Hoag Hospital's decision to stop performing elective abortions in the wake of its affiliation with a Catholic health-care group has sparked an outcry among women's rights advocates, who say the move diminishes access to high-quality reproductive care.
Pro-choice advocates plan to protest outside the hospital at a rally next week, and eight Hoag-affiliated doctors recently penned a public letter registering their disapproval. Some donors to the Newport Beach hospital — typically seen as a top-tier facility in an upscale area — have threatened to withhold support.
"The No. 1 thing a hospital has to have is credibility, and I think they're taking a risk ..." said Suzanne Savary, president of the Newport Beach Democratic Women's Club. "I don't think women's groups are going to let it go away. I think Hoag's reputation is on the line, and that's not a good thing for the [hospital] board to allow."
Hospital officials have said the move was a business decision to refer out an infrequently used service and was not motivated by the religious views of its new health-care partner, St. Joseph Health. They compared the decision to one five years ago where Hoag began referring in-patient pediatrics to Children's Hospital of Orange County (CHOC).
While elective abortions are no longer offered, Hoag still provides emergency contraception following rape or sexual assault, emergency services for women who experience complications from pregnancy termination at other facilities, or management of ectopic or other pregnancy problems, according to a letter sent to affiliated doctors last month.
The two providers have retained separate identities and leadership, though together they form the Covenant Health Network, headed by former Hoag Hospital Presbyterian's president, Dr. Richard Afable.
Neither Afable, nor anyone representing St. Joseph Health, would comment on whether Hoag had been asked to stop performing abortions or other services to better align with St. Joseph's religious values.
Robert T. Braithwaite, Hoag's president and chief executive, has said that the Hoag board was not pressured by St. Joseph.
Last week, he said the decision came after "pretty careful review of all the facts and considerations that were related to this service," which led the board to ultimately seek out "a different venue of care for that service."
"Not everybody agreed, but the board felt comfortable this was the right thing for Hoag and we moved forward," Braithwaite said.
In addition, Braithwaite and Gary McKitterick, chairman of the Hoag Board of Directors, said in a May 24 letter to the Daily Pilot that women's heath is a paramount concern at Hoag.
"Women's health is an extremely important issue to the Hoag Board of Directors and administration," they wrote. "We took a proactive approach to the preservation and continuation of health services for women."
In interviews and letters to the Daily Pilot, obstetrician/gynecologists and community members doubted that eliminating such a highly politicized procedure soon after affiliating with a Roman Catholic entity was coincidental.
"There are people who need to terminate a pregnancy, for medical health, socioeconomic reasons — it's never an easy decision, and for me to not be able to continue to help them, to care for them throughout all their needs is kind of anathema," said Dr. Beverly Sansone, one of eight doctors with Hoag privileges who signed the letter to the Pilot opposing the board's decision.
"When we heard about the merger, we said, 'Wait a minute, they have all these rules,' [and Hoag administrators] flat out said, 'It's not going to affect you at all,'" she said. "My feeling is, 'Listen, if you are having a problem with something going on in our department, why wouldn't you come to us?' They've thrown out so many excuses that don't hold water."
Former Newport Beach City Manager Robert Shelton, a longtime resident, called official explanations of the decision "wholly inadequate" in a letter to the Pilot.
"I'm waiting to hear the full story of what and who influenced the decision, and whether Hoag will rescind it," he wrote. "Until then, I'm withholding my financial support for the first time in over 50 years."
Braithwaite said that "the chances of reversing that decision aren't there," and that the board didn't plan to revisit the discussion. He said no other services were eliminated as a result of the merger.
In other letters, area residents said they were happy with the elimination of any abortion venue — though most seemed to view the move as taking what one Costa Mesa man called "a moral stance."
"Isn't the Hippocratic Oath primarily about preserving life, which is what Hoag does?" wrote Rick Rainey. "Even if abortion is legal, that doesn't necessarily mean it's morally right ... Don't people and organizations have a right to disagree?"
No comment from GOP
GOP leaders have been silent on the Hoag debate. Republican Party of Orange County Chairman Scott Baugh did not return a call for comment, and Newport Harbor Republican Women President Robin Sanders declined to comment.
However, the Republican Party platform formally opposes abortion.
Nationwide, concerns about Catholic health-care providers refusing to provide certain procedures on religious grounds have spread as such providers have grown — particularly in medically underserved communities.
"It's concerning for those involved in reproductive health. It's a new situation for all of us," said Jon Dunn, president and chief executive of Planned Parenthood in Orange and San Bernardino counties. "It is my understanding that over 20 of these types of mergers or affiliations have taken place in the last year."
He added that, typically, such deals come with "compromises in services so that [hospitals] can come into alignment with Catholic directives."
St. Joseph Health representatives declined interview requests because, as a spokesman wrote in an email, "most of this has been reported previously." In an email, spokesman Brian Greene responded to one of several questions, regarding the state attorney general's role in monitoring the affiliation.
"In these types of affiliations, the attorney general's office typically monitors many of the services provided for a period of time to ensure community needs are being met," he wrote. "These guidelines are based on a formal needs assessment that is conducted at the time of the affiliation. Hoag and St. Joseph would consider changing services if there is a necessity to adjust services based on the health-care needs of those we serve."
Hoag administrators said the hospitals will be monitored by the attorney general's office for 10 years, a longer-than-usual term that progressive reproductive health advocates have seen as a victory.
Questions about which procedures or services St. Joseph chooses not to perform in order to comply with Catholic health-care directives were not answered.
Officials at the Roman Catholic Diocese of Orange could not be reached for comment.
Hoag administrators said the decision to discontinue elective abortions at Hoag facilities in favor of referring patients to outside providers early last month followed a months-long review of hospital services that executives said showed that the hospital saw just 100 such procedures in a year, compared with about 6,000 deliveries.
Those doctors opposed to the ban, in their letter, contested that assessment, saying that far more than 100 abortions are performed there each year.
That review was conducted as Hoag prepared to cement an alliance with St. Joseph Health. The deal was approved by the state attorney general's office earlier this year.
"In addition to the internal evaluation of our service line, we looked at what else was available within the community and whatever potential partners were providing excellent care or best care for similar services," said Dr. Allyson Brooks, the executive medical director for Hoag's Women's Health Institute.
Medicine, she said, "has become increasingly sub-specialized," and that outside providers like Planned Parenthood and UC Irvine Health's Women's Options Center have doctors on-staff who've undergone family planning training.
Sansone, however, said Hoag is well-equipped to handle challenging operations, and that the vast majority of abortions are essentially the same procedure as ones that OB/GYNs perform in the event of a miscarriage, called dilation and curettage.
Braithwaite said no other procedures were eliminated as a result of the most recent review, but in the past Hoag has worked to refer patients to other facilities. Most notably, the hospital decided about five years ago to eliminate in-patient pediatric care because it felt those patients were best served by CHOC.
Dunn, of Planned Parenthood, said that regardless of the rationale behind the decision, he's working in collaboration with Hoag to "balance making sure access remains available" with outside providers.
"I can tell you that the vast majority of abortions can be safely provided in an outpatient setting like at Planned Parenthood, and in fact, it's more cost-effective," he said. "Probably even without this affiliation we could have served most of those women in our centers."
He estimated that elective abortions at Hoag likely made up only a tiny proportion of the overall number performed throughout the county at all providers per year — an estimated 20,000 to 25,000.
Still, some in the community view the decision as a betrayal.
"Since soon after its inception, my wife [Women in Leadership President and founding member Melinda Seely] and I have been supporters of Hoag Hospital," local attorney Hall Seely wrote in a letter to hospital executives earlier this month. "No longer. The election of Hoag Hospital to become the arbiter of any decision by a woman and her physician regarding the possible termination of a pregnancy terminate our confidence in, and support for, Hoag Hospital as a health-care provider."
Other community members echoed the concern that the move could be a first step down a slippery slope leading to other services that Catholic hospitals sometimes choose not to perform — such as fertility treatments or sterilization — being eliminated.
While Braithwaite stressed that the hospital has no plans to change any other services, and will continue to honor advanced directives, Virginia Laddey of Irvine said she's still concerned about having any end-of-life directives honored. Some Catholic hospitals may be bound to preserve life, even if, as she put it people must be kept alive, "with any kind of expensive, painful treatment."
"I'm 91, so I'm a little excited about end-of-life choices," she said. "They're trying to make this abortion thing a little minor thing and you saw those obstetricians, and they said that wasn't true at all."
Irvine Councilwoman Beth Krom said Hoag's decision could have wider ranging effects. Hoag's newest hospital is located in Irvine.
"Speaking as both a woman and a public official, I am deeply troubled by Hoag's decision to reduce health-care options for women and abridge the relationship between patient and doctor," she wrote in an email. "As a premier health organization in Orange County, Hoag's decision to eliminate abortion procedures suggests a radical shift in philosophy."