Practicing With Hands Tied: A Slippery Slope UCSF-Dignity Health Partnership Expansion

Hundreds of UCSF staff, providers, faculty and students have denounced a proposed partnership expansion between UCSF and Dignity Health that directly infringes on the core values that we at UCSF stand for.

These core values as defined by the UCSF mission statement include the following declaration: “UCSF Health treats all patients who require our services, without regard to race, color, religion, national origin, citizenship or other protected characteristics.”

However Dignity Health, being a Catholic healthcare system, openly discriminates against women, reproductive rights and LGBTQ communities.

Nevertheless, according to the LA Times, the proposal would expand the UC-Dignity Health partnership to the Dominican Hospital in Santa Cruz, Sequoia Hospital in Redwood City, St. Francis Memorial and St. Mary’s Medical Center in San Francisco.

The UCSF-Dignity Health expansion, which was originally announced in August 2017, sparked an uproar earlier this year resulting in an outpouring of objection denouncing the partnership.

A petition headed by Matthew Ryan, a UCSF MD/PHD candidate, called for a cease and desist of any Dignity Health partnerships and was signed by hundreds of UCSF affiliates last spring. Headlines were made across not only our campus but also many other UC campuses who were also planning an expansion with Dignity Health.

And UC affiliates are not the only segment of the population with concerns. There are a number of organizations that have spoken against the partnership, including the ACLU, the SF LGBTQ center, Planned Parenthood, Lambda Legal, and Equality California to name a few.

Although UCSF has been associated with Dignity Health for several years, the proposed expansion would require providers and students at Dignity Health facilities to adhere to Catholic Church directives.

These directives often require performing care that does not comply with UCSF medical and ethical practices. Health care professionals at Dignity Health are not trained or required to provide evidence-based patient care.

Though the announcement of expansion didn’t pick up traction until more recently, it had actually begun a year prior when the UCSF hospitalist group beat out then incumbent Vituity Hospitalists during contract negotiations early 2018.

The formal integration of the UCSF hospitalist group at St. Mary’s happened in October 2018 and was considered to be a “core component of the expanding partnership between UCSF and Dignity Health.”

The UCSF hospitalist group at St. Mary’s currently hold two direct care teams and two teaching teams consisting of UCSF providers and St. Mary’s residents.

Despite the petition and the subsequent announcement in May 2019 that UCSF officials planned to end the expansion, email sent to the UCSF Student Listserv from Chancellor Sam Hawgood reveal UCSF has previously entered into contracts with Dignity Health.

The contracts between UCSF and Dignity Health, which were recently made public thanks to an ACLU Public Records Act request, showcase how troublesome this partnership really is.

According to the ACLU, “Contract language explicitly states that students and providers are restricted by Catholic Directives.”

Excerpts of Dignity Health’s standards of care are outlined in records obtained by the ACLU:

In a May 2019 email to UCSF students, Hawgood claimed the expansion was necessary due to a lack of hospital beds at UCSF facilities, citing that in 2018 UCSF turned away more than 850 patients due to lack of accommodations.

However, according to the SF Chronicle, these patients came predominantly from select services such as labor and delivery.

Further accommodations for labor and delivery patients can be found at Zuckerberg San Francisco General Hospital, CPMC | California West, and CPMC | Mission Bernal, all outside of the Dignity Health Network.

In a June 2018 update of the Catholic directives imposed at Dignity Health, reproductive health care was severely restricted. Use of in-vitro fertilization, sperm or ovum donor, and surrogates continue to be denied.

Similarly, contraceptives and the termination of pregnancy were also denied at Dignity Health. These restrictions on reproductive health not only affect women, but also the ability of gay, lesbian, and transgender individuals to have children.

Dignity Health also does not allow for gender affirming care for transgender people, such as hormones or surgery.

For a public health institution like UCSF, expanding this affiliation would serve to accept the discrimination that Dignity Health routinely exhibits against LGBTQ populations and women.

Patients of color are also being affected by this affiliation.

According to the ACLU, “pregnant people of color are already more likely than white people to give birth at Catholic facilities, meaning they are more likely to receive care that is dictated by religious doctrine rather than evidence-based medicine, exacerbating existing health disparities.”

UCSF should be attempting to provide evidence-based care for these patients and maintaining its commitment to comprehensive care rather than sending patients and providers to Catholic facilities where they cannot receive patient centered care.

In May 2019, the Trump administration issued an order that could make it easier for providers and healthcare professionals to refuse any treatment to which they have religious or moral objections.

San Francisco federal Judge William Alsup has already blocked this order, a clear indication that the community’s values and that of the Catholic hospitals are not the same.

According to an opinion piece published in the San Francisco Chronicle by UCSF physicians David Teitel and Dana Gossett, some UCSF physicians have defended the affiliation between UC schools and Dignity Health:

“UCSF physicians will always live and speak UCSF values, regardless of whether the hospital at which we practice has a faith affiliation… There will be no limits on the advice UCSF doctors provide, and we will refer patients — including existing Dignity patients who currently lack access to services not offered by Dignity — to other facilities, including UCSF, for those services. Our absolute commitment to women’s reproductive health, LGBTQ health, evidence-based medicine, and nondiscriminatory care will remain unchanged, unhindered and unwavering.”

However, according to Dr. Lori Friedman, a UCSF sociologist and Catholic healthcare researcher, there have been zero instances in which a private Catholic hospital has loosened their restrictions because of a partnership with a public institution.

In several instances, Dignity Health has failed to provide adequate care for its patients in light of its religious restrictions. As a result, they have faced lawsuits that challenge their Catholic restrictions.

Rebecca Chamorro from Redding, for example, was denied tubal ligation during a caesarian section at the Mercy hospital, even though performing the two surgeries together is typically done at other hospitals.

Evan Minton was denied a hysterectomy when the hospital discovered he was transgender. One doctor reported that he was not allowed to perform an abortion for a woman whose sepsis condition caused her to reach a body temperature of 106o F.

The hospital claimed that they could not terminate the pregnancy because the fetus still had a discernible heartbeat (LA Times).

The incident is reminiscent of Savita Halappanavar, an Indian woman in Ireland who was denied an abortion following an incomplete miscarriage on the grounds that it would be illegal under Irish law. She died of sepsis five days later.

While the details of the expanding affiliation are still not public, it is clear that the UCSF faculty and doctors practicing at Dignity Health’s hospitals would be bound to comply with their restrictions on gender-affirming care for transgender people and reproductive care.

In a Nov. 15, 2019 letter to Hawgood and Sharmila Majumdar, UCSF Academic Senate Chair the ACLU wrote that “even at the time of these assertions, UCSF ... already had entered into contracts with Dignity Health that explicitly tie the hands of UC providers and require them to comply with Dignity Health’s religious doctrine.”

As an institution, UCSF should not be promoting any standard of care that may prevent certain populations from accessing certain procedures or care.

“First, in talking with fellow students there has been considerable confusion around what these recent emails mean,” Ryan told Synapse. “As students, we have consistently been left out of the loop on this issue, and these recent emails have compounded this lack of clarity.

“Second, these decisions have major implications for our education. We chose to attend a public school because we believe in its mission. These agreements reinforce healthcare disparities, undermine our PRIDE values, and establish two curricula when it comes to clinical environments, one in which we provide the standard-of-care and the other in which we provide substandard, discriminatory care.”

If UC Regents approve this expanding affiliation, it can create a huge hospital network of UC Dignity Health alliance.

Clearly, given the undergoing lawsuits at Dignity Health, this affiliation can affect reproductive assistance, care for transgender patients, and care for patients of color.

There is a clear difference in values between UC schools and Dignity Health, which brings us to question why UCSF is hastily pursuing this deal rather than looking for alternatives.

If values such as inclusion, autonomy, and integrity are important to UCSF, then why can’t the institution adhere to them?