"PIMC does not provide maternity services," PIMC CEO Jim Barnhart told the local hospital district. If a private facility provides maternity care and receives taxpayer funds it is required by state law to provide a full range of reproductive services as required by state law.
Barnhart's characterization of the services provided at the local critical access hospital, if accurate, would allow the facility to continue to receive taxpayer dollars while not providing the legally mandated services. Peace Health, the Catholic healthcare organization that owns PIMC, places restrictions on reproductive servies including terminating pregnancies, tubal ligations, vasectomies, the morning after pill, and contraceptives.
Some procedures are not allowed at all. Contraception is allowed if medically necessary. In the case of rape the morning after pill can be prescribed only if a pregancy test is negative.
A recent Attorney General's opinion regarding hospital districts stated: "If the state provides, directly or by contract, maternity care benefits, services, or information to women through any program administered or funded in whole or in part by the state, the state shall also provide women otherwise eligible for any such program with substantially equivalent benefits, services, or information to permit them to voluntarily terminate their pregnancies." The term state includes hospital districts.
San Juan County Hospital District No. 1, which formerly ran Inter Island Medical Center, turns over almost all of the revenue the district collects from taxpayers to PeaceHealth. The Catholic healthcare system owns PIMC. Bayuk says the 2nd amendment in the 50-year contract between PeaceHealth and the hospital district, specifies that the taxpayer funds are to be used for emergency and charitable care.
Whether Barnhart's and the hospital commissioners interpretation of the services provided by PIMC is accurate depends on how one views the services currently provided at PIMC.
Anacortes obstetrician/gynecologist Dr. Prins sees patients at the facility once a month. Other obstetrical care is provided by a midwife who sees patients at PIMC. When a pregnant woman sees a PIMC doctor she is given a referral for her maternity care.
PIMC provides the space to Prins and the midwife "as a courtesy," Barnhart said. "Dr. Prins is not a member of the medical staff."
Hospital Commissioner Dr. Michael Edwards said obstetrical care was at the top of the steering committee's list when creation of the hospital was first discussed. "Once we looked at the volumes, we had to preclude doing that. We just couldn't provide it safely," he said.
Commission Chair Lenore Bayuk said the cost was beyond what the district can afford. "We didn't contract that with PeaceHealth," she said.
Commissioner Keri Talbott said, "Finances have always been a factor in determining what services will be provided."
Bayuk started the discussion about what healthcare services are available, by saying she had done a lot of research in the past month.
Death with Dignity is available through Skagit Valley Hospital's Hospice Northwest she said. The two doctors affiliated with the hospice will sign the forms needed. However, they will not prescribe the medication the terminally ill patient needs to end his/her life.
Asked how a patient obtains a prescription, Bayuk said they can get in touch with Compassion and Care. The Death with Dignity state-wide law was approved by more than 70 percent of the voters in San Juan County.
PeaceHealth doctors are prohibited from participating in Death with Dignity. According to Barnhart, individual physicians can choose to do so outside of the PeaceHealth as long as they acting as individuals not as PeaceHealth employees. They would not be covered by PeaceHealth's physician insurance. None of the medical providers at PIMC provide Death with Dignity care outside of PIMC.
Death with Dignity and the full-range of reproductive services conflict with the Bishop's Ethical and Religious Directives. Last month it was pointed out to the hospital board that PeaceHealth's website stated the organization abides by the ER&Ds.
Dr. Edwards was surprised by the statement. At the September 25 meeting he said "the disparity has been cleared up." PIMC's policies are posted on the PIMC website and PeaceHealth's are posted on the PeaceHealth website. And he noted, it is his understanding that "PeaceHealth does not strictly abide by the Bishop's Ethical and Religious Directives."
The FAQ (frequently asked questions) section of the PIMC website includes answers to questions about Advanced Directives and contraception.
The answer to the question "Does PeaceHealth honor Living Will instructions even if they conflict with Catholic teachings" skirts around the issue. It says: "Advance directives (“Living Wills”) are typically consistent with Catholic teachings, and PeaceHealth encourages their use. PeaceHealth will honor an advance directive that is drafted by a competent patient and executed by an appointed durable power of attorney, as required by law." It doesn't mention that the law allows PeaceHealth to not follow a patient's Advanced Directive if they conflict with Catholic teachings.
Regarding contraception, doctors are not limited in what they may discuss with their patients, according to the website. Contraception may be prescribed if medically indicated.
Legal action against the hospital district is likely since PeaceHealth's and the hospital district's definition of "directly or by contract, maternity care benefits, services, or information" differs from the way many other people see it.