administratively separate. That's how it works in Detroit, where a hospital has designated its top floor as a discrete facility that offers full reproductive services.

Many of Gilroy's residents hope to reach a similar accommodation with their reinvented hospital. The town's five obstetrician-gynecologists sent a letter to the local newspaper asserting that it is "unconscionable, un-Christian, un-Catholic and unwise to deny sterilization services to a community." To be fair, women can travel to another hospital for such services. But the nearest one with comparable facilities is 35 miles away. That's a hardship for a population that is composed largely of poor farmworkers, many of whom have limited transportation. Besides, women like Campos might not have the luxury of time when the baby is on the way. "I had my last kid in 15 minutes," she says. "The doctor didn't even make it on time."

For now, St. Louise's owners are holding their ground. Carol Bayley, director of medical ethics for Catholic Healthcare West, argues that the deal was not a merger. "We've bought the building, and St. Louise, the surviving hospital, is taking over." But the hard-line stance could backfire. Last year in Manchester, N.H., the Catholic Medical Center, which had recently merged with another local hospital, refused to perform an emergency abortion on a woman in danger of prematurely delivering a 14-week fetus--even though her doctor had determined that she was at risk for a lethal infection. The incident generated so much outrage that the hospital with which it had merged sought and won a divorce.

"Patients, already struggling with HMO gatekeepers, are facing a new level of interference from religious gatekeepers," says Lois Uttley, director of MergerWatch, an organization that campaigns against mergers between Catholic and non-Catholic hospitals. Campos intends to tear down that gate. She doesn't want to have her baby at St. Louise and her tubal ligation at another hospital two months later. "I'm going to put up a fight," she says firmly. "I have the right to make a choice." Perhaps St. Louise should consider what wise men inevitably learn: it doesn't pay to argue with a pregnant woman.

--Reported by Dick Thompson/Washington and James Willwerth/Gilroy